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Control of plasma aldosterone during chronic hemodialysis
Insights
Chronic hemodialysis (CH) did not significantly alter plasma aldosterone or cortisol levels. While potassium increased, sodium fluctuated, and correlations between parameters during CH were largely random.
Area of Science:
- Nephrology
- Endocrinology
- Physiology
Background:
- Terminal renal failure necessitates chronic hemodialysis (CH).
- Adrenal aldosterone release is crucial for fluid and electrolyte balance.
- The renin-angiotensin system significantly influences aldosterone secretion.
Purpose of the Study:
- To investigate the impact of CH on adrenal aldosterone release.
- To assess changes in plasma aldosterone, renin activity, cortisol, potassium, and sodium during CH.
- To evaluate correlations between these parameters and physiological markers like blood pressure and body weight.
Main Methods:
- Longitudinal study of 42 patients with terminal renal failure undergoing CH.
- Monthly measurements of plasma aldosterone, renin activity, cortisol, potassium, and sodium for up to 26 months.
- Simultaneous monitoring of body weight, systolic, and diastolic blood pressure.
Main Results:
- Plasma aldosterone, renin activity, cortisol, body weight, and blood pressure remained largely unchanged.
- Serum potassium significantly increased after month 2.
- Serum sodium showed significant increases in 12 of 26 test periods.
- Significant correlations between plasma aldosterone and renin activity were observed in 16 months.
- Significant correlations between systolic and diastolic blood pressure were observed in 20 months.
Conclusions:
- The influence of the renin-angiotensin system on plasma aldosterone remains intact during CH.
- Observed correlations between various parameters during CH appear to be random, not reflecting a consistent relationship.
- CH primarily affects serum potassium and sodium levels, with minimal impact on the renin-angiotensin-aldosterone axis and cortisol.
Abstract:
To investigate the effect of chronic hemodialysis (CH) on adrenal aldosterone release plasma aldosterone (PA), plasma renin activity (PRA), plasma cortisol (PC) and the serum concentrations of potassium (K) and sodium (Na) were measured before and at monthly intervals up to 26 months after initiation of CH in 42 patients with terminal renal failure. Body weight (BW), systolic (BPs) and diastolic (BPd) blood pressure were determined simultaneously. With 2 exceptions PA, PRA and PC as well as BW, BPs and BPd showed no significant changes. Following month 2 K was always significantly higher than the starting value while significantly higher Na values were observed in 12 of 26 different test periods (P less than 0.05--less than 0.001). Correlation analysis between the various parameters determined in this study revealed in 16 of 26 different months a significant relationship between PA and PRA (P less than 0.05--less than 0.001) and as expected in 20 of 26 between BPs and BPd (P less than 0.05--less than 0.001). Only at times were punctual correlations seen between any of the remaining parameters. Our results demonstrate that the prime influence of the renin angiotensin system on PA remains unaltered during CH. We conclude that the observed punctual correlations between the various parameters determined in this study are random and do not reflect a true relationship.