Ettema Esmée M, Zittema Debbie, Kuipers Johanna, Gansevoort Ron T, Vart Priya, de Jong Paul E, Westerhuis Ralf, Franssen Casper F M
Division of Nephrology, Department of Internal Medicine, University Medical Center Groningen, Groningen, The Netherlands.
Am J Nephrol. 2014;39(2):100-9. doi: 10.1159/000358203. Epub 2014 Feb 6.
Intradialytic hypotension is a common complication of hemodialysis (HD). Some studies have suggested that inadequate arginine vasopressin (AVP) increase could play a role in the pathogenesis of intradialytic hypotension. However, AVP levels during HD and its relation to hypotension has never been systematically studied.
PubMed and Embase were searched (1970-2013, search terms 'vasopressin' and 'hemodialysis') for studies reporting on AVP levels during standard HD or other dialysis techniques. Observational studies reporting on AVP levels pre- and postdialysis were additionally included in a meta-analysis. Thirty-seven studies were included in the systematic literature review, of which 26 studies were eligible for meta-analysis. The main findings were that pretreatment AVP levels were higher in dialysis patients compared with healthy controls (6.4 ± 3.5 vs. 2.5 ± 1.3 pg/ml, p = 0.003) and that plasma AVP levels showed little or no increase during HD (from 7.0 ± 4.9 to 8.8 ± 9.3, p = 0.433). Significant heterogeneity was found between studies. Meta-regression analysis revealed no significant associations between AVP and patient or study characteristics. Studies on other dialysis techniques showed mixed results regarding the AVP course. The eight studies that addressed the relation between intradialytic hypotension and AVP also showed inconsistent results.
Plasma AVP levels are higher in dialysis patients compared with healthy controls, but show little or no increase during HD. The lack of a rise in AVP levels during HD may be pathophysiologically involved in the onset of intradialytic hypotension, but firm conclusions are not possible from our review of the literature.
透析中低血压是血液透析（HD）的常见并发症。一些研究表明，精氨酸加压素（AVP）分泌增加不足可能在透析中低血压的发病机制中起作用。然而，HD期间的AVP水平及其与低血压的关系从未得到系统研究。
检索了PubMed和Embase数据库（1970 - 2013年，检索词为“加压素”和“血液透析”），以查找关于标准HD或其他透析技术期间AVP水平的研究报告。另外，纳入了关于透析前后AVP水平的观察性研究进行荟萃分析。系统文献综述纳入了37项研究，其中26项研究符合荟萃分析的条件。主要发现是，与健康对照相比，透析患者的预处理AVP水平更高（6.4±3.5 vs. 2.5±1.3 pg/ml，p = 0.003），并且HD期间血浆AVP水平几乎没有增加（从7.0±4.9至8.8±9.3，p = 0.433）。研究之间存在显著异质性。荟萃回归分析显示AVP与患者或研究特征之间无显著关联。关于其他透析技术的研究显示，AVP变化过程的结果不一。八项关于透析中低血压与AVP关系的研究结果也不一致。
与健康对照相比，透析患者的血浆AVP水平更高，但在HD期间几乎没有增加。HD期间AVP水平缺乏升高可能在病理生理上与透析中低血压的发生有关，但根据我们对文献的综述尚无法得出确凿结论。
