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Article ; Online: Redefining the Burden of Intradialytic Hypotension in the Modern Era of Hemodialysis.

Van Buren, Peter Noel

2019 Volume 49, Issue 6, Page(s) 494–496

MeSH term(s)	Humans ; Hypotension ; Prevalence ; Renal Dialysis
Language	English
Publishing date	2019-05-23
Publishing country	Switzerland
Document type	Editorial ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't ; Comment
ZDB-ID	604540-6
ISSN	1421-9670 ; 0250-8095
ISSN (online)	1421-9670
ISSN	0250-8095
DOI	10.1159/000500878
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Article ; Online: Relative blood volume monitoring in hemodialysis patients: identifying its appropriate role.

Van Buren, Peter Noel

Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association

2018 Volume 34, Issue 8, Page(s) 1251–1253

MeSH term(s)	Blood Volume ; Blood Volume Determination/methods ; Humans ; Kidney Failure, Chronic/physiopathology ; Monitoring, Physiologic/methods ; Predictive Value of Tests ; Renal Dialysis
Language	English
Publishing date	2018-12-21
Publishing country	England
Document type	Journal Article ; Comment
ZDB-ID	90594-x
ISSN	1460-2385 ; 0931-0509
ISSN (online)	1460-2385
ISSN	0931-0509
DOI	10.1093/ndt/gfy368
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Article: Redefining the Burden of Intradialytic Hypotension in the Modern Era of Hemodialysis

Van Buren, Peter Noel

American Journal of Nephrology

2019 Volume 49, Issue 6, Page(s) 494–496

Institution	Dallas Veterans Affairs Medical Center, Dallas, Texas, USA University of Texas Southwestern Medical Center, Dallas, Texas, USA
Language	English
Publishing date	2019-05-23
Publisher	S. Karger AG
Publishing place	Basel, Switzerland
Document type	Article
Note	Editorial
ZDB-ID	604540-6
ISSN	1421-9670 ; 0250-8095
ISSN (online)	1421-9670
ISSN	0250-8095
DOI	10.1159/000500878
Database	Karger publisher's database

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Article ; Online: Pathophysiology and implications of intradialytic hypertension.

Van Buren, Peter Noel

Current opinion in nephrology and hypertension

2017 Volume 26, Issue 4, Page(s) 303–310

Abstract: Purpose of review: Intradialytic hypertension occurs regularly in 10--15% of hemodialysis patients. A large observational study recently showed that intradialytic hypertension of any magnitude increased mortality risk comparable to the most severe ... ...

Abstract	Purpose of review: Intradialytic hypertension occurs regularly in 10--15% of hemodialysis patients. A large observational study recently showed that intradialytic hypertension of any magnitude increased mortality risk comparable to the most severe degrees of intradialytic hypotension. The present review review discusses the most recent evidence underlying the pathophysiology of intradialytic hypertension and implications for its management. Recent findings: Patients with intradialytic hypertension typically have small interdialytic weight gains, but bioimpedance spectroscopy shows these patients have significant chronic extracellular volume excess. Intradialytic hypertension patients have lower albumin and predialysis urea nitrogen levels, which may contribute to small reductions in osmolarity that prevents blood pressure decreases. Intradialytic vascular resistance surges remain implicated as the driving force for blood pressure increases, but mediators other than endothelin-1 may be responsible. Beyond dry weight reduction, the only controlled intervention shown to interrupt the blood pressure increase is lowering dialysate sodium. Summary: Patients with recurrent intradialytic hypertension should be identified as high-risk patients. Dry weight should be re-evaluated, even if patients do not clinically appear volume overloaded. Antihypertensive drugs should be prescribed because of the persistently elevated ambulatory blood pressure. Dialysate sodium reduction should be considered, although the long term effects of this intervention are uncertain.
MeSH term(s)	Antihypertensive Agents/therapeutic use ; Blood Pressure Monitoring, Ambulatory ; Humans ; Hypertension/diagnosis ; Hypertension/drug therapy ; Hypertension/etiology ; Hypertension/physiopathology ; Renal Dialysis/adverse effects ; Water-Electrolyte Imbalance/etiology ; Water-Electrolyte Imbalance/physiopathology
Chemical Substances	Antihypertensive Agents
Language	English
Publishing date	2017
Publishing country	England
Document type	Journal Article ; Review
ZDB-ID	1151092-4
ISSN	1473-6543 ; 1535-3842 ; 1062-4813 ; 1062-4821
ISSN (online)	1473-6543 ; 1535-3842
ISSN	1062-4813 ; 1062-4821
DOI	10.1097/MNH.0000000000000334
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Zs.A 3686: Show issues

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Article ; Online: Evaluation and Treatment of Hypertension in End-Stage Renal Disease Patients on Hemodialysis.

Van Buren, Peter Noel

Current cardiology reports

2016 Volume 18, Issue 12, Page(s) 125

Abstract: Hypertension is one of the most common cardiovascular comorbidities in end-stage renal disease patients on hemodialysis. Its complex pathophysiology is related to extracellular volume overload, increased vascular resistance stemming from factors related ... ...

Abstract	Hypertension is one of the most common cardiovascular comorbidities in end-stage renal disease patients on hemodialysis. Its complex pathophysiology is related to extracellular volume overload, increased vascular resistance stemming from factors related to uremia or abnormal signaling from the failing kidneys, as well as the unique blood pressure changes that take place during and between hemodialysis treatments. Despite the changing nature of blood pressure over time in hemodialysis patients, hypertension diagnosed in or out of the hemodialysis unit is associated with increased cardiovascular morbidity and mortality. This review details the causes of hypertension in hemodialysis patients and provides an updated review of the clinical consequences and management of hypertension.
MeSH term(s)	Comorbidity ; Humans ; Hypertension/diagnosis ; Hypertension/etiology ; Hypertension/physiopathology ; Hypertension/therapy ; Kidney Failure, Chronic/complications ; Kidney Failure, Chronic/mortality ; Kidney Failure, Chronic/physiopathology ; Kidney Failure, Chronic/therapy ; Prognosis ; Renal Dialysis ; Risk Factors
Language	English
Publishing date	2016-12
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	2055373-0
ISSN	1534-3170 ; 1523-3782
ISSN (online)	1534-3170
ISSN	1523-3782
DOI	10.1007/s11886-016-0805-y
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Zs.A 5524: Show issues

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Article ; Online: Hyperphosphatemia and its relationship with blood pressure, vasoconstriction, and endothelial cell dysfunction in hypertensive hemodialysis patients.

Jung, Jinwoo / Jeon-Slaughter, Haekyung / Nguyen, Hang / Patel, Jiten / Sambandam, Kamalanathan K / Shastri, Shani / Van Buren, Peter Noel

BMC nephrology

2022 Volume 23, Issue 1, Page(s) 291

Abstract: Background: Hyperphosphatemia occurs frequently in end-stage renal disease patients on hemodialysis and is associated with increased mortality. Hyperphosphatemia contributes to vascular calcification in these patients, but there is emerging evidence ... ...

Abstract	Background: Hyperphosphatemia occurs frequently in end-stage renal disease patients on hemodialysis and is associated with increased mortality. Hyperphosphatemia contributes to vascular calcification in these patients, but there is emerging evidence that it is also associated with endothelial cell dysfunction. Methods: We conducted a cross-sectional study in hypertensive hemodialysis patients. We obtained pre-hemodialysis measurements of total peripheral resistance index (TPRI, non-invasive cardiac output monitor) and plasma levels of endothelin-1 (ET-1) and asymmetric dimethylarginine (ADMA). We ascertained the routine peridialytic blood pressure (BP) measurements from that treatment and the most recent pre-hemodialysis serum phosphate levels. We used generalized linear regression analyses to determine independent associations between serum phosphate with BP, TPRI, ET-1, and ADMA while controlling for demographic variables, parathyroid hormone (PTH), and interdialytic weight gain. Results: There were 54 patients analyzed. Mean pre-HD supine and seated systolic and diastolic BP were 164 (27), 158 (21), 91.5 (17), and 86.1 (16) mmHg. Mean serum phosphate was 5.89 (1.8) mg/dL. There were significant correlations between phosphate with all pre-hemodialysis BP measurements (r = 0.3, p = .04; r = 0.4, p = .002; r = 0.5, p < .0001; and r = 0.5, p = .0003.) The correlations with phosphate and TPRI, ET-1, and ADMA were 0.3 (p = .01), 0.4 (p = .007), and 0.3 (p = .04). In our final linear regression analyses controlling for baseline characteristics, PTH, and interdialytic weight gain, independent associations between phosphate with pre-hemodialysis diastolic BP, TPRI, and ET-1 were retained (β = 4.33, p = .0002; log transformed β = 0.05, p = .005; reciprocal transformed β = -0.03, p = .047). Conclusions: Serum phosphate concentration is independently associated with higher pre-HD BP, vasoconstriction, and markers of endothelial cell dysfunction. These findings demonstrate an additional negative impact of hyperphosphatemia on cardiovascular health beyond vascular calcification. Trial registration: The study was part of a registered clinical trial, NCT01862497 (May 24, 2013).
MeSH term(s)	Blood Pressure/physiology ; Cross-Sectional Studies ; Endothelial Cells ; Humans ; Hyperphosphatemia ; Hypertension/complications ; Hypertension/epidemiology ; Kidney Failure, Chronic/complications ; Parathyroid Hormone ; Phosphates ; Renal Dialysis/adverse effects ; Vascular Calcification/complications ; Vasoconstriction ; Weight Gain
Chemical Substances	Parathyroid Hormone ; Phosphates
Language	English
Publishing date	2022-08-23
Publishing country	England
Document type	Clinical Study ; Journal Article ; Research Support, Non-U.S. Gov't ; Research Support, U.S. Gov't, Non-P.H.S. ; Research Support, N.I.H., Extramural
ZDB-ID	2041348-8
ISSN	1471-2369 ; 1471-2369
ISSN (online)	1471-2369
ISSN	1471-2369
DOI	10.1186/s12882-022-02918-0
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article: A Case of Severe Neutropenia From Short-Term Exposure to Moxifloxacin.

Chen, Weihan / Van Buren, Peter Noel

Journal of investigative medicine high impact case reports

2017 Volume 5, Issue 1, Page(s) 2324709617700648

Abstract: Moxifloxacin is commonly prescribed in the inpatient and outpatient management of community-acquired pneumonia and other common infections. We report a case of a 76-year-old man who developed severe neutropenia after several days of treatment for ... ...

Abstract	Moxifloxacin is commonly prescribed in the inpatient and outpatient management of community-acquired pneumonia and other common infections. We report a case of a 76-year-old man who developed severe neutropenia after several days of treatment for community-acquired pneumonia. The patient had a history of alcohol abuse; however, there were no other offending medications prescribed, and a thorough laboratory workup for other possible causes of neutropenia was negative. The patient's neutrophils and white blood count responded quickly to cessation of fluoroquinolones. This case highlights the importance of identifying patients that might be at high risk for neutropenia that may need closer monitoring on this commonly prescribed medication.
Language	English
Publishing date	2017-03-28
Publishing country	United States
Document type	Journal Article
ZDB-ID	2710326-2
ISSN	2324-7096
ISSN	2324-7096
DOI	10.1177/2324709617700648
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Article ; Online: Special situations: Intradialytic hypertension/chronic hypertension and intradialytic hypotension.

Van Buren, Peter Noel / Inrig, Jula K

Seminars in dialysis

2017 Volume 30, Issue 6, Page(s) 545–552

Abstract: Hypertension is a comorbidity that is present in the majority of end-stage renal disease patients on maintenance hemodialysis. This population is particularly unique because of the dynamic nature of blood pressure (BP) during dialysis. Modest BP ... ...

Abstract	Hypertension is a comorbidity that is present in the majority of end-stage renal disease patients on maintenance hemodialysis. This population is particularly unique because of the dynamic nature of blood pressure (BP) during dialysis. Modest BP decreases are expected in most hemodialysis patients, but intradialytic hypotension and intradialytic hypertension are two special situations that deviate from this as either an exaggerated or paradoxical response to the dialysis procedure. Both of these phenomena are particularly important because they are associated with increased mortality risk compared to patients with modest decreases in BP during dialysis. While the detailed pathophysiology is complex, intradialytic hypotension occurs more often in patients prescribed fast ultrafiltration rates, and reducing this rate is recommended in patients that regularly exhibit this pattern. Patients with intradialytic hypertension have a poorly explained increase in vascular resistance during dialysis, but the consistent associations with extracellular volume overload point toward more aggressive fluid management as the initial management choices for these patients. This up to date review provides the most recent evidence supporting these recommendations as well as the most up to date epidemiologic and mechanistic research studies that have added to this area of dialysis management.
MeSH term(s)	Antihypertensive Agents/therapeutic use ; Blood Pressure/physiology ; Blood Volume/physiology ; Chronic Disease ; Female ; Humans ; Hypertension/drug therapy ; Hypertension/etiology ; Hypotension/etiology ; Kidney Failure, Chronic/complications ; Kidney Failure, Chronic/therapy ; Male ; Renal Dialysis/adverse effects
Chemical Substances	Antihypertensive Agents
Language	English
Publishing date	2017-06-30
Publishing country	United States
Document type	Journal Article ; Review ; Research Support, Non-U.S. Gov't ; Research Support, N.I.H., Extramural
ZDB-ID	1028193-9
ISSN	1525-139X ; 0894-0959
ISSN (online)	1525-139X
ISSN	0894-0959
DOI	10.1111/sdi.12631
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Zs.A 2879: Show issues

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Article ; Online: The associations between orthostatic blood pressure changes and extracellular volume in hemodialysis patients.

Jeon-Slaughter, Haekyung / Gregg, Lucile Parker / Concepcion, Michael / Lederer, Swati / Penfield, Jeffrey / Van Buren, Peter Noel

Hemodialysis international. International Symposium on Home Hemodialysis

2021 Volume 26, Issue 1, Page(s) 124–133

Abstract: Introduction: Extracellular volume (ECV) predicts mortality in hemodialysis patients, but it is difficult to assess clinically. Peridialytic blood pressure (BP) measurements can help ECV assessment. Orthostatic BP is routinely measured clinically, but ... ...

Abstract	Introduction: Extracellular volume (ECV) predicts mortality in hemodialysis patients, but it is difficult to assess clinically. Peridialytic blood pressure (BP) measurements can help ECV assessment. Orthostatic BP is routinely measured clinically, but its association with ECV is unknown. Methods: In a cohort of hypertensive hemodialysis patients, we measured posthemodialysis ECV/weight with bioimpedance spectroscopy and analyzed its association with post-HD orthostatic BP measurements obtained during routine care. Using linear and logistic regression, the primary outcomes were orthostatic BP change and orthostatic hypotension (OH) defined by systolic BP decrease of at least 20 mmHg or diastolic decrease of at least 10 mmHg. Model 1 controlled for sex, age, and diabetes. Model 2 additionally controlled for ultrafiltration rate and antihypertensive medications. We conducted sensitivity analysis using OH definition of systolic BP decrease of at least 30 mmHg. Findings: Among 57 participants, mean orthostatic systolic BP change was -7.30 (20) mmHg and mean ECV/weight was 0.24 (0.04) L/kg. Post-HD ECV/weight was not associated with orthostatic systolic BP change (β = 8.2, p = 0.6). There were 16 participants with and 41 participants without OH. The ECV/weight did not differ between these groups (0.22 [0.04] vs. 0.24 [0.05] L/Kg, p = 0.09) and did not predict OH in logistic regression (OR 11, 4.04; 95% CI 0.2-671, 0.03-0.530 in the two models.) In a sensitivity analysis, ECV/weight was lower in the OH group (0.22 [0.03] vs. 0.25 [0.04] L/kg, p = 0.005), but this was accompanied by differences in sex and diabetes. Using logistic regression, there was no independent association between ECV/weight with OH. Discussion: Orthostatic systolic BP change after HD completion is not a reliable indicator of posthemodialysis ECV. When considering other factors associated with orthostatic BP, ECV/weight is not independently associated with OH. Although transient postdialytic differences in intravascular volume may be associated with OH, posthemodialysis OH does not necessarily indicate ECV depletion.
MeSH term(s)	Blood Pressure/physiology ; Diabetes Mellitus ; Humans ; Hypertension/drug therapy ; Hypotension, Orthostatic ; Renal Dialysis
Language	English
Publishing date	2021-08-16
Publishing country	Canada
Document type	Journal Article ; Research Support, N.I.H., Extramural ; Research Support, U.S. Gov't, Non-P.H.S.
ZDB-ID	2192458-2
ISSN	1542-4758 ; 1492-7535
ISSN (online)	1542-4758
ISSN	1492-7535
DOI	10.1111/hdi.12979
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Article ; Online: Mechanisms and Treatment of Intradialytic Hypertension.

Van Buren, Peter Noel / Inrig, Jula K

Blood purification

2016 Volume 41, Issue 1-3, Page(s) 188–193

Abstract: Background: Intradialytic hypertension is a condition where there is an increase in blood pressure (BP) from pre- to post-hemodialysis; this condition has been recently identified as an independent mortality risk factor in hypertensive hemodialysis ... ...

Abstract	Background: Intradialytic hypertension is a condition where there is an increase in blood pressure (BP) from pre- to post-hemodialysis; this condition has been recently identified as an independent mortality risk factor in hypertensive hemodialysis patients. The mechanisms and management of intradialytic hypertension have been explored in numerous research studies over the past few years. Summary: Patients with intradialytic hypertension have been found to be more chronically volume overloaded compared to other hemodialysis patients, although no causal role has been established. Patients with intradialytic hypertension have intradialytic vascular resistance surges that likely explain the BP increase during dialysis. Acute intradialytic changes in endothelial cell function have been proposed as etiologies for the increase in vascular resistance, although it is unclear if endothelin-1 or some other vasoconstrictive peptide is responsible. There is an association between dialysate to serum sodium gradients and BP increase during dialysis in patients with intradialytic hypertension, although it is unclear if this is related to endothelial cell activity or acute osmolar changes. In addition to probing the dry weight of patients with intradialytic hypertension, other management strategies include lowering dialysate sodium and changing antihypertensives to include carvedilol or other poorly dialyzed antihypertensives. Key messages: Hemodialysis patients with intradialytic hypertension have an increased mortality risk compared to patients with modest decreases in BP during dialysis. Intradialytic hypertension is associated with extracellular volume overload in addition to acute increases in vascular resistance during dialysis. Management strategies should include reevaluation of dry weight and modification of both the dialysate prescription and medication prescription.
MeSH term(s)	Antihypertensive Agents/therapeutic use ; Blood Pressure/drug effects ; Body Weight ; Carbazoles/therapeutic use ; Dialysis Solutions/chemistry ; Dialysis Solutions/therapeutic use ; Endothelial Cells/drug effects ; Endothelial Cells/metabolism ; Endothelial Cells/pathology ; Fluid Therapy/adverse effects ; Humans ; Hypertension/drug therapy ; Hypertension/etiology ; Hypertension/mortality ; Hypertension/physiopathology ; Kidney Failure, Chronic/blood ; Kidney Failure, Chronic/mortality ; Kidney Failure, Chronic/physiopathology ; Kidney Failure, Chronic/therapy ; Propanolamines/therapeutic use ; Renal Dialysis/adverse effects ; Risk Factors ; Sodium/adverse effects ; Survival Analysis ; Vascular Resistance/drug effects
Chemical Substances	Antihypertensive Agents ; Carbazoles ; Dialysis Solutions ; Propanolamines ; carvedilol (0K47UL67F2) ; Sodium (9NEZ333N27)
Language	English
Publishing date	2016
Publishing country	Switzerland
Document type	Journal Article ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't ; Review
ZDB-ID	605548-5
ISSN	1421-9735 ; 0253-5068
ISSN (online)	1421-9735
ISSN	0253-5068
DOI	10.1159/000441313
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