[Relationship between vasoactive substances and changes in blood pressure during hemodialysis]

In order to clarify the relationship between vasoactive substances and changes in blood pressure (BP) during hemodialysis (HD) in patients with end-stage renal disease, we measured plasma renin activity (PRA), plasma concentration of aldosterone (PAC), and the plasma concentrations of epinephrine (E), norepinephrine (NE), dopamine (DA) and atrial natriuretic peptide (ANP) in patients on HD. Fourty-eight patients, consisting of 24 males and 24 females, were included in this study. Their mean age was 63.8 years, and their mean HD duration was 55.9 months. In 9 patients without diabetes mellitus (DM) and whose BP was stable during HD, PRA and plasma concentrations of E and NE increased significantly during HD, and that of DA decreased during HD. In 9 patients without DM and whose BP fell during HD, PRA and plasma concentrations of E and NE showed no significant response to the decrease in body weight during HD. In spite of the increase in NE concentration during HD in 8 patients without DM and whose BP was usually hypotensive, BP remained low. This might be due to the decrease in sensitivity of their peripheral autonomic receptors to NE. In the 9 patients with DM whose BP was stable and 13 patients with DM whose BP fell during HD, vasoactive substances made almost no effective response to the decrease in body weight during HD. In conclusion, we must take into consideration the fact that both hypotensive patients during HD and diabetic patients on HD might exhibit an abnormal response of their vasoactive substances.