Disordered aldosterone-volume relationship in end-stage kidney disease.
BACKGROUND
Sodium loading, and subsequent volume expansion, suppresses aldosterone levels in individuals with normal renal function. We hypothesised that loss of renal function impairs this volume-aldosterone relationship.


METHODS
With multifrequency bioimpedance spectroscopy, we measured total body water (TBW), extracellular volume (ECV), and intracellular volume in five haemodialysis patients at varied states of hydration and in five healthy volunteers during low-, normal-, and high-salt diets. Serum aldosterone, potassium, and C-reactive protein were measured simultaneously. Scatterplots and general estimating equations were used to examine the relationship among these variables.


RESULTS
In healthy volunteers with salt loading, and in haemodialysis subjects with increased inter-dialytic weight gain, expansion of ECV led to reciprocal declines in serum aldosterone concentrations. The relationship was more profound in healthy volunteers (p<0.001) than in haemodialysis subjects (p=0.1). Notably, haemodialysis subjects posted consistently higher levels of ECV (median 49.6% TBW, IQR 43.9-51.8% compared to 41.1%, 39.9-42.8% in volunteers) and serum aldosterone (median 26.7 ng/dl, IQR 19.8-29.6 compared to 12.4 ng/dl, 8.8-16.0 in volunteers). Serum potassium did not appear to influence aldosterone concentration (p=0.9).


CONCLUSIONS
The shift of the volume-aldosterone curve in haemodialysis subjects suggests that end-stage kidney disease is a state of high volume and inappropriately high aldosterone. These data have important clinical implications, as dialysis patients may benefit from both volume reduction and mineralocorticoid receptor blockade.
Columbia University College of Physicians and Surgeons, Department of Medicine, Division of Nephrology, New York, NY, USA. asb68@columbia.edu
Andrew S
AS
Bomback
Abhijit V
AV
Kshirsagar
Maria E
ME
Ferris
Philip J
PJ
Klemmer
D000293:Adolescent; D000328:Adult; D000368:Aged; D000450:Aldosterone / Q000097:blood*; D002097:C-Reactive Protein / Q000378:metabolism; D002648:Child; D017097:Electric Impedance; D005110:Extracellular Space / Q000378:metabolism; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D011188:Potassium / Q000378:metabolism; D006435:Renal Dialysis; D012982:Sodium, Dietary / Q000378:metabolism; D014883:Water-Electrolyte Imbalance / Q000378:metabolism*
D012982:Sodium, Dietary; D000450:Aldosterone; D002097:C-Reactive Protein; D011188:Potassium