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[Atrial natriuretic factor in hemodialyzed children]
K Laborde1, I Thiriet, M F Gagnadoux
1Département de Physiologie, Hôpital des Enfants Malades, Paris.
Insights
In pediatric hemodialysis patients, elevated plasma atrial natriuretic factor (ANF) strongly correlates with increased extracellular volume (ECV). This finding highlights volume overload as a key factor in ANF elevation for these children.
Area of Science:
- Nephrology
- Endocrinology
- Pediatrics
Context:
- Pediatric hemodialysis patients often experience fluid balance issues.
- Atrial natriuretic factor (ANF) is a hormone involved in regulating fluid balance.
- Elevated ANF levels are frequently observed in hemodialysis patients.
Purpose:
- To investigate the correlation between plasma atrial natriuretic factor (ANF) levels and extracellular volume (ECV) in pediatric hemodialysis patients.
- To determine if volume overload is a major determinant of ANF elevation in this population.
Summary:
- A significant positive correlation (r = 0.66, p < 0.001) was found between plasma ANF levels and ECV in 30 pediatric hemodialysis patients.
- Patients with blood pressure drops during dialysis had lower ANF and ECV.
- Patients requiring antihypertensive therapy exhibited higher ANF and ECV levels.
Impact:
- Provides indirect evidence that volume overload is the primary driver of elevated ANF in pediatric hemodialysis.
- Suggests ANF and ECV measurements could be useful in managing fluid status in these patients.
- Informs clinical practice regarding fluid management and cardiovascular risk in pediatric hemodialysis.
Abstract:
Indirect evidence suggest that volume overload is the major determinant of plasma atrial natriuretic factor (ANF) elevation in hemodialysis patients. Correlations between plasma ANF levels and extracellular volume (ECV) were investigated by simultaneously measuring both parameters in 30 pediatric hemodialysis patients (aged 1 to 17.5 years; 18 M, 12 F) 24 hours after a dialysis session. Plasma ANF was determined using a commercially available RIA (Amersham) after plasma extraction (SEP-Pack C18); ECV was estimated by determining the volume of distribution of inulin and expressing the result as the % of body weight. In hemodialysis children, ANF levels ranged from 43 to 427 pg/ml (versus 30-70 pmoles/ml in age-matched controls) and EVC ranged from 17 to 33% BW. A significant positive correlation was found between plasma ANF levels and ECV (r = 0.66; p less than 0.001). Patients who exhibited falls in blood pressure during the dialysis session had lower mean ANF and ECV values (133 +/- 90 pg/ml and 23 +/- 3% BW, respectively) than those who did not (211 +/- 123 pg/ml and 26 +/- 4% BW, respectively). Conversely, patients who needed chronic antihypertensive therapy had higher mean plasma ANF and ECV values (204 +/- 122 pg/ml and 26 +/- 4% BW, respectively) than those who did not (149 +/- 100 pg/ml and 23. 5 +/- 4.5% BW, respectively). In a small subgroup of patients who had repeated determinations, individual plasma ANF and ECV changes were closely matched and both parameters were well correlated.(ABSTRACT TRUNCATED AT 250 WORDS)