Response of serum angiotensin converting enzyme, plasma renin activity and plasma aldosterone to conventional dialysis in patients on chronic haemodialysis

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Abstract
The aim of this study was to examine serum angiotensin converting enzyme (SACE) activity and the renin-angiotensin-aldosterone system in patients on chronic haemodialysis during one routine dialysis session. Fourteen patients (8 men and 6 women; mean age 51.9±17 years) with end stage renal disease, receiving regular haemodialysis treatment for an average of 6 months, were studied. The patients were dialysed for 4 hours three times a week using cellulose membranes (cuprophan). After an overnight fast blood samples were taken from the patients before and after the haemodialysis session. Serum and plasma were separated and stored at −20°C until assayed for SACE, plasma renin activity (PRA) and plasma aldosterone (PA). For comparison, SACE, PRA and PA were also measured in 8 patients after renal allotransplantation and on treatment with cyclosporin A (5 men, 3 women; mean age 38.9±12.3 years) and in 19 healthy subjects (13 men, 6 women; mean age 38.9±12.3 years). SACE levels in patients with chronic renal failure and on haemodialysis (17.55±9.03 nmol/ml/min) and in patients with renal transplantation (18.12±3.92) were significantly higher than those of the healthy subjects (9.27±1.67) (p<0.0001, respectively). At the end of the dialysis session SACE levels in patients with chronic renal failure (14.9±7.19) did not increase in respect to pre-dialysis levels (17.55±9.03; p=0.132). PRA and PA values increased after the dialysis session (p<0.026 and p<0.044, respectively). Correlation of SACE with PRA and PA was not demonstrated before or after the dialysis session. In patients with chronic renal failure and on haemodialysis our findings suggest that a disarrangement exists between the circulatory components of the renin-angiotensin-aldosterone system before and after the dialysis session.