The Role of Nitric Oxide on Hypotension During Hemodialysis

Kim, Nam Ho; Jung, Kwon; Kim, Soo Wan; Jung, Young Do; Lee, Kee Young; Ahn, Bong Whan; Lee, Jong Un; Choi, Ki Chul; Kang, Young Joon

Abstract

It has been well known that patients with end-stage renal failure were treated by hemodialysis to recover their renal function. However, several side effects have been resulted from in the treatment with hemodialysis. Especially, hypotensis on and hypoxemia are well known as the complications induced by hemodialysis. The present study was aimed at investigating interaction of nitric oxide and hypotension during hemodialysis. Blood pressure and heart rate were checked during hemodialysis in 24 end-stage renal failure patients, who were treated in Artificial Kidney Unit of Chonnam University Hospital. We also measured NOx before and after hemodialysis using Griess method. The results obtained are as follows. 1) Mean NOx level was 188.5+/-121.4 microM in the hemodialysis group. 2) Patients who had hypotensive episodes during hemodialysis were 7, patients who had no hypotensive spisodes during hemodialysis were 8, and patients who had hypertensive episodes during hamodialysis were 9. 3) In patients who did not have hypotensive episodes and whose mean blood pressure did not change during hemodialysis, plasma NOx levels were significantly decreased from 253.8+/-142.4 to 88.0+/-51.0 microM(p=0.018) 4) In patients who have hypotensive episodes and whose mean blood pressure decreased more than 10mmHg during hemodialysis, plasma NOx levels were significantly decreased from 253.8+/-142.4 to 88.0+/-51.0 microM(p=0.012)5) In patients who did not have hypotensive episodes, rather than whose mean blood pressure incrased more than 10mmHg during hemodialysis, plasma NOx levels were also significantly decreased from 230.0+/-162.7 to 67.7+/-54.9 microM(p=0.008) 6) In patients who had hypotensive episodes(n=7) or no hypotensive episodes(n=8), even hypertensive episodes(n=9) during hemodialysis, plasma NOx levels were significantly decreased(p<0.001). 7) The correlation coefficiency for the association between the changes of blood pressure and the changes of NOx levels was 0.029.These results indicated that the changes of NOx did not affect the changes of blood pressure during hemodialysis, and although the pathogenesis of this constant decrease of NOx after hemodialysis is not known yet, NOx may be removed during hemodialysis partially.