{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T17:25:34Z","timestamp":1790702734793,"version":"4.1.0"},"reference-count":61,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2017,7,9]],"date-time":"2017-07-09T00:00:00Z","timestamp":1499558400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Seminars in Dialysis"],"published-print":{"date-parts":[[2017,11]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>Homeostatic regulation of plasma osmolality (<jats:styled-content style=\"fixed-case\">PO<\/jats:styled-content>sm) is critical for normal cellular function in humans. Arginine vasopressin (<jats:styled-content style=\"fixed-case\">AVP<\/jats:styled-content>) is the major hormone responsible for the maintenance of <jats:styled-content style=\"fixed-case\">PO<\/jats:styled-content>sm and acts to promote renal water retention in conditions of increased <jats:styled-content style=\"fixed-case\">PO<\/jats:styled-content>sm. However, <jats:styled-content style=\"fixed-case\">AVP<\/jats:styled-content> also exerts pressor effects, and its release can be stimulated by the development of effective arterial blood volume depletion. Patients with end\u2010stage renal disease on hemodialysis, particularly those with minimal or no residual renal function, have impaired ability to regulate water retention in response to <jats:styled-content style=\"fixed-case\">AVP<\/jats:styled-content>. While hemodialysis can assist with this task, patients are subject to relatively rapid shifts in volume and electrolytes during the procedure. This can result in the development of transient osmotic gradients that lead to the movement of water from the extracellular to the intracellular space. Hypotension may result\u2014both as a consequence of water movement out of the intravascular compartment, but also from impaired <jats:styled-content style=\"fixed-case\">AVP<\/jats:styled-content> release and inadequate vascular tone. In this review, we explore the evidence for <jats:styled-content style=\"fixed-case\">PO<\/jats:styled-content>sm changes during hemodialysis, associations with adverse outcomes, and methods to minimize the rapidity of changes in <jats:styled-content style=\"fixed-case\">PO<\/jats:styled-content>sm in an effort to reduce patient symptoms and minimize intra\u2010dialytic hypotension.<\/jats:p>","DOI":"10.1111\/sdi.12629","type":"journal-article","created":{"date-parts":[[2017,7,10]],"date-time":"2017-07-10T03:12:40Z","timestamp":1499656360000},"page":"509-517","source":"Crossref","is-referenced-by-count":30,"title":["Osmolality and blood pressure stability during hemodialysis"],"prefix":"10.1111","volume":"30","author":[{"given":"Anika T.","family":"Singh","sequence":"first","affiliation":[{"name":"University College Dublin School of Medicine and Medical Science Dublin Ireland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Finnian R.","family":"Mc Causland","sequence":"additional","affiliation":[{"name":"Renal Division Department of Medicine Brigham and Women's Hospital Boston MA USA"},{"name":"Harvard Medical School Boston MA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2017,7,9]]},"reference":[{"key":"e_1_2_8_2_1","volume-title":"From fish to philosopher. 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