Human atrial natriuretic peptide (hANP) in various modes of blood purification

Dialysis hypotension is mainly caused by reduction of plasma volume (PV), that is due to weight loss by ultrafiltration and water shift by osmolar change. Reduction of PV results in both decrease of venous return and cardiac output. Secretion of hANP is regulated by atrial tension and its half life is within several minutes. We measured hANP to assess whether it could be an indicator of vascular stability in various modes of blood purification. In this study pre and post serum concentration of hANP with 10l substitution fluid with no removal of body weight were evaluated in six combination of Na (135, 165mEq/l), HCO3- (35, 60mEq/l) and glucose (0, 250mg/dl). As the methods with body weight reduction, single ultrafiltration (UF), bicarbonate hemodialysis (BiHD) with Na 135 or 145mEq/l, and acetate hemodialysis (AcHD) with Na 135 or 145mEq/l were performed. Fluid removal was 2% of pre-body wight in the first one hour. In HF without body weight reduction, %hANP changed significantly with different Na and glucose concentration. Change with HCO3- was not significant. Na and glucose work as osmolar active solute to preserve PV. In single UF, BiHD and AcHD, %hANP changed significantly with different Na and buffers (BiHD vs AcHD). With body weight reduction, %hANP were as follows: BiHD (Na 145)>UF>BiHD (Na 135)=AcHD (Na145)>AcHD (Na135). Our date supports preveous reports on vascular stability. hANP could be useful marker to select or develop blood purification with superior vascular stability.