Blood pressure and renin in long-term hemodialysis patients

Blood pressure (BP), plasma active renin concentration (ARC), plasma renin activity (PRA), aldosterone (Aldo), atrial natriuretic peptide (HANP), plasma sodium (Na), plasma potassium (K), total protein (TP), hematocrit (Ht) and body weight (BW) have been measured in 101 patients, including 9 diabetic patients, undergoing hemodialysis for 5 through 278 months. BP, ARC, PRA and HANP correlated inversely with the duration of dialysis. Among 13 patients undergoing hemodialysis for more than 20 years, only one patient received antihypertensive drugs. This finding suggested that relative low ability of renin secretion and a slightly low concentration of HANP causes low blood pressure in long-term dialysis patients. ARC was significantly correlated with PRA, Aldo, Na, TP-A (TP concentration after hemodialysis), Ht Δ% (difference between before and after hemodialysis) and BWΔ%. These investigations suggest that the removal of large quantities of water and salt in each dialysis session may cause excessive secretion of renin. Though no relation was demonstrated between ARC and blood pressure in 101 patients, ARC was correlated significantly with blood pressure in 37 non-DM patients undergoing hemodialysis for less than 10 years and was inversely correlated in 55 non-DM patients undergoing hemodialysis for more than 10 years. Therefore, further analysis of other factors that maintain blood pressure, especially in long-term dialysis patients is required. Multiple regression analysis showed that major factors regulating the levels of blood pressure were duration of dialysis, HtΔ% and BWΔ%. During dialysis, we observed significant correlation between ARCΔ % and HtΔ %, but we did not find any correlation between the change in blood pressure and ARC. Forthermore, we found that caution should be paid to body water control especially in diabetic patients. because of their remarkable fall of BP during dialysis.