Mechanisms of Intradialytic Hypertension

Patients with end-stage renal disease (ESRD) are at significantly higher risk for death due
to cardiovascular disease. Those with paradoxical increases in blood pressure (BP) during
hemodialysis (HD), defined as intradialytic hypertension (IDH), are at even greater risk of
cardiovascular mortality. This study seeks to determine the mechanisms that underlie IDH, and
whether mindfulness meditation might improve BP during dialysis in these patients. The
investigators will first determine if increased adrenaline levels during volume removal
contributes to IDH. The investigators will then determine lack of suppression of adrenaline
levels in the setting of a high BP also contributes to IDH. This will be done by manipulating
blood pressure by using small amounts of vasoactive drugs, and determining if an appropriate
response in adrenaline levels occurs. Lastly, the investigators will determine if an
intradialytic mindfulness meditation program improves BP and adrenaline levels in ESRD
patients with IDH.