Evaluation of plasma osmolality and hormone responses in elderly chronic hemodialysis patients with excessive interdialytic weight gain.

Abstract

Elderly patients may exhibit changes in plasma hormone levels, as well as thirst disorders. Two groups of elderly hemodialysis patients were evaluated to determine if excessive interdialytic weight gain was related to differences in postdialysis plasma osmolality or postdialysis measurement of plasma renin activity, or plasma levels of angiotensin II (a dipsogenic hormone), aldosterone, and vasopressin. Patients mean age was 77.0 +/- 8.8 years and patients were divided into groups, I and II, with less than or greater than 2 kg interdialytic weight gain. Postdialysis plasma osmolality was similar in both groups of patients (309.3 +/- 2.3 vs. 309.6 +/- 2.4 mOsm/Kg, p = 0.8) and postdialysis AVP levels also were no different (2.7 +/- 0.6 vs. 2.1 +/- 0.2 pg/mL, p = 0.3). There was also no statistical difference between postdialysis angiotensin II and aldosterone levels in either group of patients. Plasma renin activity (PRA) was also not different in either group (2.3 +/- 1.1 vs. 0.43 +/- 0.1 ng/mL/hr, p = 0.1), but group I patients, with less than 2 kg weight gain, tended to exhibit higher PRA values perhaps reflecting proximity to their dry weight postdialysis. Since excessive fluid intake did not appear to relate to plasma osmolality and hormone levels studied, it might be suggested that excessive drinking could be due to excessive sodium intake associated with personal dietary habits or perhaps other as yet unmeasured factors.