Excessive Ultrafiltration During Hemodialysis Plays a Role in Intradialytic Hypertension Through Decreased Serum Nitric Oxide (NO) Level

Background: Intradialytic hypertension is one of many complications during Hemodialysis (HD). The mechanism of intradialytic hypertension is currently unclear. Objective: This research aims to understand the association between excessive Ultrafiltration (UF) and intradialytic hypertension episode and its relationship with changes in endothelin-1 level (ET-1), Asymmetric Dimethylarginine (ADMA) level and Nitric Oxide (NO) level during HD. Methods: This study utilized a case-control design. A sample of one hundred and eleven patients who were already undergoing maintenance HD for more than three months was included. Serum levels of NO, ET-1, and ADMA were examined before and after HD; samples were followed by as much as six times consecutive HD session, in which ultrafiltration and blood pressure during HD were noted. Results: From 112 samples obtained, 32.1% (36/112) had intradialytic hypertension. Using regression analysis, we found a significant association between changes in NO levels and intradialytic hypertension. We found a significant association between excessive UF and intradialytic hypertension (p=0.001), adjusted OR=5.17. Path analysis showed the existence of a significant relationship between UF volume during HD and intradialytic hypertension (CR 5.74; p<0.01), as well as a significant relationship between UF volume during HD and NO levels (CR -3.70: p<0.01). There was a direct relationship between NO serum levels with intradialytic hypertension (CR -7.08: p<0.01). Conclusion: Excessive UF during HD plays a role in intradialytic hypertension episode through decreased NO serum levels. There was no clear role of ADMA and ET-1 serum levels on intradialytic hypertension episode. Keywords: Hemodialysis, Intradialytic hypertension, Ultrafiltration, NO, ADMA, ET-1.