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Abstract: SA-PO580

Endothelial Glycocalyx Injury due to Hemodialysis Induces Intradialytic Hypotension

Session Information

Category: Dialysis

  • 801 Dialysis: Hemodialysis and Frequent Dialysis

Authors

  • Miura, Tomotaka, Gifu University Graduate School of Medicine, Gifu, Japan
  • Suzuki, Keiko, Gifu University Graduate School of Medicine, Gifu, Japan
  • Suzuki, Kodai, Gifu University Graduate School of Medicine, Gifu, Japan
  • Takada, Chihiro, Gifu University Graduate School of Medicine, Gifu, Japan
  • Okada, Hideshi, Gifu University Graduate School of Medicine, Gifu, Japan
Background

Hemodialysis (HD) plays a pivotal role in replacing renal function for patients with end-stage renal failure. When the patients undergo hemodialysis, HD complications, such as intradialytic hypotension and arrhythmia, are inevitable. The vascular endothelial glycocalyx, which exists on the inner surface of vascular endothelial cells and maintains vascular homeostasis, has been suggested to be impaired by hemodialysis. However, it is unclear whether the endothelial glycocalyx injury is associated with HD complications.

Methods

We enrolled the patients who underwent outpatient hemodialysis at Gifu Seiryu Hospital between April 2022 and July 2022 (346 hemodialysis sessions). Patients aged <20 years. This single-center retrospective study evaluated the association between syndecan-1, an endothelial glycocalyx dysfunction marker, and complications of hemodialysis. Complication events, as the primary outcome, were defined as intradialytic hypotension, arrhythmia, and subjective symptoms such as chest pain, nausea, general malaise, and leg cramps during HD. Patients undergoing outpatient maintenance HD at Gifu Seiryu Hospital undergo blood tests at the beginning of each month. The GEE model was used to reveal the association between the serum syndecan-1 concentration in pre-HD and hypotension. Age, sex, and BNP were included in the model as covariates to adjust for confounders.

Results

In total, 92 patients were enrolled. The median HD period was 40 months. The most common primary illness was diabetic nephropathy. In pre-HD, the median serum syndecan-1 concentration was 67.7 ng/mL. In post-HD, the median serum syndecan-1 concentration was 98.3 ng/mL. According to the generalized estimating equations (GEE) model adjusted for age, sex, BNP, and amount of water removed per hour, no association was found between serum syndecan-1 concentration in pre-HD and appearance of intradialytic hypotension (odds ratio (OR): 1.001, P<0.741). However, a GEE model using the same adjustment factors showed that the greater the amount of change in serum syndecan-1 concentration before and after HD, the more complications appeared (OR: 1.005, P<0.013).

Conclusion

The study revealed that the quantitative assessment of the endothelial glycocalyx injury by measuring the concentration of serum syndecan-1 during HD is associated with intradialytic hypotension.