PLASMA ADRENOMEDULLIN IN CHRONIC RENAL FAILURE PATIENTS

SUMMARY AND CONCLUSIONAdrenomedullin (AM) was discovered from human pheochromcytoma tissue by monitoring the elevating activity of intracellular cyclic adenosine monophosphate (cAMP) in rat platelets. AM elicits multiple biological activities, among which the most characteristic one is a potent and very powerful hypotensive activity caused by dilatation of resistance vessels. A sensitive and specific radioimmunoassay revealed that AM is present in circulating blood as well as in a variety of tisssues including the kidney. The plasma AM levels are increased in renal disease. AM, therefore, seems to function as a novel system that controls circulation and body fluid and may be involved in pathophysiological changes in renal disease.The aim of the present study was to measure plasma concentration of Adrenomedullin (AM) in patients with chronic renal failure on different modalities of treatment (conservative and haemodialysis) and correlate their level with mean arterial blood pressure.This study was conducted on the 40 subjects. They were divided into 3 groups:1-Control group:This group comprised 10 subjects; 5 females and 5 males, matched for age and sex as control.2-Chronic renal failure patients on hemodialysis:It included 20 patients with CRF on hemodialysis, 9 males and 11 females with exclusion of heart failure, lung disease, septicaemia and atherosclerosis.3-Chronic renal failure on conservative treatment:It included 10 patients with impaired renal failure (IRF) on conservative treatment; 4 males and 6 females matched for age and sex, all with exclusion criteria of group 2.All patients and control subjects were submitted to full clinical assessment including history taking, clinical examination and the following investigations:Routine laboratory investigations:• Kidney function tests.• Liver function tests.• Serum cholesterol LDH, HDL and serum triglyceride level (lipid profile).• Complete blood picture.• Urine analysis.• Arterial blood gases.• Serum, Na, K, Ca and phosphorus.Body weight measuring pre- and post-dialysis.Mean arterial blood pressure.Electrocardiogram.Radiological study:• Plain chest X-ray.• Abdominal and pelvic sonography.Specific laboratory investigations:• Total plasma adrenomedullin.Our results show:Compared to age and body weight-matched healthy subjects, hemodialysis patients had significantly higher mean systolic and diastolic blood pressure values.Hemodialysis patients had significantly increased plasma level of adrenomedullin.There were significant differences in circulating adrenomedullin between subgroups (pre and post) hemodialysis patients.There were significant correlations between systolic and mean arterial pressure and predialysis plasma AM concentrations in all groups (patients). Hemodialysis-induced ultrafiltration result in a significant reduction of body weight (2.5 kg), a significant fall in blood pressure values and a significant rise in pulse rate.Hemodialysis did not acutely affect plasma level of AM. Correction of postdialysis AM for ultrafiltration induced contraction of intravascular volume revealed a slight but not statistically significantly rise in plasma AM as compared to predialysis group (patients).Despite slight gain in body weight (0.9 kg) measurement of plasma AM 14-20 h after dialysis session showed a significant reduction in plasma AM concentration as compared to predialysis or the first post-dialysis plasma AM concentration even for corrected plasma AM concentration.ConclusionPlasma Adrenomedullin elevation in hemodialysis patients is related to a fall of mean arterial blood pressure and blood volume regulation in patients undergoing HD.RecommendationPlasma Adrenomadullin (AM) can be removed by hemodialysis treatment by using high flux dialyser more than low flux dialyser so hemodialysis patient may used high flux dialyser to mentain stability of blood pressure during hemodialysis.