title: Inappropriately elevated endothelin-1 plays a role in the pathogenesis of intradialytic hypertension.
abstract: The aim of this study is to investigate the effects of endogenous vasoactive substances on the occurrence of intradialytic hypertension (IDH) in patients during maintenance hemodialysis. Thirty-four maintenance hemodialysis patients were enrolled in this trial, and 17 of them were diagnosed with IDH (defined as an increase in blood pressure of at least 10 mmHg during or immediately after a hemodialysis session), while 17 age-matched and sex-matched controls without IDH were selected for a retrospective comparison. We collected patients' blood samples before and after a dialysis session and measured the plasma levels of N-terminal fragment brain natriuretic peptide, renin, angiotensin-II, aldosterone (ALD), angiotensin-converting enzyme (ACE), endothelin-1 (ET-1), nitric oxide (NO), norepinephrine (NOR), and adrenomedullin. The post-dialysis serum ET-1 concentrations were significantly higher (4.09 ± 2.06 vs. 2.75 ± 1.34 pg/mL, P < 0.05), while the post-dialysis ratio of NO to ET-1 was lower (17.79 ± 5.65 vs. 24.78 ± 12.04, P < 0.05) in IDH patients compared with the control group. Post-dialysis ALD and NOR values were significantly lower (P < 0.01) and ACE levels were significantly higher (P < 0.01) than the pre-dialysis concentrations only in the control and not in the IDH group. All other measured factors did not differ significantly between the groups and between pre-dialysis and post-dialysis determinations. Compared with blood angiotensin-II, ALD, ACE, NOR, adrenomedullin, N-terminal fragment brain natriuretic peptide, and NO status, inappropriately elevated ET-1 plasma concentrations may play a predominant role in the pathogenesis of IDH.
authors.affiliation: Department of Nephrology, Zhongshan Hospital, Shanghai Medical College, Fudan University, No 180 Fenglin Road, Shanghai, 200032, China; Kidney and Dialysis Institute of Shanghai, No 180 Fenglin Road, Shanghai, 200032, China; Kidney and Blood Purification Laboratory of Shanghai, No 180 Fenglin Road, Shanghai, 200032, China.
authors.forename: Jie
authors.initials: J
authors.lastname: Teng
authors.forename: Jie
authors.initials: J
authors.lastname: Tian
authors.forename: Wen-Lv
authors.initials: WL
authors.lastname: Lv
authors.forename: Xiao-Yan
authors.initials: XY
authors.lastname: Zhang
authors.forename: Jian-Zhou
authors.initials: JZ
authors.lastname: Zou
authors.forename: Yi
authors.initials: Y
authors.lastname: Fang
authors.forename: Jinbo
authors.initials: J
authors.lastname: Yu
authors.forename: Bo
authors.initials: B
authors.lastname: Shen
authors.forename: Zhong-Hua
authors.initials: ZH
authors.lastname: Liu
authors.forename: Xiao-Qiang
authors.initials: XQ
authors.lastname: Ding
mesh_terms: D053607:Adrenomedullin / Q000097:blood; D000328:Adult; D000368:Aged; D000450:Aldosterone / Q000097:blood; D000804:Angiotensin II / Q000097:blood; D019332:Endothelin-1 / Q000097:blood*; D005260:Female; D006801:Humans; D006973:Hypertension / Q000097:blood* / Q000209:etiology; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood; D009569:Nitric Oxide / Q000097:blood; D009638:Norepinephrine / Q000097:blood; D007703:Peptidyl-Dipeptidase A / Q000097:blood; D006435:Renal Dialysis
chemical_list: D019332:Endothelin-1; D000804:Angiotensin II; D020097:Natriuretic Peptide, Brain; D053607:Adrenomedullin; D009569:Nitric Oxide; D000450:Aldosterone; D007703:Peptidyl-Dipeptidase A; D009638:Norepinephrine
keywords: Intradialytic hypertension; dialysis; endothelin-1; maintenance hemodialysis