Hemodynamics, compartments and the renin-aldosterone system in chronic heart failure

In 12 patients with chronic mitral or aortic disease plasma renin activity (PRA) and aldosterone secretion rate (ASR) were correlated to hemodynamics, kidney function, plasma and interstitial fluid volume, and plasma sodium concentration, both in the congestive state (I) and after sodium depletion (II). PRA (I) and ASR (I) were normal or slightly elevated and increased normally after sodium depletion. A significant inverse correlation between plasma concentration (I + II) and PRA (I + II) was found. Further an abnormal inverse correlation between increments in PRA and cumulative sodium loss was demonstrated. By contrast, no correlations were found between PRA and ASR on one hand and pressures, kidney function or compartments on the other, neither in I - elevated pressures in the atria, low renal plasma flow, large compartments, nor in II - reduced pressures and compartments, almost unchanged kidney function. It is concluded that PRA hardly plays any primary role in the maintenance of sodium and fluid retention in human chronic congestive heart failure.