Plasma Catecholamine Response to Postural Stimulation in Normotensive and Dialysis Hypotension-Prone Uremic Patients

Cannella, Giuseppe; Picotti, G. B.; Movilli, Ezio; Cancarini, Giovanni; Marinis, S. De; Galva, M. D.; Maiorca, R

doi:10.1159/000182072

Cited by 16 publications

(4 citation statements)

References 20 publications

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“…The clinical data for the diabetic patients with neuropathy are given in Table 1. Patients 8 and 9 also had renal failure, a condition which per se can alter plasma catecholamine concentrations [8,21]. Therefore, the results for these patients were evaluated separately and not averaged with those for the other neuropathic subjects.…”

Section: Methodsmentioning

confidence: 99%

Plasma adrenaline and noradrenaline concentrations in diabetic patients with and without autonomic neuropathy at rest and during sympathetic stimulation

Caviezel

Picotti

Margonato³

et al. 1982

Diabetologia

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Summary. Plasma concentrations of adrenaline and noradrenaline were measured radio-enzymatically in nine patients with diabetic autonomic neuropathy, seven diabetic patients without autonomic neuropathy and nine normal subjects, in the recumbent position and after standing. Furthermore, in six patients with autonomic neuropathy and in the normal subjects, plasma noradrenaline and adrenaline concentrations were determined during and after cyclo-ergometer exercise. No differences in plasma adrenaline concentrations were found at any time in the study. Basal plasma noradrenaline levels were significantly lower in diabetic patients with autonomic neuropathy than in the non-neuropathic diabetics or healthy control subjects. After standing, plasma noradrenaline rose to significantly higher levels in both control and diabetic subjects without neuropathy than in the patients with autonomic neuropathy. During exercise (up to 100 W load), plasma noradrenaline rose to similar levels in healthy controls and in patients with diabetic neuropathy. These data indicate that in diabetic autonomic neuropathy there is reduced peripheral neurosympathetic tone at rest but a normal response to moderate exercise. Blunted neurosympathetic responses to standing seem to be a consistent feature of diabetic autonomic neuropathy, particularly in those patients with severe postural hypotension.Key words: Plasma catecholamines, adrenaline, noradrenaline, sympathetic nervous activity, diabetes mellitus, autonomic neuropathy, postural stimulation, orthostatic hypotension, muscular exercise.Autonomic neuropathy in diabetes mellitus produces a variety of different symptoms and signs due to variable involvement of the sympathetic and parasympathetic branches of the autonomic nervous system [6,14,16].Plasma catecholamine levels have been investigated in only a few studies in recent years, as a possible humoral index of sympathetic function in complicated or uncomplicated diabetes. While the results obtained from these studies indicate that plasma catecholamine levels in uncomplicated diabetes are normal, the frequency of sympathetic deficiency, as reflected by subnormal plasma noradrenaline concentrations, in diabetic autonomic neuropathy and its possible importance in relation to symptoms, such as postural hypotension, is less clear [1,9,10,12,19]. This uncertainty could be due, at least in part, to difficulties in the accurate measurement of catecholamine responses and also in the characterization of diabetic autonomic neuropathic syndromes.The present investigation was aimed at evaluating peripheral sympathetic function and reactivity to appropriate stimuli, such as standing and muscular exercise, in diabetic patients with autonomic neuropathy, compared with diabetics without neuropathy and normal subjects. For this purpose, the presence of diabetic autonomic neuropathy was ascertained from a series of clinical and instrumental evaluations. Plasma adrenaline and noradrenaline concentrations, measured by a sensitive and specific radio-enzymatic me...

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Section: Methodsmentioning

confidence: 99%

Plasma adrenaline and noradrenaline concentrations in diabetic patients with and without autonomic neuropathy at rest and during sympathetic stimulation

Caviezel

Picotti

Margonato³

et al. 1982

Diabetologia

Self Cite

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“…Epinephrine and norepinephrine levels of both groups were similar during the HD session. A study demonstrated that normotensive and hypotension‐prone HD patients had similar epinephrine and norepinephrine responses to postural activation interdialytically . This finding suggests that there is a normal sympathetic responsiveness in HD patients independent of their propensity for IDH.…”

Section: Discussionmentioning

confidence: 98%

Low Copeptin Levels in Patients With Intradialytic Hypotension

et al. 2019

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Intradialytic hypotension (IDH) is related to high morbidity and mortality. There is evidence that arginine‐vasopressin (AVP) responses could play a role. Copeptin is a reliable biomarker of AVP. In this study, copeptin, aldosterone, epinephrine, and norepinephrine levels in patients with IDH were evaluated throughout a hemodialysis (HD) session and compared with the control group. The study includes 15 patients who were normotensive during HD and 15 patients with IDH with a minimum HD vintage of 1 year. Blood samples were collected before the initiation of an HD session (T0), in the mid‐session for control group, 30 min after mean arterial pressure drop for IDH patients (T1), and at the end of the session (T2). Groups had similar demographic features and health parameters, interdialytic weight gains, and ultrafiltration amounts. The IDH group had a mean arterial pressure decline of 39.9 (±6.4) mm Hg. Copeptin levels of the control group increased an average of 79.9 (±97.5) pmol/L at T1 and an additional 24.8 (±33.9) pmol/L at T2. In the IDH group, copeptin level increases at T1 and T2 were 3.2 (±5.5) pmol/L and 34 (±44.6) pmol/L, respectively. Copeptin levels of the IDH group were significantly lower at T1 (P < 0.001) and at the T0–T2 interval than control group (P = 0.05). In the control group, aldosterone levels distinctly decreased, and in the IDH group, aldosterone levels were elevated (P < 0.001). Small changes were detected in epinephrine and norepinephrine levels for both groups but did not reach significance (P = 0.6 and P = 0.3, respectively). Lower copeptin level alterations suggest inadequate AVP responses in patients with IDH.

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“…Each of these steps may be variously altered in uremic patients. Previous data demonstrate the enhanc ement of Tyr-hydroxylase and monoamine oxidase (MAO) activities with reduction of NE reuptake at nerve terminals in uremic rats [5] and decreased acticity of COMT in erythrocytes of patients with chronic renal failure [34,35], In uremic patients, stimulated release of NE in acute postural testing seems unaffected [14,15,18,36]: moreover, a progressive reduction of the renal excre tion of CA, with increasing degrees of renal insufficiency, has been reported [37], Patients studied here exhibited a manyfold increase of all sulfated CA, as observed in previous studies [19,20], Very recent data regarding plasma sCA in uremia [19] showed higher levels with respect to our findings. These discrepancies may be explained chiefly by an excessive dilution of plasma samples which induces an overestima tion of sCA levels [38,39], The same investigators [19,39] showed 'normal' plasma levels of glucuronoconjugated CA (gCA) in uremic patients.…”

Section: Discussionmentioning

confidence: 99%

Free and Sulfoconjugated Catecholamines in Normotensive Uremic Patients: Effects of Hemodialysis

Musso¹,

Pende²,

Vergassola³

et al. 1989

Nephron

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In 9 normotensive uremic patients undergoing chronic hemodialysis, the baseline plasma catecholamines varied widely from low-normal to very high; sulfoconjugated plasma catecholamines were constantly high. A dialysis-induced fall of all sulfated catecholamines and epinephrine was observed. Norepinephrine decreased in 5 patients and increased in 4, with a strong inverse correlation between predialysis norepinephrine and Δ norepinephrine (p < 0.0001). No correlation was evident between clinical parameters (mean arterial pressure, heart rate) and catecholamines (both predialysis and postdialysis). Significant (p < 0.0001 and p < 0.0002) inverse correlations between epinephrine and norepinephrine and their sulfoconjugation degree were demonstrated only in predialysis. Our data may support the presence of a uremic autonomic neuropathy and adrenoceptor damage.

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Plasma Catecholamine Response to Postural Stimulation in Normotensive and Dialysis Hypotension-Prone Uremic Patients

Cited by 16 publications

References 20 publications

Plasma adrenaline and noradrenaline concentrations in diabetic patients with and without autonomic neuropathy at rest and during sympathetic stimulation

Plasma adrenaline and noradrenaline concentrations in diabetic patients with and without autonomic neuropathy at rest and during sympathetic stimulation

Low Copeptin Levels in Patients With Intradialytic Hypotension

Free and Sulfoconjugated Catecholamines in Normotensive Uremic Patients: Effects of Hemodialysis

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