Increased levels of plasma renin, aldosterone, catecholamines and vasopressin in chronic ambulatory peritoneal dialysis (CAPD) patients.
Fluid excess can cause hyporeninemia and hypoaldosteronemia in hemodialysis patients. In six patients on CAPD, plasma renin activity (PRA) and plasma aldosterone (PA) were elevated to levels of : PRA 10.2 +/- 2.9 nl (1-5 ng/ml/h), and PA: 47.4 +/- 16.2 (normal 5-20 ng/dl). In 4 patients, data posthemodialysis and later during CAPD revealed that PRA increased from 0.9 +/- 0.3 to 14.1 +/- 4.6 and PA increased from 3.4 +/- 0.3 to 67.4 +/- 24.9 on CAPD (p less than 0.05). Mean arterial pressure was lower on CAPD and serum glucose was higher. No significant difference was seen in weight, hematocrit, BUN, or potassium, however. Plasma volume was not decreased in five CAPD patients: 3619 +/- 358 ml (predicted 3083 +/- 201 ml). Elevated catecholamine levels were seen in CAPD patients: norepinephrine 868.0 +/- 104.1 (normal 358.4 +/- 41.5 pg/ml), epinephrine 386.3 +/- 49.2 (normal 58.3 +/- 10.6 pg/ml). Plasma vasopressin levels were elevated to the range usually seen with hyperosmolality. In eight patients who lost or gained weight on CAPD, levels of PRA and PA changed as expected, but catecholamine levels did not correlate with weight changes. The data suggest that in CAPD patients, PRA and PA may be elevated in association with augmented sympathetic stimulation and elevated vasopressin levels. Serial observations demonstrated that PRA and PA can respond appropriately to changes in body weight, while catecholamine and vasopressin levels seem to be influenced by other factors.
Zabetakis
P M
PM
Department of Medicine, Lenox Hill Hospital, New York, NY 10021.
Kumar
D N
DN
Gleim
G W
GW
Gardenswartz
M H
MH
Agrawal
M
M
Robinson
A G
AG
Michelis
M F
MF
D000450:Aldosterone / Q000097:blood*; D001806:Blood Urea Nitrogen; D003404:Creatinine / Q000097:blood; D004573:Electrolytes / Q000097:blood; D004837:Epinephrine / Q000097:blood*; D006400:Hematocrit; D006801:Humans; D007676:Kidney Failure, Chronic / Q000097:blood* / Q000628:therapy; D009638:Norepinephrine / Q000097:blood*; D010531:Peritoneal Dialysis, Continuous Ambulatory; D012083:Renin / Q000097:blood*; D014667:Vasopressins / Q000097:blood*; D014882:Water-Electrolyte Balance
D004573:Electrolytes; D014667:Vasopressins; D000450:Aldosterone; D003404:Creatinine; D012083:Renin; D009638:Norepinephrine; D004837:Epinephrine