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Abstract: PO1096

Endothelin 1 and Parameters of Systolic Blood Pressure in Hemodialysis Patients

Session Information

Category: Dialysis

  • 701 Dialysis: Hemodialysis and Frequent Dialysis

Authors

  • Singh, Anika T., Harvard Medical School, Boston, Massachusetts, United States
  • Sarvode mothi, Suraj, Brigham and Women's Hospital, Boston, Massachusetts, United States
  • Li, Ping, Chinese PLA General Hospital, Beijing, Beijing, China
  • Waikar, Sushrut S., Boston Medical Center, Boston, Massachusetts, United States
  • McCausland, Finnian R., Brigham and Women's Hospital, Boston, Massachusetts, United States

Group or Team Name

  • Mc Causland Lab
Background

Blood pressure (BP) fluctuates widely during intermittent hemodialysis (HD), with greater variability associated with adverse cardiovascular outcomes. As endothelin-1 (ET-1) is a potent vasoconstrictor, we hypothesized that higher concentrations of ET-1 is associated with higher pre-HD systolic BP (SBP).

Methods

ET-1 concentrations were measured at baseline from the DaVita Biorepository (N=784), a longitudinal prospective cohort study with quarterly collection of clinical data and biospecimens. Unadjusted and adjusted linear mixed effects regression models were fit to determine associations of log-transformed ET-1 with SBP at dialysis (pre-HD, nadir intra-HD, post-HD, drop (pre- minus nadir-HD) and delta (pre- minus post-HD). Multivariable models were adjusted for age, sex, race, access, diabetes, heart failure, cardiovascular disease, peripheral vascular disease and pre-HD SBP.

Results

Mean age was 58 years, 59% were males, 40% black. Mean pre-HD SBP was 152 (± 28) mmHg and mean ET-1 concentration was 2.3 (±1.1) ng/mL. Subjects in higher quartiles of baseline ET-1 tended to be younger, diabetic, have higher SBP and lower serum albumin. In fully adjusted models, each unit increase in SD of log-transformed ET-1 was associated with a 3.0 (95% CI 1.8 to 4.2) mmHg higher pre-SBP; 1.2 (95%CI 0.5 to 1.9) mmHg higher nadir-SBP; 1.6 (95% CI 0.6 to 2.5) mmHg higher post-SBP; 1.2 (95%CI 0.2 to 1.5) mmHg lower SBP drop and 1.6 mmHg (95% CI 0.6 to 1.08) lower delta SBP. In categorical analyses a monotonic increase in pre-SBP was noted in higher quartiles of ET-1 (Q4: 7.8 mmHg increase (95% CI 4.5 to 11.2; P<0.001) compared with Q1. Similar patterns were noted for the other variables of interest.

Conclusion

Higher ET-1 is independently associated with higher SBP in maintenance HD patients. These results suggest a role for studying ET-1 antagonism in HD patients with resistant hypertension.