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Intraindividual comparison of ANP, cGMP and plasma catecholamines between HD and CAPD
1Department of Medicine, University of Düsseldorf.
Insights
Patients with end-stage renal failure show high atrial natriuretic peptide (ANP) levels, a key fluid status indicator. This study compared hemodialysis (HD) and continuous ambulatory peritoneal dialysis (CAPD), finding similar ANP but higher cGMP levels with CAPD.
Area of Science:
- Nephrology
- Cardiovascular Physiology
- Biochemistry
Background:
- End-stage renal failure (ESRF) is associated with elevated plasma atrial natriuretic peptide (ANP).
- ANP is a sensitive indicator of body fluid status in ESRF patients.
- A direct comparison of ANP and related markers between hemodialysis (HD) and continuous ambulatory peritoneal dialysis (CAPD) was lacking.
Purpose of the Study:
- To prospectively compare plasma levels of ANP, cyclic guanosine monophosphate (cGMP), adrenaline, noradrenaline, and dopamine in ESRF patients undergoing HD versus CAPD.
- To evaluate the impact of dialysis modality on these biomarkers and body fluid status.
Main Methods:
- A prospective study involving six ESRF patients (59 +/- 10 yrs, residual diuresis 1.3 +/- 0.61 L/day).
- Measurements of plasma ANP, cGMP, adrenaline, noradrenaline, and dopamine were taken in the predialysis phase and under steady-state conditions on HD and CAPD.
- Blood and dialysate samples were analyzed, with ultrafiltration volume, dry weight, and blood pressure monitored.
Main Results:
- ANP and cGMP levels were highest in the predialysis phase and decreased post-dialysis.
- Mean ANP levels did not significantly differ between HD (279 +/- 175 pg/ml) and CAPD (320 +/- 213 pg/ml).
- cGMP concentrations were significantly higher in CAPD patients (15.7 +/- 5.4 pmol/ml) compared to HD patients (10.5 +/- 3.4 pmol/ml, p < 0.05).
- Plasma noradrenaline was elevated predialysis and decreased with dialysis, with no significant differences between HD and CAPD.
- Adrenaline and dopamine levels remained within normal ranges.
Conclusions:
- Both HD and CAPD effectively reduce elevated ANP and noradrenaline levels in ESRF patients.
- CAPD may be associated with higher cGMP levels compared to HD, suggesting potential differences in fluid or cardiovascular regulation.
- ANP and cGMP serve as valuable biomarkers for monitoring fluid status and cardiovascular adaptation in patients with end-stage renal failure undergoing different dialysis modalities.
Abstract:
Patients with end stage renal failure have elevated plasma levels of atrial natriuretic peptide (ANP) which seems to be a sensitive parameter of body fluid status. A prospective study comparing patients on hemodialysis (HD) and continuous ambulatory peritoneal dialysis (CAPD) was still missing. Six identical patients (59 +/- 10 yrs, residual diuresis 1.3 +/- 0.61, 1 data expressed as means +/- SEM) were studied in the predialysis phase and under steady state conditions on HD and on CAPD. Plasma levels of ANP, cyclic guanosine monophosphate (cGMP), adrenaline, noradrenaline and dopamine were determined. Blood and dialysate samples were repeatedly taken. Ultrafiltration-volume, dry weight and blood pressure were not different between HD and CAPD. ANP and cGMP reached the highest plasma levels in the predialysis phase with 421 +/- 180 pg/ml and 19.8 +/- 6.4 pmol/ml and decreased after the onset of dialysis treatment. On HD mean ANP levels of 279 +/- 175 pg/ml were not significantly different from those on CAPD (320 +/- 213 pg/ml). However, cGMP concentrations on CAPD (15.7 +/- 5.4 pmol/ml) surpassed the values measured on HD (10.5 +/- 3.4 pmol/ml, p less than 0.05). Plasma noradrenaline was markedly elevated in the predialysis phase (421 +/- 180 pg/ml) and decreased under dialysis treatment. Differences between HD and CAPD were not found. Adrenaline and dopamine concentrations fell within the normal range.