Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Article
  • Published:

Hypocholesterolemia is a risk factor for reduced systemic vascular resistance reactivity during hemodialysis

Hypertension Research volume 44, pages 988–995 (2021)Cite this article

Abstract

Intradialytic hypotension (IDH) is associated with high mortality. Peripheral vascular resistance and circulating blood volume are important factors in IDH; however, the effects of hemodialysis (HD) on vascular resistance in IDH remain unclear. We herein performed a retrospective observational cohort study to investigate changes in and factors related to vascular resistance during HD. A total of 101 HD patients were divided into two groups (Decreased blood pressure (BP) during HD group: N = 19, Nondecreased BP group: N = 82), and cardiac output was measured with electrical velocimetry (AESCLON) for 3 h. The systemic vascular resistance index (SVRI) was significantly decreased in the Decreased BP group, while the cardiac index was similar in both groups. A multivariate regression analysis identified hypocholesterolemia as a predictor of reduced vascular resistance reactivity during HD. Furthermore, a correlation was found between changes in the SVRI and cholesterol levels in patients with a higher Geriatric Nutritional Risk Index (GNRI) but not in those with a lower GNRI. The present results suggest that hypocholesterolemia contributes to reducing systematic vascular resistance reactivity during HD, which is an important predictor of a reduction in BP during HD. The relationship between hypocholesterolemia and vascular resistance may involve mechanisms other than malnutrition.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Kooman J, Basci A, Pizzarelli F, Canaud B, Haage P, Fouque D, et al. EBPG guideline on hemodynamic instability. Nephrol Dial Transpl. 2007;22:ii22–44.

    Article  Google Scholar 

  2. Shoji T, Tsubakihara Y, Fujii M, Imai E. Hemodialysis associated hypotension as an independent risk factor for two-year mortality in hemodialysis patients. Kidney Int. 2004;66:1212–20.

    Article  PubMed  Google Scholar 

  3. Puskar D, Pasini J, Savic I, Bedalov G, Sonicki Z. Survival of primary arteriovenous fistula in 463 patients on chronic hemodialysis. Croat Med J. 2002;43:306–31.

    PubMed  Google Scholar 

  4. Nette RW, van den Dorpel MA, Krepel HP, le EHY, van den Meiracker AH, Poldermans D, et al. Hypotension during hemodialysis results from an impairment of arteriolar tone and left ventricular function. Clin Nephrol. 2005;63:276–83.

    Article  CAS  PubMed  Google Scholar 

  5. Straver B, Roggekamp MC, de Vries PM, ter Wee PM. Systemic vascular resistance in intradialytic hypotension determined by means of impedance cardiography. Blood Purif. 1998;16:281–9.

    Article  CAS  PubMed  Google Scholar 

  6. Kubo K, Sanaka T, Suzuki T, Muto H, Sugino N, Kimata S. Cardiovascular function of patients undertaking longterm hemodialysis, Part II—clinical evaluation of hemodynamic changes during hemodialysis. Jpn Soc Dialysis Ther. 1981;14:1–6.

    Article  Google Scholar 

  7. Yoshihara F, Kishida M, Ogawa K, Nishigaki T, Nakasaki H, Isgizuka A, et al. Stroke volume variation is an independent predictor for decreased blood pressure during hemodialysis. Ther Apher Dial. 2017;21:166–72.

    Article  CAS  PubMed  Google Scholar 

  8. Murasawa T, Hanyuda Y, Suzuki O, Ueda Y, Hara F. Evaluation of cardiac function during hemodialysis in diabetic nephropathy as reflected in double product, Stroke work index and systemic vascular resistance. Jpn J Artif Organs. 1988;17:94–7.

    Google Scholar 

  9. Frank M, Ulrich G, Jeroen P, George B, Karel M. Energy transfer is the single most important factor for the difference in vascular response between isolated ultrafiltration and hemodialysis. J Am Soc Nephrol. 2000;11:1512–7.

    Article  Google Scholar 

  10. Toshiki F, Hideaki H, Katsuyuki N, Yuji Y. Prognostic expectation of hemodialysis patients using Geriatric Nutritional Risk Index(GNRI): comparison with single application of body mass index (BMI) or serum albumin. Tosekikaishi. 2014;47:75–84.

    Google Scholar 

  11. Burton JO, Jefferies HJ, Selby NM, McIntyre CW. Hemodialysis-induced cardiac injury: determinants and associated outcomes. Clin J Am Soc Nephrol. 2009;4:914–20.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Iseki K, Yamazato M, Tozawa M, Takishita S. Hypocholesterolemia is a significant predictor of death in a cohort of chronic hemodialysis patients. Kidney Int. 2002;61:1887–93.

    Article  PubMed  Google Scholar 

  13. Degoulet P, Legrain M, Reach I, Aime F, Devries C, Rojas P, et al. Mortality risk factors in patients treated by chronic hemodialysis. report of the Diaphane collaborative study. Nephron. 1982;31:103–10.

    Article  CAS  PubMed  Google Scholar 

  14. Sageman S, Riffenburgh R, Spiess B. Equivalence of bioimpedance and Thermodilution in measuring cardiac index after cardiac surgery. J Cardiothorac Vasc Anesth. 2002;6:8–14.

    Article  Google Scholar 

  15. Schmidt C, Theilmeier G, Van Aken H, Korsmeier P, P. Wirtz S, Berendes E, et al. Comparison of electrical velocimetry and transesophageal Doppler echocardiography for measuring stroke volume and cardiac output. Br J Anaesth. 2005;95:603–10.

    Article  CAS  PubMed  Google Scholar 

  16. Zoremba N, Bickenbach J, Krauss B, Rossaint R, Kuhlen R, Schalte G. Comparison of electrical velocimetry and thermodilution techniques for the measurement of cardiac output. Acta Anaesthesiol Scand. 2007;51:1314–9.

    Article  CAS  PubMed  Google Scholar 

  17. Xiong J, Wang M, Zhang Y, Nie L, He T, Wang Y, et al. Association of Geriatric Nutritional Risk Index with mortality in hemodialysis patients: a meta-analysis of cohort studies. Kidney Blood Press Res. 2018;43:1878–89.

    Article  PubMed  Google Scholar 

  18. Liu Y, Coresh J, Eustace JA, Longenecker JC, Jaar B, Fink NE, et al. Association between cholesterol level and mortality in dialysis patients: role of inflammation and malnutrition. JAMA. 2004;291:451–9.

    Article  CAS  Google Scholar 

  19. Iseki K, Kinjo K, Kimura Y, Osawa A, Fukiyama K. Evidence for high risk of cerebral hemorrhage in chronic dialysis patients. Kidney Int. 1993;44:1086–90.

    Article  CAS  PubMed  Google Scholar 

  20. Ettema EM, Kuipers J, Groen H, Kema IP, Westerhuis R, Jong PE, et al. Vasopressin release is enhanced by the Hemocontrol biofeedback system and could contribute to better haemodynamic stability during haemodialysis. Nephrol Dial Transpl. 2012;27:3263–70.

    Article  CAS  Google Scholar 

  21. El-Shafey EM, El-Nagar GF, Selim MF, El-Sorogy HA, Sabry AA. Is there a role for endothelin-1 in the hemodynamic changes during hemodialysis? Clin Exp Nephrol. 2008;12:370–5.

    Article  CAS  PubMed  Google Scholar 

  22. Raj DS, Vincent B, Simpson K, Sato E, Jones KL, Welbourne TC, et al. Hemodynamic changes during hemodialysis: role of nitric oxide and endothelin. Kidney Int. 2002;61:697–704.

    Article  CAS  PubMed  Google Scholar 

  23. Teng J, Tian J, Lv WL, Zhang XY, Zou JZ, Fang Y, et al. Inappropriately elevated endothelin-1 plays a role in the pathogenesis of intradialytic hypertension. Hemodial Int. 2015;19:279–86.

    Article  PubMed  Google Scholar 

  24. Nakamura T, Ushiyama C, Osada S, Inoue T, Shimada N, Koide H. Effect of low-density lipoprotein apheresis on plasma endothelin-1 levels in diabetic hemodialysis patients with arteriosclerosis obliterans. J Diabetes Complications. 2003;17:349–54.

    Article  PubMed  Google Scholar 

  25. Sahebkar A, Kotani K, Serban C, Ursoniu S, Mikhailidis DP, et al. Statin therapy reduces plasma endothelin-1 concentrations: a meta-analysis of 15 randomized controlled trials. Atherosclerosis. 2015;241:433–42.

    Article  CAS  PubMed  Google Scholar 

  26. Ohwaki T, Sakai H, Hirata Y. Partial characterization of endothelin-converting enzyme activity in human serum. Atherosclerosis. 1994;108:175–81.

    Article  CAS  PubMed  Google Scholar 

  27. Merkel LA, Bilder GE. Modulation of vascular reactivity by vasoactive peptides in aortic rings from hypercholesterolemic rabbits. Eur J Pharm. 1992;222:175–9.

    Article  CAS  Google Scholar 

  28. Mathew V, Cannan CR, Miller VM, Barber DA, Hasdai D, Schwartz RS, et al. Enhanced endothelin-mediated coronary vasoconstriction and attenuated basal nitric oxide activity in experimental hypercholesterolemia. Circulation. 1997;96:1930–6.

    Article  CAS  PubMed  Google Scholar 

  29. Romerio SC, Linder L, Flammer J, Haefeli WE. Correlation between apolipoprotein B and endothelin-1-induced vasoconstriction in humans. Peptides. 2000;21:871–4.

    Article  CAS  PubMed  Google Scholar 

  30. Yeganeh B, Wiechec E, Ande SR, Sharma P, Moghadam AR, Post M, et al. Targeting the mevalonate cascade as a new therapeutic approach in heart disease, cancer and pulmonary disease. Pharm Ther. 2014;143:87–110.

    Article  CAS  Google Scholar 

  31. Samouilidou EC, Karpouza AP, Kostopoulos V, Bakirtzi T, Pantelias K, Petras D, et al. Lipid abnormalities and oxidized LDL in chronic kidney disease patients on hemodialysis and peritoneal dialysis. Ren Fail. 2012;34:160–4.

    Article  CAS  PubMed  Google Scholar 

  32. Boaz M, Smetana S, Weinstein T, Matas Z, Gafter U, Iaina A, et al. Secondary prevention with antioxidants of cardiovascular disease in endstage renal disease (SPACE): randomised placebo-controlled trial. Lancet. 2000;356:1213–8.

    Article  CAS  PubMed  Google Scholar 

  33. Tepel M, van der Giet M, Statz M, Jankowski J, Zidek W. The antioxidant acetylcysteine reduces cardiovascular events in patients with end-stage renal failure: a randomized, controlled trial. Circulation. 2003;107:992–5.

    Article  CAS  PubMed  Google Scholar 

  34. Gutkin M, Levinson GE, King AS, Lasker N. Plasma renin activity in end-stage kidney disease. Circulation. 1969;40:563–74.

    Article  CAS  Google Scholar 

  35. Craswell PW, Hird VM, Judd PA, Baillod RA, Varghese Z, Moorhead JF. Plasma renin activity and blood pressure in 89 patients receiving maintenance haemodialysis therapy. Br Med J. 1972;4:749–53.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

Download references

Acknowledgements

We thank Yoko Saito and Chie Nishiguchi for their excellent assistance. This study was supported by a 2019 Novartis Research Grant.

Author information

Authors and Affiliations

  1. Division of Nephrology and Hypertension, National Cerebral and Cardiovascular Center, Osaka, Japan

    Miki Matsuo, Shiori Kojima, Tetsuya Arisato, Masaki Matsubara, Ryo Koezuka, Masatsugu Kishida & Fumiki Yoshihara

  2. Clinical Engineering Department, National Cerebral and Cardiovascular Center, Osaka, Japan

    Koji Ogawa & Hiroshi Inoue

Authors
  1. Miki Matsuo
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Shiori Kojima
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Tetsuya Arisato
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Masaki Matsubara
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Ryo Koezuka
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Masatsugu Kishida
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Koji Ogawa
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Hiroshi Inoue
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Fumiki Yoshihara
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Fumiki Yoshihara.

Ethics declarations

Conflict of interest

The authors declare no competing interests.

Additional information

Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Matsuo, M., Kojima, S., Arisato, T. et al. Hypocholesterolemia is a risk factor for reduced systemic vascular resistance reactivity during hemodialysis. Hypertens Res 44, 988–995 (2021). https://doi.org/10.1038/s41440-021-00640-2

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/s41440-021-00640-2

Keywords

This article is cited by

Search

Advanced search

Quick links