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Durstregulation bei terminaler Niereninsuffizienz

Thirst regulation in endstage renal disease

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Summary

About 30% of hemodialyzed patients are suffering from chronic fluid overload despite advice to restrict the oral fluid intake. To investigate the cause of the abnormal drinking behaviour a clinical study was performed in 51 non-diabetic patients with endstage renal disease exhibiting lower interdialytic weight gain (<3 kg,n=17) and increased interdialytic weight gain (>3 kg,n=34). Blood pressure, body weight self-estimated thirst intensity before and after hemodialysis were analyzed. Biochemical and behavioral variables were measured including hormonal factors of water and sodium metabolism. Significant differences of dry weight, creatinine, urea nitrogen and thirst intensity were found between the two groups. Catecholamines, renin, angiotensin II, aldosterone, vasopressin and atrial natriuretic peptide exhibited a similar pattern in both groups. Atrial natriuretic peptide decreased during hemodialysis in both groups, angiotensin II, however, and norepinephrine showed an exaggerated response to ultrafiltration rate in polydipsic patients. These results suggest that changes in serum osmolality during hemodialysis did not contribute to thirst and drinking behaviour. It seems that postdialytic hypovolaemia together with higher plasma-angiotensin II-levels is responsible for increased oral intake of fluid and excessive weight gain.

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Heidbreder, E., Bahner, U., Hess, M. et al. Durstregulation bei terminaler Niereninsuffizienz. Klin Wochenschr 68, 1127–1133 (1990). https://doi.org/10.1007/BF01798063

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Key words

  • Thirst regulation
  • Vasopressin
  • Renin-angiotensin-system
  • Atrial natriuretic peptide
  • Endstage renal disease