Renal and endocrine responses in the elderly during head-out water immersion

After overnight food and fluid restriction, seven healthy old (62-74 yr) and eight young (21-28 yr) men were examined before, during, and after 3-h head-out immersion (HOI) in thermoneutral water (34.5 +/- 0.5 degrees C). On separate days, all subjects remained seated in air for 5 h to obtain the time control data. Although HOI induced a reversible increase in urine flow in all subjects, the response was faster and greater in magnitude in the elderly than in the young. Na excretion and osmolal clearance also followed a response pattern identical to that of urine flow; thus the HOI-induced diuresis was entirely osmotic. Endogenous creatinine clearance increased in the elderly at 2 h of HOI, suggesting an age-related modification in kidney hemodynamics. Although there was virtually the same cephalad blood shift (measured by impedance cardiography), mean arterial pressure significantly increased (P less than 0.05) during HOI in the elderly, which also indicated a different response of peripheral circulation to HOI in the elderly. Control level of plasma atrial natriuretic factor (ANF) was nearly twofold greater in the elderly compared with the young. The HOI induced a nearly fourfold increase in ANF in the elderly, whereas that for the young was threefold. Both plasma aldosterone and ADH responses to HOI were attenuated in the elderly compared with the young, which had no correlation with urine flow or Na excretion. It is concluded that the elderly release more ANF at a given cephalad volume expansion compared with the young, but the vasodilative reaction to ANF was attenuated in the elderly.