The Association of High Sensitivity C-reactive protein and Nitric Oxide with Elevated Blood Pressure during Dialysis in Intradialytic Hypertension

Stella Palar; Cerelia Sugeng; Octavianus Umboh; Fandy Gosal; Cynthia Natalia

doi:10.3889/oamjms.2023.11377

Authors

Stella Palar Department of Internal Medicine, Division of Nephrology, Faculty of Medicine, Sam Ratulangi University, Prof. Dr. R. D. Kandou Hospital, Manado, Indonesia
Cerelia Sugeng Department of Internal Medicine, Division of Nephrology, Faculty of Medicine, Sam Ratulangi University, Prof. Dr. R. D. Kandou Hospital, Manado, Indonesia
Octavianus Umboh Department of Internal Medicine, Division of Nephrology, Faculty of Medicine, Sam Ratulangi University, Prof. Dr. R. D. Kandou Hospital, Manado, Indonesia
Fandy Gosal Department of Internal Medicine, Division of Gastroenterology Hepatology, Faculty of Medicine, Sam Ratulangi University, Prof. Dr. R. D. Kandou Hospital, Manado, Indonesia
Cynthia Natalia Department of Internal Medicine, Faculty of Medicine, Sam Ratulangi University, Prof. Dr. R. D. Kandou Hospital, Manado, Indonesia

DOI:

https://doi.org/10.3889/oamjms.2023.11377

Keywords:

Intradialytic hypertension, hemodialysis, chronic kidney disease, hs-CRP, Nitric Oxide

Abstract

BACKGROUND: Hemodialysis (HD) is a procedure to replace part of kidney function in patients with end-stage kidney disease. Hemodynamic disturbances during HD may include elevated blood pressure (BP). It is reported that about 5–15% of patients undergoing regular HD have increased BP during HD. This condition is called intradialytic hypertension (IDH). Increased high sensitivity C-reactive protein (hs-CRP) levels are associated with decreased endothelial dilatation response of blood vessels. Nitric Oxide (NO) is one of the mediators that act as a vasodilator to regulate vascular pressure. Endothelial dysfunction is one of the factors thought to contribute to the incidence of IDH.

AIM: This study aimed to determine the association of hs-CRP and NO with elevated BP in IDH.

METHODS: This observational cross-sectional study was conducted at Prof. Dr. R.D. Kandou General Hospital, Manado, from November 2021 to April 2022. Participants were selected through consecutive sampling methods. The levels of hs-CRP and NO were examined in all patients. The correlation between hs-CRP and NO was performed using the Spearman test, while the association of hs-CRP and NO with elevated BP was performed using the Fisher- exact test or Chi-square test.

RESULTS: Forty patients were included in this study. The median hs-CRP, NO, and systolic BP (SBP) of the patients were 6.55 mg/dL (0.50–43.5), 27.77 mg/dL (3.65–72.19), and 20 mmHg (10–30), respectively. The correlation analysis showed that there was a strong significant negative correlation between hs-CRP levels and NO (r = −0.680, p = 0.000). Based on the Chi-Square or Fisher Exact test, there was a significant association between hs-CRP levels and elevated SBP (OR = 5.06; 95% CI = 1.095–23.44; p = 0.040), as well as between NO levels and elevated SBP (OR = 17.14; 95% CI = 3.063–95.938; p = 0.000).

CONCLUSION: There was a significant association between hs-CRP and NO levels with elevated SBP in end-stage renal disease (ESRD) patients with IDH. ESRD on hemodialysis (ESRD on R-HD) patients with hs-CRP ≤3 mg/dL or NO levels <25 mg/dL tends to have increased SBP ≥20 mmHg after HD compared to ESRD patients with low hs-CRP or high NO levels.

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