Supplementary Material for: Dialysis Hypotension: A Role for Inadequate Increase in Arginine Vasopressin Levels? A Systematic Literature Review and Meta-Analysis

Background: Intradialytic hypotension is a common complication of hemodialysis (HD). Some studies have suggested that inadequate arginine vasopressin (AVP) increase could play a role in the pathogenesis of intradialytic hypotension. However, AVP levels during HD and its relation to hypotension has never been systematically studied. Summary: PubMed and Embase were searched (1970-2013, search terms ‘vasopressin' and ‘hemodialysis') for studies reporting on AVP levels during standard HD or other dialysis techniques. Observational studies reporting on AVP levels pre- and postdialysis were additionally included in a meta-analysis. Thirty-seven studies were included in the systematic literature review, of which 26 studies were eligible for meta-analysis. The main findings were that pretreatment AVP levels were higher in dialysis patients compared with healthy controls (6.4 ± 3.5 vs. 2.5 ± 1.3 pg/ml, p = 0.003) and that plasma AVP levels showed little or no increase during HD (from 7.0 ± 4.9 to 8.8 ± 9.3, p = 0.433). Significant heterogeneity was found between studies. Meta-regression analysis revealed no significant associations between AVP and patient or study characteristics. Studies on other dialysis techniques showed mixed results regarding the AVP course. The eight studies that addressed the relation between intradialytic hypotension and AVP also showed inconsistent results. Key Messages: Plasma AVP levels are higher in dialysis patients compared with healthy controls, but show little or no increase during HD. The lack of a rise in AVP levels during HD may be pathophysiologically involved in the onset of intradialytic hypotension, but firm conclusions are not possible from our review of the literature.

背景：血液透析（HD）过程中发生低血压是一种常见的并发症。一些研究表明，精氨酸加压素（AVP）不足的增加可能在低血压的发病机制中起作用。然而，AVP在血液透析过程中的水平及其与低血压的关系尚未得到系统研究。摘要：通过PubMed和Embase数据库（1970-2013年，检索词为‘加压素’和‘血液透析’）检索了关于标准血液透析或其他透析技术过程中AVP水平的报道研究。此外，还将报道透析前后AVP水平的观察性研究纳入了荟萃分析。共纳入了37项系统文献综述，其中26项研究符合荟萃分析条件。主要发现是，透析患者的治疗前AVP水平高于健康对照组（6.4 ± 3.5 vs. 2.5 ± 1.3 pg/ml，p = 0.003），并且血浆AVP水平在血液透析过程中升高不明显或无增加（从7.0 ± 4.9到8.8 ± 9.3，p = 0.433）。研究发现不同研究之间存在显著的异质性。多因素回归分析未发现AVP与患者或研究特征之间存在显著关联。关于其他透析技术的AVP过程的研究结果不一。针对血液透析过程中低血压与AVP之间关系的8项研究也显示了不一致的结果。关键信息：与健康对照组相比，透析患者的血浆AVP水平较高，但在血液透析过程中并无明显或无增加。血液透析过程中AVP水平的无显著上升可能从病理生理学角度参与到了低血压的发生，但基于现有文献的回顾，尚无法得出明确结论。