Mallamaci F, Parlongo S, Zoccali C
Endothelin-1 and reflex circulatory control in dialysis
patients
33rd Congress of the Eur Dial Transplant Assoc
Nephrol Dial Transplant
(Jun) 11:A207 1996
This study investigates whether circulating Endothelin I (ET-1) is
sensitive to volume stimuli in HD patients.
Isotonic volume
removal (-2.3 L) caused a 21% fall in MAP which was accompanied by
a marked increase in plasma Norepinephrine and Epinephrine
(P<0.02) and in plasma AVP (P<0.02). Baseline plasma ET-1
concentration was markedly raised (171.1 pg/ml, Normal range 0.2-1.2
pg/ml) and was significantly related with diastolic pressure
(r=0.59, P=0.0006). However, ET-1 was very little affected by
isolated ultrafiltration. Changes in plasma ET-1 were independent of
plasma Epinephrine, Nor Epinephrine and AVP as well as of arterial
pressure changes (P>0.20). Tilting caused a 10 % fall in MAP which
was again paralleled by a marked rise in plasma catecholamins and in
plasma AVP(P<0.01). Plasma ET-1, however, did not change after
tilting and was again unrelated to plasma catecholamins, AVP and to
arterial pressure changes.This study, while confirming that
circulating ET-1 is markedly raised in dialysis patients and that in
steady state conditions it is related to arterial pressure, shows
that in these patients plasma ET-1 is unresponsive to changes in
ECV and in central blood volume of such magnitude to bring about
marked increases in sympathetic activity and in AVP release.
Comment: These data, which are fully in line with the
paper presented
at this same meeting by MF Hand et al indicate that it is
unlikely that circulating ET-1 plays a role in the
counter-regulatory response to central hypovoemia and ECV
depletion in dialysis patients (Carmine Zoccali, M.D., Reggio
Calabria, Italy).
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33rd Congress of the Eur Dial Transplant Assoc
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