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Nitric Oxide and Hemodialysis-Induced Hypotension
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TO THE EDITOR:
Yokokawa and colleagues [1] provide interesting data suggesting that increased nitric oxide production may contribute to the development of hemodialysis-induced hypotension. The authors speculate that individual patient sensitivity to heparin, an agent shown to promote nitric oxide production in cultured human vascular endothelial cells [2], may explain the increased production of nitric oxide seen in hypotensive patients, despite the administration of equal amounts of heparin. The mechanism by which increased nitric oxide production occurs, however, remains largely unknown.
Another complication of uremia—disordered hemostasis—is also thought to be related in part to platelet dysfunction associated with elevated nitric oxide levels [3, 4]. Interestingly, correction of anemia through transfusion or erythropoietin potentiates platelet function and improves the bleeding tendency associated with uremia. The effect of increased hematocrit to correct the uremic bleeding disorder may be related to the ability of the heme moiety to interfere with the release or production of nitric oxide [5]. A similar effect of increased hematocrit may blunt the nitric oxide-associated hypotension in patients receiving dialysis. Thus, it would be interesting to know whether a lower hematocrit or iron deficiency was present in the hypotensive group that had increased nitric oxide levels compared with the normotensive group.
Mark A. Perazella, MD
Yale University School of Medicine
New Haven, CT 06510
The Editors welcome submissions for possible publication in the Letters section. Authors of letters should:
•Include no more than 300 words of text, three authors, and five references
•Type with double-spacing
•Send three copies of the letter, an authors' form signed by all authors, and a cover letter describing any conflicts of interest related to the contents of the letter.
Letters commenting on an Annals article will be considered if they are received within 6 weeks of the time the article was published. Only some of the letters received can be published. Published letters are edited and may be shortened; tables and figures are included only selectively. Authors will be notified that the letter has been received. If the letter is selected for publication, the author will be notified about 3 weeks before the publication date. Unpublished letters cannot be returned.
Annals welcomes electronically submitted letters.
- Copyright ©2004 by the American College of Physicians
