J Korean Med Sci.  2007 Aug;22(4):604-610. 10.3346/jkms.2007.22.4.604.

Associations between Sympathetic Activity, Plasma Concentrations of Renin, Aldosterone, and Parathyroid Hormone, and the Degree of Intractability of Blood Pressure Control in modialysis Patients

Affiliations
  • 1Department of Internal Medicine, Soonchunhyang University College of Medicine, Cheonan, Korea. hwgil@sch.ac.kr
  • 2Department of Medical Informatics & Epidemiology, Soonchunhyang University College of Medicine, Cheonan, Korea.
  • 3Department of Biostatistics, Soonchunhyang University College of Medicine, Cheonan, Korea.

Abstract

This study was designed to examine how such factors as hemodialysis parameters, body mass index, renin and aldosterone concentrations, sympathetic nervous activity, and parathyroid hormone concentrations are associated with the control of hypertension in hemodialysis patients. Hemodialysis patients (n=114) were grouped into four categories. Group 1 had normal BP without antihypertensive medication. Group 2 needed one antihypertensive drug, Group 3 needed combination of two or three categories of antihypertensive drugs without minoxidil. Group 4 needed more than three categories of antihypertensive drugs including minoxidil. Parathyroid hormone, beta2-microglobulin, renin and aldosterone, epinephrine, norepinephrine, and hemodialysis parameters were measured. The fractional clearance of urea as Kt/V urea was significantly lower in Group 3 and Group 4 than in Group 2 (p<0.01). Concentrations of parathyroid hormone were significantly higher in Group 4 than the other groups (p<0.01). Pre-hemodialysis norepinephrine concentrations were significantly higher in Group 4 than the other groups (p<0.05). Traditional factors associated with hypertension did not seem to be relevant to the degree of hypertension in hemodialysis patients in the present study. In conclusion, poor Kt/V urea, elevated parathyroid hormone concentrations, and elevated concentrations of plasma norepinephrine seemed to be the factors that might be associated with control of hypertension in hemodialysis patients.

Keyword

Hypertension; Hemodialysis; Hyperparathyroidism

MeSH Terms

Adult
Aged
Aldosterone/*blood
Analysis of Variance
Antihypertensive Agents/therapeutic use
Blood Pressure/drug effects/*physiology
Epinephrine/blood
Female
Humans
Hypertension/blood/drug therapy/physiopathology
Kidney Failure, Chronic/blood/physiopathology/therapy
Male
Middle Aged
Norepinephrine/blood
Parathyroid Hormone/*blood
*Renal Dialysis
Renin/*blood
Sympathetic Nervous System/*physiology
Urea/metabolism

Figure

  • Fig. 1 Comparison of the fractional clearance of urea as a function of its distribution volume (Kt/V urea) among groups. The value of Kt/V urea was significantly lower in Groups 3 and 4 (*) than in Group 2 tested by one-way analysis of variances (p<0.01) and Turkey's multiple comparison test. iPTH, intact parathyroid hormone.

  • Fig. 2 Comparison of the concentration of intact parathyroid hormone (PTH) among groups. Intact PTH concentrations were significantly higher in Group 4 (*) compared to the other groups tested by oneway analysis of variances (p<0.01) and Turkey's multiple comparison test.

  • Fig. 3 Comparison of norepinephrine concentrations among groups. Norepinephrine concentrations prior to hemodialysis (pre-HD) were significantly higher in Group 4 (*) than in Groups 1 and 3 tested by one-way analysis of variances (p<0.05) and Turkey's multiple comparison test.


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