الفهرس 
Mortality Rate and Prevention Mechanisms, Outcome, Treatment,IDH Epidemiology, Pathophysiology,Only 14 pages are availabe for public view
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Abstract
Intradialytic hypertension is a common problem observed in patients on maintenance hemodialysis and considered as an independent predictor of adverse clinical outcomes. Aim of the work: To study the possible pathogenic role of Endothelin-1 in intradialytic hypertension and effect of Carvedilol in disease improvement in maintenance hemodialysis patients. Methodology: the study is a case control study included 60 patients with end stage renal disease (ESRD) on maintenance hemodialysis, selected from Ain shams university hemodialysis unit during the period from March. 2016 to September 2017. group A: 30 patients with intradialytic hypertension (IDH). group B: 30 patients without intradialytic hypertension (IDH). All patients submitted to full history taking and clinical examination; laboratory investigations included routine investigations and estimation of Endothelin-1 (ET-1) post dialysis. group A patients with intradialytic hypertension (IDH) subjected to a non controlled single blinded clinical trial, Carvedilol was given on regular basis for 4 weeks titration period (starting dose 6.25 mg BID) till maximal tolerated dose reached, then patients subjected to assessment of ET-1 level before and after dialysis to estimate the effect of Carvedilol on ET-1 level and its possible association with intradialytic hypertension improvement.Results: serum Endothelin-1 (ET-1) ranges between (.45-9.00pg/ml) in cases group with the mean of 1.82±1.99 in comparison to (.75-3.85pg/ml) in controls group with the mean of 1.61±1.01 with no statistically significance between both groups. group A intradialytic hypertension patients subjected to Carvedilol have ET-1 level before and after dialysis was estimated after intake with ranges from (.75-9.0 pg/ml) pre hemodialysis with a mean of [4.25±3.13] and (.50-9.0 pg/ml) after hemodialysis with a mean of [2.84±2.41] with highly statistically significance between pre and post hemodialysis E-1 after Carvedilol. Conclusion: Intradialytic hemodynamic changes including IDH is a complex interplay of endothelin-1, and endothelial function. Carvedilol intake shows marked improvement of Endothelin-1 level and also improvement of intradialytic hypertension.