Division of Nephrology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX; Department of Internal Medicine, Duke University, Durham, NC; Department of Medicine, Quintiles Global Clinical Research Organization, Morrisville, NC.
School of Medicine, University of Texas Southwestern Medical Center, Dallas, TX.
Am J Kidney Dis. 2015 Mar;65(3):464-73. doi: 10.1053/j.ajkd.2014.10.021. Epub 2014 Dec 17.
Intradialytic hypertension affects ∼15% of hemodialysis patients and is associated with increased morbidity and mortality. While intradialytic hypertension is associated with increases in endothelin 1 relative to nitric oxide (NO), the cause of these imbalances is unknown. In vitro evidence suggests that altering plasma sodium levels could affect endothelial-derived vasoregulators and blood pressure (BP). Thus, we hypothesized that compared to high dialysate sodium, low dialysate sodium concentration would lower endothelin 1 levels, increase NO release, and reduce BP.
3-week, 2-arm, randomized, crossover study.
SETTING & PARTICIPANTS: 16 patients with intradialytic hypertension.
Low (5 mEq/L below serum sodium) versus high (5 mEq/L above serum sodium) dialysate sodium concentration.
Endothelin 1, nitrite (NO2(-)), and BP.
Mixed linear regression was used to compare the effect of dialysate sodium (low vs high) and randomization arm (low-then-high vs high-then-low) on intradialytic changes in endothelin 1, NO2(-), and BP values.
The average systolic BP throughout all hemodialysis treatments in a given week was lower with low dialysate sodium concentrations compared with treatments with high dialysate sodium concentrations (parameter estimate, -9.9 [95% CI, -13.3 to -6.4] mm Hg; P < 0.001). The average change in systolic BP during hemodialysis also was significantly lower with low vs high dialysate sodium concentrations (parameter estimate, -6.1 [95% CI, -9.0 to -3.2] mm Hg; P < 0.001). There were no significant differences in intradialytic levels of endothelin 1 or NO2(-) with low vs high dialysate sodium concentrations.
Carryover effects limited the power to detect significant changes in endothelial-derived vasoregulators, and future studies will require parallel trial designs.
Low dialysate sodium concentrations significantly decreased systolic BP and ameliorated intradialytic hypertension. Longer studies are needed to determine the long-term effects of low dialysate sodium concentrations on BP and clinical outcomes.
透析中高血压影响约 15%的血液透析患者，与发病率和死亡率的增加有关。虽然透析中高血压与内皮素 1 相对于一氧化氮（NO）的增加有关，但这些失衡的原因尚不清楚。体外证据表明，改变血浆钠水平可能会影响内皮衍生的血管调节剂和血压（BP）。因此，我们假设与高透析液钠相比，低透析液钠浓度会降低内皮素 1 水平，增加 NO 释放，并降低 BP。
为期 3 周、2 臂、随机、交叉研究。
16 例透析中高血压患者。
低（低于血清钠 5 mEq/L）与高（高于血清钠 5 mEq/L）透析液钠浓度。
混合线性回归用于比较透析液钠（低与高）和随机分组臂（低-高与高-低）对内源性一氧化氮（NO2(-)）和 BP 变化的影响。
与高透析液钠浓度相比，低透析液钠浓度下整个一周内所有血液透析治疗的平均收缩压均较低（参数估计，-9.9 [95%CI，-13.3 至-6.4] mmHg；P<0.001）。与高透析液钠浓度相比，低透析液钠浓度下血液透析期间平均收缩压变化也显著较低（参数估计，-6.1 [95%CI，-9.0 至-3.2] mmHg；P<0.001）。低与高透析液钠浓度对内源性一氧化氮（NO2(-)）或内皮素 1 水平无显著差异。
交叉效应限制了检测内皮衍生血管调节剂显著变化的能力，未来的研究将需要平行试验设计。
低透析液钠浓度显著降低收缩压并改善透析中高血压。需要进行更长时间的研究以确定低透析液钠浓度对 BP 和临床结局的长期影响。
