CLINICAL STUDY OF TOTAL PLASMA VOLUME, TOTAL BODY EXCHANGEABLE SODIUM AND PLASMA RENIN ACTIVITY IN PATIENTS WITH MAINTENANCE HEMODIALYSIS
1979 Volume 70 Issue 11 Pages 1189-1202
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1979 Volume 70 Issue 11 Pages 1189-1202
Recently as the cases of long-term hemodialysis have increased, it has become very important in the maintenance hemodialysis to prevent the complications of hemodialysis; hypertension, anemia and disorder of Ca metabolism. In our research hypertension, one of those complications, will be analyzed for the cause and condition. Thirty-four cases of long-term maintenance hemodialysis are examined about PRA, TBV, TPV and [Na]E.
The results of our analysis are as follows:
I) Studies on PRA, body fluid volume and blood pressure
1. In the cases of long-term maintenance hemodialysis TPV before hemodialysis reduces to about 80% of the normal value; TBV to about 70%. Significant difference can not be found out in TPV and TBV after hemodialysis.
2. Systolic pressure before hemodialysis has much relation to TPV, TPV/Kg and TPV/m2 (r=0.65, 0.68, 0.62). Diastolic pressure before hemodialysis also has much relation to TPV, TPV/Kg and TPV/m2 (r=0.60, 0.68, 0.62). But both systolic pressure and diastolic pressure after hemodialysis have no relation to TPV, TPV/Kg and TPV/m2. Additionally TBV has the same relation to blood pressure as the relation between TPV and blood pressure.
3. Before hemodialysis PRA has much relation to TPV, TPV/Kg and TPV/m2 (r=0.88, -0.85, -0.87).
4. Sodium space is found to reduce after hemodialysis; [Na]E is 1099±122mEq. But [Na]E has no relation to blood pressure and PRA.
Those facts above show us that in the cases of long-term maintenance hemodialysis blood pressure is much affected by TPV and TBV. And the reduce of body fluid after hemodialysis is indicated by that of sodium space, and TPV and TBV are not different after hemodialysis, although fluid is removed from vessels.
II) Influence of hemodialysis on PRA
1. PRA at the hemodialysis is apt to increase in its development.
2. In using high Na dialysate TPV and TBV are higher and PRA is lower than in using low Na dialysate.
It shows that the use of high Na dialysate retains water and Na in the body so that TPV and TBV increase and PRA decreases.
III) Clinical classification of long-term hemodialysis cases
The cases of long-term hemodialysis are examined, being divided into the next four groups from the points of PRA and blood pressure.
(A) Normal PRA and normotension group: in the cases the passages of hemodialysis are wholly good.
(B) Normal PRA and hypertension group: which is considered ‘Water and salt dependent hypertension’. In the cases ultrafiltration at the hemodialysis can bring hypertension to normotension.
(C) High PRA and hypertension group: in the cases what is diagnosed ‘Renin dependent hypertension’ bilateral nephrectomy should be done immediately. In other cases ultrafiltration at the hemodialysis can bring hypertension to normotension.
(D) High PRA and normotension group: in the group high PRA is caused by hypovolemia, so the increase of TBV and TPV can reduce PRA.
Group (B), (C), (D) should be improved to the condition of group (A) by treatment. This classification shows us the suitable treatment for each group of long-term hemodialysis cases.
