Nephrol Dial Transplant (1992) 7: 306-310 © 1992 European Dialysis and Transplant Association-European Renal Association
Nephrology Dialysis Transplantation
Original Article Hormonal changes in patients with severe chronic congestive heart failure treated by ultrafiltration T. Forslund1, F. Riddervold2, P. Fauchald2, D. Torvik2, F. Fyhrquist1 and S. Simonsen2 'Minerva Institute for Medical Research, Helsinki, Finland; 2Rikshospitalet, Oslo University Hospital, Oslo, Norway
Abstract. Plasma atrial natriuretic peptide (ANP), antidiuretic hormone (ADH), plasma renin activity (PRA), and circulatory haemodynamics were studied in five patients with chronic congestive heart failure undergoing ultrafiltration on two consecutive days. The patients were in the New York Heart Association class IV, and were considered candidates for heart transplantation. A mean of 3.3±0.5 litres of fluid was removed during each ultrafiltration. Plasma ANP concentration remained unchanged during ultrafiltration: 369 ±151 pg/ml at start and 316±116 pg/ml at the end, while plasma ADH concentration and PRA increased from 5.1 ±2.1 to 7.5 ±3.4 pg/ml CPsterr. (Gambro, Lund, Sweden) with a Gambro plate filter (Pro 3H; polycarbonate; surface area 1.0 m2). A bolus of 2000 U heparin was given at the beginning of UF, and thereafter 1000 U was given every hour. Duration of the ultrafiltration session (n=10) was 195 ± 15 min (range 170 to 220 min) removing 3310 ± 500 ml (2300-4000 ml) of fluid, at a mean filtration rate of 17.0±2.0 ml,min. Hyponatraemia was corrected by hypertonic sodium chloride (1 mmol ml). A mean of 100 mmol sodium chloride was given per session (range 0-200 mmol/session).
Blood sampling and assays Venous blood was sampled simultaneously with the haemodynamic measurements. Ten millilitres of blood was collected into prechilled (0'C) polyethene tubes containing 6 g/1 of disodium-edetate (Na2-EDTA) and 100 ul of 20 000 U/l aprotinin (Trasylol). Plasma was separated by 5 min centrifugation at 3000 r.p.m. at +4°C, and stored at -20°C until assayed for plasma ANP [3], antidiuretic hormone (ADH) [10], and aldosterone (commercial kit; Abbott Laboratories, Chicago, 111) concentration, and for plasma renin activity (PRA) [11] by radioimmunoassay.
Instrumentation and measurements Other measurements
After 30 min of rest in the supine position, a Swan-Ganz thermodilution catheter (93A-131H, 7F, Edwards Laboratories) was introduced through the right internal jugular vein and positioned in the pulmonary artery, and a singlelumen catheter was placed in the femoral vein for the ultrafiltration procedure. Right atrial, pulmonary artery, and pulmonary capillary wedge pressures were measured by standard techniques. Cardiac output was determined by thermodilution. Systemic blood pressure was measured by a standard mercury sphygmomanometer simultaneously with heart rate registration. All measurements were performed at the start, and after 30, 60, and 120 min, at the end, and 1 h after discontinuation of ultrafiltration.
Plasma colloid osmotic pressure was measured by colloid osmometer made for 5 ul samples at the start and end of each ultrafiltration session [12].
Statistics All values are presented as mean±SD. Statistical calculations were performed after logarithmic transformation. Two-tailed Student's /-test and linear regression were used for unpaired and paired observations. / )
Nephrology Dialysis Transplantation
Original Article Hormonal changes in patients with severe chronic congestive heart failure treated by ultrafiltration T. Forslund1, F. Riddervold2, P. Fauchald2, D. Torvik2, F. Fyhrquist1 and S. Simonsen2 'Minerva Institute for Medical Research, Helsinki, Finland; 2Rikshospitalet, Oslo University Hospital, Oslo, Norway
Abstract. Plasma atrial natriuretic peptide (ANP), antidiuretic hormone (ADH), plasma renin activity (PRA), and circulatory haemodynamics were studied in five patients with chronic congestive heart failure undergoing ultrafiltration on two consecutive days. The patients were in the New York Heart Association class IV, and were considered candidates for heart transplantation. A mean of 3.3±0.5 litres of fluid was removed during each ultrafiltration. Plasma ANP concentration remained unchanged during ultrafiltration: 369 ±151 pg/ml at start and 316±116 pg/ml at the end, while plasma ADH concentration and PRA increased from 5.1 ±2.1 to 7.5 ±3.4 pg/ml CPsterr. (Gambro, Lund, Sweden) with a Gambro plate filter (Pro 3H; polycarbonate; surface area 1.0 m2). A bolus of 2000 U heparin was given at the beginning of UF, and thereafter 1000 U was given every hour. Duration of the ultrafiltration session (n=10) was 195 ± 15 min (range 170 to 220 min) removing 3310 ± 500 ml (2300-4000 ml) of fluid, at a mean filtration rate of 17.0±2.0 ml,min. Hyponatraemia was corrected by hypertonic sodium chloride (1 mmol ml). A mean of 100 mmol sodium chloride was given per session (range 0-200 mmol/session).
Blood sampling and assays Venous blood was sampled simultaneously with the haemodynamic measurements. Ten millilitres of blood was collected into prechilled (0'C) polyethene tubes containing 6 g/1 of disodium-edetate (Na2-EDTA) and 100 ul of 20 000 U/l aprotinin (Trasylol). Plasma was separated by 5 min centrifugation at 3000 r.p.m. at +4°C, and stored at -20°C until assayed for plasma ANP [3], antidiuretic hormone (ADH) [10], and aldosterone (commercial kit; Abbott Laboratories, Chicago, 111) concentration, and for plasma renin activity (PRA) [11] by radioimmunoassay.
Instrumentation and measurements Other measurements
After 30 min of rest in the supine position, a Swan-Ganz thermodilution catheter (93A-131H, 7F, Edwards Laboratories) was introduced through the right internal jugular vein and positioned in the pulmonary artery, and a singlelumen catheter was placed in the femoral vein for the ultrafiltration procedure. Right atrial, pulmonary artery, and pulmonary capillary wedge pressures were measured by standard techniques. Cardiac output was determined by thermodilution. Systemic blood pressure was measured by a standard mercury sphygmomanometer simultaneously with heart rate registration. All measurements were performed at the start, and after 30, 60, and 120 min, at the end, and 1 h after discontinuation of ultrafiltration.
Plasma colloid osmotic pressure was measured by colloid osmometer made for 5 ul samples at the start and end of each ultrafiltration session [12].
Statistics All values are presented as mean±SD. Statistical calculations were performed after logarithmic transformation. Two-tailed Student's /-test and linear regression were used for unpaired and paired observations. / )
