PLASMA 18-HYDROXYCORTICOSTERONE DURING CONTINUOUS AMBULATORY PERITONEAL-DIALYSIS

  • 1 January 1983
    • journal article
    • research article
    • Vol. 102  (4) , 604-612
Abstract
Continuous ambulatory peritoneal dialysis (CAPD) [for treatment of end-stage renal disease] entails the continous presence of hypertonic dialysate in the peritoneal cavity. Apparently, the continuous, gradual ultrafiltration produces chronic activation of the [human] renin-angiotensin system and the adrenal zona glomerulosa. To explore this hypothesis, plasma levels of PRA [plasma renin activity], active renin (AR), total renin (TR), inactive renin (IR), 18-hydroxycorticosterone (18-OH-B) and aldosterone (PAC) under basal and stimulated conditions. At 0800 and 1200 h after overnight recumbency, plasma levels of PRA, AR, TR, IR and 18-OH-B were elevated above the range for NA-replete recumbent normal subjects. PAC, however, was normal. The increase in TR was due predominantly to an increase in AR. After the combined stimulus of 4 h ambulation and the ultrafiltration induced by a 2 l exchange, plasma levels of PRA, AR, TR, IR and PAC were within the range for Na-replete upright normal subjects. Plasma 18-OH-B levels, however, remained markedly elevated. Graded i.v. infusion of ACTH at rates of 0.03 to 10 ng/min demonstrated that the threshold for an ACTH-stimulated rise in plasma 18-OH-B and PAC is at least as low as that for cortisol and corticosterone. CAPD produces activation of the renin-angiotensin system. The high circulating levels of PRA, AR, and, presumably, angiotensin II result in increased secretion of 18-OH-B by the adrenal zona glomerulosa.

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