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Probing the mechanisms of intradialytic hypertension: a pilot study targeting endothelial cell dysfunction.

Publication ,  Journal Article
Inrig, JK; Van Buren, P; Kim, C; Vongpatanasin, W; Povsic, TJ; Toto, R
Published in: Clin J Am Soc Nephrol
August 2012

BACKGROUND AND OBJECTIVES: Intradialytic hypertension may be caused by an impaired endothelial cell response to hemodialysis. Carvedilol has been shown to improve endothelial cell function in vivo and to block endothelin-1 release in vitro. This study hypothesized that carvedilol would improve endothelial cell function and reduce the occurrence of intradialytic hypertension. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: A prospective 12-week pilot study of carvedilol titrated to 50 mg twice daily was performed among 25 hemodialysis participants with intradialytic hypertension. Each patient served as his or her own control. Paired tests were used to analyze changes in BP and endothelial cell function--assessed by flow-mediated vasodilation, endothelial progenitor cells (aldehyde dehydrogenase bright activity and CD34(+)CD133(+)), asymmetric dimethylarginine, and endothelin-1--from baseline to study end. RESULTS: Flow-mediated vasodilation was significantly improved with carvedilol (from 1.03% to 1.40%, P=0.02). There was no significant change in endothelial progenitor cells, endothelin-1, or asymmetric dimethylarginine. Although prehemodialysis systolic BP was unchanged (144-146 mmHg, P=0.5), posthemodialysis systolic BP, 44-hour ambulatory systolic BP, and the frequency of intradialytic hypertension decreased with carvedilol (159-142 mmHg, P<0.001; 155-148 mmHg, P=0.05; and 77% [4.6 of 6] to 28% [1.7 of 6], P<0.001, respectively). CONCLUSIONS: Among hemodialysis participants with intradialytic hypertension, targeting endothelial cell dysfunction with carvedilol was associated with modest improvements in endothelial function, improved intradialytic and interdialytic BP, and reduced frequency of intradialytic hypertension. Randomized controlled trials are required to confirm these findings.

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Published In

Clin J Am Soc Nephrol

DOI

EISSN

1555-905X

Publication Date

August 2012

Volume

7

Issue

8

Start / End Page

1300 / 1309

Location

United States

Related Subject Headings

  • Vasodilator Agents
  • Vasodilation
  • Vascular Stiffness
  • Urology & Nephrology
  • Treatment Outcome
  • Time Factors
  • Texas
  • Stem Cells
  • Renal Dialysis
  • Prospective Studies
 

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Inrig, J. K., Van Buren, P., Kim, C., Vongpatanasin, W., Povsic, T. J., & Toto, R. (2012). Probing the mechanisms of intradialytic hypertension: a pilot study targeting endothelial cell dysfunction. Clin J Am Soc Nephrol, 7(8), 1300–1309. https://doi.org/10.2215/CJN.10010911
Inrig, Jula K., Peter Van Buren, Catherine Kim, Wanpen Vongpatanasin, Thomas J. Povsic, and Robert Toto. “Probing the mechanisms of intradialytic hypertension: a pilot study targeting endothelial cell dysfunction.Clin J Am Soc Nephrol 7, no. 8 (August 2012): 1300–1309. https://doi.org/10.2215/CJN.10010911.
Inrig JK, Van Buren P, Kim C, Vongpatanasin W, Povsic TJ, Toto R. Probing the mechanisms of intradialytic hypertension: a pilot study targeting endothelial cell dysfunction. Clin J Am Soc Nephrol. 2012 Aug;7(8):1300–9.
Inrig, Jula K., et al. “Probing the mechanisms of intradialytic hypertension: a pilot study targeting endothelial cell dysfunction.Clin J Am Soc Nephrol, vol. 7, no. 8, Aug. 2012, pp. 1300–09. Pubmed, doi:10.2215/CJN.10010911.
Inrig JK, Van Buren P, Kim C, Vongpatanasin W, Povsic TJ, Toto R. Probing the mechanisms of intradialytic hypertension: a pilot study targeting endothelial cell dysfunction. Clin J Am Soc Nephrol. 2012 Aug;7(8):1300–1309.

Published In

Clin J Am Soc Nephrol

DOI

EISSN

1555-905X

Publication Date

August 2012

Volume

7

Issue

8

Start / End Page

1300 / 1309

Location

United States

Related Subject Headings

  • Vasodilator Agents
  • Vasodilation
  • Vascular Stiffness
  • Urology & Nephrology
  • Treatment Outcome
  • Time Factors
  • Texas
  • Stem Cells
  • Renal Dialysis
  • Prospective Studies