A Study of Plasma Vasopressin in Patients Undergoing Chronic Hemodialysis KAZUAKI SHIMAMOTO, IKUO WATARAI,* AND MITSUO MIYAHARA Second Department of Internal Medicine, Sapporo Medical College, S-l W-16, Sapporo, Japan, and *Watarai lin Clinic, S-14 W-15, Sapporo, Japan ABSTRACT. Plasma vasopressin (VP) was determined in 28 patients with chronic renal failure undergoing hemodialysis. Plasma VP levels were significantly higher in the patients than in the normal subjects. It was also observed that plasma VP levels did not fall significantly despite a marked decrease of effective plasma osmolality following hemodialysis, and that no correlation was obtained between

I

N PATIENTS with chronic renal failure, various reports are available on hypothalamic-pituitary axis dysfunction (1-4) and other endocrinological dysfunction (5-8). With respect to the vasopressin (VP) action on the kidney, VP-resistant hyposthenuria was found in the advanced stages of chronic renal diseases (9,10). However, no report is available on the VP release and metabolism thereof in patients undergoing chronic hemodialysis, although Buchborn (11) described that the relation between plasma ADH levels and effective plasma osmolality was preserved normally even in patients with chronic renal failure. It is well known that the regulation of VP release is controlled predominantly by plasma osmolality (12-15), circulating blood volume (13,16) and blood pressure (15,17,18), and that expanded blood volume and high blood pressure are frequently observed in renal failure. In the present investigation, plasma VP levels, plasma osmolality, blood volume and blood pressure were simultaneously measured before and after hemodialysis in order to evaluate the function of the hypothalamic-posterior pituitary axis in patients undergoing chronic hemodialysis. Materials and Methods Plasma VP levels and plasma osmolality were determined in 33 normal subjects ranging in age Received July 16, 1976.

the plasma VP levels and effective plasma osmolality, both before and after hemodialysis. By analyzing the changes in blood volume and blood pressure in addition to plasma osmolality in each case, a dysfunction of VP release in response to osmotic stimulus was found in 5 out of 28 patients. (J Clin Endocrinol Metab 45: 714, 1977)

from 19 to 40 years in a control study and 28 patients with chronic renal failure ranging in age from 17 to 61 years. All of patients were maintained on 4-6 h hemodialysis twice or thrice weekly. Three multivitamin capsiiles and 3.0 g Alumigel were given with each meal daily. One case (case 14) received 500 mg alpha-methyl dopa orally for the control of hypertension. The dialysate contained 135 mEq sodium/liter, 2.0 mEq potassium/liter and 200 mg/dl glucose. The renal diseases were divided as follows: chronic glommerulonephritis (22 cases), renal tuberculosis (3 cases), hydronephrosis (1 case), systemic lupus erythematosus (1 case) and polycystic kidney (1 case). The residual renal function in these patients was extremely lowered, since daily urinary volume was zero in 21 cases, 50 ml in 3 cases (case 5, 20, 24), 80-100 ml in 2 cases (case 14 and 27) and 200 ml in 2 cases (case 12 and 25), and creatinine clearance was less than 1.0 ml/min in all patients. The patients remained in a recumbent position for 30 min before the blood sampling. Blood samples were drawn immediately before and after the hemodialysis for the measurement of plasma VP levels, osmolality, hematocrit, blood urea nitrogen (BUN), serum creatinine, glucose and electrolytes. In addition, changes in body weight and blood pressure were observed following the hemodialysis. The patients ate their usual noon meal during hemodialysis but they were forbidden to smoke for 10 h prior to the experiment and during hemodialysis. Plasma VP levels were measured by the heterologous radioimmunoassay method previously reported by us (14). Plasma osmolality was measured by freezing point determination (Osmette

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40.4 4.2

36.7

2.4

Mean

± SEM

56 M 2M 93 M 46 M 23 M 32 M 27 M 45 M 34 M 33 M 46 M 27 M 59 M 13 M 43 M 2M 36 M 50 M 48 M 36 M 48 M 56 M 93 M 53 M 32 M 62 M 8M 27 M 6.7 0.4

9.8 6.3 6.4 5.1 5.8 7.0 5.5 6.5 4.9 6.4 4.6 4.6

10.6

8.2

10.4 10.8

4.7 6.2 6.9 7.3 7.1 7.3 7.2 5.8 5.8 7.3 4.6 4.2

Vasop. Pg/ml

293 1.5

290 292 285 292 292 294 300 300 288 306 300 290 279 288 289 289 296 284 304 315 295 280 287 292 289 301 301 297

Effective Osmol. mOsm/1

113 4

21.4 0.8

97 138 125 85 90 120 120 93 122 127 97 122 63 103 135 139 139 128 127 93 143 115 80 106 123 90 132 92

m-BP mm Hg

22.8 20.5 21.8 20.8 17.8 30.0 29.8 23.3 23.8 19.5 24.0 18.5 15.0 22.8 22.0 23.0 20.0 19.8 28.8 23.5 22.0 20.0 11.5 17.0 19.5 14.0 28.8 19.0

Ht. %

1.5

51.6

42.8 46.4 68.2 59.5 45.0 63.0 56.6 47.2 46.8 38.5 61.5 51.5 43.0 61.8 53.2 45.0 53.8 55.0 46.5 45.6 57.5 47.5 45.1 43.0 46.3 65.8 53.5 55.0

BW kg

6.6 0.6

9.8 9.4 9.8 6.7 5.8 3.4 5.3 4.6 7.1 8.7 5.1 5.2 1.0 4.7 5.6 5.0 6.6 4.3 5.9 4.9 4.6

15.0 14.4

4.6 6.2 8.8 6.1 5.0

Vasop. Pg/ml

0.9

2791

275 282 274 273 278 275 278 283 278 277 283 277 275 272 283 280 291 273 284 283 281 275 278 277 278 288 282 279

Effective Osmol. mOsm/1

1.1

23.6f

22.8 20.5 22.5 21.5 17.8 38.0 31.0 25.5 25.8 21.0 25.8 21.5 18.3 28.0 20.3 27.9 22.2 22.0 33.5 25.5 24.2 22.0 12.4 17.0 25.0 14.3 32.0 21.3

Ht. %

101 5

97 136 122 87 97 117 83 73 103 103 87 123 49 104 103 138 144 120 87 77 117 117 67 90 123 63 117 83

m-BP mm Hg

After hemodialysis

CG = chronic glomerulonephritis; HN = hydronephrosis; Tbc = renal tuberculosis; SLE = systemic lupus erythematosus; PK = polycystic kidney. * Bilateral nephrectomized patient. t Significantly lower or higher than before hemodialysis.

6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28

5

CG CG CG CG CG CG CG CG CG CG CG CG HN CG PK CG CG CG SLE Tbc Tbc CG CG Tbc CG CG CG CG

F F M M F M M F F F M F M M M F M M F F M M M* F F M* F F

39 17 21 42 51 28 50 36 28 24 47 26 18 34 51 4930 61 40 24 56 28 21 46 44 24 46 46

1 2 3 4

of

dialysis

Diagnosis

Sex

Age

no.

Case

Duration

Before hemodialysis

TABLE 1. The values of plasma vasopressin (Vasop.), effective plasma osmolality (Osmol.), hematocrit (Ht.), mean blood pressure (m-BP) and body weight (BW) before and after hemodialysis

1.5

50.lt

42.4 45.1 66.0 58.2 43.5 58.5 56.6 46.2 44.2 37.2 59.7 49.5 41.8 59.8 53.0 42.2 52.0 52.5 45.0 44.6 56.7 46.5 43.6 42.5 44.6 65.0 52.0 53.9

BW kg

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n

CO CO

w

o

$ CO

SHIMAMOTO, WATARAI AND MIYAHARA

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A study of plasma vasopressin in patients undergoing chronic hemodialysis.

A Study of Plasma Vasopressin in Patients Undergoing Chronic Hemodialysis KAZUAKI SHIMAMOTO, IKUO WATARAI,* AND MITSUO MIYAHARA Second Department of I...
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