Increased plasma levels of atrial natriuretic peptide in patients with chronic renal failure: effect of noradrenaline infusion.

Basal plasma atrial natriuretic peptide (ANP) and blood pressure were measured in 11 patients with chronic renal failure before requirement of dialysis, 13 patients on chronic dialysis, and 28 control subjects (Study 1). Changes in ANP during noradrenaline infusion were determined in eight patients with chronic renal failure before dialysis, 12 patients on chronic dialysis, and 17 control subjects (Study 2). ANP was also measured in 14 healthy control subjects during angiotensin II infusion (Study 3). Study 1 showed a significantly greater ANP in patients before the stage of dialysis (median 23 pg/ml) and in dialysis patients (34 pg/ml) than in control subjects (19 pg/ml) P less than 0.01 for both. In Study 2, noradrenaline induced an increase in ANP in the non-dialysed patients (P less than 0.05) and in the control subjects (P less than 0.01), but not in the dialysis patients. According to Study 3, ANP was unchanged during angiotensin II infusion. Blood pressure was increased in all groups during noradrenaline and angiotensin II infusions. It can be concluded that ANP Is increased both in patients with chronic renal failure before requirement of dialysis and in patients on maintenance dialysis. It is suggested that noradrenaline stimulates ANP release.