Clinical Investigation

Kidney International (1993) 44, 107–114; doi:10.1038/ki.1993.219

Abnormal hemodynamics and elevated angiotensin II plasma levels in polydipsic patients on regular hemodialysis treatment

Giorgio Graziani1, Salvatore Badalamenti1, Alberto Del Bo1, Monica Marabini1, Gabriella Gazzano1, Giovanna Como1, Elena Viganò1, Giancarlo Ambroso1, Alberto Morganti1 and Lucia Turolo with the technical assistance of1

1Divisione di Nefrologia e Dialisi Ospedale Maggiore IRCCS, and Istituto Clinica Medica Generale e Terapia Medica and Centro di Fisiologia Clinica e Ipertensione, Università di Milano, Milan, Italy

Correspondence: Professor Giorgio Graziani, Divisione Nefrologia e Dialisi, Via Commenda 15, 20122 Milano, Italy.

Received 4 May 1992; Revised 16 February 1993; Accepted 18 February 1993.

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Abstract

Abnormal hemodynamics and elevated angiotensin II plasma levels in polydipsic patients on regular hemodialysis treatment. To investigate the cause and the mechanisms responsible of the compulsive thirst and excessive fluid intake observed in many patients on chronic dialysis treatment, we measured plasma antidiuretic hormone (ADH), angiotensin II (Ang II) and some hemodynamic parameters in seven polydipsic and in six normodipsic patients before hemodialysis, at the end of it and several times during the interdialytic interval. Before dialysis we found that ADH was elevated in both groups (6.9 plusminus 1.9 vs. 6.9 plusminus 1.3 pg/ml, respectively in polydipsics and controls), whereas Ang II was abnormally high only in polydipsics (51 plusminus 12 vs. 11 plusminus3 pg/ml, P < 0.01); these patients also had significantly higher heart rate and cardiac indices and lower total peripheral resistances than control patients. Overall these hemodynamic indices were related with Ang II but not with ADH. Ang II rose markedly in polydipsics after dialysis, reaching a peak at the fourth hour after its termination (136 plusminus 12 pg/ml) and remained consistently elevated throughout the interdialytic period, whereas in controls Ang II was practically unchanged with respect to baseline. In contrast, ADH had minor and similar modifications in both groups, in whom also the hemodynamic changes were superimposable. Significant correlations were found between the absolute and percent changes of Ang II and those of plasma volume during the interdialytic interval (P < 0.001 for both), and between the individual values of Ang II measured during the whole study and the interdialytic weight gain (P < 0.05). These results demonstrate that polydipsic patients have abnormally high levels of Ang II before and after the hemodialysis-induced volume depletion. The high circulating levels of this peptide are expression of the hyperreactivity of the renin system that, apparently, represents the humoral counterpart of an hyperkinetic circulation which, in conjunction with the dipsogenic effect of Ang II, may be the cause of the compulsive thirst complained by these patients.

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References

  1. Oldenburg B, MacDonald GJ, Perkins RJ: Factors influencing excessive thirst and fluid intake in dialysis patients. Dial Transplant 17:21–23, 1988
  2. Henrich WL: Hemodynamic instability during hemodialysis. Kidney Int 30:605–612, 1986 | PubMed | ISI | ChemPort |
  3. Fitzsimons JT: The Physiology of Thirst and Sodium Appeti. Cambridge, Cambridge University Press, 1979
  4. Rolls BJ, Rolls ET: Thirst. Cambridge, Cambridge University Press, 1982
  5. Robertson GL: Thirst and vasopressin function in normal and disordered states of water balance. J Lab Clin Med 101:351–371, 1983
  6. Rogers PW, Kurtzman NA: Renal failure, uncontrollable thirst and hyperreninemia. Cessation of thirst with bilateral nephrectomy. JAMA 225:1236–1238, 1973
  7. Wirth JB, Folstein MF: Thirst and weight gain during hemodialysis. Psychosomatics 23:1125–1134, 1982 | PubMed |
  8. Yamamoto T, Shimizu M, Morioka M, Kitano W, Wakabayashi H, Aizawa N: Role of angiotensin II in the pathogenesis of hyperdipsia in chronic renal failure. JAMA 256:604–608, 1986
  9. Caillens H, Pruszczynski W, Meyrier A, Ang KS, Rousselet F, Ardaillou R: Relationship between change in volemia at constant osmolality and plasma antidiuretic hormone. Miner Electrol Metabol 4:161–171, 1980
  10. Jawadi MH, Ho LS, Dipette D, Ross DL: Regulation of plasma arginine-vasopressin in patients with chronic renal failure maintained on hemodialysis. Am J Nephrol 6:175–181, 1986
  11. Watson PE, Watson ID, Batt RD: Total body volumes for adult males and females estimated from simple anthropometric measurements. Am J Clin Nutr 33:27–39, 1980 | PubMed | ISI | ChemPort |
  12. Santoro A, Mancini E, Spongano M, Rossi M, Paolini F, Zucchelli P: A haemodynamic study of hypotension during haemodialysis using electrical bioimpedance cardiography. Nephrol Dial Transplant 5(Suppl 1):S147–S153, 1990
  13. Editorial: Measurement of cardiac output. Lancet ii:257–258, 1988
  14. Graziani G, Como G, Ambroso G, Badalamenti S, Morganti A, Ponticelli C: The reliability of thoracic fluid bioimpedance in haemodialysis patients, (submitted for publication)
  15. Maher JF: Replacement of Renal Function by Dialysis. Boston, Kluwer Academic Publishers, 1989, p. 776
  16. Morganti A, Grassi G, Giannattasio C, Bolla G, Turolo L, Saino A, Sala C, Mancia G, Zanchetti A: Effect of angiotensin converting enzyme inhibition on cardiovascular regulation during reflex sympathetic activation in sodium-replete patients with essential hypertension. J Hypertens 7:825–835, 1989 | PubMed |
  17. Del Bo A, Marabini M, Morganti A, Zanchetti A: Regulation of vasopressin release in moderately severe essential hypertension. Clin Auton Res 1:109–114, 1991
  18. Kirschbaum B: Comparison of indirect methods to estimate plasma volume changes during hemodialysis. Int J Artif Organs 12:307–313, 1988
  19. Winer DS: Statistical Principles in Experimental Designs. New York, McGraw-Hill, 1971
  20. Arieff AI, Massry SG, Barrientos A, Kluman C: Brain water and electrolyte metabolism in uremia, effects of slow and rapid hemodialysis. Kidney Int 4:177–187, 1973 | PubMed | ISI | ChemPort |
  21. Rabkin R, Share L, Payne PA, Young J, Crafton J: The handling of immunoreactive vasopressin by the isolated perfused rat kidney. J Clin Invest 63:6–13, 1979
  22. Argent NB, Burrell LM, Goodship THJ, Wilkinson R, Baylis PH: Osmoregulation of thirst and vasopressin release in severe chronic renal failure. Kidney Int 39:295–300, 1991
  23. Shimamoto K, Ando T, Nakao T, Watarai I, Miyahara M: Permeability of antidiuretic hormone and other hormones through the dialysis membrane in patients undergoing chronic hemodialysis. J Clin Endocrinol Metab 45:818–820, 1977
  24. Pruszczynski W, Viron B, Mignon F, Ardaillou R: Massive plasma arginine vasopressin (AVP) removal during hemofiltration stimulates AVP secretion in humans. J Clin Endocrinol Metab 64:383–386, 1987
  25. Peck JW, Blass EM: Localization of thirst and antidiuretic osmoreceptors by intracranial injections in rats. Am J Physiol 228:1501–1509, 1975
  26. Phillips PA, Rolls BJ, Ledingham JYY, Forsling ML, Morton JJ, Row MJ, Wollner L: Reduced thirst after water deprivation in healthy elderly men. N Engl J Med 311:753–759, 1984
  27. Davis JO, Freeman RH: Mechanisms regulating renin release. Physiol Rev 56:1–56, 1976 | PubMed | ISI | ChemPort |
  28. Lumbers ER, McCloskey DI, Potter EK: Inhibition of baroreceptor evoked activity in cardiac vagal efferent nerves by angiotensin II. J Physiol 294:69–80, 1979
  29. Freer RJ, Pappano AJ, Peach MJ, Bing KT, McLean MJ, Vogel S, Sperelakis N: Mechanism for the positive inotropic effect of angiotensin II on isolated cardiac muscle. Circ Res 39:178–183, 1975
  30. Henderson LW, Chenoweth DE: Biocompatibility of artificial organs; an overview. Blood Purif 5:100–111, 1987
  31. Cavaillon JM, Poignet JL, Fitting C, Delons S: Serum interleukin-6 in long-term hemodialyzed patients. Nephron 60:307–313, 1992 | PubMed | ISI | ChemPort |
  32. Quillen EW, Reid IA, Keil LC: Cardiac and arterial baroreceptor influences on plasma vasopressin and drinking, in Vasopressin: Cellular and Integrative Functions, edited by Cowley AW, Liard JF Ausiello DA, New York, Raven Press, 1988, p. 405
  33. Phillips PA, Rolls BJ, Ledingham JGG, Morton JJ, Forsling NL: Angiotensin II induced thirst and vasopressin release in man. Clin Sci 68:669–674, 1985
  34. Mann JFE, Johnson AK, Ganten D, Ritz E: Thirst and the renin-angiotensin system. Kidney Int 32(Suppl 21):S27–S34, 1987
  35. Rolls BJ, Wood RJ, Rolls ET, Lind H, Lind W, Ledingham JGG: Thirst following water deprivation in humans. Am J Physiol 239:R476–R482, 1986
  36. Barney CE, Katovich MJ, Fregly MJ: The effect of acute administration of angiotensin I converting enzyme inhibitor on experimental induced thirst in rats. J Pharmacol Exp Ther 212:53–57, 1980
  37. Robinson MM, Evered MD: Angiotensin II and arterial pressure in the control of thirst, in The Physiology of Thirst and Sodium Appetite, edited by De Caro G, Epstein AN, Massi M, New York, Plenum Press, 1986, p. 193
  38. Reid I: Actions of angiotensin on the brain: Mechanism and physiological role. Am J Physiol 246:F533–F543, 1984
  39. Phillips MI: Functions of angiotensin in the central nervous system. Ann Rev Physiol 49:413–435, 1987 | ChemPort |
  40. Grossman SP: Brain mechanism of thirst: Intracranial angiotensin, in Thirst and Sodium Appetite. Physiological Basis. London, Academic Press, 1990, p. 133
  41. Ganong WF: The brain renin-angiotensin system. Annu Rev Physiol 46:17–31, 1984
  42. Costales M, Vijande M, Marin B, Brime JI, Lopez-Sela P: Renin dependence of insulin induced thirst, in The Physiology of Thirst and Sodium Appetite, edited by De Caro G, Epstein AN, Massi M, New York, Plenum Press, 1986, p. 181
  43. Oldemburg B, MacDonald GJ, Shelley S: Controlled trial of enalapril in patients with chronic fluid overload undergoing dialysis. Br Med J 296:1089–1091, 1988
  44. Vaughan ED, Carey RM, Ayers CR, Peach MJ: Hemodialysis resistant hypertension: Control with an orally active inhibitor of angiotensin converting enzyme. J Clin Endocrinol Metab 48:869–871, 1979

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