Hypertension in terminal renal failure

Abstract

Inverse interrelations between plasma renin activity and exchangeable sodium or blood volume were found in both normotensive (N = 23) and hypertensive (N = 29) hemodialysis patients (r = 0.47; P<0.005); however, mean plasma renin for any given sodium/volume state was at least two fold higher in hypertensive than in normotensive hemodialysis patients or normal subjects (N = 31). In the hemodialysis patients, blood pressure correlated weakly but significantly with the products of circulating renin and exchangeable sodium (r = 0.37; P<0.005) or blood volume (r = 0.29; P<0.05). Multiple regression analysis including duration of previous hypertension as the second independent variable increased these correlation coefficients to 0.44 and 0.42, respectively. This suggests that hypertension in end stage kidney disease is often associated with resetting of the body sodium/fluid renin feedback mechanism. Inappropriately increased plasma renin activity relative to the body sodium/volume state as well as high blood pressure induced vascular changes may play important complementary roles, but it appears evident that additional mechanisms are also operative in maintaining end stage renal hypertension.