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Nagami GT, Kraut JA. The Role of the Endocrine System in the Regulation of Acid-Base Balance by the Kidney and the Progression of Chronic Kidney Disease. Int J Mol Sci 2024; 25:2420. [PMID: 38397097 PMCID: PMC10889389 DOI: 10.3390/ijms25042420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 02/07/2024] [Accepted: 02/16/2024] [Indexed: 02/25/2024] Open
Abstract
Systemic acid-base status is primarily determined by the interplay of net acid production (NEAP) arising from metabolism of ingested food stuffs, buffering of NEAP in tissues, generation of bicarbonate by the kidney, and capture of any bicarbonate filtered by the kidney. In chronic kidney disease (CKD), acid retention may occur when dietary acid production is not balanced by bicarbonate generation by the diseased kidney. Hormones including aldosterone, angiotensin II, endothelin, PTH, glucocorticoids, insulin, thyroid hormone, and growth hormone can affect acid-base balance in different ways. The levels of some hormones such as aldosterone, angiotensin II and endothelin are increased with acid accumulation and contribute to an adaptive increase in renal acid excretion and bicarbonate generation. However, the persistent elevated levels of these hormones can damage the kidney and accelerate progression of CKD. Measures to slow the progression of CKD have included administration of medications which inhibit the production or action of deleterious hormones. However, since metabolic acidosis accompanying CKD stimulates the secretion of several of these hormones, treatment of CKD should also include administration of base to correct the metabolic acidosis.
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Affiliation(s)
- Glenn T. Nagami
- Nephrology Section, VA Greater Los Angeles Healthcare System, Los Angeles, CA 90073, USA;
- Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA 90095, USA
| | - Jeffrey A. Kraut
- Nephrology Section, VA Greater Los Angeles Healthcare System, Los Angeles, CA 90073, USA;
- Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA 90095, USA
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Rosenberg ML, Yaneff A, Ferradás GM, Villafañe Tapia MP, Davio CA, Goette NP, Vlachovsky SG, Peroni RN, Oddo EM, Azurmendi PJ. Total and Extracellular Vesicle cAMP Contents in Urine Are Associated with Autosomal Dominant Polycystic Kidney Disease (ADPKD) Progression. Life (Basel) 2023; 13:1817. [PMID: 37763221 PMCID: PMC10532713 DOI: 10.3390/life13091817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 08/23/2023] [Accepted: 08/26/2023] [Indexed: 09/29/2023] Open
Abstract
ADPKD is the most common genetic renal disease, characterized by the presence of multiple cysts which, through slow and gradual growth, lead to glomerular filtration rate (GFR) decline and end-stage renal disease. Cystic growth is associated with increased intracellular levels of 3',5'-cyclic adenosine monophosphate (cAMP). Extracellular vesicles (EVs) are proposed to participate in "remote sensing" by transporting different cargoes, but their relevance to ADPKD progression is poorly understood. This study aimed to determine whether cAMP is contained in urinary EVs and, if so, how total and/or EV cAMP contents participate in disease progression. Fourteen ADPKD patients, naïve for V2 receptor antagonism treatment, and seven controls were studied. Progression was evaluated by estimating GFR (eGFR) and height-adjusted total kidney volume (htTKV). Fresh morning urine was collected to determine cAMP by the competitive radioligand assay. Urine EVs were isolated using an adapted centrifugation method and characterized by electron microscopy, dynamic light scanning, flow cytometry with FITC CD63 labeling, protein and RNA content, and AQP2 and GAPDH mRNA detection. Total and EV cAMP was measurable in both control and patient urine samples. Total cAMP was significantly correlated with eGFR and its annual change but inversely correlated with htTKV. The cAMP-EVs showed a bimodal pattern with htTKV, increasing to ~1 L/m and falling at larger sizes. Our results demonstrate that urine cAMP correlates with ADPKD progression markers, and that its extracellular delivery by EVs could reflect the architectural disturbances of the organ.
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Affiliation(s)
- María Lucía Rosenberg
- Instituto de Investigaciones Médicas Alfredo Lanari, Facultad de Medicina, Universidad de Buenos Aires (UBA), Buenos Aires 1427, Argentina (N.P.G.)
- Instituto de Investigaciones Médicas, UBA—Consejo Nacional de Investigaciones Científicas y Técnicas (IDIM, UBA-CONICET), Facultad de Medicina, Universidad de Buenos Aires, Buenos Aires 1427, Argentina
| | - Agustín Yaneff
- Instituto de Investigaciones Farmacológicas (ININFA-UBA-CONICET), Facultad de Farmacia y Bioquímica, Universidad de Buenos Aires, Buenos Aires 1113, Argentina (R.N.P.)
| | - Gonzalo Manuel Ferradás
- Instituto de Investigaciones Médicas Alfredo Lanari, Facultad de Medicina, Universidad de Buenos Aires (UBA), Buenos Aires 1427, Argentina (N.P.G.)
- Instituto de Investigaciones Médicas, UBA—Consejo Nacional de Investigaciones Científicas y Técnicas (IDIM, UBA-CONICET), Facultad de Medicina, Universidad de Buenos Aires, Buenos Aires 1427, Argentina
| | - Margarita Paz Villafañe Tapia
- Instituto de Investigaciones Farmacológicas (ININFA-UBA-CONICET), Facultad de Farmacia y Bioquímica, Universidad de Buenos Aires, Buenos Aires 1113, Argentina (R.N.P.)
| | - Carlos Alberto Davio
- Instituto de Investigaciones Farmacológicas (ININFA-UBA-CONICET), Facultad de Farmacia y Bioquímica, Universidad de Buenos Aires, Buenos Aires 1113, Argentina (R.N.P.)
| | - Nora Paula Goette
- Instituto de Investigaciones Médicas Alfredo Lanari, Facultad de Medicina, Universidad de Buenos Aires (UBA), Buenos Aires 1427, Argentina (N.P.G.)
- Instituto de Investigaciones Médicas, UBA—Consejo Nacional de Investigaciones Científicas y Técnicas (IDIM, UBA-CONICET), Facultad de Medicina, Universidad de Buenos Aires, Buenos Aires 1427, Argentina
| | - Sandra Gabriela Vlachovsky
- Instituto de Investigaciones Médicas Alfredo Lanari, Facultad de Medicina, Universidad de Buenos Aires (UBA), Buenos Aires 1427, Argentina (N.P.G.)
- Instituto de Investigaciones Médicas, UBA—Consejo Nacional de Investigaciones Científicas y Técnicas (IDIM, UBA-CONICET), Facultad de Medicina, Universidad de Buenos Aires, Buenos Aires 1427, Argentina
| | - Roxana Noemí Peroni
- Instituto de Investigaciones Farmacológicas (ININFA-UBA-CONICET), Facultad de Farmacia y Bioquímica, Universidad de Buenos Aires, Buenos Aires 1113, Argentina (R.N.P.)
- Departamento de Farmacología, Facultad de Farmacia y Bioquímica, Universidad de Buenos Aires, Buenos Aires 1113, Argentina
| | - Elisabet Mónica Oddo
- Instituto de Investigaciones Médicas Alfredo Lanari, Facultad de Medicina, Universidad de Buenos Aires (UBA), Buenos Aires 1427, Argentina (N.P.G.)
- Instituto de Investigaciones Médicas, UBA—Consejo Nacional de Investigaciones Científicas y Técnicas (IDIM, UBA-CONICET), Facultad de Medicina, Universidad de Buenos Aires, Buenos Aires 1427, Argentina
| | - Pablo Javier Azurmendi
- Instituto de Investigaciones Médicas Alfredo Lanari, Facultad de Medicina, Universidad de Buenos Aires (UBA), Buenos Aires 1427, Argentina (N.P.G.)
- Instituto de Investigaciones Médicas, UBA—Consejo Nacional de Investigaciones Científicas y Técnicas (IDIM, UBA-CONICET), Facultad de Medicina, Universidad de Buenos Aires, Buenos Aires 1427, Argentina
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Parkinson E, Hooper L, Fynn J, Wilsher SH, Oladosu T, Poland F, Roberts S, Van Hout E, Bunn D. Low-intake dehydration prevalence in non-hospitalised older adults: Systematic review and meta-analysis. Clin Nutr 2023:S0261-5614(23)00185-1. [PMID: 37330324 DOI: 10.1016/j.clnu.2023.06.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 05/11/2023] [Accepted: 06/05/2023] [Indexed: 06/19/2023]
Abstract
BACKGROUND & AIMS Low-intake dehydration amongst older people, caused by insufficient fluid intake, is associated with mortality, multiple long-term health conditions and hospitalisation. The prevalence of low-intake dehydration in older adults, and which groups are most at-risk, is unclear. We conducted a high-quality systematic review and meta-analysis, implementing an innovative methodology, to establish the prevalence of low-intake dehydration in older people (PROSPERO registration: CRD42021241252). METHOD We systematically searched Medline (Ovid), Cochrane CENTRAL, Embase (Ovid), CINAHL and Proquest from inception until April 2023 and Nutrition and Food Sciences until March 2021. We included studies that assessed hydration status for non-hospitalised participants aged ≥65 years, by directly-measured serum/plasma osmolality, calculated serum/plasma osmolarity and/or 24-h oral fluid intake. Inclusion, data extraction and risk of bias assessment was carried out independently in duplicate. RESULTS From 11,077 titles and abstracts, we included 61 (22,398 participants), including 44 in quality-effects meta-analysis. Meta-analysis suggested that 24% (95% CI: 0.07, 0.46) of older people were dehydrated (assessed using directly-measured osmolality >300 mOsm/kg, the most reliable measure). Subgroup analyses indicated that both long-term care residents (34%, 95% CI: 0.09, 0.61) and community-dwelling older adults (19%, 95% CI: 0.00, 0.48) were highly likely to be dehydrated. Those with more pre-existing illnesses (37%, 95% CI: 0.14, 0.62) had higher low-intake dehydration prevalence than others (15%, 95% CI: 0.00, 0.43), and there was a non-significant suggestion that those with renal impairment (42%, 95% CI: 0.23, 0.61) were more likely to be dehydrated than others (23%, 95% CI: 0.03, 0.47), but there were no clear differences in prevalence by age, sex, functional, cognitive or diabetic status. GRADE quality of evidence was low as to the exact prevalence due to high levels of heterogeneity between studies. CONCLUSION Quality-effects meta-analysis estimated that a quarter of non-hospitalised older people were dehydrated. Widely varying prevalence rates in individual studies, from both long-term care and community groups, highlight that dehydration is preventable amongst older people. IMPLICATIONS One in every 4 older adults has low-intake dehydration. As dehydration is serious and prevalent, research is needed to better understand drinking behaviour and assess effectiveness of drinking interventions for older people.
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Affiliation(s)
- Ellice Parkinson
- School of Health Sciences, University of East Anglia, Norwich, NR4 7TJ, United Kingdom.
| | - Lee Hooper
- Norwich Medical School, University of East Anglia, Norwich, NR4 7TJ, United Kingdom.
| | - Judith Fynn
- Norwich Medical School, University of East Anglia, Norwich, NR4 7TJ, United Kingdom.
| | | | - Titilopemi Oladosu
- Norwich Medical School, University of East Anglia, Norwich, NR4 7TJ, United Kingdom.
| | - Fiona Poland
- School of Health Sciences, University of East Anglia, Norwich, NR4 7TJ, United Kingdom.
| | - Simone Roberts
- The Centre for Research in Public Health and Community Care (CRIPACC), University of Hertfordshire, Hatfield, United Kingdom.
| | - Elien Van Hout
- School of Health Sciences, University of East Anglia, Norwich, NR4 7TJ, United Kingdom.
| | - Diane Bunn
- School of Health Sciences, University of East Anglia, Norwich, NR4 7TJ, United Kingdom.
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Kakeshita K, Koike T, Imamura T, Fujioka H, Yamazaki H, Kinugawa K. Impact of urine cyclic AMP relative to plasma arginine vasopressin on response to tolvaptan in patients with chronic kidney disease and heart failure. Clin Exp Nephrol 2023; 27:427-434. [PMID: 36752971 DOI: 10.1007/s10157-023-02325-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Accepted: 01/25/2023] [Indexed: 02/09/2023]
Abstract
BACKGROUND The clinical utility of tolvaptan in chronic kidney disease (CKD) patients with heart failure remains uncertain. The level of urine cyclic adenosine monophosphate (AMP) relative to plasma arginine vasopressin (AVP) indicates the residual function of the collecting ducts in response to AVP stimulation and might be a key to predicting response of tolvaptan. METHODS CKD patients who were hospitalized to treat their congestive heart failure refractory to conventional loop diuretics were considered to receive tolvaptan and included in this prospective study. The impact of urine cyclic AMP/plasma AVP ratio for prediction of response to tolvaptan, which was defined as any increase in urine volume at day 7 from day 0, was investigated. RESULTS A total of 30 patients (median 75 years old, 24 men, and median estimated glomerular filtration rate 14.4 mL/min/1.73 m2) were included. As compared to baseline, urine volume increased at day 7 in 17 responders, whereas urine volume decreased at day 7 in 13 non-responders. Baseline urine cyclic AMP/plasma AVP ratio distributed between 0.25 and 4.01 with median 1.90. The urine cyclic AMP/plasma AVP ratio was a significant predictor of response to tolvaptan, which was adjusted for 6 potential confounders with a cutoff of 1.24. CONCLUSIONS Baseline urine cyclic AMP/plasma AVP ratio is an independent predictor of response to tolvaptan in advanced CKD patients with heart failure. CLINICAL TRIAL REGISTRATION UMIN000022422.
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Affiliation(s)
- Kota Kakeshita
- The Second Department of Internal Medicine, University of Toyama, 2630 Sugitani, Toyama, 930-0194, Japan
| | - Tsutomu Koike
- The Second Department of Internal Medicine, University of Toyama, 2630 Sugitani, Toyama, 930-0194, Japan
| | - Teruhiko Imamura
- The Second Department of Internal Medicine, University of Toyama, 2630 Sugitani, Toyama, 930-0194, Japan.
| | - Hayato Fujioka
- The Second Department of Internal Medicine, University of Toyama, 2630 Sugitani, Toyama, 930-0194, Japan
| | - Hidenori Yamazaki
- The Second Department of Internal Medicine, University of Toyama, 2630 Sugitani, Toyama, 930-0194, Japan
| | - Koichiro Kinugawa
- The Second Department of Internal Medicine, University of Toyama, 2630 Sugitani, Toyama, 930-0194, Japan
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Kakeshita K, Koike T, Imamura T, Fujioka H, Yamazaki H, Kinugawa K. Prognostic impact of urine cyclic AMP levels in patients with chronic kidney disease. Clin Exp Nephrol 2022; 26:1194-1199. [PMID: 35999301 DOI: 10.1007/s10157-022-02264-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Accepted: 08/06/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND Urine cyclic adenosine monophosphate (cAMP) is a biomarker to assess the residual function of the collecting duct in the kidney. Prognostic implication of urine cAMP levels in patients with chronic kidney disease (CKD) remains unknown. METHODS Patients who were followed at our specific outpatient clinic to treat their CKD between December 2015 and December 2019 were included in this prospective study. The impact of urine cAMP levels on the composite of dialysis administration, cardiovascular death, and doubling of serum creatinine concentration was investigated. RESULTS A total of 106 patients (median 72 years old, 80 men, and median estimated glomerular filtration rate 28.4 mL/min/1.73 m2) were included. Urine cAMP levels ranged widely between 0.35 and 4.08 nmol/mg of creatinine with a median value of 1.99 nmol/mg of creatinine. A urine cAMP level was an independent predictor of the primary endpoint with a hazard ratio of 0.41 (95% confidence interval 0.18-0.91, p = 0.029) adjusted for 5 potential confounders with a cutoff of 1.55 nmol/mg of creatinine. CONCLUSIONS A lower urine cAMP is an independent predictor of renal deterioration and cardiovascular death in patients with CKD.
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Affiliation(s)
- Kota Kakeshita
- The Second Department of Internal Medicine, University of Toyama, Sugitani, 2630, Toyama, Toyama, 930-0194, Japan
| | - Tsutomu Koike
- The Second Department of Internal Medicine, University of Toyama, Sugitani, 2630, Toyama, Toyama, 930-0194, Japan
| | - Teruhiko Imamura
- The Second Department of Internal Medicine, University of Toyama, Sugitani, 2630, Toyama, Toyama, 930-0194, Japan.
| | - Hayato Fujioka
- The Second Department of Internal Medicine, University of Toyama, Sugitani, 2630, Toyama, Toyama, 930-0194, Japan
| | - Hidenori Yamazaki
- The Second Department of Internal Medicine, University of Toyama, Sugitani, 2630, Toyama, Toyama, 930-0194, Japan
| | - Koichiro Kinugawa
- The Second Department of Internal Medicine, University of Toyama, Sugitani, 2630, Toyama, Toyama, 930-0194, Japan
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