PMID- 9669432
OWN - NLM
STAT- MEDLINE
DCOM- 19980806
LR  - 20220408
IS  - 1523-6838 (Electronic)
IS  - 0272-6386 (Linking)
VI  - 32
IP  - 1
DP  - 1998 Jul
TI  - Effect of acetate, bicarbonate dialysis, and acetate-free biofiltration on nitric 
      oxide synthesis: implications for dialysis hypotension.
PG  - 115-24
AB  - The effect of acetate dialysis (AD), bicarbonate dialysis (BD), and acetate-free 
      biofiltration (AFB) on nitric oxide (NO) synthesis and the implications for 
      dialysis hypotension was studied. The finding that uremic plasma is a potent 
      inducer of NO synthesis by endothelial cells in vitro suggested that the 
      cardiovascular instability of dialysis patients might result from excessive NO 
      formation. Cardiovascular instability is more frequent in patients undergoing AD 
      than BD. To see whether these differences were attributable to NO, we studied the 
      NO synthetic pathway ex vivo in patients undergoing different dialysis 
      procedures. Five patients were treated, in a random order, with AD, BD, and AFB, 
      a technique using a buffer-free dialysate and postdilution of a sterile 
      bicarbonate solution. Each type of dialysis was used for 1 week, comprising three 
      dialysis sessions. A polyacrylonitrile dialyzer was used for all three methods. 
      Before and after the third dialysis, plasma was collected, added to 
      [3H]L-arginine, and incubated with human umbilical vein endothelial cells 
      (HUVECs) for 24 hours. NO synthesis was evaluated as [3H]L-citrulline formation. 
      Plasma concentrations of interleukin-1beta (IL-1beta), a potent inducer of 
      inducible NO synthase (iNOS) in endothelial cells, were also measured. Plasma 
      collected from patients after AD stimulated endothelial NO synthesis more than 
      plasma from the same patients before the dialysis session (pre-AD, 0.173+/-0.028 
      nmol/10(5) cells v post-AD, 0.280+/-0.093 nmol/10(5) cells; P < 0.05). A slight, 
      although not significant, increase was also observed when HUVECs were incubated 
      with plasma drawn after BD (pre-BD, 0.151+/-0.014 nmol/10(5) cells; post-BD, 
      0.230+/-0.055 nmol/10(5) cells). AFB did not aggravate the stimulatory effect of 
      uremic plasma on endothelial NO synthesis (pre-AFB, 0.184+/-0.038 nmol/10(5) 
      cells; post-AFB, 0.189+/-0.040 nmol/10(5) cells). Plasma IL-1beta was greater (P 
      < 0.01) after AD than after BD and AFB (post-AD, 0.234+/-0.028 pg/mL; post-BD, 
      0.124+/-0.019 pg/mL; post-AFB, 0.120+/-0.013 pg/mL). With AD, there was a greater 
      intradialytic decrease in systolic blood pressure than with BD or AFB. Weight and 
      blood volume loss and sodium balance were similar in AD, BD, and AFB. These data 
      were consistent with the possibility that NO and cytokines, released in excessive 
      amounts during AD, may contribute to hemodynamic instability.
FAU - Noris, M
AU  - Noris M
AD  - Mario Negri Institute for Pharmacological Research, Bergamo, Italy. 
      noris@irfmn.mnegri.it
FAU - Todeschini, M
AU  - Todeschini M
FAU - Casiraghi, F
AU  - Casiraghi F
FAU - Roccatello, D
AU  - Roccatello D
FAU - Martina, G
AU  - Martina G
FAU - Minetti, L
AU  - Minetti L
FAU - Imberti, B
AU  - Imberti B
FAU - Gaspari, F
AU  - Gaspari F
FAU - Atti, M
AU  - Atti M
FAU - Remuzzi, G
AU  - Remuzzi G
LA  - eng
PT  - Clinical Trial
PT  - Comparative Study
PT  - Journal Article
PT  - Randomized Controlled Trial
PL  - United States
TA  - Am J Kidney Dis
JT  - American journal of kidney diseases : the official journal of the National Kidney 
      Foundation
JID - 8110075
RN  - 0 (Acetates)
RN  - 0 (Bicarbonates)
RN  - 0 (Hemodialysis Solutions)
RN  - 0 (Interleukin-1)
RN  - 31C4KY9ESH (Nitric Oxide)
SB  - IM
MH  - Acetates/*pharmacology
MH  - Adult
MH  - Aged
MH  - Bicarbonates/*pharmacology
MH  - Cells, Cultured
MH  - Cross-Over Studies
MH  - Endothelium, Vascular/cytology/metabolism
MH  - Female
MH  - *Hemodiafiltration
MH  - Hemodialysis Solutions/*chemistry/pharmacology
MH  - Hemodynamics/physiology
MH  - Humans
MH  - Hypotension/*etiology
MH  - Interleukin-1/blood
MH  - Kidney Failure, Chronic/metabolism/physiopathology/therapy
MH  - Male
MH  - Middle Aged
MH  - Nitric Oxide/*biosynthesis
MH  - Pilot Projects
MH  - Renal Dialysis/adverse effects/*methods
MH  - Umbilical Veins/cytology
EDAT- 1998/07/21 00:00
MHDA- 1998/07/21 00:01
CRDT- 1998/07/21 00:00
PHST- 1998/07/21 00:00 [pubmed]
PHST- 1998/07/21 00:01 [medline]
PHST- 1998/07/21 00:00 [entrez]
AID - S0272-6386(98)00186-3 [pii]
AID - 10.1053/ajkd.1998.v32.pm9669432 [doi]
PST - ppublish
SO  - Am J Kidney Dis. 1998 Jul;32(1):115-24. doi: 10.1053/ajkd.1998.v32.pm9669432.