Effect of Changes in Posture and Volume Expansion on Central Venous Pressure (CVP). Atrial Natriuretic Peptide (ANP), and Plasma Renin Activity (PRA) in Patients with Chronic Renal Failure (CRF)

1993 ◽  
Vol 84 (s28) ◽  
pp. 32P-32P
Author(s):  
SY Tan ◽  
K Craig ◽  
CP Swainson
1987 ◽  
Vol 72 (1) ◽  
pp. 19-24 ◽  
Author(s):  
Robert G. Walker ◽  
Charles P. Swainson ◽  
Tim G. Yandle ◽  
M. Gary Nicholls ◽  
Eric A. Espiner

1. Plasma levels of immunoreactive alpha human atrial natriuretic peptide (IR-ANP) were measured in nine patients with chronic renal failure before and after removal of 1.3–3.7 litres of fluid by ultrafiltration and again during volume repletion with intravenous sodium chloride solution (150 mmol/l: saline). 2. Baseline levels of IR-ANP were elevated but fell by 22% during ultrafiltration. 3. Saline infusion induced a rapid and steep rise in IR-ANP levels which were 150% of baseline while body weight was still 2% below baseline. 4. Changes in plasma renin, angiotensin II, aldosterone and vasopressin during the study were slight compared with the change in IR-ANP, but noradrenaline levels rose threefold during ultrafiltration. 5. There was a significant positive relationship between arterial pressure and IR-ANP levels before and after ultrafiltration. 6. These results lend support to the suggestion that atrial peptides are of physiological importance, especially in states of chronic fluid overload such as chronic renal failure.


1992 ◽  
Vol 73 (2) ◽  
pp. 530-538 ◽  
Author(s):  
C. Stadeager ◽  
L. B. Johansen ◽  
J. Warberg ◽  
N. J. Christensen ◽  
N. Foldager ◽  
...  

To investigate whether prolonged water immersion (WI) results in reduction of central blood volume and attenuation of renal fluid and electrolyte excretion, these variables were measured in connection with 12 h of immersion. On separate days, nine healthy males were investigated before, during, and after 12 h of WI to the neck or during appropriate control conditions. Central venous pressure, stroke volume, renal sodium (UNaV) and fluid excretion increased on initiation of WI and thereafter gradually declined but were still elevated compared with control values at the 12th h of WI. Atrial natriuretic peptide (ANP) concentration in plasma initially increased threefold during WI and thereafter declined to preimmersion levels, whereas plasma renin activity, plasma aldosterone, and norepinephrine remained constantly suppressed. It is concluded that, compared with the initial increases, central blood volume (central venous pressure and stroke volume) is reduced during prolonged WI and renal fluid and electrolyte excretion is attenuated. UNaV is still increased at the 12th h of WI, whereas renal water excretion returns to control values within 7 h. The WI-induced changes in ANP, plasma renin activity, plasma aldosterone, and norepinephrine may all contribute to the initial increase in UNaV. The results suggest, however, that the attenuation of UNaV during the later stages of WI is due to the decrease in ANP release.


1987 ◽  
Vol 131 (2) ◽  
pp. 265-272 ◽  
Author(s):  
H. J. SCHÜTTEN ◽  
A. C. JOHANNESSEN ◽  
C. TORP-PEDERSEN ◽  
K. SANDER-JENSEN ◽  
P. BIE ◽  
...  

1983 ◽  
Vol 245 (2) ◽  
pp. H194-H202 ◽  
Author(s):  
G. M. London ◽  
J. A. Levenson ◽  
M. E. Safar ◽  
A. C. Simon ◽  
A. P. Guerin ◽  
...  

Central and forearm arterial and venous hemodynamics, arterial baroreflex sensitivity, plasma renin activity, and catecholamines were studied in supine position and after -10 degrees head-down tilt in 29 patients with sustained essential hypertension and in 29 normotensive controls of the same age and sex. In both populations, blood pressure, heart rate, and arterial baroreflex sensitivity did not change during the maneuver. Head-down tilt induced a similar increase in cardiopulmonary blood volume in controls and hypertensives, whereas the increase in central venous pressure, cardiac output, and forearm blood flow was higher in hypertensives. Forearm venous tone decreased in controls (from 16.6 +/- 0.8 to 13.8 +/- 0.9 mmHg X ml-1 X 100 g-1; P less than 0.01) but did not change in hypertensive patients (24.9 +/- 1.6 vs. 25.1 +/- 1.9. The magnitude of forearm vascular resistance changes induced by head-down tilt were significantly related to the basal venous tone in the overall population (P less than 0.01). The decrease in plasma renin activity and plasma catecholamines was similar in the two groups. The study provides the evidence that the higher increase in cardiac output and local flow observed in head-down tilt in hypertensive patients is probably due to a higher change in central venous pressure related to a decrease in venous distensibility.


1985 ◽  
Vol 249 (4) ◽  
pp. H807-H813
Author(s):  
G. M. London ◽  
A. P. Guerin ◽  
J. D. Bouthier ◽  
A. M. London ◽  
M. E. Safar

Plasma renin activity (PRA) and systemic and forearm hemodynamics were studied during acute changes in cardiopulmonary blood volume and central venous pressure in 20 subjects, including 9 normotensive controls and 11 essential hypertensive patients of the same age. Changes in cardiopulmonary blood volume and central venous pressure were induced by a "head-down" tilt and thigh-cuff inflation. Blood pressure, pulse pressure, and heart rate did not change during cardiopulmonary blood volume variations, whereas significant changes in cardiac output, forearm blood flow, and PRA were observed. A significant negative correlation between cardiopulmonary blood volume (CPBV) and PRA existed, and slope of this correlation of delta PRA/delta CPBV was estimated as a sensitivity index of control of renin release. Sensitivity of neural control of renin release was not statistically different in normal subjects and hypertensive patients. In two groups, sensitivity of this reflex mechanism similarly decreased with age. Aging seems to be an important factor influencing the sensitivity of neural control of renin release, both in normal and essential hypertensive humans.


1986 ◽  
Vol 71 (2) ◽  
pp. 157-160 ◽  
Author(s):  
M. R. Wilkins ◽  
J. A. Wood ◽  
D. Adu ◽  
C. J. Lote ◽  
M. J. Kendall ◽  
...  

1. Plasma immunoreactive human atrial natriuretic peptide (Ir-ANP) levels were measured in eight patients with chronic renal failure who were volume-expanded and during treatment by sequential ultrafiltration and haemodialysis. One patient was studied at two separate treatment sessions. 2. Plasma Ir-ANP levels were raised in all patients (mean ± SE 184 ± 44 pmol/l, n = 9) compared with healthy controls (11 ± 1.4 pmol/l), but showed considerable inter-patient variability. 3. Plasma Ir-ANP levels fell with fluid removal during ultrafiltration (123 ± 30 pmol/l, n = 9, P < 0.02) and again as fluid was removed during haemodialysis (76 ± 20 pmol/l, n = 9, P < 0.02). 4. Seven patients studied 48 h later, before their next dialysis treatment, had regained weight and showed a coincident rise in circulating plasma Ir-ANP (130 ± 33 pmol/l, n = 7). 5. Our data would support the hypothesis that the secretion of ANP is determined by volume or by a stimulus related to volume. However, it does not exclude the possibility that a factor other than extracellular fluid volume expansion contributes to the raised plasma Ir-ANP levels in chronic renal failure.


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