The Relationship between Body Fluid Compartment Volumes, Renin Activity and Blood Pressure in Chronic Renal Failure

Dathan, J. R. E.; Johnson, Darlene; Goodwin, F. J.

doi:10.1042/cs0450077

Cited by 13 publications

(6 citation statements)

References 16 publications

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“…de Planque et al [29] found a good correlation between blood pressure and extracellular volume in hypertensive patients with advanced renal failure who were not yet treated with dialysis. Dathan et al [30] failed to find a correlation between extracellular water and blood pressure in patients with chronic renal failure not yet on dialysis [30]. However, they found a relation between blood pressure and exchangeable sodium and blood volume.…”

Section: Discussionmentioning

confidence: 98%

Blood Pressure Control and Hemodynamic Changes in Patients on Long Time Dialysis Treatment

et al. 1998

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In dialysis patients blood pressure can be well controlled with long dialysis (3 times a week for 8 h) in contrast to a more common short dialysis regime (3 times a week for 4 h). We studied whether the good blood pressure control in patients on long dialysis as compared to patients on short dialysis was associated with a decrease in extracellular fluid volume. Two-day interdialytic ambulatory blood pressure monitoring was performed in 26 non-diabetic patients on long dialysis, in 22 patients on short dialysis, matched for the years they were on dialysis treatment, and during 24 h in 19 healthy volunteers. After full equilibration, 24 h after dialysis, echography of the inferior caval vein was performed to determine fluid state. Cardiac dimensions and stroke index were measured by echocardiography. A blood sample was drawn for the determination of electrolytes and vasoactive hormones. 73% of the patients on short dialysis were using antihypertensive medication in contrast to none of the patients on long dialysis. However, blood pressure was significantly lower in patients on long dialysis (115 ± 21/67 ± 11 mm Hg) when compared to patients on short dialysis (143 ± 26/81 ± 16 mm Hg). Indexed caval vein diameter, left ventricular diameter index, and atrial natriuretic peptide were not significantly different in patients on long dialysis compared to patients on short dialysis. Also the cardiac index was comparable in patients on long and short dialysis. However, the total peripheral resistance index was significantly lower in patients on long dialysis compared to the patients on short dialysis and normal controls. The left ventricular mass index was increased in both patients on long and short dialysis compared to controls. We conclude that patients on long dialysis have adequate blood pressure control that seems mainly to be caused by a low total peripheral resistance. These data also suggest that factors other than a lower fluid state contribute to the good blood pressure control in patients on long dialysis.

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Section: Discussionmentioning

confidence: 98%

Blood Pressure Control and Hemodynamic Changes in Patients on Long Time Dialysis Treatment

et al. 1998

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“…There are data showing that in such patients blood pressure correlates positively with exchangeable sodium and ex tracellular volume [4][5][6]. Likewise, Cangiano et al [3] described a highly significant positive correlation between blood volume and total peripheral vascular resistance.…”

Section: Volume and Sodium Status As Determinants Of Hypertension In mentioning

confidence: 96%

Pathophysiology of Hypertension in Patients on Renal Replacement Therapy

Leeuw

1994

Blood Purif

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Hypertension is a frequent problem in patients with renal failure, whether or not they are on renal replacement therapy. Little is known, however, about the pathophysiological mechanisms leading to an elevation of blood pressure. Although there is a relationship between body fluid volumes and blood pressure, it is unlikely that hypertension can be explained on the basis of volume expansion alone. Haemodynamically, hypertension in renal failure is characterized by an increased peripheral vascular resistance, but there is no convincing evidence that this is secondary to a high-output state. Among the pressor systems that have been implicated, the renin-angiotensin system and the adrenergic system are likely candidates, but overactivity of these systems or enhanced reactivity to the mediators still cannot explain all elements of renal failure associated hypertension. Therefore, other factors, such as intracellular electrolytes and the Na-K pump, are under scrutiny. However, given the heterogeneity of patient groups studied so far, it is virtually impossible to draw any meaningful conclusions about the pathogenesis of high blood pressure in patients on renal replacement therapy.

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“…In a teleological sense, this exaggerated blood pressure increase has been attributed to a reaction of the body in order to compensate for the impaired sodium removal because of the reduced kidney mass due to the pressurenatriuresis principle [9]. Especially in hypertensive uremic patients not yet treated with dialysis, an increase in extracellular volume [10] and total exchangeable sodium is a common finding [11], whereas in the majority of these patients blood pressure is better controlled after salt and fluid removal. The success of the Tassin group has been largely attributed to improved sodium and water removal.…”

Section: Sodium and Fluid Overload And Hypertension Of Esrdmentioning

confidence: 99%

Salt and Hypertension in End-Stage Renal Disease

1998

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Salt and fluid overload play an important role in the pathogenesis of hypertension in patients with end-stage renal disease. However, in the individual patient, the relation between salt loading and blood pressure response is variable and appears to be influenced by various neurohumoral regulatory mechanisms. This may also have implications for the pathogenesis of structural cardiovascular abnormalities in patients with end-stage renal disease.

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The Relationship between Body Fluid Compartment Volumes, Renin Activity and Blood Pressure in Chronic Renal Failure

Cited by 13 publications

References 16 publications

Blood Pressure Control and Hemodynamic Changes in Patients on Long Time Dialysis Treatment

Blood Pressure Control and Hemodynamic Changes in Patients on Long Time Dialysis Treatment

Pathophysiology of Hypertension in Patients on Renal Replacement Therapy

Salt and Hypertension in End-Stage Renal Disease

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