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. 2021 Nov 20;34(11):1203-1208.
doi: 10.1093/ajh/hpab104.

Endothelin-1 and Parameters of Systolic Blood Pressure in Hemodialysis

Anika T Singh  1   2 , Suraj Sarvode Mothi  1   2 , Ping Li  3 , Venkata Sabbisetti  1   2 , Sushrut S Waikar  4 , Finnian R Mc Causland  1   2
Affiliations

Endothelin-1 and Parameters of Systolic Blood Pressure in Hemodialysis

Anika T Singh et al. Am J Hypertens. .

Abstract

Background: Hypertension is common in hemodialysis (HD) patients. Increased blood pressure (BP) variability, particularly higher and lower extremes, is associated with adverse outcomes. We explored the association of endothelin-1 (ET-1), a potent vasoconstrictor, with different BP parameters (pre-HD, intra-HD, and post-HD) during HD in a contemporary patient cohort.

Methods: This study uses the DaVita Biorepository, a longitudinal prospective cohort study with quarterly collection of clinical data and biospecimens. Unadjusted and adjusted linear mixed effects regression models were fit to determine association of pre-HD ET-1 (log-transformed and quartiles) with HD-related systolic BP (SBP) parameters (pre-HD, nadir intra-HD, and post-HD). As ET-1 was measured at baseline, analyses were restricted to 1 year of follow-up.

Results: Among 769 participants, mean age was 52 years, 42% were females, and 41% were Black. Mean pre-HD SBP was 152 (±28) mm Hg and mean ET-1 concentration was 2.3 (±1.2) ng/ml. In fully adjusted models, each unit increase in SD of log-transformed ET-1 was associated with a 2.7 (95% confidence interval [CI] 1.5, 4.0) mm Hg higher pre-SBP; 1.6 (95% CI 0.9, 2.3) mm Hg higher nadir SBP; and 2.0 (95% CI 1.1, 2.9) mm Hg higher post-SBP. Each SD increase in log-transformed ET-1 was associated with 21% higher odds of experiencing intradialytic hypertension (odds ratio 1.21; 95% CI 1.10-1.34).

Conclusions: Higher baseline ET-1 levels are independently associated with higher SBP and higher odds of intradialytic hypertension. These results highlight a potential role for ET-1 in BP control in HD patients and raise the possibility of ET-1 antagonism as a therapeutic target.

Keywords: blood pressure; endothelin; hemodialysis; hypertension.

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Figures

Figure 1.
Figure 1.
Consort diagram. Abbreviations: ET-1, endothelin-1; HD, hemodialysis.
Figure 2.
Figure 2.
Association of quartiles of endothelin-1 with systolic blood pressure (SBP) outcomes. Abbreviation: Q1, quartile 1.
See this image and copyright information in PMC

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