Abstract
Remarkable hyperaldosteronemia (HA) (PAC>160ng/dl) has been recognized in about 20% of patients on long-term hemodialysis (HD) therapy in Japan. We have shown that the weight gain occurring after renal transplantation from live-related donors in non-nephrectomized recipients with remarkable HA was significantly higher than in other patients, and concluded that chronic and severe dehydration during HD therapy could cause remarkable HA. In the present study, the effects of increment of body weight (BW) on PAC, PRA and other clinical findings were investigated in 10 HD patients with remarkable HA. BW before and after HD was increased from 1.7±0.2kg (3.0±0.3%) to 2.0±0.2kg (3.6±0.4%), respectively. Hypotensive episodes during HD found in 7 patients were eliminated in all cases. CTR was increased (45.0±1.4→48.1±1.4%) and blood pressure before HD was elevated significantly in each patient. PAC and PRA before HD were decreased significantly (PAC, 331±48→119±17ng/dl, PRA 6.1±1.3→3.0±0.6ng/ml/h). A significant correlation was recognized between the rate of decrease of PAC and the rate of increase of BW. From these results, we conclude that chronic dehydration during long-term HD therapy causes remarkable HA (perhaps showing adrenal hyperplasia) which can be corrected by fluid replacement. Measurement of PAC and PRA may be useful for evaluating the dry weight of chronic HD patients.
