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Published on: July 3, 2013
Disordered aldosterone-volume relationship in end-stage kidney disease
Andrew S Bomback1, Abhijit V Kshirsagar, Maria E Ferris
1Columbia University College of Physicians and Surgeons, Department of Medicine, Division of Nephrology, New York, NY, USA. asb68@columbia.edu
Journal of the Renin-Angiotensin-Aldosterone System : JRAAS
|October 30, 2009
Summary
Volume expansion normally lowers aldosterone. In end-stage kidney disease patients on dialysis, this relationship is impaired, showing high extracellular volume and inappropriately high aldosterone levels. This suggests benefits from volume reduction and mineralocorticoid receptor blockade.
Area of Science:
- Nephrology
- Endocrinology
- Physiology
Background:
- Sodium loading and volume expansion typically suppress aldosterone in healthy individuals.
- Loss of renal function may disrupt the normal volume-aldosterone relationship.
- Investigating this relationship is crucial for understanding fluid balance in kidney disease.
Purpose of the Study:
- To investigate the impact of renal function on the volume-aldosterone relationship.
- To compare extracellular volume and aldosterone levels in hemodialysis patients versus healthy volunteers.
- To determine potential therapeutic targets for dialysis patients.
Main Methods:
- Utilized multifrequency bioimpedance spectroscopy to measure total body water, extracellular volume, and intracellular volume.
- Assessed serum aldosterone, potassium, and C-reactive protein levels.
- Employed scatterplots and general estimating equations to analyze relationships.
Main Results:
- Healthy volunteers and hemodialysis patients showed decreased aldosterone with increased extracellular volume.
- This inverse relationship was more pronounced in healthy individuals (p<0.001) than in hemodialysis patients (p=0.1).
- Hemodialysis patients exhibited higher extracellular volume and aldosterone levels compared to controls.
Conclusions:
- End-stage kidney disease is characterized by high extracellular volume and inappropriately elevated aldosterone.
- This altered volume-aldosterone dynamic has significant clinical implications.
- Dialysis patients may benefit from strategies including volume reduction and mineralocorticoid receptor blockade.
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