Effect of plasma sodium concentration on blood pressure regulators during hemodialysis: a randomized crossover study

• Published in: BMC nephrology 2018-08, Vol.19 (1), p.214-214, Article 214
• Main Authors: Ettema, Esmée M, Kuipers, Johanna, van Faassen, Martijn, Groen, Henk, van Roon, Arie M, Lefrandt, Joop D, Westerhuis, Ralf, Kema, Ido P, van Goor, Harry, Gansevoort, Ron T, Gaillard, Carlo A J M, Franssen, Casper F M
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; Biofeedback; Biomarkers - blood; Blood levels; Blood pressure; Blood Pressure - physiology; Catecholamines; Cross-Over Studies; Endothelin 1; Endothelins; Endothelium; Feedback; Female; Health aspects; Heart Rate; Hemodialysis; Humans; Hypotension; Influence; Male; Methemoglobin; Middle Aged; Nephrology; Netherlands - epidemiology; Neurophysins - blood; Osmolar Concentration; Patients; Plasma; Pressure regulators; Prospective Studies; Protein Precursors - blood; Renal Dialysis - adverse effects; Renal Dialysis - trends; Renal Insufficiency, Chronic - blood; Renal Insufficiency, Chronic - epidemiology; Renal Insufficiency, Chronic - therapy; Risk factors; Sodium; Sodium - blood; Sodium in the body; Sympathetic activity; Vasopressin; Vasopressins - blood
• ISSN: 1471-2369; 1471-2369
• DOI: 10.1186/s12882-018-0997-z

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. 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. 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. 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. ClinicalTrials.gov. Identifier: NCT03578510 . Date of registration: July 5th, 2018. Retrospectively registered.