Effect of Hemodialysis on Plasma Levels of Vasoactive Peptides: Endothelin, Calcitonin Gene-Related Peptide and Human Atrial Natriuretic Peptide

Abstract

To determine the role of vasoactive peptides such as endothelin (ET), calcitonin gene-related peptide (CGRP) and human atrial natriuretic peptide (hANP) in the regulation of blood pressure in uremic patients, and to determine the effect of various types of dialyzer membranes on hemodialysis (HD)-induced changes in plasma levels of such peptides, plasma ET, CGRP and hANP were measured in HD patients and patients on continuous ambulatory peritoneal dialysis (CAPD). Plasma levels of ET, CGRP, and hANP were significantly higher in HD and CAPD patients than in healthy subjects. There were no significant differences in plasma levels of ET, CGRP, and hANP between hypertensive and normotensive HD patients, and no significant correlation was observed between HD-induced changes in plasma levels and changes in blood pressure. Plasma levels of ET decreased when HD was performed using high-flux membranes, such as polyacrylonitrile (PAN), polymethyl methacrylate (PMMA) and cellulose triacetate (CTA), but did not decrease using a saponified cellulose (SC) membrane. Plasma levels of CGRP decreased in the case of PAN, but increased significantly with PMMA and showed no change with SC and CTA. Plasma levels of hANP decreased in all types of dialyzer membranes due to decreased secretion. These results indicate that the effect of HD on plasma levels of ET and CGRP, but not hANP, depends on the type of dialyzer membrane used.

Effect of a Hemodialysis Session on Plasma Levels of Endothelin-1 in Hypertensive and Normotensive Subjects with End-Stage Renal Failure

“…In agreement with an earlier report by Koyama et al [4], others have also found a decrease in plasma ET-1 concentrations on hemodialysis [7, 8], in contrast to those who reported unchanged [5, 11, 13]or even increased [14]plasma ET-1 after a hemodialysis session. In addition, it was not clarified whether volume loss associated with ultrafiltration or hemodialysis is responsible for changes in plasma ET-1 associated with hemodialysis [11, 13, 14, 15, 16]. …”

“…Since they studied an unselected group of ESRF subjects it is likely that both normotensives and hypertensives were included, all the more because 8 out of their 16 subjects had left ventricular hypertrophy on echocardiography. For the same reason, namely the lack of division of the study group on the basis of blood pressure values, we are not able to comment on the lack of effect of isolated ultrafiltration through non-high-flux dialyzers on plasma ET-1 reported by Peco-Antic et al [15]in children and by Niwa et al [11]in adults. However, that Peco- Antic et al [15]reported that isolated hemodialysis produced more pronounced rises in the children with hypertrophied left ventricle (and presumably with hypertension), is not totally discordant with our finding of elevated plasma ET-1 in hypertensives after the first protocol stage.…”

“…Plasma levels of ET-1 were shown to be elevated in patients with end-stage renal failure (ESRF) on maintenance hemodialysis [4, 5, 6, 7, 8, 9, 10, 11, 12]. This phenomenon may be due to impaired renal clearance of ET-1 [10]and as well it may be partially linked to the process of dialysis by itself [4, 5, 10].…”

“…Miyauchi et al [7]have even observed a correlation between predialysis values of blood pressure and plasma ET-1. On the other hand, Stockenhuber et al [9]and Niwa et al [11]reported that plasma ET-1 was elevated to a similar degree in the normotensive ESRF subjects and those with borderline or established hypertension. Similarly, Warrens et al [5]and Mallamaci et al [10]detected no relationship between arterial blood pressure and ET-1 in blood samples drawn prior to a hemodialysis session.…”

Endothelin in renal disease: role of endothelin antagonists

“…This may explain the differences observed between peritoneal dialysis (CAPD) and no dialysis on the one hand and haemodialysis on the other, although this is controversial [46,58]. High-flux membranes (PAN, PMMA, CTA) seem to clear endothelin better than normal membranes [61]. Whether these findings reflect a pathogenetic role for endothelin in chronic renal disease in humans will be clarified by appropriate clinical studies with endothelin antagonists in the future.…”