Plasma Concentration of Antidiuretic Hormone in Patients with Chronic Renal Insufficiency on Maintenance Dialysis

Abstract

Radioimmunoassay of plasma arginine-vasopressin (AVP) in regularly dialyzed patients with chronic renal insufficiency revealed a parallel increase of AVP and plasma osmolality (POsm) before dialysis (4.16 +/- 0.36 pg/ml and 312.6 +/- 1.80 mOsm/1) and their parallel declin to the normal range (1.93 +/- 0.27 pg/ml and 292.0 +/- 1.27 mOsm/1) during dialysis. Plasma AVP correlated with POsm before and after dialysis (r = 0.611 and 0.453, p less than 0.01 and less than 0.05 respectively). The increase of AVP before dialysis was lower than would correspond to the rise of POsm and lower than that recorded in healthy subjects during dehydration. Statistical correlation between plasma AVP and indicators of body fluid volume changes between or during dialysis were not proved. We found statistical correlation between the mean blood pressure and AVP before dialysis (r = 0.468, p less than 0.05). These findings suggest that in chronic renal insufficiency changes of POsm remain primary regulating factor of AVP secretion. The expansion of extracellular fluid volume has probably only a modifying effect. It remains to be elucidated whether the revealed statistical relationship between the mean blood pressure and AVP before dialysis plays also a pathogenetic role in the development of hypertension in chronic renal insufficiency.

Regulation of Plasma Arginine Vasopressin in Patients with Chronic Renal Failure Maintained on Hemodialysis

“…Our results indicating the lack of correlation of AVP versus osmolality and AVP versus mean blood pressure were in agreement with those of Shimamito et al [10], Vaziri et al [12] and Pastoriza-Munoz et al [8], but dis agreed with those of Horky et al [11], who found a weak but positive correlation between blood pressure versus AVP before dialysis only and serum osmolality versus AVP for both before and after dialysis. Variability in salt and fluid intake, type of instruments, dialysing mem brane and dialysate may contribute to these differences.…”

Dialysis Hypotension: A Role for Inadequate Increase in Arginine Vasopressin Levels? A Systematic Literature Review and Meta-Analysis

“…Twenty-six of these studies, comprising 496 patients, were eligible for the meta-analysis since these studies reported the mean and standard deviation of plasma AVP levels before and after standard HD. Several studies observed a significant increase in plasma AVP levels during HD [15,16,29,38,52,53,57], whereas the other studies did not [32,33,34,35,36,37,39,40,41,42,43,44,46,49,50,51,54,55,56,58]. Overall, plasma AVP levels showed little or no increase during standard HD (7.0 ± 4.9 and 8.8 ± 9.3 pg/ml for pre- and post-HD, respectively; p = 0.433) .…”

“…Other stimuli for the release of AVP during HD include nausea and pain related to puncture of the fistula. The effect of conventional HD on plasma osmolality is not well delineated, with some studies reporting no change [29,34] and others reporting a decrease in plasma osmolality [15,35,36,37,38,39,40,41,42,43,44]. Table 1 summarizes the theoretical effects of HD on AVP release.…”

“…Other studies did not specify whether their patient populations were hypotension-prone or not, but also found no change, or even a decrease, in plasma AVP levels during HD, irrespective of whether blood pressure remained stable [41,43,50,51,58] or decreased during HD [33,35,36,39,40,46]. …”

Estrogen-Stimulated Neurophysin in Chronic Renal Failure

“…It was reported that in patients undergoing hemodialysis, plasma A DH levels were significantly increased [6,15]. Elevation of plasma neuro physin in patients with CRF has also been observed [1,2,7,13].…”