Intradialytic Hypotension (IDH) and Bradykinin B2 Receptor Blockade

Intradialytic hypotension (IDH) is a common clinical complication and is associated with increased morbidity and mortality in patients undergoing maintenance hemodialysis (MHD). The pathogenesis of IDH has been attributed to the rapid reduction of plasma volume during hemodialysis and the inadequate compensatory mechanisms in response to hypovolemia, such as the lack of vasoconstriction.

A new study published in BMC Nephrology suggests that a bradykinin B2 receptor blocker may prevent the occurrence of intradialytic hypotension.

Study Overview

This study tests the hypothesis that bradykinin B2 receptor blockade prevents intradialytic hypotension. The researchers performed a post-hoc analysis of a double-blind, placebo-controlled, randomized, 2 × 2 crossover clinical trial comparing the continuous infusion of icatibant, a bradykinin B2 receptor blocker, and placebo during hemodialysis. Icatibant or placebo was infused for 30 min before and during hemodialysis in 11 patients on MHD.

Results

• Seven of the patients had IDH, defined as a reduction of systolic blood pressure equal to or greater than 20 mmHg during hemodialysis.
• Stratified analysis, based on the presence of IDH, revealed that icatibant prevented the decrease in blood pressure compared to placebo in patients with IDH [blood pressure at average nadir (2.5 h after hemodialysis): Placebo, 114.3 ± 8.9 vs. icatibant, 125.6 ± 9.1 mmHg, mean ± S.E.M].
• Icatibant did not affect blood pressure in the group of patients without IDH.

Bradykinin B2 receptor blocker may prevent the occurrence of IDH. Further studies should evaluate the hemodynamic effects of icatibant during hemodialysis and the symptomatology associated with IDH.

Reference

Gamboa, J.L., Mambungu, C.A., Clagett, A.R. et al. Bradykinin B2 receptor blockade and intradialytic hypotension. BMC Nephrol 24, 134 (2023). https://doi.org/10.1186/s12882-023-03192-4