Arterial hypotension in chronic hemodialyzed patients

Daul, A; Wang, Xiao L.; Michel, Martin C.; Brodde, Otto‐Erich

doi:10.1038/ki.1987.267

Cited by 77 publications

(44 citation statements)

References 25 publications

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“…In conclusion: patients on maintenance hemodialysis exhibit numerous alterations in the activity of the sympathetic nervous system [1, 2, 3]including hyporesponsiveness of α- and β-adrenoceptors [4, 7, 22, 23]. The present results show that for β-adrenoceptor hyporesponsiveness – at least partly – the presence of inhibitory substance(s) in uremic plasma could be responsible; the mechanism leading to α-adrenoceptor hyporesponsiveness remains to be elucidated.…”

Section: Discussionmentioning

confidence: 85%

“…Thus, the β-adrenoceptor agonist isoprenaline causes smaller increases in systolic blood pressure in hemodialysis patients than in controls [4]; the heart rate response to isoprenaline is also reduced in experimental uremia in rats [5]. Similarly, vascular α-adrenoceptor responsiveness was found to be reduced in chronic hemodialysis patients [6, 7]and in experimental uremia in rats [8, 9]. The mechanism underlying this α- and β-adrenoceptor hyporesponsiveness in chronic uremia is, however, only poorly investigated.…”

Section: Introductionmentioning

confidence: 99%

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Effects of Uremic Plasma on α- and β-Adrenoceptor Subtypes

Ferchland

Rettkowski²,

Pönicke³

et al. 1998

Nephron

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Responsiveness of adrenergic receptors is decreased in patients on maintenance hemodialysis. In this study we investigated whether uremic plasma might affect adrenergic receptors. For this purpose we determined the effects of uremic plasma obtained from 10 patients on hemodialysis treatment (mean age 61 ± 3 years, dialysis frequency 3 × 4 h/week, duration of treatment 3 ± 1 years) before and at the end of the 4-hour dialysis treatment on binding of radioligands to β₁- and β₂- as well as α₁- and α₂-adrenoceptors. Plasma from 6 healthy volunteers served as control; the plasmas were studied in three dilutions: undiluted, 1:1 (v/v) and 1:4 (v/v) with saline diluted. Plasma from healthy control did not significantly affect the number of β₁- and β₂- or α₁- and α₂-adrenoceptors. On the other hand, uremic plasma significantly decreased the number of β₁- and β₂-adrenoceptors; this inhibitory effect was also observed when plasma obtained at the end of the 4-hour dialysis treatment was investigated. On the other hand, uremic plasma did not significantly decrease the number of α₁- and α₂-adrenoceptors. We conclude that in patients on maintenance hemodialysis, the presence of inhibitory substance(s) in uremic plasma could be – at least partly – responsible for the β-adrenoceptor hyporesponsiveness; the mechanism leading ot α-adrenoceptor hyporesponsiveness, however, remains to be elucidated.

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Section: Discussionmentioning

confidence: 85%

Section: Introductionmentioning

confidence: 99%

Effects of Uremic Plasma on α- and β-Adrenoceptor Subtypes

Ferchland

Rettkowski²,

Pönicke³

et al. 1998

Nephron

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“…Our results show that hypotension during HD is closely associated with severe coronary arteriosclerosis, suggesting that reduced coronary blood flow capacity diminishes cardiac compensation for the loss of blood volume. Dual et al [28]demonstrated that the duration of HD negatively correlated with both the mean BP and α 2 -adrenoceptor density, and positively correlated with plasma noradrenaline level. Moreover, they noted that a reduction in α 2 -adrenoceptor responsiveness to α-adrenergic stimuli might be an important cause of hypotension in patients undergoing long-term HD treatment [28].…”

Section: Discussionmentioning

confidence: 99%

Relationship between Fluctuation Pattern of Blood Pressure during Hemodialysis Treatment and Cardiovascular Morphology: An Autopsy Study of 53 Cases

Matsumae¹,

Matsumae²,

Hasegawa

et al. 2001

Nephron

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Background: Cardiovascular morphological changes are often conspicuous in autopsy examination of chronic hemodialysis (HD) patients. On the other hand, the fluctuation pattern in blood pressure (BP) during HD treatment varies from one patient to another. Cardiovascular changes may correlate with clinical findings including BP fluctuation patterns during HD, although no autopsy studies have previously examined this issue. Methods: In this study, 53 autopsies of patients who had been on chronic HD were reviewed. We determined the relationship between BP fluctuation during HD treatment along with stable and cardiovascular morphology, including heart weight, ventricular wall thickness, circumferences of the valves and the severity of aortic arteriosclerosis and coronary stenosis. Patients were divided into 4 groups according to the pattern of BP fluctuation during HD treatment at about 6 months before death: group 1 (n = 13), symptomatic hypotension and/or decline pattern during HD; group 2 (n = 11), continuously high BP during HD treatment; group 3 (n = 17), continuous normal BP during HD treatment, and group 4 (n = 12), continuously low BP without symptomatic hypotension during HD treatment. Results: Heart weight and ventricular wall thickness were greatest in group 2. The scores for aortic arteriosclerosis in groups 1 and 2 were higher than in groups 3 and 4. The coronary stenosis index was significantly higher in group 1 than in the other groups, and that in group 2 was higher than in group 4. Multiple regression analysis showed that age, HD duration and pulse pressure were independent variables for the score of arteriosclerosis, and the decline pattern of BP fluctuation during HD and pulse pressure were independent variables for coronary stenosis index. Conclusions: Our results suggest that certain clinical parameters including BP during HD may reflect cardiovascular morphological changes in stable HD patients, although further examination, such as 24-hour blood pressure measurement is recommended to elucidate the pathophysiology of cardiovascular diseases in HD patients.

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“…Re cently. it has been shown that the concentra tion of plasma noradrenaline increased sig nificantly with increasing duration of dialysis treatment [4]. The absence o f receptor downregulation in the presence o f a high concen tration o f the physiological agonist could he the consequence o f an altered receptor func tion and/or defective postreceptor events.…”

mentioning

confidence: 99%