Hypertension in terminal renal failure

Hypertension in terminal renal failure. 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