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Intradialytic hypertension and its association with endothelial cell dysfunction.

Publication ,  Journal Article
Inrig, JK; Van Buren, P; Kim, C; Vongpatanasin, W; Povsic, TJ; Toto, RD
Published in: Clin J Am Soc Nephrol
August 2011

BACKGROUND AND OBJECTIVES: Intradialytic hypertension is associated with adverse outcomes, yet the mechanism is uncertain. Patients with intradialytic hypertension exhibit imbalances in endothelial-derived vasoregulators nitric oxide and endothelin-1, indirectly suggesting endothelial cell dysfunction. We hypothesized that intradialytic hypertension is associated in vivo with endothelial cell dysfunction, a novel predictor of adverse cardiovascular outcomes. DESIGN, SETTINGS, PARTICIPANTS, & MEASUREMENTS: We performed a case-control cohort study including 25 hemodialysis (HD) subjects without (controls) and 25 with intradialytic hypertension (an increase in systolic BP pre- to postdialysis ≥10 mmHg ≥4/6 consecutive HD sessions). The primary outcome was peripheral blood endothelial progenitor cells (EPCs) assessed by aldehyde dehydrogenase activity (ALDH(br)) and cell surface marker expression (CD34(+)CD133(+)). We also assessed endothelial function by ultrasonographic measurement of brachial artery flow-mediated vasodilation (FMD) normalized for shear stress. Parametric and nonparametric t tests were used to compare EPCs, FMD, and BP. RESULTS: Baseline characteristics and comorbidities were similar between groups. Compared with controls, 2-week average predialysis systolic BP was lower among subjects with intradialytic hypertension (144.0 versus 155.5 mmHg), but postdialysis systolic BP was significantly higher (159.0 versus 128.1 mmHg). Endothelial cell function was impaired among subjects with intradialytic hypertension as measured by decreased median ALDH(br) cells and decreased CD34(+)CD133(+) cells (ALDH(br), 0.034% versus 0.053%; CD34(+)CD133(+), 0.033% versus 0.059%). FMD was lower among subjects with intradialytic hypertension (1.03% versus 1.67%). CONCLUSIONS: Intradialytic hypertension is associated with endothelial cell dysfunction. We propose that endothelial cell dysfunction may partially explain the higher event rates observed in these patients.

Duke Scholars

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Published In

Clin J Am Soc Nephrol

DOI

EISSN

1555-905X

Publication Date

August 2011

Volume

6

Issue

8

Start / End Page

2016 / 2024

Location

United States

Related Subject Headings

  • Vasodilation
  • Urology & Nephrology
  • Ultrasonography, Doppler, Pulsed
  • Texas
  • Stem Cells
  • Renal Dialysis
  • Prospective Studies
  • Peptides
  • Middle Aged
  • Male
 

Citation

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Inrig, J. K., Van Buren, P., Kim, C., Vongpatanasin, W., Povsic, T. J., & Toto, R. D. (2011). Intradialytic hypertension and its association with endothelial cell dysfunction. Clin J Am Soc Nephrol, 6(8), 2016–2024. https://doi.org/10.2215/CJN.11351210
Inrig, Jula K., Peter Van Buren, Catherine Kim, Wanpen Vongpatanasin, Thomas J. Povsic, and Robert D. Toto. “Intradialytic hypertension and its association with endothelial cell dysfunction.Clin J Am Soc Nephrol 6, no. 8 (August 2011): 2016–24. https://doi.org/10.2215/CJN.11351210.
Inrig JK, Van Buren P, Kim C, Vongpatanasin W, Povsic TJ, Toto RD. Intradialytic hypertension and its association with endothelial cell dysfunction. Clin J Am Soc Nephrol. 2011 Aug;6(8):2016–24.
Inrig, Jula K., et al. “Intradialytic hypertension and its association with endothelial cell dysfunction.Clin J Am Soc Nephrol, vol. 6, no. 8, Aug. 2011, pp. 2016–24. Pubmed, doi:10.2215/CJN.11351210.
Inrig JK, Van Buren P, Kim C, Vongpatanasin W, Povsic TJ, Toto RD. Intradialytic hypertension and its association with endothelial cell dysfunction. Clin J Am Soc Nephrol. 2011 Aug;6(8):2016–2024.

Published In

Clin J Am Soc Nephrol

DOI

EISSN

1555-905X

Publication Date

August 2011

Volume

6

Issue

8

Start / End Page

2016 / 2024

Location

United States

Related Subject Headings

  • Vasodilation
  • Urology & Nephrology
  • Ultrasonography, Doppler, Pulsed
  • Texas
  • Stem Cells
  • Renal Dialysis
  • Prospective Studies
  • Peptides
  • Middle Aged
  • Male