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Hormonal Changes in Daily Hemodialysis

Uremia is associated with endocrine abnormalities that in some cases can produce a polyendocrinopathy responsible for symptoms and complications. This is not surprising when we remember that the kidney is an endocrine organ as well as a target organ for the endocrine system. More importantly, renal failure produces the “uremic milieu” (1) within which all endocrine systems and hormones must work. The hormonal feedback systems in uremia may be altered at several different levels. Changes in the synthesis, secretion, metabolism, and biological activity, as well as in the end-organ resistance to the action of the various hormones, may occur (2). Lack of appropriate hormonal response to secretory signals, impaired renal and/or extra-renal hormonal metabolism, abnormal hormonal receptor binding or postreceptor events in endorgans, the presence of multi-molecular hormone forms with different biological activity, and the accumulation of hormones with opposing action may lead to the uremic polyendocrinopathy (3) (Fig. 1) Principal causes of endocrine dysfunctions in uremia are intoxication not adequately corrected by the current treatments, nutritional deficiencies, abnormalities in electrolyte and mineral metabolism, acidosis, and swift changes in volume and plasma osmolality. These are in addition to the absence of the endocrine and metabolic functions of the renal parenchyma. (Fig. 2) A dialysis schedule that achieves the greatest removal of uremic toxins in a more physiological fashion allows for an “internal milieu” with a better equilibrium where many hormones and enzymatic systems can react and function in an almost normal way. Daily hemodialysis (DHD) is, in our experience, the best depurative treatment not only quantitatively but also qualitatively (4, 5).