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Published ahead of print on February 6, 2008
Clin J Am Soc Nephrol 3: 729-735, 2008
© 2008 American Society of Nephrology
doi: 10.2215/CJN.05341107
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Dialysis

Serum Vasopressin Response in Patients With Intradialytic Hypotension: A Pilot Study

Mira Rho, Mark A. Perazella, Chirag R. Parikh, Aldo J. Peixoto, and Ursula C. Brewster

Yale University School of Medicine, New Haven, Connecticut

Correspondence: Dr. Ursula C. Brewster, Department of Internal Medicine, Yale University School of Medicine, FMP 107, 330 Cedar Street, PO Box 208029, New Haven, CT 06520-8029. Phone: 203-785-4184; Fax: 203-785-4904; E-mail: ursula.brewster{at}yale.edu

Background and Objectives: Arginine vasopressin (AVP), an endogenous hormone with vasopressor properties, may be inadequately secreted during episodes of intradialytic hypotension (IDH).

Design, Setting, Participants, and Measurements: To evaluate this, we performed a prospective, observational pilot study of 20 chronic hemodialysis patients assessing the baseline AVP level and trend of AVP with ultrafiltration in patients with a diagnosis of IDH compared with patients without IDH. Ten symptomatic IDH patients and 10 controls were enrolled and matched for age, gender, and dialysis vintage. AVP levels were obtained hourly throughout the dialysis session and during hypotensive episodes.

Results: We observed that IDH patients experienced greater decreases in both systolic and diastolic blood pressure during the dialysis session despite equivalent ultrafiltration in both groups. AVP concentration did not increase in the IDH patients (5.0 ± 1.8) compared with controls (6.4 ± 6.0) (P = 0.5) despite hypotensive events.

Conclusions: This study suggests that symptomatic IDH patients are unable to mount an appropriate increase in AVP secretion in the setting of hypotension. These findings support the possibility of AVP as a mechanism driven therapy for patients with symptomatic IDH.






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