الفهرس 
Chronic Maintenance HemodialysisOnly 14 pages are availabe for public view
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Abstract
Intradialytic hypertension (IDH), defined as an increase in mean arterial blood pressure (MAP) ≥ 15 mmHg during or immediately after hemodialysis (Chazot and Jean, 2010), is a well-known but uncommon complication that affects more than 15% of hemodialysis patients. Intradialytic hypertension increases the incidence of cardiovascular morbidity and mortality (Eftimovska-Otovic et al., 2015).
Although the problem has been known for decades, the pathogenetic mechanism is not yet clarified. It is agreed that intradialytic hypertension is multifactorial: volume overload, increased activity of the sympathetic nervous system and the renin – angiotensin – aldosterone system (RAAS), imbalance of electrolytes, particularly sodium and calcium, endothelial dysfunction, removal of antihypertensive drugs in dialysis. The dialysis-related increase in endothelin-1 (ET-1) concentrations have been documented in several studies (Sebastian et al., 2016).
The aim of this study was to evaluate the role of ET-1 in intradialytic hypertension in ESRD patients during maintenance dialysis. This case control study was conducted in Zagazig University hospitals and Alahrar Educational hospital on 56 ESRD patients on regular hemodialysis and 28 normal individuals who served as control. Subjects were divided into 3 groups:
group I: 28 patients with intradialytic hypertension.
group II: 28 patients with well-controlled blood pressure, and no history of intradialytic hypertension throughout HD.
group III: 28 controlled healthy volunteers.
The mean age in this study was 50.1 years in group I, 57.1 years in group II, 34.7 years in group III. There was no significant difference between groups as regards baseline demographic and clinical laboratory characteristics except age. There were statistically significant differences between the three studied groups in all laboratory parameters except serum Ca and Na. There was statistically significant increase in K level in group I compared to group II. Also, ejection fraction was significantly lower in the HD groups, and LVMI was significantly higher in in group II compared to both groups I and III.
MAP significantly increased during dialysis in group I and significantly decreased in group II. D MAP started to increase ≥ 15 mmHg, i.e. IDH, 2 hours after the start of HD session. Endothelin-1 level was significantly higher in HD groups compared with healthy volunteers group, and in group I (281.8 pg/dl) compared with group II (250.5 pg/dl). There was significant positive correlation between ET-1 level after 2 hours of starting of HD session and MAP and D MAP. There was significant positive correlation between ET-1 and K in group I patients and there was no correlation between ET-1 and Na in group I.
The sensitivity of ET-1 in differentiation between patients and control at cut off ≥ 95 was 100%, specificity was 100% and the accuracy was 100%, while the sensitivity of ET-1 in differentiation between group I and group II at cut off ≥ 237.5 was 71.4%, specificity was 67.9% and the accuracy was 69.6%.
These results suggest that endothelin-1 is a significant risk factor for having intradialytic hypertension and may be endothelin-1 level had a significant diagnostic performance in prediction of intradialytic hypertension, but larger studies are required to confirm this in the future.