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Increased Nitric Oxide Production in Patients with Hypotension during Hemodialysis

Koji Yokokawa, MD, PhD; Rita Mankus, MD; Mohammed G. Saklayen, MD; Masakazu Kohno, MD, PhD; Kenichi Yasunari, MD, PhD; Mieko Minami, MD; Hiroaki Kano, MD; Takeshi Horio, MD, PhD; Tadanao Takeda, MD; and Anil K. Mandel, MD
[+] Article, Author, and Disclosure Information

From Osaka City University Medical School, Osaka, Japan; and Wright State University, Dayton, Ohio. Requests for Reprints: Koji Yokokawa, MD, PhD, The First Department of Internal Medicine, Osaka City University Medical School, 1-5-7 Asahi-machi, Abeno-ku, Osaka 545, Japan.

Copyright ©2004 by the American College of Physicians

Ann Intern Med. 1995;123(1):35-37. doi:10.7326/0003-4819-123-1-199507010-00005
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Objective: To determine the involvement of nitric oxide production in hemodialysis-induced hypotension.

Design: Examination of nitric oxide synthesis, cyclic guanosine 3′5′-monophosphate (cGMP) levels, and endothelin-1 levels in plasma before and after hemodialysis.

Setting: Veterans Affairs medical center.

Patients: 13 patients with end-stage renal failure who were receiving hemodialysis: Six patients had hypotensive episodes during dialysis and 7 did not.

Intervention: Patients received heparin at a bolus dose of 2000 U at the initiation of dialysis followed by 1000 U/h during 4-hour hemodialysis sessions.

Results: Nitric oxide production markedly increased during hemodialysis-induced hypotensive episodes; this increase was not seen in patients who did not have a hypotensive episode. In both groups, the plasma cGMP and endothelin-1 levels decreased after hemodialysis. According to multiple regression analysis, standard coefficients of nitric oxide production, plasma cGMP levels, and endothelin-1 levels with mean blood pressure after hemodialysis were −0.743,-0.07, and 0.31, respectively.

Conclusion: Nitric oxide production increased in patients who had a hypotensive episode during hemodialysis but did not increase in those who did not have a hypotensive episode.


Grahic Jump Location
Figure 1.
Mean blood pressures (panel A); the sum of plasma nitrite (N0 2 ) and nitrate (NO 3 ) levels (panel B); plasma cyclic guanosine 3′5′-monophosphate (cGMP) levels (panel C), and plasma endothelin-1 levels (panel D) in patients with hypotensive episodes (hypotension[+]) and those without hypotensive episodes (hypotension[−]) before and after a single 4-hour hemodialysis (HD) session.tt

Asterisk indicates the paired -test; plus sign indicates the unpaired Student -test.

Grahic Jump Location




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