Vasoactive hormones in uraemic patients with chronic hypotension.
BACKGROUND
We evaluated the possible role of an imbalance between vasoconstrictor and vasodilator hormones in the pathophysiology of chronic hypotension in uraemia.


METHODS
Fourteen hypotensive haemodialysed patients, 14 normotensive haemodialysed patients, and 17 control subjects were included in this study. Plasma renin activity (PRA) and plasma levels of catecholamines, angiotensin II (AII), atrial natriuretic peptide (ANP), and arginine vasopressin (AVP) were measured.


RESULTS
The mean time on haemodialysis (HD) was longer in hypotensive patients than in normotensive patients (P < 0.01). Catecholamine levels were higher in the whole group of HD patients than in controls (P < 0.01). Catecholamine levels were higher in hypotensive patients than in normotensive patients, but the differences reached significance only for adrenaline (P < 0.05). PRA and plasma AII levels were higher in hypotensive patients than in the other two groups (P < 0.05), while no differences were observed between normotensive patients and controls. Plasma ANP and AVP levels were higher in HD patients than in controls (P < 0.01), but there were no differences between hypotensive and normotensive patients. In HD patients, mean blood pressure inversely correlated with PRA (r = -0.59, P < 0.01) and plasma AII levels (r = -0.80, P < 0.01).


CONCLUSIONS
Our results indicate that in HD patients with chronic hypotension there is an activation of the sympathetic and the renin-angiotensin systems. This activation is probably secondary in an attempt to compensate the vascular resistance to pressor stimuli reported in these patients.
Armengol
N E
NE
Nephrology Unit, Hospital Clinic i Provincial, Barcelona, Catalonia, Spain.
Cases Amenós
A
A
Bono Illa
M
M
Calls Ginesta
J
J
Gaya Bertrán
J
J
Rivera Fillat
F R
FR
D000328:Adult; D000368:Aged; D000804:Angiotensin II / Q000097:blood; D001127:Arginine Vasopressin / Q000097:blood; D009320:Atrial Natriuretic Factor / Q000097:blood; D002395:Catecholamines / Q000097:blood; D002908:Chronic Disease; D005260:Female; D006801:Humans; D007022:Hypotension / Q000097:blood* / Q000209:etiology; D008297:Male; D008875:Middle Aged; D010281:Parathyroid Hormone / Q000097:blood; D012083:Renin / Q000097:blood; D014511:Uremia / Q000097:blood* / Q000503:physiopathology
D002395:Catecholamines; D010281:Parathyroid Hormone; D000804:Angiotensin II; D001127:Arginine Vasopressin; D009320:Atrial Natriuretic Factor; D012083:Renin