Catecholamines, Renin, Aldosterone and Arterial Pressure in Patients on Chronic Hemodialysis Treatment

To assess the interaction between adrenergic activity and blood pressure regulation, plasma catecholamines (CA), plasma renin activity (PRA) and plasma aldosteron (PA) were measured in 66 normal subjects and 18 dialysis patients. Prior to dialysis, blood levels of free norepinephrine (NE), epinephrine (E) and PRA were normal, but total (free and conjugated) CA as well as PA were significantly elevated.There was a spectrum of response during hemodialysis. On an average mean arterial blood pressure (MAP) fell during the first two hours of treatment, concomitantly followed by an increase in mean NE level. Whereas PRA and PA were highest at the end of treatment, mean free NE returned promptly to predialysis values through the late dialysis period. Severe hypotensive episodes during dialysis were associated with a baroreceptor-mediated adrenergic stimulation. These results indicate a qualitatively normal reaction of dialysis patients to volume removal and the importance of the renin-angiotensin-system in maintaining blood pressure during dialysis.