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    "textoCompleto" => "<p class="elsevierStylePara"><span class="elsevierStyleBold">Dear Editor&#44;</span></p><p class="elsevierStylePara">With interest&#44; we read the article by Beladi-Mousavi et al&#46;<span class="elsevierStyleSup">1</span>&#160;on the effect of intranasal DDAVP &#40;Desmopressin&#41; for the prevention of dialysis hypotension&#46; The authors showed that&#44; compared with placebo&#44; intranasally administered DDAVP was associated with a significant decrease in the incidence of intradialytic hypotension episodes and higher postdialysis mean arterial blood pressures in 17 hypotension-prone patients&#46; This observation adds evidence to the efficacy of vasopressin analogues for the prevention of dialysis hypotension following the study of Lindberg et al&#46;&#160;showing that intranasal lysine-vasopressin increased intradialytic blood pressure in 6 patients with refractory dialysis hypotension&#46;<span class="elsevierStyleSup">2</span> However&#44; in our opinion&#44; important questions should be answered before intranasal vasopressin analogues can be recommended for the prevention of dialysis hypotension&#46; First&#44; the optimal timing and dosage of intranasal Desmopressin and vasopressin administration must be determined&#46; Therefore&#44; it is important to know which dosage of DDAVP spray &#40;2 puffs&#41; Beladi-Mousavi et al&#46;&#160;exactly used in their study&#46; Second&#44; the safety of repetitive intranasal administration of vasopressin analogues should be studied&#46; Did Beladi-Mousavi et al&#46;&#160;observe side effects of DDAVP treatment&#63; Finally&#44; future studies should compare the efficacy and safety profile of this treatment with other established measures for the prevention of dialysis hypotension&#44; like cold dialysate and Midrodrine administration&#46;</p><p class="elsevierStylePara">We have some methodological comments on the study by Beladi-Mousavi et al&#46;&#160;The authors did not state whether the placebo nasal spray &#40;distilled water&#41; was indistinguishable from the intranasal DDAVP spray&#46; This is relevant to ensure that this was indeed a double-blind study&#44; especially since all patients were first treated with placebo and then with intranasal DDAVP&#46; Beladi-Mousavi et al&#46;&#160;used a rather liberal definition of dialysis hypotension&#58; a fall in systolic blood pressure &#62;10mmHg&#46; Although there is no standardized definition of intradialytic hypotension&#44; recent guidelines propose a more strict definition&#58; a decrease in systolic blood pressure &#8805;20mmHg or a decrease in MAP by 10mmHg in combination with a clinical event and the need for a nursing intervention&#46;<span class="elsevierStyleSup">3</span></p><p class="elsevierStylePara">Notably&#44; there are alternative vasopressin-related measures for the prevention of dialysis hypotension&#46; Recently&#44; we showed that hemodialysis with the biofeedback system Hemocontrol is associated with a significant increase of plasma vasopressin levels&#44; whereas vasopressin levels did not change during conventional hemodialysis&#46;<span class="elsevierStyleSup">4</span> Hemocontrol is a technique in which ultrafiltration rate and dialysate conductivity are continuously adjusted in response to blood volume changes&#46; The augmented vasopressin release early during Hemocontrol hemodialysis is likely caused by a higher initial plasma sodium concentration and ultrafiltration rate&#46;</p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Conflict of interest</span></p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara">The authors declare that there is no conflict of interest associated with this manuscript&#46;</p>"
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