| Summary: | 碩士 === 國立成功大學 === 臨床醫學研究所 === 102 === Blood pressure changes during hemodialysis are very common and make patients uncomfortable by causing muscle cramps or headaches and may affect survival if this change becomes severe to induce hypotension or hypertension for previous studies. However, in regard to the etiology of dialysis, induced hypotension or hypertension remains speculative. This study hypothesizes that this endothelial cell dysfunction may be related to abnormal blood pressure changes after hemodialysis.
In this study, 61 hemodialysis patients in Tainan City, Taiwan were divided into three groups: Control group: hemodynamically stable: BP decrease 〈10mmHg; Low group : BP decrease ≧10mmHg, and High group: BP increase ≧ 0mmHg. ELISA for serum endothelin-1, NO (nitrite+ nitrate) before and after hemodialysis were also collected from the 61 patients, and statistical analysis was used to determine the differences in the three groups.
Among the three groups, post-dialysis endothelin-1 was higher in both the Low group and High group compared with the Control group (P=0.03). Endothelin-1 changes after hemodialysis was higher in the High group as compared to either the Low group or the Control group. (3.75±3.2 pg/ml, P〈0.0005). The odds ratio in polytomas logistic regression in regard to △endothelin-1 for the Low group/Control group was 1.3 (P〈0.005), and for the High group/Control group, it was 1.4 (P=0.001). In the multiple linear regression, endothelin-1 changes indicated significance for blood pressure changes after H/D (regression coefficient=2.07, P〈0.005) and had strong interactions with UF/Dry BW (%) (P〈0.005). A three-dimensional graph was constructed to observe and reflect the changes among the three groups. Therefore we can see that in the case of hemodialysis unstable blood pressure groups, not only did UF play important role in our study, but endothelial function (including FMD or △NO /△endothelin-1) also became important. Maybe in the near future, we can use exercise, diet or even drugs to improve endothelial cell function for these patients in order to make blood pressure more stable during hemodialysis.
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