TY - JOUR
T1 - Effect of plasma sodium concentration on blood pressure regulators during hemodialysis
T2 - A randomized crossover study
AU - Ettema, Esmée M.
AU - Kuipers, Johanna
AU - Van Faassen, Martijn
AU - Groen, Henk
AU - Van Roon, Arie M.
AU - Lefrandt, Joop D.
AU - Westerhuis, Ralf
AU - Kema, Ido P.
AU - Van Goor, Harry
AU - Gansevoort, Ron T.
AU - Gaillard, Carlo A.J.M.
AU - Franssen, Casper F.M.
N1 - Funding Information:
CAJMG received consulting fees from Vifor, Amgen and Keryx, and grant support from Roche, Amgen and Vifor. The other authors declare no relevant conflicts of interest.
Funding Information:
This work was supported by the Jan Kornelis de Cock Foundation (grant 2015–18). The funders had no role in the study design, in the collection, analysis and interpretation of data, in the writing of the manuscript or in the decision to submit the manuscript for publication.
Publisher Copyright:
© 2018 The Author(s).
PY - 2018/8/22
Y1 - 2018/8/22
N2 - Background: Intradialytic hypotension is a common complication of hemodialysis. The Hemocontrol biofeedback system, improving intradialytic hemodynamic stability, is associated with an initial transient increase in plasma sodium levels. Increases in sodium could affect blood pressure regulators. Methods: We investigated whether Hemocontrol dialysis affects vasopressin and copeptin levels, endothelial function, and sympathetic activity in twenty-nine chronic hemodialysis patients. Each patient underwent one standard hemodialysis and one Hemocontrol hemodialysis. Plasma sodium, osmolality, nitrite and nitrate (NOx), endothelin-1, angiopoietins-1 and 2, and methemoglobin as measures of endothelial function, plasma catecholamines as indices of sympathetic activity and plasma vasopressin and copeptin levels were measured six times during each modality. Blood pressure, heart rate, blood volume, and heart rate variability were repeatedly monitored. Generalized Estimating Equations was used to compare the course of the parameters during the two treatment modalities. Results: Plasma sodium and osmolality were significantly higher during the first two hours of Hemocontrol hemodialysis. Overall, mean arterial pressure (MAP) was higher during Hemocontrol dialysis. Neither the measures of endothelial function and sympathetic activity nor copeptin levels differed between the two dialysis modalities. In contrast, plasma vasopressin levels were significantly higher during the first half of Hemocontrol dialysis. The intradialytic course of vasopressin was associated with the course of MAP. Conclusions: A transient intradialytic increase in plasma sodium did not affect indices of endothelial function or sympathetic activity compared with standard hemodialysis, but coincided with higher plasma vasopressin levels. The beneficial effect of higher intradialytic sodium levels on hemodynamic stability might be mediated by vasopressin. Trial registration: ClinicalTrials.gov. Identifier: NCT03578510. Date of registration: July 5th, 2018. Retrospectively registered.
AB - Background: Intradialytic hypotension is a common complication of hemodialysis. The Hemocontrol biofeedback system, improving intradialytic hemodynamic stability, is associated with an initial transient increase in plasma sodium levels. Increases in sodium could affect blood pressure regulators. Methods: We investigated whether Hemocontrol dialysis affects vasopressin and copeptin levels, endothelial function, and sympathetic activity in twenty-nine chronic hemodialysis patients. Each patient underwent one standard hemodialysis and one Hemocontrol hemodialysis. Plasma sodium, osmolality, nitrite and nitrate (NOx), endothelin-1, angiopoietins-1 and 2, and methemoglobin as measures of endothelial function, plasma catecholamines as indices of sympathetic activity and plasma vasopressin and copeptin levels were measured six times during each modality. Blood pressure, heart rate, blood volume, and heart rate variability were repeatedly monitored. Generalized Estimating Equations was used to compare the course of the parameters during the two treatment modalities. Results: Plasma sodium and osmolality were significantly higher during the first two hours of Hemocontrol hemodialysis. Overall, mean arterial pressure (MAP) was higher during Hemocontrol dialysis. Neither the measures of endothelial function and sympathetic activity nor copeptin levels differed between the two dialysis modalities. In contrast, plasma vasopressin levels were significantly higher during the first half of Hemocontrol dialysis. The intradialytic course of vasopressin was associated with the course of MAP. Conclusions: A transient intradialytic increase in plasma sodium did not affect indices of endothelial function or sympathetic activity compared with standard hemodialysis, but coincided with higher plasma vasopressin levels. The beneficial effect of higher intradialytic sodium levels on hemodynamic stability might be mediated by vasopressin. Trial registration: ClinicalTrials.gov. Identifier: NCT03578510. Date of registration: July 5th, 2018. Retrospectively registered.
KW - Endothelium
KW - Hemodialysis
KW - Sodium
KW - Sympathetic activity
KW - Vasopressin
UR - http://www.scopus.com/inward/record.url?scp=85051921284&partnerID=8YFLogxK
U2 - 10.1186/s12882-018-0997-z
DO - 10.1186/s12882-018-0997-z
M3 - Article
C2 - 30134847
AN - SCOPUS:85051921284
SN - 1471-2369
VL - 19
JO - BMC Nephrology
JF - BMC Nephrology
IS - 1
M1 - 214
ER -