Remarked hyperaldosteronemia in long-term hemodialysis patients who were recipients of renal transplantation

Marked hyperaldosteronemia with hypereninemia has appeared in about 20% of the patients with long-term hemodialysis therapy in Japan. Many of them have been reported to be hypotensive. To evaluate these patients, we studied retrospectively 19 non-nephrectomized recipients of renal transplantation from related living donors. PRA and PAC had been measured in 11 patients. Seven patients had great hyperaldosteronemia (PAC>160ng/dl) with hypereninemia (PRA>5ng/ml/hr). Six of them had experienced hypotensive episode during hemodialysis. In the 7 patients, weight gain was 11.1±1.4% on the 15th day after transplantation, indicating that their post-dialysis weight was significantly lower than ideal body weight obtained when kidney function was normal. The PRA and PAC normalized within 1 week after transplantation. However, in the other patients, the weight gain was 0.2±1.1%. In conclusion, chronic dehydration during hemodialysis therapy can cause much hyperaldosteronemia that can be corrected by fluid replacement. Measurement of PRA and PAC may be useful to evaluate the dry weight of chronic hemodialysis patients.