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Effects of mildly increasing dialysis sodium removal on renin and sympathetic system in hemodialysis patients

Shen, Yang ; Sun, Fang ; Liu, Jing ; Ma, Lijie ; Huang, Jing ; Zhou, Yilun ; Liu, Wenhu

Chinese medical journal, 2014, Vol.127 (14), p.2628-2631 [Periódico revisado por pares]

China: Faculty of Kidney Diseases, Capital Medical University, Beijing 100050, China%Department of Nephrology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing 100020, China%Department of Nephrology, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China

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  • Título:
    Effects of mildly increasing dialysis sodium removal on renin and sympathetic system in hemodialysis patients
  • Autor: Shen, Yang ; Sun, Fang ; Liu, Jing ; Ma, Lijie ; Huang, Jing ; Zhou, Yilun ; Liu, Wenhu
  • Assuntos: Adult ; Blood Pressure - drug effects ; Female ; Humans ; Hypertension - therapy ; Male ; Middle Aged ; Prospective Studies ; Renal Dialysis ; Renin-Angiotensin System - drug effects ; Sodium - pharmacology ; Sympathetic Nervous System - drug effects ; 交感神经系统 ; 患者 ; 抗高血压药物 ; 稳定状态 ; 肾素 ; 血液透析 ; 血管紧张素 ; 除钠
  • É parte de: Chinese medical journal, 2014, Vol.127 (14), p.2628-2631
  • Notas: dialysate sodium; hemodialysis; renin system;sodium removal; sympathetic system
    Shen Yang, Sun Fang, Liu Jing, Ma Lijie, Huang Jing, Zhou Yilun and Liu Wenhu
    Background It has been argued that the benefits of reducing sodium loading may be offset by increased activation of the renin-angiotensin-aldosterone system （RAAS） and sympathetic nervous system. This study aimed to investigate the long-term effects of an increase in dialysis sodium removal on circulating RAAS and sympathetic system in hypertensive hemodialysis （HD） patients with ＂normal＂ post-HD volume status. Methods Thirty hypertensive HD patients were enrolled in this pilot trial. After one month period of dialysis with standard dialysate sodium of 138 mmol/L, the patients were followed up for a four months period with dialysate sodium set at 136 retool/L, without changes in instructions regarding dietary sodium control. During the period of study, the dry weight was adjusted monthly under the guidance of bioimpedance spectroscopy to maintain post-HD volume status in a steady state; 44-hour ambulatory blood pressure, plasma renin, angiotensin II （Ang II）, aldosterone, and norepinephrine （NE） were measured. Results After four months of HD with low dialysate sodium of 136 mmol/L, 44-hour systolic and diastolic blood pressures （BPs） were significantly lower （-10 and -6 mmHg）, in the absence of changes in antihypertensive medications. No significant changes were observed in plasma renin, Ang II, aldosterone, and NE concentrations. The post-HD volume parameters were kept constant. Conclusion Mildly increasing dialysis sodium removal over 4 months can significantly improve BP control and does not activate circulating RAAS and sympathetic nervous system in hypertensive HD patients. Chin Med J 2014;127 （14）： 2628-2631
    11-2154/R
    ObjectType-Article-2
    SourceType-Scholarly Journals-1
    ObjectType-Feature-1
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  • Descrição: Background It has been argued that the benefits of reducing sodium loading may be offset by increased activation of the renin-angiotensin-aldosterone system （RAAS） and sympathetic nervous system. This study aimed to investigate the long-term effects of an increase in dialysis sodium removal on circulating RAAS and sympathetic system in hypertensive hemodialysis （HD） patients with ＂normal＂ post-HD volume status. Methods Thirty hypertensive HD patients were enrolled in this pilot trial. After one month period of dialysis with standard dialysate sodium of 138 mmol/L, the patients were followed up for a four months period with dialysate sodium set at 136 retool/L, without changes in instructions regarding dietary sodium control. During the period of study, the dry weight was adjusted monthly under the guidance of bioimpedance spectroscopy to maintain post-HD volume status in a steady state; 44-hour ambulatory blood pressure, plasma renin, angiotensin II （Ang II）, aldosterone, and norepinephrine （NE） were measured. Results After four months of HD with low dialysate sodium of 136 mmol/L, 44-hour systolic and diastolic blood pressures （BPs） were significantly lower （-10 and -6 mmHg）, in the absence of changes in antihypertensive medications. No significant changes were observed in plasma renin, Ang II, aldosterone, and NE concentrations. The post-HD volume parameters were kept constant. Conclusion Mildly increasing dialysis sodium removal over 4 months can significantly improve BP control and does not activate circulating RAAS and sympathetic nervous system in hypertensive HD patients. Chin Med J 2014;127 （14）： 2628-2631
  • Editor: China: Faculty of Kidney Diseases, Capital Medical University, Beijing 100050, China%Department of Nephrology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing 100020, China%Department of Nephrology, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
  • Idioma: Inglês
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