title: Plasma concentrations of adrenomedullin and ghrelin in hemodialysis patients with sustained and episodic hypotension.
abstract: Sustained and/or episodic hypotension during hemodialysis (HD) is an important clinical issue. Plasma adrenomedullin (AM) is increased in HD patients with sustained hypotension, but little is known about its implications for episodic hypotension. Ghrelin may also contribute to the pathophysiology of hypotension in HD patients. We evaluated plasma levels of AM and total ghrelin in sustained hypotensive (SH; n = 23), episodic hypotensive (EH; n = 30) and normotensive (NT; n = 23) HD patients. In the EH group, the relationship between low blood pressure during HD and circulating levels of AM and ghrelin was also evaluated. Plasma levels of AM were significantly higher in SH (34.3 +/- 8.3 fmol/ml, p<0.01) than in NT patients (27.6 +/- 5.2 fmol/ml), but not in EH patients (30.8 +/- 6.1 fmol/ml). There was no significant difference of plasma total ghrelin in SH (548.1 +/- 426.5 fmol/ml) and in EH patients (544.6 +/- 174.3 fmol/ml), compared with NT patients (400.0 +/- 219.7 fmol/ml). On the other hand, in EH patients, the "suppressed blood pressure ratio" during HD significantly correlated with plasma AM (r = 0.77, p<0.001) and with total ghrelin levels (r = 0.44, p<0.05). Our results suggest that ghrelin, as well as AM, may play an important role as vasodilator local hormones and regulation of blood pressure during HD, especially the occurrence of EH. Further studies are necessary to clarify the implication of these hormones in the control of hypotension during HD.
authors.affiliation: Department of Public Health, Nagasaki University Graduate School of Biomedical Sciences, Sakamoto, Nagasaki, Japan.
authors.forename: Kikuko
authors.initials: K
authors.lastname: Iwanaga
authors.forename: Noboru
authors.initials: N
authors.lastname: Takamura
authors.forename: Yasuyo
authors.initials: Y
authors.lastname: Abe
authors.forename: Ye
authors.initials: Y
authors.lastname: Zhaojia
authors.forename: Ken
authors.initials: K
authors.lastname: Shinzato
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Hosoda
authors.forename: Kenji
authors.initials: K
authors.lastname: Kangawa
authors.forename: Akira
authors.initials: A
authors.lastname: Ohtsuru
authors.forename: Shigeru
authors.initials: S
authors.lastname: Kohno
authors.forename: Shunichi
authors.initials: S
authors.lastname: Yamashita
authors.forename: Kiyoshi
authors.initials: K
authors.lastname: Aoyagi
mesh_terms: D053607:Adrenomedullin; D000368:Aged; D016022:Case-Control Studies; D005260:Female; D054439:Ghrelin; D006801:Humans; D007022:Hypotension / Q000097:blood / Q000209:etiology* / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D009994:Osmolar Concentration; D036361:Peptide Hormones / Q000097:blood*; D010455:Peptides / Q000097:blood*; D006435:Renal Dialysis / Q000009:adverse effects*; D014665:Vasodilator Agents / Q000097:blood*
chemical_list: D054439:Ghrelin; D036361:Peptide Hormones; D010455:Peptides; D014665:Vasodilator Agents; D053607:Adrenomedullin