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Related Experiment Videos

Delayed decrease in plasma levels of atrial natriuretic peptide during cold hemodialysis

J Hegbrant1, H Thysell, L Mårtensson

  • 1Department of Nephrology, University Hospital, Lund, Sweden.

Nephron
|January 1, 1994
PubMed
Summary

Cold dialysate improves cardiovascular stability during hemodialysis (HD) by maintaining blood pressure. While atrial natriuretic peptide (ANP) levels decrease with HD, cold dialysate (CHD) delays this reduction, suggesting a role in hemodynamic regulation.

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Area of Science:

  • Nephrology
  • Cardiovascular Physiology
  • Endocrinology

Background:

  • Patients with chronic renal failure exhibit elevated plasma levels of atrial natriuretic peptide (ANP).
  • Hemodialysis (HD) typically leads to a substantial decrease in ANP levels, likely due to fluid volume reduction.
  • The use of cold dialysate during HD is associated with improved cardiovascular stability, but the underlying mechanisms remain unclear.

Purpose of the Study:

  • To investigate the impact of varying dialysate temperatures on hemodynamic stability during HD.
  • To examine the effect of different dialysate temperatures on plasma levels of immunoreactive ANP (p-irANP).
  • To explore the relationship between dialysate temperature, ANP levels, and cardiovascular stability in HD patients.

Main Methods:

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  • Ten stable HD patients underwent 240-minute treatments using bicarbonate dialysis fluid at three temperatures: 36.5°C (normal HD), 38.5°C (warm HD), and 34.5°C (cold HD).
  • A Cuprophan plate dialyzer was employed, with identical ultrafiltration volume and rate across all treatments for each patient.
  • Plasma immunoreactive ANP (p-irANP) was quantified using radioimmunoassay with two antisera exhibiting differential cross-reactivity to ANP-related peptides.

    • Main Results:

    • Warm HD (WHD) resulted in a significant decrease in mean arterial blood pressure (p < 0.05), unlike normal HD (NHD) and cold HD (CHD).
    • During CHD, mean arterial blood pressure remained stable throughout the dialysis session.
    • Irrespective of dialysate temperature, p-irANP levels significantly decreased (p < 0.05) during HD. However, the reduction in p-irANP was delayed and less pronounced after 120 minutes during CHD.

    Conclusions:

    • Cold dialysate (CHD) effectively maintains hemodynamic stability, evidenced by stable mean arterial blood pressure during hemodialysis.
    • While ANP levels decrease during all forms of HD, cold dialysate appears to modulate the rate of this decrease.
    • The findings suggest that cold dialysate may influence cardiovascular stability through mechanisms related to ANP regulation or other hemodynamic factors.