Abstract: 【Abstract】Objective To study blood pressure change during dialysis and the factors influencing the level of plasma asymmetric dimethylarginine (ADMA). Methods We recruited 237 maintenance hemodialysis (MHD) patients from multiple centers. They were divided into intradialytic blood pressure stable group, hypotension group and hypertension group; dialysis age was comparable in the 3 groups. Intradialytic blood pressure fluctuation was recorded. Clinical biochemical indicators before dialysis, plasma ADMA and nitric oxide productions (N0x) before and after dialysis were recruited. Multivariate linear regression was used to analyze the independent factors associated with ADMA. Results Compared with the mean arterial pressure before dialysis, there were significant differences in dialysis time and basal levels between hypotension group and hypertension group (P<0.05). Age, female proportion, intact parathyroid hormone (iPTH) and brain natriuretic peptide (BNP) were significantly higher in hypotension group than in hypertension group (P=0.008, 0.252, 0.018 and <0.001, respectively) and stable group (P=0.018, 0.005, 0.006 and <0.001, respectively). Interdialytic body weight gain was higher in hypotension group than in hypertension group (P=0.014), while sodium ion concentration was significantly lower in hypotension group than in hypertension group (P=0.038) and stable group (P=0.007). BNP was higher in hypertension group than in stable group (P<0.001). ADMA before dialysis was higher in hypotension group (P＜0.001) and hypertension group (P＜0.012) than in stable group. Multiple linear regression revealed a positive correlation of ADMA with age, iPTH and BNP (t=3.236, 4.616 and 2.430, respectively; P=0.005, 0.000 and 0.027, respectively). Conclusion The prevalence of intradialytic blood pressure fluctuation was high. Age, iPTH and BNP were the independent factors for elevated ADMA in MHD patients.

Key words: Hemodialysis, Blood pressure fluctuation,  Intradialysis, Asymmetric dimethylarginine, Nitric oxide