A Hemodynamic Evaluation of Bilateral Nephrectomy and Hemodialysis in Hypertensive Man

Three hypertensive men with end-stage primary renal disease were hemodynamically evaluated before and 3 to 4 weeks after bilateral nephrectomy and before and after 6 hours of hemodialysis with the twin coil artificial kidney. Conclusions include the following: (1) The height of the blood pressure and changes in plasma volume (P.V.) are not necessarily directly related in the early renoprival state. (2) Increased total peripheral resistance (TPR) plays an important role in maintaining elevation of blood pressure after nephrectomy. (3) We cannot document that bilateral nephrectomy has a beneficial effect on the hypertension of chronic renal failure during the first month of the anephric state. (4) Renin is not involved in maintaining elevated blood pressure after nephrectomy. (5) Increased sensitivity to ganglionic blockade may follow nephrectomy if P.V. decreases. (6) No evidence supports the existence of a "cardiodepressor" substance in uremia. (7) Increased blood pressure occasionally seen during hemodialysis is probably related to several factors (increased cardiac output, increased TPR). (8) P.V. may fall during hemodialysis even though body weight is maintained constant. (9) If P.V. is unchanged across hemodialysis, cardiac output usually does not change.