Cardiac beta-adrenoceptors in chronic uremia:: Studies in humans and rats

OBJECTIVES The purpose of this study was to elucidate whether cardiac beta-adrenergic effects may be blunted in patients on maintenance hemodialysis (HD) and may help to explain autonomic dysfunction. BACKGROUND Patients on HD often suffer fram autonomic dysfunction. METHODS We investigated the cardiovascular response of five HD patients (age: 46.1 +/- 7.9 years) and six healthy volunteers (age: 48.2 +/- 7.5 years) to isoprenaline, pirenzepine and phenylephrine. For analysis of underlying mechanisms of beta-adrenoceptor hyporesponsiveness, six-week-old male Wistar rats were rendered uremic by 5/6-nephrectomy (n = 9; SNX) and were killed for removal of the heart after six to seven weeks. Sham-operated rats (n = 15) served as controls. RESULTS In the patient study, isoprenaline (3.5, 7, 17, 35 ng/kg/min, i.v.) led to an increase in heart rate, and shortening of the heart rate corrected duration of the electromechanical systole (QS(2)c), both of which were significantly reduced in HD patients. Batoreflex sensitivity was significantly reduced in HD patients. The response to low parasympathomimetic doses of pirenzepine was unchanged. In the rat study, left ventricular strips were placed in an organ bath, electrically driven and exposed to isoprenaline (10(-11) to 10(-6) mol/liter). While pD(2) values were unchanged, maximum effect at the highest concentration was significantly reduced in SNX rats. The response to carbachol was not altered, nor was the M-2- cholinoceptor density. There was no difference in beta-adrenoceptor density, or in immunodetectable amount of G(s) and G(i) protein. Activation of adenylyl cyclase evoked by isoprenaline was significantly reduced in left ventricular membranes of SNX rats, whereas effects of 10 mu mol/liter GTP, 10 mmol/liter NaF, 10 mu mol/liter forskolin and 10 mmol/liter Mn2+ were not altered. CONCLUSIONS Cardiac beta-adrenergic responses are blunted in chronic uremia due Co reduced isoprenaline-dependent activation of adenylyl cyclase. This might be caused by an "uncoupling" of the receptor or by an inhibition of the receptor by uremic toxins. (C) 2000 by the American College of Cardiology.