Hemodialysis
Conditions
Keywords
Intradialytic Hypertension, CTAVP, Fluid Balance, Vasopressin, Hemodialysis, Copeption
Brief summary
Vasopressin is a key regulator of water and vascular homeostasis, acting through V2 receptors to control renal water reabsorption and through V1a receptors to influence vascular tone. Copeptin, a stable surrogate marker of vasopressin release, provides a reliable measure of vasopressin activity. In hemodialysis, where ultrafiltration and osmotic shifts challenge fluid balance, the contribution of vasopressin to intradialytic blood pressure regulation remains uncertain. Elevated copeptin levels in dialysis patients have been associated with interdialytic weight gain and adverse cardiovascular outcomes. This study (CODIALHYP) tests the hypothesis that vasopressin activity, assessed through copeptin levels, is associated with intradialytic hypertension. The primary objective is to evaluate the relationship between copeptin concentrations and blood pressure changes during hemodialysis. Secondary objectives include assessing whether vasopressin's antidiuretic effect is preserved in hemodialysis patients and exploring the contribution of other hormonal pathways involved in fluid and vascular regulation.
Detailed description
This study investigates the role of vasopressin activity, assessed through copeptin levels, in the hemodynamic changes occurring during hemodialysis. Vasopressin is involved in both water homeostasis and vascular regulation, yet its contribution to intradialytic blood pressure variations remains insufficiently characterized. Hemodialysis induces rapid shifts in osmotic gradients and extracellular volume, creating conditions in which vasopressinmediated mechanisms may influence vascular tone and fluid balance. The research is based on a retrospective observational design involving chronic hemodialysis patients. Clinical records were reviewed to collect blood pressure measurements obtained before, during, and after dialysis sessions, as well as laboratory data including copeptin, plasma osmolality, cortisol, and aldosterone. When residual diuresis was present, urinary volume and osmolality were documented. Additional information related to dry weight, ultrafiltration parameters, and routine markers of fluid balance was extracted from standard clinical evaluations. These data provide a framework for examining the association between vasopressin activity and intradialytic hypertension, and for exploring the contribution of other hormonal pathways involved in fluid and vascular regulation.
Interventions
DIAGNOSTIC_TESTRoutine biology samples et blood pressure mesures
Copeptin concentration will be measured from routine plasma samples, and blood pressure values will be recorded before, during, and after hemodialysis sessions using standard clinical monitoring. The primary outcome is the association between copeptin levels and intradialytic blood pressure variation.
Sponsors
Central Hospital, Nancy, France
ALTIR Nancy
Study design
Observational model
COHORT
Time perspective
RETROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Adult patients (≥18 years old). * Undergoing chronic hemodialysis treatment \> 3 months. * Availability of routine predialysis blood samples for copeptin and biochemical measurements. * Availability of blood pressure recordings before, during, and after hemodialysis sessions. No
Exclusion criteria
if inclusion criteria is filled
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Copeptin Concentration Measured in Plasma Samples and Intradialytic Blood Pressure Variation | At baseline (M0) and at 3 months (M3), with copeptin measured at dialysis initiation (prehemodialysis) without additional blood sampling. | Copeptin concentration will be measured from routine plasma samples, and blood pressure values will be recorded before, during, and after hemodialysis sessions using standard clinical monitoring. The primary outcome is the correlation between copeptin levels and intradialytic blood pressure variation. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Plasma Osmolality | Baseline (M0) | Plasma osmolality (mOsm/kg) will be obtained from routine predialysis laboratory measurements. These measurements will be used to evaluate whether the antidiuretic effect of vasopressin is preserved in hemodialysis patients. |
| Copeptin level | Baseline (M0) | Copeptin levels (pmol/L) will be obtained from routine predialysis laboratory measurements. |
| Serum Cortisol and Aldosterone Concentrations | Baseline (M0) | Serum cortisol and aldosterone concentrations will be measured from routine predialysis blood samples collected as part of standard care. These hormonal markers will be used to explore additional mechanisms potentially involved in intradialytic hypertension. |
| Urinary Osmolality | Baseline (M0) | Urinary volume and urine osmolality will be collected from standard clinical assessments in patients with residual diuresis. These measurements will be used to evaluate whether the antidiuretic effect of vasopressin is preserved in hemodialysis patients. |
Countries
France
Outcome results
None listed