Plasma free, sulfo- and glucuro-conjugated catecholamines in uremic patients

Cuche, Jean-Louis; Prinseau, J; Selz, Françoise; Ruget, G; Baglin, A

doi:10.1038/ki.1986.222

Cited by 68 publications

(27 citation statements)

References 21 publications

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“…Measurement of plasma catecholamines as an indicator of sympathetic neural activity demands caution in ESRD because of the complex metabolic alterations that are present in these patients. Plasma NE concentration in ESRD patients undergoing dialysis has been reported to be high [13][14][15][16][17][18][19][20][21] or normal. [22][23][24] Sympathetic microneurography is presently the golden standard for measuring sympathetic activity.…”

Section: Sympathetic Activity In Esrdmentioning

confidence: 99%

Plasma Norepinephrine Predicts Survival and Incident Cardiovascular Events in Patients With End-Stage Renal Disease

et al. 2002

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Background-Sympathetic tone is consistently raised in patients with end-stage renal disease (ESRD). We therefore tested the hypothesis that sympathetic activation is associated with mortality and cardiovascular events in a cohort of 228 patients undergoing chronic hemodialysis who did not have congestive heart failure at baseline and who had left ventricular ejection fraction Ͼ35%. Methods and Results-The plasma concentration of norepinephrine (NE) was used as a measure of sympathetic activity. Plasma NE exceeded the upper limit of the normal range (cutoff 3.54 nmol/L) in 102 dialysis patients (45%). In a multivariate Cox regression model that included all univariate predictors of death as well as the use of sympathicoplegic agents and ␤-blockers, plasma NE proved to be an independent predictor of this outcome (hazard ratio [1-nmol/L increase in plasma NE]: 1.07, 95% CI 1.01 to 1.14, Pϭ0.03). Similarly, plasma NE emerged as an independent predictor of fatal and nonfatal cardiovascular events (hazard ratio [1-nmol/L increase in plasma NE] 1.08, 95% CI 1.02 to 1.15, Pϭ0.01) in a model that included previous cardiovascular events, pulse pressure, age, diabetes, smoking, and use of sympathicoplegic agents and ␤-blockers. The adjusted relative risk for cardiovascular complications in patients with plasma NE Ͼ75th percentile was 1.92 (95% CI 1.20 to 3.07) times higher than in those below this threshold (Pϭ0.006). Conclusions-Sympathetic nerve overactivity is associated with mortality and cardiovascular outcomes in ESRD.Controlled trials with antiadrenergic drugs are needed to determine whether interference with the sympathetic system could reduce the high cardiovascular morbidity and mortality in dialysis patients.

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Section: Sympathetic Activity In Esrdmentioning

confidence: 99%

Plasma Norepinephrine Predicts Survival and Incident Cardiovascular Events in Patients With End-Stage Renal Disease

et al. 2002

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“…Plasma NE in ESRD patients was found to be high in most studies performed between the 1970s and 1980s, [17][18][19][20][21][22][23][24][25] and on the basis of these studies, chronic renal failure was considered a situation characterized by enhanced sympathetic activity. The interpretation of plasma NE as a marker of sympathetic activity is complex in patients with renal failure because circulating NE represents only a small proportion of the neurotransmitter amount secreted from adrenergic nerve terminals 26 and because these patients display metabolic alterations that may alter the plasma concentration of this substance.…”

Section: Ne and Sympathetic Activity In Esrdmentioning

confidence: 99%

Norepinephrine and Concentric Hypertrophy in Patients With End-Stage Renal Disease

Zoccali¹,

Mallamaci²,

Tripepi³

et al. 2002

Hypertension

128

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Abstract-We have recently observed that in patients with end-stage renal disease (ESRD) raised plasma norepinephrine (NE) is an independent predictor of incident cardiovascular events but that its prognostic power is reduced when this sympathetic marker is tested in statistical models including also left ventricular mass. Because left ventricular hypertrophy (LVH) may be a mechanism whereby NE contributes to the high rate of cardiovascular events in ESRD, we examined the relationship between plasma NE and echocardiographic parameters of left ventricle mass in a large group of ESRD patients. Mean wall thickness (MWT) was higher in patients in the third NE tertile than in the other 2 tertiles (Pϭ0.001), and such an increase was paralleled by a rise in relative wall thickness (RWT) (Pϭ0.006).Concentric LVH was more prevalent in patients in the third NE tertile (46%) than in the second (38%) and first (25%) NE tertiles. Multivariate regression analysis confirmed that the association of plasma NE with the muscular component of left ventricle (MWT) and with RWT was independent (PՅ0.001) of other cardiovascular risk factors, and in these models, plasma NE ranked as the second correlate of MWT and RWT. Similarly, multiple logistic regression analysis showed that the association of plasma NE with concentric LVH was strong and again independent of other risk factors (Pϭ0.003). Plasma NE is associated to concentric LVH in ESRD patients. These observations constitute a sound basis for testing the effect of anti-adrenergic drugs on left ventricle mass and on cardiovascular outcomes in patients with ESRD. Key Words: cardiovascular risk Ⅲ dialysis Ⅲ left ventricular hypertrophy Ⅲ norepinephrine Ⅲ renal failure Ⅲ sympathetic activity Ⅲ uremia A t least 3 prospective studies have coherently demonstrated that raised left ventricular mass (LVM) has a strong negative prognostic impact in patients with end-stage renal disease (ESRD), 1-3 and on this basis, left ventricular hypertrophy (LVH) is now considered a major cardiovascular risk factor in these patients. The pathogenesis of LVH is multifactorial, and several causative factors have been identified-including hypertension, anemia, hyperparathyroidism, and chronic volume expansion 4 -but these factors only in part account for the high prevalence of this alteration in patients with ESRD. Sympathetic activity measured by sympathetic nerve microneurography is increased in patients with mild to moderate renal dysfunction 5 and in those with ESRD,6 and high sympathetic tone is considered a major player in the pathogenesis of hypertension in renal diseases. 7,8 Although sympathetic overactivity is being suspected as a likely mechanism responsible for the high cardiovascular morbidity and mortality in patients with chronic renal diseases, to our knowledge there is no study linking raised norepinephrine (NE) to alterations in left ventricular mass in these patients.In a large cohort of dialysis patients, we have recently observed that raised plasma NE is a strong and independent predicto...

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“…It is necessary, however, to note that conjugated CA is more susceptible to the renal function. Moderately impaired renal function induced a significant increase in conjugated plasma CA as a result of decreased renal clearance (27,28) and possibly of decreased renal desulfation (24).…”

Section: Correlation Of Pda To Other Variablesmentioning

confidence: 99%

Plasma Free Dopamine: Physiological Variability and Pathophysiological Significance

et al. 1995

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Dopamine (DA) is the most abundant catecholamines in human plasma and exists mostly in the sulfoconjugated form (DA sulfate), a biologically inactive metabolite. The paucity of unconjugated DA (PDA) in plasma throws doubt on its physiological significance. However, PDA, when measured with a highly sensitive radioenzymatic method, showed quite different features from norepinephrine and epinephrine in some types of clinical hypertension, lower in essential hypertension and higher in primary aldosteronism and pheochromocytoma. There was a weak but significant correlation between the values of PDA and DA sulfate measured in the same specimens, but DA sulfate was more susceptible to impaired renal function. Upright posture, high salt diets and an intravenous injection of metoclopramide (MCP, 10 mg), a DA receptor antagonist, induced a slight but significant increase in PDA in normal and hypertensive subjects. An intravenous dexamethasone (2 mg) caused a gradual increase in PDA over 150 min after medication, which was completely blocked by concomitant administration of a-methyl p-tyrosine, a tyrosine hydroxylase inhibitor. The responses of PDA to both high salt diets and MCP were blunted in salt-sensitive patients with uncomplicated essential hypertension. The results suggest that DA is not only a precursor of norepinephrine biosynthesis but also plays an inherent role as an active neurotransmitter in the peripheral sympathoadrenal system, and that PDA is a sensitive marker of peripheral dopaminergic activity, which may operate to modulate the cardiovascular and endocrine functions and participate in the pathogenesis of some types of hypertension. (Hypertens Res 1995; 18 Suppl. I: S65-S72)

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Plasma free, sulfo- and glucuro-conjugated catecholamines in uremic patients

Cited by 68 publications

References 21 publications

Plasma Norepinephrine Predicts Survival and Incident Cardiovascular Events in Patients With End-Stage Renal Disease

Plasma Norepinephrine Predicts Survival and Incident Cardiovascular Events in Patients With End-Stage Renal Disease

Norepinephrine and Concentric Hypertrophy in Patients With End-Stage Renal Disease

Plasma Free Dopamine: Physiological Variability and Pathophysiological Significance

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