Mechanisms and Treatment of Intradialytic Hypertension - Sodium (MATCH-Sodium)

The University of Texas System (UT)

Status: Completed

Conditions: Intradialytic Hypertension; Hypertension; Hemodialysis; End-stage Renal Disease

Study type: Observational

Funder types: Other

Identifiers

NCT01371890

092018-018

Details and patient eligibility

About

The purpose of this study is to determine the role of dialysate exposure and fluid removal during hemodialysis in the pathophysiology of intradialytic hypertension.

Full description

Specific Aim #1 To determine in a crossover study of 15 maintenance hemodialysis patients with intradialytic hypertension whether standard dialysis with ultrafiltration (dialysate Na of 140), dialysis without ultrafiltration (dialysate Na of 140), or ultrafiltration alone (no dialysate) is associated with the an increase in systolic blood pressure during hemodialysis

Specific Aim #2 To determine in a crossover study of 15 maintenance hemodialysis with intradialytic hypertension whether standard dialysis with ultrafiltration, dialysis without ultrafiltration, or ultrafiltration alone is associated with change in either endothelin-1 or nitric oxide during hemodialysis

SUBSTUDY AIMS

Specific Aim #1 To determine in a randomized 3-week, 2 period crossover study of 15 maintenance hemodialysis patients with intradialytic hypertension whether high vs low dialysate-to-serum Na gradients impairs release of NO, increases ET-1 or causes an acute intradialytic increase in systolic BP,.

Specific Aim #2 TO determine in a randomized 16-week, 2-period crossover study of 30 hemodialysis patients with intradialytic hypertension the effects of 8 weeks of high dialysate-to-plasma Na gradients to 8-weeks of low Na gradients on EC function (FMD and ADMA) and 44 hour ambulatory BP.

Enrollment: 18 patients

Sex: All

Ages: 18 to 85 years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• on hemodialysis > 30 days
• male and female participants, aged 18 to 85 years old, of all races and ethnic origin
• ability to provide informed consent
• Primary nephrologist deems patient is at target dry weight
• KDOQI defined hypertension (predialysis SBP >140 or postdialysis SBP>130) AND
• pre to post hemodialysis SBP increase (>10 mmHg) during 4/6 last HD session

Exclusion criteria

• Patients with active cancer or active wounds
• Patient currently on antibiotics or on IV antibiotics within the last month
• BP unable to be measured by routine mechanisms in the upper extremity
• Life expectancy < 6 months
• Inability to provide informed consent
• Larger interdialytic weight gain (>5 kg/treatment on average)

Trial design

18 participants in 1 patient group

Intradialytic hypertension

Description:

Patients with systolic blood pressure increases \> 10 mmHg during 4/6 hemodialysis sessions