1
|
Paz-Graniel I, Valle-Hita C, Babio N, Serra-Majem L, Vioque J, Zomeño MD, Corella D, Pintó X, Cano-Ibáñez N, Tur JA, Cuadrado-Soto E, Martínez JA, Díaz-López A, Torres-Collado L, Goday A, Fernández-Carrión R, Nissenshon M, Riera-Mestre A, Garrido-Garrido E, Bouzas C, Abete I, Daimiel L, Cornejo-Pareja I, Vázquez-Ruiz Z, Khoury N, Pérez-Vega KA, Salas-Salvadó J. Long-term association between water intake and kidney function in a population at high cardiovascular risk. J Nutr Health Aging 2024; 28:100327. [PMID: 39137622 DOI: 10.1016/j.jnha.2024.100327] [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: 05/15/2024] [Revised: 07/23/2024] [Accepted: 07/26/2024] [Indexed: 08/15/2024]
Abstract
OBJECTIVES The evidence on water intake in the prevention of kidney function decline is scarce at population level in well-being individuals at high cardiovascular risk. Therefore, we aimed to longitudinally evaluate the associations between total water intake and subtypes and kidney function, through estimated-Glomerular Filtration Rate (eGFR). METHODS Three-year prospective analysis conducted in 1986 older adults (aged 55-75 year) with overweight/obesity and metabolic syndrome from the PREDIMED-Plus study. Water intake was assessed using validated beverage and food frequency questionnaires. Serum creatinine-based eGFR (SCr-based eGFR; ml/min/1.73 m2) was estimated using the CKD-EPI equation at baseline, one-year and 3-years of follow-up. Mixed-effects linear regression models were fitted to evaluate the associations between baseline total water intake and subtypes, and SCr-based eGFR over 3-years of follow-up. RESULTS Participants in the highest baseline tertile of total water intake, plain water and water from all fluids showed a lower decrease in SCr-based eGFR after 3-years of follow-up, compared to those in the lowest tertile. Participants with the highest tap water consumption showed a lower SCr-based eGFR decline after 1-year and 3-years of follow-up, in comparerd to participants in the lowest intake category (T3 vs. T1: β: 1.4 ml/min/1.73 m2; 95%CI: 0.5-2.3, β: 1.0; 95%CI: 0.1-2.0, respectively). CONCLUSIONS Plain water rather than other water sources, and especially tap water, was associated with lower kidney function decline assessed through eGFR over 3-years of follow-up, in older individuals at high cardiovascular risk. TRIAL REGISTRATION ISRCTN89898870. Retrospectively registered on 24 July 2014.
Collapse
Affiliation(s)
- Indira Paz-Graniel
- Consorcio Centro de Investigación Biomédica en Red, M.P. Fisiopatología de la Obesidad y Nutrición, Instituto de Salud Carlos III, Madrid, Spain; Universitat Rovira i Virgili, Departament de Bioquímica i Biotecnología, Alimentaciò, Nutrició, Desenvolupament i Salut Mental (ANUT-DSM), Reus, Spain; Institut d'Investigació Sanitària Pere Virgili (IISPV), Reus, Spain
| | - Cristina Valle-Hita
- Consorcio Centro de Investigación Biomédica en Red, M.P. Fisiopatología de la Obesidad y Nutrición, Instituto de Salud Carlos III, Madrid, Spain; Universitat Rovira i Virgili, Departament de Bioquímica i Biotecnología, Alimentaciò, Nutrició, Desenvolupament i Salut Mental (ANUT-DSM), Reus, Spain; Institut d'Investigació Sanitària Pere Virgili (IISPV), Reus, Spain
| | - Nancy Babio
- Consorcio Centro de Investigación Biomédica en Red, M.P. Fisiopatología de la Obesidad y Nutrición, Instituto de Salud Carlos III, Madrid, Spain; Universitat Rovira i Virgili, Departament de Bioquímica i Biotecnología, Alimentaciò, Nutrició, Desenvolupament i Salut Mental (ANUT-DSM), Reus, Spain; Institut d'Investigació Sanitària Pere Virgili (IISPV), Reus, Spain
| | - Lluís Serra-Majem
- Consorcio Centro de Investigación Biomédica en Red, M.P. Fisiopatología de la Obesidad y Nutrición, Instituto de Salud Carlos III, Madrid, Spain; Research Institute of Biomedical and Health Sciences (IUIBS), University of Las Palmas de Gran Canaria & Centro Hospitalario Universitario Insular Materno Infantil (CHUIMI), Canarian Health Service, Las Palmas de Gran Canaria, Spain
| | - Jesus Vioque
- CIBER de Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain; Instituto de Investigación Sanitaria y Biomédica de Alicante, Universidad Miguel Hernández (ISABIAL-UMH), Alicante, Spain
| | - María Dolores Zomeño
- Consorcio Centro de Investigación Biomédica en Red, M.P. Fisiopatología de la Obesidad y Nutrición, Instituto de Salud Carlos III, Madrid, Spain; Cardiovascular Risk and Nutrition, Hospital del Mar Medical Research Institute, Barcelona, Spain; School of Health Sciences, Blanquerna-Ramon Llull University, Barcelona, Spain
| | - Dolores Corella
- Consorcio Centro de Investigación Biomédica en Red, M.P. Fisiopatología de la Obesidad y Nutrición, Instituto de Salud Carlos III, Madrid, Spain; Departament of Preventive Medicine and Public Health, School of Medicine, Valencia, Spain
| | - Xavier Pintó
- Consorcio Centro de Investigación Biomédica en Red, M.P. Fisiopatología de la Obesidad y Nutrición, Instituto de Salud Carlos III, Madrid, Spain; Internal Medicine Department. Hospital Universitari Bellvitge, Barcelona, Spain; Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Spain; Clinical Sciences Department, Faculty of Medicine and Health Sciences, Universitat de Barcelona, Barcelona, Spain
| | - Naomi Cano-Ibáñez
- CIBER de Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain; Department of Preventive Medicine and Public Health, University of Granada, Granada, Spain; Instituto de Investigación Biosanitaria (ibs. GRANADA), Complejo Hospitales Universitarios de Granada/Universidad de Granada, 18071, Granada, Spain
| | - Josep A Tur
- Consorcio Centro de Investigación Biomédica en Red, M.P. Fisiopatología de la Obesidad y Nutrición, Instituto de Salud Carlos III, Madrid, Spain; Research Group on Community Nutrition and Oxidative Stress, University of Balearic Islands, Palma de Mallorca, Spain; Health Research Institute of the Balearic Islands (IdISBa), Palma de Mallorca, Spain
| | - Esther Cuadrado-Soto
- Consorcio Centro de Investigación Biomédica en Red, M.P. Fisiopatología de la Obesidad y Nutrición, Instituto de Salud Carlos III, Madrid, Spain; Nutritional Control of the Epigenome Group, Precision Nutrition and Obesity Program, IMDEA Food, CEI UAM+CSIC, Madrid, Spain; Grupo de Investigación VALORNUT-UCM, Departamento de Nutrición y Ciencia de los Alimentos, Facultad de Farmacia, Universidad Complutense de Madrid, 28040 Madrid, Spain
| | - J A Martínez
- Consorcio Centro de Investigación Biomédica en Red, M.P. Fisiopatología de la Obesidad y Nutrición, Instituto de Salud Carlos III, Madrid, Spain; Department of Nutrition, Food Sciences, and Physiology, Center for Nutrition Research, University of Navarra, Pamplona, Spain; Precision Nutrition and Cardiometabolic Health Program, IEA Food, CEI UAM+CSIC, Madrid, Spain; Departament of Medicine and Endocrinology, University of Valladolid, Spain
| | - Andrés Díaz-López
- Consorcio Centro de Investigación Biomédica en Red, M.P. Fisiopatología de la Obesidad y Nutrición, Instituto de Salud Carlos III, Madrid, Spain; Institut d'Investigació Sanitària Pere Virgili (IISPV), Reus, Spain; Nutrition and Mental Health (NUTRISAM) Research Group, Nutrition and Public Health Unit, Universitat Rovira I Virgili, Reus 43204, Spain
| | - Laura Torres-Collado
- CIBER de Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain; Instituto de Investigación Sanitaria y Biomédica de Alicante, Universidad Miguel Hernández (ISABIAL-UMH), Alicante, Spain
| | - Albert Goday
- Consorcio Centro de Investigación Biomédica en Red, M.P. Fisiopatología de la Obesidad y Nutrición, Instituto de Salud Carlos III, Madrid, Spain; IMIM, Endocrinology and Diabetes Unit, Hospital del Mar, Barcelona, Spain; Departament de Medicina, Universitat Autónoma de Barcelona, Spain
| | - Rebeca Fernández-Carrión
- Consorcio Centro de Investigación Biomédica en Red, M.P. Fisiopatología de la Obesidad y Nutrición, Instituto de Salud Carlos III, Madrid, Spain; Departament of Preventive Medicine and Public Health, School of Medicine, Valencia, Spain
| | - Mariela Nissenshon
- Research Institute of Biomedical and Health Sciences (IUIBS), University of Las Palmas de Gran Canaria & Centro Hospitalario Universitario Insular Materno Infantil (CHUIMI), Canarian Health Service, Las Palmas de Gran Canaria, Spain
| | - Antoni Riera-Mestre
- Consorcio Centro de Investigación Biomédica en Red, M.P. Fisiopatología de la Obesidad y Nutrición, Instituto de Salud Carlos III, Madrid, Spain; Internal Medicine Department. Hospital Universitari Bellvitge, Barcelona, Spain; Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Spain; Clinical Sciences Department, Faculty of Medicine and Health Sciences, Universitat de Barcelona, Barcelona, Spain
| | - Eva Garrido-Garrido
- Primary Care Center Zaidín-Center, Andalusian Health Service, Granada, Spain
| | - Cristina Bouzas
- Consorcio Centro de Investigación Biomédica en Red, M.P. Fisiopatología de la Obesidad y Nutrición, Instituto de Salud Carlos III, Madrid, Spain; Research Group on Community Nutrition and Oxidative Stress, University of Balearic Islands, Palma de Mallorca, Spain; Health Research Institute of the Balearic Islands (IdISBa), Palma de Mallorca, Spain
| | - Itziar Abete
- Consorcio Centro de Investigación Biomédica en Red, M.P. Fisiopatología de la Obesidad y Nutrición, Instituto de Salud Carlos III, Madrid, Spain; Department of Nutrition, Food Sciences, and Physiology, Center for Nutrition Research, University of Navarra, Pamplona, Spain
| | - Lidia Daimiel
- Consorcio Centro de Investigación Biomédica en Red, M.P. Fisiopatología de la Obesidad y Nutrición, Instituto de Salud Carlos III, Madrid, Spain; Nutritional Control of the Epigenome Group, Precision Nutrition and Obesity Program, IMDEA Food, CEI UAM+CSIC, Madrid, Spain; Departamento de Ciencias Farmacéuticas y de la Salud, Faculty de Farmacia, Universidad San Pablo-CEU, CEU Universities, Boadilla del Monte, Spain
| | - Isabel Cornejo-Pareja
- Consorcio Centro de Investigación Biomédica en Red, M.P. Fisiopatología de la Obesidad y Nutrición, Instituto de Salud Carlos III, Madrid, Spain; Virgen de la Victoria Hospital, Department of Endocrinology, Instituto de Investigación Biomédica de Málaga (IBIMA), University of Málaga, 29010 Málaga, Spain
| | - Zenaida Vázquez-Ruiz
- Consorcio Centro de Investigación Biomédica en Red, M.P. Fisiopatología de la Obesidad y Nutrición, Instituto de Salud Carlos III, Madrid, Spain; Department of Preventive Medicine and Public Health, Instituto de Investigación Sanitaria de Navarra (IdiSNA), University of Navarra, 31008 Pamplona, Spain
| | - Nadine Khoury
- Consorcio Centro de Investigación Biomédica en Red, M.P. Fisiopatología de la Obesidad y Nutrición, Instituto de Salud Carlos III, Madrid, Spain; Universitat Rovira i Virgili, Departament de Bioquímica i Biotecnología, Alimentaciò, Nutrició, Desenvolupament i Salut Mental (ANUT-DSM), Reus, Spain; Institut d'Investigació Sanitària Pere Virgili (IISPV), Reus, Spain
| | - Karla Alejandra Pérez-Vega
- Consorcio Centro de Investigación Biomédica en Red, M.P. Fisiopatología de la Obesidad y Nutrición, Instituto de Salud Carlos III, Madrid, Spain; Cardiovascular Risk and Nutrition, Hospital del Mar Medical Research Institute, Barcelona, Spain
| | - Jordi Salas-Salvadó
- Consorcio Centro de Investigación Biomédica en Red, M.P. Fisiopatología de la Obesidad y Nutrición, Instituto de Salud Carlos III, Madrid, Spain; Universitat Rovira i Virgili, Departament de Bioquímica i Biotecnología, Alimentaciò, Nutrició, Desenvolupament i Salut Mental (ANUT-DSM), Reus, Spain; Institut d'Investigació Sanitària Pere Virgili (IISPV), Reus, Spain.
| |
Collapse
|
2
|
Yamanaga S, Hidaka Y, Kawabata C, Toyoda M, Tanaka K, Yamamoto Y, Inadome A, Takeda A, Yokomizo H. Water intake, baseline biopsy, and graft function after living donor kidney transplantation. Sci Rep 2024; 14:3715. [PMID: 38355944 PMCID: PMC10866883 DOI: 10.1038/s41598-024-54163-0] [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: 04/11/2023] [Accepted: 02/09/2024] [Indexed: 02/16/2024] Open
Abstract
Increased water intake is recommended for kidney transplant recipients; however, its efficacy remains controversial. We hypothesized that pre-existing histological findings of the allograft might modulate the impact of water intake. We retrospectively analyzed 167 adults with living-donor kidney transplants (April 2011-May 2020; median observation period, 77 months) whose baseline biopsy data were available. We compared the chronic-change group (n = 38) with the control group (n = 129) to assess the impact of self-reported daily water intake on the estimated glomerular filtration rate (eGFR). The range distribution of water intake was as follows: - 1000 ml (n = 4), 1000-1500 ml (n = 23), 1500-2000 ml (n = 64), 2000-2500 ml (n = 57), 2500-3000 ml (n = 16), and 3000 - ml (n = 3). Donor age was significantly higher in the chronic-change group. In the control group, the ΔeGFR/year increase was correlated with water intake. However, the increase in the water intake of the chronic-change group significantly decreased ΔeGFR/year (1000-1500 ml: + 1.95 ml/min/1.73 m2 and > 2000 ml: - 1.92 ml/min/1.73 m2, p = 0.014). This study suggested a potential influence of increased water intake on recipients with marginal grafts in living donor kidney transplantation.
Collapse
Affiliation(s)
- Shigeyoshi Yamanaga
- Department of Surgery, Japanese Red Cross Kumamoto Hospital, 2-1-1 Nagamine Minami, Higashi-ku, Kumamoto, 861-8520, Japan.
| | - Yuji Hidaka
- Department of Surgery, Japanese Red Cross Kumamoto Hospital, 2-1-1 Nagamine Minami, Higashi-ku, Kumamoto, 861-8520, Japan
| | - Chiaki Kawabata
- Department of Nephrology, Japanese Red Cross Kumamoto Hospital, Kumamoto, Japan
| | - Mariko Toyoda
- Department of Nephrology, Japanese Red Cross Kumamoto Hospital, Kumamoto, Japan
| | - Kosuke Tanaka
- Department of Surgery, Kyoto University, Kyoto, Japan
| | - Yasuhiro Yamamoto
- Department of Urology, Japanese Red Cross Kumamoto Hospital, Kumamoto, Japan
| | - Akito Inadome
- Department of Urology, Japanese Red Cross Kumamoto Hospital, Kumamoto, Japan
| | - Asami Takeda
- Department of Nephrology, Japanese Red Cross Nagoya Daini Hospital, Aichi, Japan
| | - Hiroshi Yokomizo
- Department of Surgery, Japanese Red Cross Kumamoto Hospital, 2-1-1 Nagamine Minami, Higashi-ku, Kumamoto, 861-8520, Japan
| |
Collapse
|
3
|
Lebedeva S, Margaryan A, Smolyarchuk E, Nedorubov A, Materenchuk M, Tonevitsky A, Mutig K. Metabolic effects of vasopressin in pathophysiology of diabetic kidney disease. Front Endocrinol (Lausanne) 2023; 14:1176199. [PMID: 37790608 PMCID: PMC10545091 DOI: 10.3389/fendo.2023.1176199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 08/23/2023] [Indexed: 10/05/2023] Open
Abstract
The diabetic kidney disease (DKD) is the major cause of the chronic kidney disease (CKD). Enhanced plasma vasopressin (VP) levels have been associated with the pathophysiology of DKD and CKD. Stimulation of VP release in DKD is caused by glucose-dependent reset of the osmostat leading to secondary pathophysiologic effects mediated by distinct VP receptor types. VP is a stress hormone exhibiting the antidiuretic action in the kidney along with broad adaptive effects in other organs. Excessive activation of the vasopressin type 2 (V2) receptor in the kidney leads to glomerular hyperfiltration and nephron loss, whereas stimulation of vasopressin V1a or V1b receptors in the liver, pancreas, and adrenal glands promotes catabolic metabolism for energy mobilization, enhancing glucose production and aggravating DKD. Increasing availability of selective VP receptor antagonists opens new therapeutic windows separating the renal and extra-renal VP effects for the concrete applications. Improved understanding of these paradigms is mandatory for further drug design and translational implementation. The present concise review focuses on metabolic effects of VP affecting DKD pathophysiology.
Collapse
Affiliation(s)
- Svetlana Lebedeva
- Department of Pharmacology, Institute of Pharmacy, I.M. Sechenov First Moscow State Medical University, Moscow, Russia
| | - Arus Margaryan
- Department of Pharmacology, Institute of Pharmacy, I.M. Sechenov First Moscow State Medical University, Moscow, Russia
| | - Elena Smolyarchuk
- Department of Pharmacology, Institute of Pharmacy, I.M. Sechenov First Moscow State Medical University, Moscow, Russia
| | - Andrey Nedorubov
- Department of Pharmacology, Institute of Pharmacy, I.M. Sechenov First Moscow State Medical University, Moscow, Russia
| | - Maria Materenchuk
- Department of Pharmacology, Institute of Pharmacy, I.M. Sechenov First Moscow State Medical University, Moscow, Russia
| | | | - Kerim Mutig
- Department of Pharmacology, Institute of Pharmacy, I.M. Sechenov First Moscow State Medical University, Moscow, Russia
- Department of Translational Physiology, Charité-Universitätsmedizin, Berlin, Germany
| |
Collapse
|
4
|
Kuo YW, Huang YY, Tsai SY, Wang JY, Lin JH, Syu ZJ, Wang HS, Hsu YC, Chen JF, Hsia KC, Ho HH. Probiotic Formula Ameliorates Renal Dysfunction Indicators, Glycemic Levels, and Blood Pressure in a Diabetic Nephropathy Mouse Model. Nutrients 2023; 15:2803. [PMID: 37375705 DOI: 10.3390/nu15122803] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 06/09/2023] [Accepted: 06/17/2023] [Indexed: 06/29/2023] Open
Abstract
One-third of patients with end-stage chronic kidney disease (CKD) experience diabetic nephropathy (DN), which worsens the progression of renal dysfunction. However, preventive measures for DN are lacking. Lactobacillus acidophilus TYCA06, Bifidobacterium longum subsp. infantis BLI-02, and Bifidobacterium bifidum VDD088 probiotic strains have been demonstrated to delay CKD progression. This study evaluated their biological functions to stabilize blood-glucose fluctuations and delay the deterioration of renal function. The db/db mice were used to establish a DN animal model. This was supplemented with 5.125 × 109 CFU/kg/day (high dose) or 1.025 × 109 CFU/kg/day (low dose) mixed with probiotics containing TYCA06, BLI-02, and VDD088 for 8 weeks. Blood urea nitrogen (BUN), serum creatinine, blood glucose, and urine protein were analyzed. Possible mechanisms underlying the alleviation of DN symptoms by probiotic strains were evaluated through in vitro tests. Animal experiments revealed that BUN, serum creatinine, and blood glucose upon probiotic administration were significantly lower than in the control group. The rate of change of urine protein decreased significantly, and blood pressure, glucose tolerance, and renal fibrosis were improved. In vitro testing indicated that TYCA06 and BLI-02 significantly increased acetic acid concentration. TYCA06, BLI-02, and VDD088 were associated with better antioxidation, anti-inflammation, and glucose consumption activities relative to the control. A combination of the probiotics TYCA06, BLI-02, and VDD088 attenuated renal function deterioration and improved blood-glucose fluctuation in a diabetes-induced CKD mouse model.
Collapse
Affiliation(s)
- Yi-Wei Kuo
- Department of Research and Design, Glac Biotech Co., Ltd., Tainan 744, Taiwan
| | - Yen-Yu Huang
- Department of Research and Design, Glac Biotech Co., Ltd., Tainan 744, Taiwan
| | - Shin-Yu Tsai
- Department of Research and Design, Glac Biotech Co., Ltd., Tainan 744, Taiwan
| | - Jiu-Yao Wang
- Center of Allergy, Immunology, and Microbiome (AIM), China Medical University Children's Hospital, Taichung 404, Taiwan
- Allergy and Clinical Immunology Research (ACIR) Center, National Cheng Kung University, Tainan 701, Taiwan
- Department of Allergy and Immunology, China Medical University Children's Hospital, Taichung 404, Taiwan
| | - Jia-Hung Lin
- Department of Research and Design, Glac Biotech Co., Ltd., Tainan 744, Taiwan
| | - Zun-Jie Syu
- Department of Research and Design, Glac Biotech Co., Ltd., Tainan 744, Taiwan
| | - Hui-Shan Wang
- Department of Research and Design, Glac Biotech Co., Ltd., Tainan 744, Taiwan
| | - Yu-Chieh Hsu
- Department of Research and Design, Glac Biotech Co., Ltd., Tainan 744, Taiwan
| | - Jui-Fen Chen
- Department of Research and Design, Glac Biotech Co., Ltd., Tainan 744, Taiwan
| | - Ko-Chiang Hsia
- Department of Research and Design, Glac Biotech Co., Ltd., Tainan 744, Taiwan
| | - Hsieh-Hsun Ho
- Department of Research and Design, Glac Biotech Co., Ltd., Tainan 744, Taiwan
| |
Collapse
|
5
|
Bankir L, Guerrot D, Bichet DG. Vaptans or voluntary increased hydration to protect the kidney: how do they compare? Nephrol Dial Transplant 2023; 38:562-574. [PMID: 34586414 DOI: 10.1093/ndt/gfab278] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Indexed: 11/13/2022] Open
Abstract
The adverse effects of vasopressin (AVP) in diverse forms of chronic kidney disease have been well described. They depend on the antidiuretic action of AVP mediated by V2 receptors (V2R). Tolvaptan, a selective V2R antagonist, is now largely used for the treatment of patients with autosomal dominant polycystic kidney disease. Another way to reduce the adverse effects of AVP is to reduce endogenous AVP secretion by a voluntary increase in fluid intake. These two approaches differ in several ways, including the level of thirst and AVP. With voluntary increased drinking, plasma osmolality will decline and so will AVP secretion. Thus, not only will V2R-mediated effects be reduced, but also those mediated by V1a and V1b receptors (V1aR and V1bR). In contrast, selective V2R antagonism will induce a loss of fluid that will stimulate AVP secretion and thus increase AVP's influence on V1a and V1b receptors. V1aR is expressed in the luminal side of the collecting duct (CD) and in inner medullary interstitial cells, and their activation induces the production of prostaglandins, mostly prostaglandin E2 (PGE2). Intrarenal PGE2 has been shown to reduce sodium and water reabsorption in the CD and increase blood flow in the renal medulla, both effects contributing to increase sodium and water excretion and reduce urine-concentrating activity. Conversely, non-steroidal anti-inflammatory drugs have been shown to induce significant water and sodium retention and potentiate the antidiuretic effects of AVP. Thus, during V2R antagonism, V1aR-mediated actions may be responsible for part of the diuresis observed with this drug. These V1aR-dependent effects do not take place with a voluntary increase in fluid intake. In summary, while both strategies may have beneficial effects, the information reviewed here leads us to assume that pharmacological V2R antagonism, with resulting stimulation of V1aR and increased PGE2 production, may provide greater benefit than voluntary high water intake. The influence of tolvaptan on the PGE2 excretion rate and the possibility to use somewhat lower tolvaptan doses than presently prescribed remain to be evaluated.
Collapse
Affiliation(s)
- Lise Bankir
- Centre de Recherche des Cordeliers, INSERM, Sorbonne Université, Université de Paris, Paris, France.,CNRS, ERL 8228-Laboratoire de Physiologie Rénale et Tubulopathies, Paris, France
| | - Dominique Guerrot
- Départment de Néphrologie, Hôpital Universitaire de Rouen, Rouen, France.,Université de Normandie, UNIROUEN, INSERM U1096, Rouen, France
| | - Daniel G Bichet
- Université de Montréal, Montréal, Quebec, Canada.,Département de Pharmacologie, Département de Physiologie, and Département de Médecine, Hôpital du Sacré-Coeur de Montréal, Montréal, Quebec, Canada
| |
Collapse
|
6
|
Lee YJ, Heo CM, Park S, Kim IH, Park JH, Ko J, Park BS, Kim YW. Clinical significance of copeptin as an early predictor of renal graft dysfunction in renal transplant recipients. KOSIN MEDICAL JOURNAL 2022. [DOI: 10.7180/kmj.22.107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Background: Copeptin is the carboxyl-terminal part of the vasopressin precursor protein, and its concentration is an independent predictor of the onset of chronic kidney disease and a rapid decline in the glomerular filtration rate. The glomerular filtration rate is regarded as the best indicator of kidney transplant function and is a predictor of graft and patient survival. We investigated the clinical significance of copeptin as an early predictor of renal graft dysfunction in renal transplant recipients.Methods: We measured serum creatinine, cystatin C, and copeptin concentrations in renal transplant recipients on the day of their operation, as well as on postoperative days 3, 7, 30, and 365. Acute rejection was defined as a sudden decrease in renal function accompanied by histological changes.Results: Eight renal transplant recipients were enrolled in the study from July 2018 to December 2019. Four patients experienced histologically confirmed transplant rejection. All four cases involved acute T-cell rejection. No significant correlation was found between the copeptin level and the presence or absence of rejection at any time point. In subgroup analyses, changes in creatinine, the estimated glomerular filtration rate, cystatin, and copeptin did not show statistical significance.Conclusions: We anticipated that copeptin would be useful to identify individuals at high risk of transplant rejection; however, our study failed to show an association. Further research will be needed to overcome the limitations of this study.
Collapse
|
7
|
Arroyo JP, Akwo EA, Terker AS, Alsouqi A, Bhave G, Harris RC, Hung AM, Ikizler TA. Peripheral Insulin Resistance Is Associated with Copeptin in Patients with Chronic Kidney Disease. KIDNEY360 2021; 2:1434-1440. [PMID: 35373107 PMCID: PMC8786142 DOI: 10.34067/kid.0002622021] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 06/30/2021] [Indexed: 02/04/2023]
Abstract
Background Insulin resistance is associated with cardiovascular disease risk and worsened kidney function. Patients with CKD have higher levels of insulin resistance. Elevated levels of copeptin (a surrogate for vasopressin levels) have been associated with an increased incidence and progression of CKD, and with incident diabetes mellitus. The purpose of our study was to examine the relationship between insulin resistance, copeptin, and CKD. Methods We performed a cross-sectional study to investigate if insulin resistance was associated with higher copeptin levels in nondiabetic patients with stage 3-4 CKD versus controls. We measured plasma copeptin levels and used data from 52 patients with stage 3-4 CKD and 85 controls (eGFR ≥60 ml/min per 1.73 m2) enrolled in the Insulin Resistance in Chronic Kidney Disease (IRCKD) study. We then used a multivariable linear-regression model to assess the independent relationship between peripheral or hepatic insulin resistance and copeptin across levels of eGFR. Results We found that in patients with CKD (eGFR of 30-60 ml/min per 1.73 m2), but not in controls, peripheral insulin resistance was significantly correlated with higher levels of log copeptin (r=-0.21, P=0.04). In patients with CKD, when adjusted for age, sex, BMI, serum osmolality, log IL6, and log leptin/adiponectin ratio, each 1 SD decrease in insulin sensitivity was associated with a 39% increase in serum copeptin levels. The relationship between hepatic insulin resistance, copeptin, and eGFR is similar between controls and patients with reduced eGFR. Conclusion Peripheral insulin resistance is associated with elevated copeptin levels in nondiabetic patients with stage 3-4 CKD. Further research into how the interaction between peripheral insulin resistance and elevated vasopressin affects CKD progression could be of interest.
Collapse
Affiliation(s)
- Juan Pablo Arroyo
- Division of Nephrology and Hypertension, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee,Vanderbilt Center for Kidney Disease, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Elvis A. Akwo
- Division of Nephrology and Hypertension, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Andrew S. Terker
- Division of Nephrology and Hypertension, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee,Vanderbilt Center for Kidney Disease, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Aseel Alsouqi
- Division of Nephrology and Hypertension, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Gautam Bhave
- Division of Nephrology and Hypertension, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee,Vanderbilt Center for Kidney Disease, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Raymond C. Harris
- Division of Nephrology and Hypertension, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee,Vanderbilt Center for Kidney Disease, Vanderbilt University School of Medicine, Nashville, Tennessee,Department of Veterans Affairs, Nashville, Tennessee
| | - Adriana M. Hung
- Division of Nephrology and Hypertension, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee,Vanderbilt Center for Kidney Disease, Vanderbilt University School of Medicine, Nashville, Tennessee,Department of Veterans Affairs, Nashville, Tennessee
| | - T. Alp Ikizler
- Division of Nephrology and Hypertension, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee,Vanderbilt Center for Kidney Disease, Vanderbilt University School of Medicine, Nashville, Tennessee,Department of Veterans Affairs, Nashville, Tennessee
| |
Collapse
|
8
|
Sholokh A, Klussmann E. Local cyclic adenosine monophosphate signalling cascades-Roles and targets in chronic kidney disease. Acta Physiol (Oxf) 2021; 232:e13641. [PMID: 33660401 DOI: 10.1111/apha.13641] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 02/26/2021] [Accepted: 03/01/2021] [Indexed: 12/20/2022]
Abstract
The molecular mechanisms underlying chronic kidney disease (CKD) are poorly understood and treatment options are limited, a situation underpinning the need for elucidating the causative molecular mechanisms and for identifying innovative treatment options. It is emerging that cyclic 3',5'-adenosine monophosphate (cAMP) signalling occurs in defined cellular compartments within nanometre dimensions in processes whose dysregulation is associated with CKD. cAMP compartmentalization is tightly controlled by a specific set of proteins, including A-kinase anchoring proteins (AKAPs) and phosphodiesterases (PDEs). AKAPs such as AKAP18, AKAP220, AKAP-Lbc and STUB1, and PDE4 coordinate arginine-vasopressin (AVP)-induced water reabsorption by collecting duct principal cells. However, hyperactivation of the AVP system is associated with kidney damage and CKD. Podocyte injury involves aberrant AKAP signalling. cAMP signalling in immune cells can be local and slow the progression of inflammatory processes typical for CKD. A major risk factor of CKD is hypertension. cAMP directs the release of the blood pressure regulator, renin, from juxtaglomerular cells, and plays a role in Na+ reabsorption through ENaC, NKCC2 and NCC in the kidney. Mutations in the cAMP hydrolysing PDE3A that cause lowering of cAMP lead to hypertension. Another major risk factor of CKD is diabetes mellitus. AKAP18 and AKAP150 and several PDEs are involved in insulin release. Despite the increasing amount of data, an understanding of functions of compartmentalized cAMP signalling with relevance for CKD is fragmentary. Uncovering functions will improve the understanding of physiological processes and identification of disease-relevant aberrations may guide towards new therapeutic concepts for the treatment of CKD.
Collapse
Affiliation(s)
- Anastasiia Sholokh
- Max‐Delbrück‐Center for Molecular Medicine (MDC) Helmholtz Association Berlin Germany
| | - Enno Klussmann
- Max‐Delbrück‐Center for Molecular Medicine (MDC) Helmholtz Association Berlin Germany
- DZHK (German Centre for Cardiovascular Research) Berlin Germany
| |
Collapse
|
9
|
Horie S, Muto S, Kawano H, Okada T, Shibasaki Y, Nakajima K, Ibuki T. Preservation of kidney function irrelevant of total kidney volume growth rate with tolvaptan treatment in patients with autosomal dominant polycystic kidney disease. Clin Exp Nephrol 2021; 25:467-478. [PMID: 33471240 PMCID: PMC8038960 DOI: 10.1007/s10157-020-02009-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 12/02/2020] [Indexed: 11/29/2022]
Abstract
Background Tolvaptan slowed the rates of total kidney volume (TKV) growth and renal function decline over a 3-year period in patients with autosomal dominant polycystic kidney disease (ADPKD) enrolled in the Tolvaptan Efficacy and Safety in Management of Autosomal Dominant Polycystic Kidney Disease and Its Outcomes (TEMPO) 3:4 trial (NCT00428948). In this post hoc analysis of Japanese patients from TEMPO 3:4, we evaluated whether the effects of tolvaptan on TKV and on renal function are interrelated. Methods One hundred and forty-seven Japanese patients from TEMPO 3:4 were included in this analysis (placebo, n = 55; tolvaptan, n = 92). Tolvaptan-treated patients were stratified into the responder group (n = 37), defined as tolvaptan-treated patients with a net decrease in TKV from baseline to year 3, and the non-responder group (n = 55), defined as tolvaptan-treated patients with a net increase in TKV. Results Mean changes during follow-up in the placebo, responder, and non-responder groups were 16.99%, − 8.33%, and 13.95%, respectively, for TKV and − 12.61, − 8.47, and − 8.58 mL/min/1.73 m2, respectively, for estimated glomerular filtration rate (eGFR). Compared with the placebo group, eGFR decline was significantly slowed in both the responder and non-responder groups (P < 0.05). Conclusion Tolvaptan was effective in slowing eGFR decline, regardless of TKV response, over 3 years in patients with ADPKD in Japan. Treatment with tolvaptan may have beneficial effects on slowing of renal function decline even in patients who have not experienced a reduction in the rate of TKV growth by treatment with tolvaptan. Supplementary Information The online version contains supplementary material available at 10.1007/s10157-020-02009-0.
Collapse
Affiliation(s)
- Shigeo Horie
- Department of Urology, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan. .,Department of Advanced Informatics for Genetic Diseases, Juntendo University Graduate School of Medicine, Tokyo, Japan.
| | - Satoru Muto
- Department of Urology, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan.,Department of Advanced Informatics for Genetic Diseases, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Haruna Kawano
- Department of Urology, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan.,Department of Advanced Informatics for Genetic Diseases, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Tadashi Okada
- Department of Clinical Development, Otsuka Pharmaceutical Co., Ltd, Osaka, Japan
| | | | - Koji Nakajima
- Medical Affairs, Otsuka Pharmaceutical Co., Ltd, Tokyo, Japan
| | - Tatsuki Ibuki
- Medical Affairs, Otsuka Pharmaceutical Co., Ltd, Tokyo, Japan
| |
Collapse
|
10
|
Mondritzki T, Mai TA, Vogel J, Pook E, Wasnaire P, Schmeck C, Hüser J, Dinh W, Truebel H, Kolkhof P. Cardiac output improvement by pecavaptan: a novel dual-acting vasopressin V1a/V2 receptor antagonist in experimental heart failure. Eur J Heart Fail 2020; 23:743-750. [PMID: 32946151 PMCID: PMC8359415 DOI: 10.1002/ejhf.2001] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 09/08/2020] [Accepted: 09/09/2020] [Indexed: 01/09/2023] Open
Abstract
AIMS Arginine vasopressin (AVP) mediates deleterious effects via vascular V1a and renal V2 receptors in heart failure (HF). Despite positive short-term decongestive effects in phase II HF studies, selective V2 receptor antagonism has shown no long-term mortality benefit, potentially related to unopposed V1a receptor activation. We compared the novel dual V1a/V2 receptor antagonist pecavaptan with the selective V2 receptor antagonist tolvaptan in pre-clinical HF models. METHODS AND RESULTS In vitro IC50 determination in recombinant cell lines revealed similar receptor selectivity profiles (V2:V1a) of tolvaptan and pecavaptan for human and dog AVP receptors, respectively. Two canine models were used to compare haemodynamic and aquaretic effects: (i) anaesthetised dogs with tachypacing-induced HF, and (ii) conscious telemetric dogs with a non-invasive cardiac output (CO) monitor. Tolvaptan and pecavaptan exhibited no differences in urinary output. In HF dogs, pecavaptan counteracted the AVP-induced increase in afterload and decrease in CO (pecavaptan: 1.83 ± 0.31 L/min; vs. tolvaptan: 1.46 ± 0.07 L/min, P < 0.05). In conscious telemetric animals, pecavaptan led to a significant increase in CO (+0.26 ± 0.17 L/min, P = 0.0086 vs. placebo), in cardiac index (+0.58 ± 0.39 L/min/m2 , P = 0.009 vs. placebo) and a significant decrease in total peripheral resistance (-5348.6 ± 3601.3 dyn × s/cm5 , P < 0.0001 vs. placebo), whereas tolvaptan was without any significant effect. CONCLUSIONS Simultaneous blockade of vascular V1a and renal V2 receptors efficiently induces aquaresis and counteracts AVP-mediated haemodynamic aggravation in HF models. Dual V1a/V2 antagonism may lead to improved outcomes in HF.
Collapse
Affiliation(s)
- Thomas Mondritzki
- Bayer AG, Wuppertal, Germany.,University of Witten/Herdecke, Witten, Germany
| | | | - Julia Vogel
- University of Witten/Herdecke, Witten, Germany.,University of Duisburg-Essen, Essen, Germany
| | | | | | | | | | - Wilfried Dinh
- Bayer AG, Wuppertal, Germany.,University of Witten/Herdecke, Witten, Germany.,Department of Cardiology, HELIOS Clinic Wuppertal, University Hospital Witten/Herdecke, Wuppertal, Germany
| | - Hubert Truebel
- Bayer AG, Wuppertal, Germany.,University of Witten/Herdecke, Witten, Germany
| | | |
Collapse
|
11
|
Lytvyn Y, Bjornstad P, van Raalte DH, Heerspink HL, Cherney DZI. The New Biology of Diabetic Kidney Disease-Mechanisms and Therapeutic Implications. Endocr Rev 2020; 41:5601424. [PMID: 31633153 PMCID: PMC7156849 DOI: 10.1210/endrev/bnz010] [Citation(s) in RCA: 76] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Accepted: 10/17/2019] [Indexed: 02/07/2023]
Abstract
Diabetic kidney disease remains the most common cause of end-stage kidney disease in the world. Despite reductions in incidence rates of myocardial infarction and stroke in people with diabetes over the past 3 decades, the risk of diabetic kidney disease has remained unchanged, and may even be increasing in younger individuals afflicted with this disease. Accordingly, changes in public health policy have to be implemented to address the root causes of diabetic kidney disease, including the rise of obesity and diabetes, in addition to the use of safe and effective pharmacological agents to prevent cardiorenal complications in people with diabetes. The aim of this article is to review the mechanisms of pathogenesis and therapies that are either in clinical practice or that are emerging in clinical development programs for potential use to treat diabetic kidney disease.
Collapse
Affiliation(s)
- Yuliya Lytvyn
- Department of Medicine, Division of Nephrology, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Petter Bjornstad
- Department of Medicine, Division of Nephrology, Department of Pediatrics, Section of Endocrinology, University of Colorado School of Medicine, Aurora, Colorado
| | - Daniel H van Raalte
- Diabetes Center, Department of Internal Medicine, VU University Medical Center, Netherlands
| | - Hiddo L Heerspink
- The George Institute for Global Health, Sydney, Australia.,Department of Clinical Pharmacology, University of Groningen, Groningen, Netherlands
| | - David Z I Cherney
- Department of Medicine, Division of Nephrology, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
12
|
Imberti B, Cerullo D, Corna D, Rota C, Locatelli M, Pezzotta A, Introna M, Capelli C, Carminati CE, Rabelink TJ, Leuning DG, Zoja C, Morigi M, Remuzzi G, Benigni A, Luyckx V. Protective Effects of Human Nonrenal and Renal Stromal Cells and Their Conditioned Media in a Rat Model of Chronic Kidney Disease. Cell Transplant 2020; 29:963689720965467. [PMID: 33663249 PMCID: PMC8718166 DOI: 10.1177/0963689720965467] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Mesenchymal stromal cells (MSCs) are emerging as a novel therapeutic option for limiting chronic kidney disease progression. Conditioned medium (CM) containing bioactive compounds could convey similar benefits, avoiding the potential risks of cell therapy. This study compared the efficacy of nonrenal and renal cell-based therapy with the corresponding CM in rats with renal mass reduction (RMR). Infusions of human kidney stromal cells (kPSCs) and CM-kPSCs, but not umbilical cord (uc) MSCs or CM-ucMSCs, reduced proteinuria and preserved podocyte number and nephrin expression in RMR rats. Glomerular fibrosis, microvascular rarefaction, and apoptosis were reduced by all treatments, while the peritubular microvascular loss was reduced by kPSCs and CM-kPSCs treatment only. Importantly, kPSCs and CM-kPSCs reduced NG2-positive pericytes, and all therapies reduced α-smooth muscle actin expression, indicating reduced myofibroblast expansion. Treatment with kPSCs also significantly inhibited the accumulation of ED1-positive macrophages in the renal interstitium of RMR rats. These findings demonstrate that the CM of ucMSCs and kPSCs confers similar renoprotection as the cells. kPSCs and CM-kPSCs may be superior in attenuating chronic renal injury as a cell source.
Collapse
Affiliation(s)
- Barbara Imberti
- Department of Molecular Medicine, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Bergamo, Italy.,Both the authors are co-first author
| | - Domenico Cerullo
- Department of Molecular Medicine, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Bergamo, Italy.,Both the authors are co-first author
| | - Daniela Corna
- Department of Molecular Medicine, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Bergamo, Italy
| | - Cinzia Rota
- Department of Molecular Medicine, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Bergamo, Italy
| | - Monica Locatelli
- Department of Molecular Medicine, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Bergamo, Italy
| | - Anna Pezzotta
- Department of Molecular Medicine, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Bergamo, Italy
| | - Martino Introna
- Laboratory of Cell Therapy "G. Lanzani", Azienda Socio Sanitaria Territoriale (ASST) Papa Giovanni XXIII, Bergamo, Italy
| | - Chiara Capelli
- Laboratory of Cell Therapy "G. Lanzani", Azienda Socio Sanitaria Territoriale (ASST) Papa Giovanni XXIII, Bergamo, Italy
| | - Claudia Elisa Carminati
- Department of Molecular Medicine, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Bergamo, Italy
| | - Ton J Rabelink
- Department of Internal Medicine, Leiden University Medical Centre, Leiden, Holland
| | - Danielle G Leuning
- Department of Internal Medicine, Leiden University Medical Centre, Leiden, Holland
| | - Carlamaria Zoja
- Department of Molecular Medicine, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Bergamo, Italy
| | - Marina Morigi
- Department of Molecular Medicine, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Bergamo, Italy
| | - Giuseppe Remuzzi
- Department of Molecular Medicine, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Bergamo, Italy.,"L. Sacco" Department of Biomedical and Clinical Science, University of Milan, Milan, Italy
| | - Ariela Benigni
- Department of Molecular Medicine, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Bergamo, Italy
| | - Valerie Luyckx
- Institute of Biomedical Ethics and History of Medicine, University of Zurich, Zurich, Switzerland.,Renal Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| |
Collapse
|
13
|
Enhörning S, Christensson A, Melander O. Plasma copeptin as a predictor of kidney disease. Nephrol Dial Transplant 2019; 34:74-82. [PMID: 29471407 PMCID: PMC6322441 DOI: 10.1093/ndt/gfy017] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Accepted: 01/06/2018] [Indexed: 12/16/2022] Open
Abstract
Background Plasma copeptin, a marker of vasopressin, is associated with renal function decline in the general population. Our aim was to study the links between elevated copeptin and future risk of kidney disease. Methods Copeptin was measured in a sample of the Malmö Preventive Project (MPP) Reinvestigation (n = 5158) and in the Malmö Diet and Cancer Cardiovascular Cohort (MDC-CC) (n = 5162). According to national registers, 89 subjects in MPP and 180 in MDC-CC developed chronic kidney disease (CKD) during follow-up (8.7 and 19.6 years, respectively). Results After multivariate adjustment (gender, age, body mass index, smoking status, estimated glomerular filtration rate, prevalent diabetes, systolic blood pressure and prevalent antihypertensive treatment), copeptin (beta-coefficient per 1 standard deviation increment of ln copeptin) was independently associated with increased risk of CKD during follow-up in both cohorts (MPP: (HR) 1.46, 95% confidence interval (CI) 1.18–1.80, P < 0.001; MDC-CC: HR 1.25, 95% CI 1.02–1.54, P = 0.03) among subjects free from prevalent kidney disease at baseline. Furthermore, in MPP, elevated copeptin predicted a specified diagnosis of kidney disease other than CKD (HR 1.31, 95% CI 1.08–1.59, P = 0.006) after multivariate adjustment. In a corresponding analysis in MDC-CC, copeptin was associated with a 10% increased risk, which, however, was non-significant (P = 0.25). A meta-analysis of the MPP and MDC-CC data showed significant association between elevated copeptin and a specified diagnosis of kidney disease other than CKD (HR 1.18, 95% CI 1.05–1.34, P = 0.008). Conclusion An increased level of copeptin independently predicts development of both CKD and other specified kidney diseases, suggesting that copeptin can be used to identify individuals at risk for kidney disease development.
Collapse
Affiliation(s)
- Sofia Enhörning
- Department of Endocrinology, Skåne University Hospital, Lund, Sweden.,Department of Clinical Sciences, Lund University, Malmö, Sweden
| | - Anders Christensson
- Department of Clinical Sciences, Lund University, Malmö, Sweden.,Department of Nephrology, Skåne University Hospital, Lund, Sweden
| | - Olle Melander
- Department of Clinical Sciences, Lund University, Malmö, Sweden.,Department of Internal Medicine, Skåne University Hospital, Lund, Sweden
| |
Collapse
|
14
|
SGLT2 inhibition increases serum copeptin in young adults with type 1 diabetes. DIABETES & METABOLISM 2019; 46:203-209. [PMID: 31816431 DOI: 10.1016/j.diabet.2019.11.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Revised: 11/13/2019] [Accepted: 11/23/2019] [Indexed: 01/17/2023]
Abstract
AIMS Copeptin, a surrogate of vasopressin, is elevated in type 1 diabetes (T1D) and predicts kidney disease and cardiovascular mortality. Given the cardiorenal protective effects of SGLT2 inhibition (SGLT2i), our aim was to examine: 1) the relationship between serum copeptin, metabolic, renal and systemic hemodynamic parameters in adults with T1D; and 2) serum copeptin after SGLT2i with empagliflozin. MATERIALS AND METHODS In this post-hoc, exploratory analysis, serum copeptin, glomerular filtration rate (GFRInulin), effective renal plasma flow (ERPFPAH), plasma renin angiotensin aldosterone system markers, HbA1c, 24-hour urine volume and sodium excretion were measured in 40 participants with T1D (24.3±5.1 years) during eu- and hyperglycaemia before and after 8 weeks of 25mg of daily empagliflozin. RESULTS Higher baseline copeptin correlated with higher HbA1c, lower 24-hour urine volume and sodium excretion, after correcting for age, sex, systolic blood pressure, and HbA1c. Copeptin concentrations increased in response to empagliflozin under euglycaemia (4.1±2.1 to 5.1±2.8pmol/L, P=0.0053) and hyperglycaemia (3.3±1.4 to 5.6±2.8pmol/L, P<0.0001). The rise in copeptin in response to empagliflozin correlated with change in 24-hour urine volume, but was independent of changes in fractional excretion of sodium and haematocrit. CONCLUSIONS Elevated serum copeptin was associated with worse glycaemic control and lower diuresis and natriuresis. SGLT2i increased serum copeptin in adults with T1D, and the rise correlated with change in diuresis, but not natriuresis and hemo-concentration. Further work is required to evaluate the clinical implications of elevated copeptin with SGLT2i, including whether it is simply a marker of diuresis or may contribute to cardiorenal disease long-term.
Collapse
|
15
|
García-Arroyo FE, Muñoz-Jiménez I, Gonzaga G, Tapia E, Osorio-Alonso H, Roncal-Jiménez CA, Iroz A, Vecchio M, Reyes-García JG, Johnson RJ, Sánchez-Lozada LG. A Role for Both V1a and V2 Receptors in Renal Heat Stress Injury Amplified by Rehydration with Fructose. Int J Mol Sci 2019; 20:ijms20225764. [PMID: 31744099 PMCID: PMC6888540 DOI: 10.3390/ijms20225764] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Revised: 11/10/2019] [Accepted: 11/14/2019] [Indexed: 01/17/2023] Open
Abstract
Chronic vasopressin secretion induced by recurrent mild heat stress exposure is significantly enhanced by limited rehydration with a fructose-containing beverage both in rodents and in humans. Moreover, this effect has been associated with upregulation of the polyol–fructokinase pathway and increased renal oxidative stress. Previously, we have shown that pharmacological inhibition of both V1a and V2 vasopressin receptors with conivaptan improved such renal alterations. The aim of this study was to evaluate the independent contributions of V1a and V2 receptors to the renal damage caused by mild heat stress and limited rehydration with a fructose-containing beverage. Osmotic minipumps were used to deliver either relcovaptan (0.64 mg/day) or tolvaptan (0.25 mg/day) in male Wistar rats for two weeks. Corresponding dilution vehicles were used as controls. To induce dehydration, rats were exposed to mild heat stress (37 °C for 1 h, Monday to Friday). All groups received a 10% fructose solution as a rehydration fluid for 2 h after mild heat stress. For the remainder of the day and on weekends, rats received tap water. The independent blockade of either the V1a or the V2 receptor prevented renal damage, reduced oxidative stress, and decreased plasma cortisol and systemic inflammation. However, the beneficial effects were regulated by different mechanisms. Tolvaptan inhibited polyol–fructokinase pathway overactivation, while relcovaptan prevented upregulation of the renin–angiotensin system and SGK1 expression. These data suggest that both V1a and V2 receptors participate in renal damage caused by heat stress-induced dehydration when fructose-containing beverages are used as rehydration fluids.
Collapse
Affiliation(s)
- Fernando E. García-Arroyo
- Department of Cardio-Renal Physiopathology, INC Ignacio Chávez, Mexico City 14080, Mexico; (F.E.G.-A.); (I.M.-J.); (G.G.); (E.T.); (H.O.-A.)
- Sección de Estudios de Posgrado e Investigación, Escuela Superior de Medicina, IPN Mexico City 11340, Mexico;
| | - Itzel Muñoz-Jiménez
- Department of Cardio-Renal Physiopathology, INC Ignacio Chávez, Mexico City 14080, Mexico; (F.E.G.-A.); (I.M.-J.); (G.G.); (E.T.); (H.O.-A.)
- Sección de Estudios de Posgrado e Investigación, Escuela Superior de Medicina, IPN Mexico City 11340, Mexico;
| | - Guillermo Gonzaga
- Department of Cardio-Renal Physiopathology, INC Ignacio Chávez, Mexico City 14080, Mexico; (F.E.G.-A.); (I.M.-J.); (G.G.); (E.T.); (H.O.-A.)
| | - Edilia Tapia
- Department of Cardio-Renal Physiopathology, INC Ignacio Chávez, Mexico City 14080, Mexico; (F.E.G.-A.); (I.M.-J.); (G.G.); (E.T.); (H.O.-A.)
| | - Horacio Osorio-Alonso
- Department of Cardio-Renal Physiopathology, INC Ignacio Chávez, Mexico City 14080, Mexico; (F.E.G.-A.); (I.M.-J.); (G.G.); (E.T.); (H.O.-A.)
| | - Carlos A Roncal-Jiménez
- Renal Diseases and Hypertension, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA; (C.A.R.-J.); (R.J.J.)
| | - Alison Iroz
- Danone Research, 91767 Palaiseau, France; (A.I.); (M.V.)
| | | | - Juan G. Reyes-García
- Sección de Estudios de Posgrado e Investigación, Escuela Superior de Medicina, IPN Mexico City 11340, Mexico;
| | - Richard J Johnson
- Renal Diseases and Hypertension, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA; (C.A.R.-J.); (R.J.J.)
| | - L Gabriela Sánchez-Lozada
- Department of Cardio-Renal Physiopathology, INC Ignacio Chávez, Mexico City 14080, Mexico; (F.E.G.-A.); (I.M.-J.); (G.G.); (E.T.); (H.O.-A.)
- Correspondence: or
| |
Collapse
|
16
|
Kanbay M, Yilmaz S, Dincer N, Ortiz A, Sag AA, Covic A, Sánchez-Lozada LG, Lanaspa MA, Cherney DZI, Johnson RJ, Afsar B. Antidiuretic Hormone and Serum Osmolarity Physiology and Related Outcomes: What Is Old, What Is New, and What Is Unknown? J Clin Endocrinol Metab 2019; 104:5406-5420. [PMID: 31365096 DOI: 10.1210/jc.2019-01049] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Accepted: 07/25/2019] [Indexed: 12/16/2022]
Abstract
CONTEXT Although the physiology of sodium, water, and arginine vasopressin (AVP), also known as antidiuretic hormone, has long been known, accumulating data suggest that this system operates as a more complex network than previously thought. EVIDENCE ACQUISITION English-language basic science and clinical studies of AVP and osmolarity on the development of kidney and cardiovascular disease and overall outcomes. EVIDENCE SYNTHESIS Apart from osmoreceptors and hypovolemia, AVP secretion is modified by novel factors such as tongue acid-sensing taste receptor cells and brain median preoptic nucleus neurons. Moreover, pharyngeal, esophageal, and/or gastric sensors and gut microbiota modulate AVP secretion. Evidence is accumulating that increased osmolarity, AVP, copeptin, and dehydration are all associated with worse outcomes in chronic disease states such as chronic kidney disease (CKD), diabetes, and heart failure. On the basis of these pathophysiological relationships, an AVP receptor 2 blocker is now licensed for CKD related to polycystic kidney disease. CONCLUSION From a therapeutic perspective, fluid intake may be associated with increased AVP secretion if it is driven by loss of urine concentration capacity or with suppressed AVP if it is driven by voluntary fluid intake. In the current review, we summarize the literature on the relationship between elevated osmolarity, AVP, copeptin, and dehydration with renal and cardiovascular outcomes and underlying classical and novel pathophysiologic pathways. We also review recent unexpected and contrasting findings regarding AVP physiology in an attempt to explain and understand some of these relationships.
Collapse
Affiliation(s)
- Mehmet Kanbay
- Division of Nephrology, Department of Medicine, Koc University School of Medicine, Istanbul, Turkey
| | - Sezen Yilmaz
- Department of Medicine, Koc University School of Medicine, Istanbul, Turkey
| | - Neris Dincer
- Department of Medicine, Koc University School of Medicine, Istanbul, Turkey
| | - Alberto Ortiz
- Dialysis Unit, School of Medicine, IIS-Fundacion Jimenez Diaz, Universidad Autónoma de Madrid, Madrid, Spain
| | - Alan A Sag
- Division of Vascular and Interventional Radiology, Department of Radiology, Duke University Medical Center, Durham, North Carolina
| | - Adrian Covic
- Nephrology Department, Dialysis and Renal Transplant Center, "Dr. C. I. Parhon" University Hospital, "Grigore T. Popa" University of Medicine and Pharmacy, Iasi, Romania
| | - Laura G Sánchez-Lozada
- Laboratory of Renal Physiopathology, Department of Nephrology, INC Ignacio Chávez, Mexico City, Mexico
| | - Miguel A Lanaspa
- Division of Renal Diseases and Hypertension, School of Medicine, University of Colorado Denver, Aurora, Colorado
| | - David Z I Cherney
- Department of Medicine, Division of Nephrology, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Richard J Johnson
- Division of Renal Diseases and Hypertension, School of Medicine, University of Colorado Denver, Aurora, Colorado
| | - Baris Afsar
- Division of Nephrology, Department of Medicine, Suleyman Demirel University School of Medicine, Isparta, Turkey
| |
Collapse
|
17
|
Mazloum M, Jouffroy J, Brazier F, Legendre C, Neuraz A, Garcelon N, Prié D, Anglicheau D, Bienaimé F. Osmoregulation Performance and Kidney Transplant Outcome. J Am Soc Nephrol 2019; 30:1282-1293. [PMID: 31217325 PMCID: PMC6622417 DOI: 10.1681/asn.2018121269] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Accepted: 03/29/2019] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Kidney transplant recipients have an impaired ability to dilute urine but seldom develop baseline hyponatremia before ESRD. Although hyponatremia is a risk factor for adverse events in CKD and in kidney transplant recipients, it remains unclear whether subtler alterations in osmoregulation performance are associated with outcome. METHODS We studied a single-center prospective cohort of 1258 kidney transplant recipients who underwent a water-loading test 3 months after transplant to determine osmoregulation performance. Measured GFR (mGFR) was performed at the same visit. A group of 164 healthy candidates for kidney donation served as controls. We further evaluated the association of osmoregulation performance with transplantation outcomes and subsequent kidney function. RESULTS Unlike controls, most kidney transplant recipients failed to maintain plasma sodium during water loading (plasma sodium slope of -0.6±0.4 mmol/L per hour in transplant recipients versus -0.12±0.3 mmol/L per hour in controls; P<0.001). Steeper plasma sodium reduction during the test independently associated with the composite outcome of all-cause mortality and allograft loss (hazard ratio [HR], 1.73 per 1 mmol/L per hour decrease in plasma sodium; 95% confidence interval [95% CI], 1.23 to 2.45; P=0.002) and allograft loss alone (HR, 2.04 per 1 mmol/L per hour decrease in plasma sodium; 95% CI, 1.19 to 3.51; P=0.01). The association remained significant in a prespecified sensitivity analysis excluding patients with hyperglycemia. In addition, a steeper plasma sodium slope 3 months after transplantation independently correlated with lower mGFR at 12 months (β=1.93; 95% CI, 0.46 to 3.41; P=0.01). CONCLUSIONS Reduced osmoregulation performance occurs frequently in kidney transplant recipients and is an independent predictor of renal outcome.
Collapse
Affiliation(s)
- Manal Mazloum
- Service de Department of Nephrology and Kidney Transplantation
- Medical Faculty, Paris University, Paris, France
| | - Jordan Jouffroy
- Medical Faculty, Paris University, Paris, France
- Department of Medical Informatics, and
| | - François Brazier
- Medical Faculty, Paris University, Paris, France
- Department of Physiology, Necker Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
- Necker Enfants-Malades Research Institute, INSERM U1151, Paris, France; and
| | - Christophe Legendre
- Service de Department of Nephrology and Kidney Transplantation
- Medical Faculty, Paris University, Paris, France
- Necker Enfants-Malades Research Institute, INSERM U1151, Paris, France; and
| | - Antoine Neuraz
- Medical Faculty, Paris University, Paris, France
- Department of Medical Informatics, and
| | | | - Dominique Prié
- Medical Faculty, Paris University, Paris, France
- Department of Physiology, Necker Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
- Necker Enfants-Malades Research Institute, INSERM U1151, Paris, France; and
| | - Dany Anglicheau
- Service de Department of Nephrology and Kidney Transplantation
- Medical Faculty, Paris University, Paris, France
- Necker Enfants-Malades Research Institute, INSERM U1151, Paris, France; and
| | - Frank Bienaimé
- Medical Faculty, Paris University, Paris, France;
- Department of Physiology, Necker Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
- Necker Enfants-Malades Research Institute, INSERM U1151, Paris, France; and
| |
Collapse
|
18
|
Giesecke T, Himmerkus N, Leipziger J, Bleich M, Koshimizu TA, Fähling M, Smorodchenko A, Shpak J, Knappe C, Isermann J, Ayasse N, Kawahara K, Schmoranzer J, Gimber N, Paliege A, Bachmann S, Mutig K. Vasopressin Increases Urinary Acidification via V1a Receptors in Collecting Duct Intercalated Cells. J Am Soc Nephrol 2019; 30:946-961. [PMID: 31097611 DOI: 10.1681/asn.2018080816] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2018] [Accepted: 03/11/2019] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND Antagonists of the V1a vasopressin receptor (V1aR) are emerging as a strategy for slowing progression of CKD. Physiologically, V1aR signaling has been linked with acid-base homeostasis, but more detailed information is needed about renal V1aR distribution and function. METHODS We used a new anti-V1aR antibody and high-resolution microscopy to investigate Va1R distribution in rodent and human kidneys. To investigate whether V1aR activation promotes urinary H+ secretion, we used a V1aR agonist or antagonist to evaluate V1aR function in vasopressin-deficient Brattleboro rats, bladder-catheterized mice, isolated collecting ducts, and cultured inner medullary collecting duct (IMCD) cells. RESULTS Localization of V1aR in rodent and human kidneys produced a basolateral signal in type A intercalated cells (A-ICs) and a perinuclear to subapical signal in type B intercalated cells of connecting tubules and collecting ducts. Treating vasopressin-deficient Brattleboro rats with a V1aR agonist decreased urinary pH and tripled net acid excretion; we observed a similar response in C57BL/6J mice. In contrast, V1aR antagonist did not affect urinary pH in normal or acid-loaded mice. In ex vivo settings, basolateral treatment of isolated perfused medullary collecting ducts with the V1aR agonist or vasopressin increased intracellular calcium levels in ICs and decreased luminal pH, suggesting V1aR-dependent calcium release and stimulation of proton-secreting proteins. Basolateral treatment of IMCD cells with the V1aR agonist increased apical abundance of vacuolar H+-ATPase in A-ICs. CONCLUSIONS Our results show that activation of V1aR contributes to urinary acidification via H+ secretion by A-ICs, which may have clinical implications for pharmacologic targeting of V1aR.
Collapse
Affiliation(s)
- Torsten Giesecke
- Institute of Vegetative Anatomy, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany; .,Berlin Institute of Health (BIH), Berlin, Germany
| | - Nina Himmerkus
- Institute of Physiology, Christian-Albrechts-Universität zu Kiel, Kiel, Germany
| | - Jens Leipziger
- Department of Biomedicine, Aarhus University, Aarhus C, Denmark
| | - Markus Bleich
- Institute of Physiology, Christian-Albrechts-Universität zu Kiel, Kiel, Germany
| | - Taka-Aki Koshimizu
- Division of Molecular Pharmacology, Department of Pharmacology, Jichi Medical University, Shimotsuke-shi, Tochigi-ken, Japan
| | - Michael Fähling
- Institute of Vegetative Physiology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Alina Smorodchenko
- Institute of Vegetative Anatomy, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Julia Shpak
- Institute of Vegetative Anatomy, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Carolin Knappe
- Institute of Vegetative Anatomy, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Julian Isermann
- Institute of Physiology, Christian-Albrechts-Universität zu Kiel, Kiel, Germany
| | - Niklas Ayasse
- Department of Biomedicine, Aarhus University, Aarhus C, Denmark
| | - Katsumasa Kawahara
- Department of Physiology, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan
| | - Jan Schmoranzer
- Advanced Medical BioImaging Core Facility, Charite-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Niclas Gimber
- Advanced Medical BioImaging Core Facility, Charite-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Alexander Paliege
- Division of Nephrology, Department of Internal Medicine III, University Hospital Carl Gustav Carus at the Technische Universität Dresden, Dresden, Germany; and
| | - Sebastian Bachmann
- Institute of Vegetative Anatomy, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Kerim Mutig
- Institute of Vegetative Anatomy, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany; .,Department of Pharmacology, I.M. Sechenov First Moscow State Medical University of the Ministry of Healthcare of the Russian Federation (Sechenovskiy University), Moscow, Russian Federation
| |
Collapse
|
19
|
Abstract
Life with a solitary functioning kidney (SFK) may be different from that when born with two kidneys. Based on the hyperfiltration hypothesis, a SFK may lead to glomerular damage with hypertension, albuminuria and progression towards end-stage renal disease. As the prognosis of kidney donors was considered to be very good, having a SFK has been considered to be a benign condition. In contrast, our research group has demonstrated that being born with or acquiring a SFK in childhood results in renal injury before adulthood in over 50% of those affected. Most congenital cases will be detected during antenatal ultrasound screening, but up to 38% of cases of unilateral renal agenesis are missed. In about 25-50% of cases of antenatally detected SFK there will be signs of hypertrophy, which could indicate additional nephron formation and is associated with a somewhat reduced risk of renal injury. Additional renal and extrarenal anomalies are frequently detected and may denote a genetic cause for the SFK, even though for the majority of cases no explanation can (yet) be found. The ongoing glomerular hyperfiltration results in renal injury, for which early markers are lacking. Individuals with SFK should avoid obesity and excessive salt intake to limit additional hyperfiltration. As conditions like hypertension, albuminuria and a mildly reduced glomerular filtration rate generally do not result in specific complaints but may pose a threat to long-term health, screening for renal injury in any individual with a SFK would appear to be imperative, starting from infancy. With early treatment, secondary consequences may be diminished, thereby providing the optimal life for anyone born with a SFK.
Collapse
|
20
|
Copeptin Plasma Levels are Associated with Decline of Renal Function in Patients with Type 2 Diabetes Mellitus. Arch Med Res 2018; 49:36-43. [DOI: 10.1016/j.arcmed.2018.04.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Accepted: 04/06/2018] [Indexed: 12/21/2022]
|
21
|
Clark WF, Devuyst O, Roussel R. The vasopressin system: new insights for patients with kidney diseases: Epidemiological evidence and therapeutic perspectives. J Intern Med 2017; 282:310-321. [PMID: 28905441 DOI: 10.1111/joim.12654] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
People with chronic kidney disease (CKD) are at risk of severe outcomes, such as end-stage renal disease or cardiovascular disease, and CKD is a globally increasing health burden with a high personal and economic cost. Despite major progresses in prevention and therapeutics in last decades, research is still needed to reverse this epidemic trend. The regulation of water balance and the state of activation of the vasopressin system have emerged as factors tightly associated with kidney health, in the general population but also in specific conditions; among them, various stages of CKD, diabetes and autosomal dominant polycystic kidney disease (ADPKD). Basic science findings and also epidemiological evidence have justified important efforts towards interventional studies supporting causality, and opening therapeutic avenues. On the basis of recent clinical data, the blockade of V2 vasopressin receptors using tolvaptan in patients with rapidly progressing ADPKD has been granted in several countries, and a long-term randomized trial evaluating the effect of an increase in water intake in patients with CKD is on-going.
Collapse
Affiliation(s)
- W F Clark
- Division of Nephrology, Department of Medicine, London Health Sciences Centre, London, ON, Canada
| | - O Devuyst
- Institute of Physiology, University of Zurich, Zurich, Switzerland
| | - R Roussel
- INSERM, UMR_S 1138, Centre de Recherche des Cordeliers, Paris, France.,Département de Diabétologie, Endocrinologie et Nutrition, Assistance Publique Hôpitaux de Paris, Hôpital Bichat, DHU FIRE, Paris, France.,Sorbonne Paris Cite, UFR de Médecine, Université Paris Diderot, Paris, France
| |
Collapse
|
22
|
Clark WF, Huang SH, Garg AX, Gallo K, House AA, Moist L, Weir MA, Sontrop JM. The Chronic Kidney Disease Water Intake Trial: Protocol of a Randomized Controlled Trial. Can J Kidney Health Dis 2017; 4:2054358117725106. [PMID: 28856009 PMCID: PMC5571765 DOI: 10.1177/2054358117725106] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Accepted: 06/13/2017] [Indexed: 01/01/2023] Open
Abstract
Background: In observational studies, drinking more water associates with a slower rate of kidney function decline; whether the same is true in a randomized controlled trial is unknown. Objective: To examine the 1-year effect of a higher vs usual water intake on estimated glomerular filtration rate (eGFR) in patients with chronic kidney disease. Design: Parallel-group randomized controlled trial. Setting: Nine centers in Ontario, Canada. Enrollment and randomization occurred between May 2013 and May 2016; follow-up for the primary outcome will continue until June 2017. Participants: Adults (n = 631) with stage 3 chronic kidney disease (eGFR 30-60 mL/min/1.73 m2) and microalbuminuria. Intervention: The high water intake group was coached to increase their oral water intake by 1.0 to 1.5 L/day (depending on sex and weight), over and above usual consumed beverages, for a period of 1 year. The control group was coached to maintain their usual water intake during this time. Measures: Participants provided 24-hour urine samples at baseline and at 6 and 12 months after randomization; urine samples were analyzed for volume, creatinine, osmolality, and the albumin-to-creatinine ratio. Blood samples were obtained at baseline and at 3- to 6-month intervals after randomization, and analyzed for creatinine, copeptin, osmolality, and electrolytes. Other measures collected included health-related quality of life, blood pressure, body mass index, and diet. Primary outcome: The between-group change in eGFR from baseline (prerandomization) to 12 months after randomization. Secondary outcomes: Change in plasma copeptin concentration, 24-hour urine albumin-to-creatinine ratio, measured creatinine clearance, estimated 5-year risk of kidney failure (using the 4-variable Kidney Failure Risk Equation), and health-related quality of life. Planned analysis: The primary analysis will follow an intention-to-treat approach. The between-group change in eGFR will be compared using linear regression. Supplementary analyses will examine alternative definitions of eGFR change, including annual percentage change, rate of decline, and rapid decline (a P value <0.05 will be interpreted as statistically significant if there is concordance with the primary outcome). Trial Registration: This randomized controlled trial has been registered at www.clinicaltrials.gov; government identifier: NCT01766687.
Collapse
|
23
|
Youhanna S, Bankir L, Jungers P, Porteous D, Polasek O, Bochud M, Hayward C, Devuyst O. Validation of Surrogates of Urine Osmolality in Population Studies. Am J Nephrol 2017; 46:26-36. [PMID: 28586769 PMCID: PMC6080694 DOI: 10.1159/000475769] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Accepted: 04/12/2017] [Indexed: 12/11/2022]
Abstract
BACKGROUND The importance of vasopressin and/or urine concentration in various kidney, cardiovascular, and metabolic diseases has been emphasized recently. Due to technical constraints, urine osmolality (Uosm), a direct reflect of urinary concentrating activity, is rarely measured in epidemiologic studies. METHODS We analyzed 2 possible surrogates of Uosm in 4 large population-based cohorts (total n = 4,247) and in patients with chronic kidney disease (CKD, n = 146). An estimated Uosm (eUosm) based on the concentrations of sodium, potassium, and urea, and a urine concentrating index (UCI) based on the ratio of creatinine concentrations in urine and plasma were compared to the measured Uosm (mUosm). RESULTS eUosm is an excellent surrogate of mUosm, with a highly significant linear relationship and values within 5% of mUosm (r = 0.99 or 0.98 in each population cohort). Bland-Altman plots show a good agreement between eUosm and mUosm with mean differences between the 2 variables within ±24 mmol/L. This was verified in men and women, in day and night urine samples, and in CKD patients. The relationship of UCI with mUosm is also significant but is not linear and exhibits more dispersed values. Moreover, the latter index is no longer representative of mUosm in patients with CKD as it declines much more quickly with declining glomerular filtration rate than mUosm. CONCLUSION The eUosm is a valid marker of urine concentration in population-based and CKD cohorts. The UCI can provide an estimate of urine concentration when no other measurement is available, but should be used only in subjects with normal renal function.
Collapse
Affiliation(s)
- Sonia Youhanna
- Institute of Physiology, University of Zurich, Zurich, Switzerland
| | - Lise Bankir
- INSERM UMRS 1138, Centre de Recherche des Cordeliers, Paris, France
- Université Pierre et Marie Curie, Paris, France
| | - Paul Jungers
- Service de Néphrologie, Hôpital Necker, Paris, France
| | - David Porteous
- Centre for Genomic & Experimental Medicine, Institute of Genetics and Molecular Medicine, Edinburgh, Scotland
| | - Ozren Polasek
- Department of Public Health, Universityof Split, Split, Croatia
| | - Murielle Bochud
- Institute of Social and Preventive Medicine, Lausanne University Hospital Center, Lausanne, Switzerland
| | - Caroline Hayward
- MRC Human Genetics Unit, Institute of Genetics and Molecular Medicine, Edinburgh, Scotland
| | - Olivier Devuyst
- Institute of Physiology, University of Zurich, Zurich, Switzerland
| |
Collapse
|
24
|
Underwood CF, Hildreth CM, Wyse BF, Boyd R, Goodchild AK, Phillips JK. Uraemia: an unrecognized driver of central neurohumoral dysfunction in chronic kidney disease? Acta Physiol (Oxf) 2017; 219:305-323. [PMID: 27247097 DOI: 10.1111/apha.12727] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Revised: 01/21/2016] [Accepted: 05/31/2016] [Indexed: 12/12/2022]
Abstract
Chronic kidney disease (CKD) carries a large cardiovascular burden in part due to hypertension and neurohumoral dysfunction - manifesting as sympathetic overactivity, baroreflex dysfunction and chronically elevated circulating vasopressin. Alterations within the central nervous system (CNS) are necessary for the expression of neurohumoral dysfunction in CKD; however, the underlying mechanisms are poorly defined. Uraemic toxins are a diverse group of compounds that accumulate as a direct result of renal disease and drive dysfunction in multiple organs, including the brain. Intensive haemodialysis improves both sympathetic overactivity and cardiac baroreflex sensitivity in renal failure patients, indicating that uraemic toxins participate in the maintenance of autonomic dysfunction in CKD. In rodents exposed to uraemia, immediate early gene expression analysis suggests upregulated activity of not only pre-sympathetic but also vasopressin-secretory nuclei. We outline several potential mechanisms by which uraemia might drive neurohumoral dysfunction in CKD. These include superoxide-dependent effects on neural activity, depletion of nitric oxide and induction of low-grade systemic inflammation. Recent evidence has highlighted superoxide production as an intermediate for the depolarizing effect of some uraemic toxins on neuronal cells. We provide preliminary data indicating augmented superoxide production within the hypothalamic paraventricular nucleus in the Lewis polycystic kidney rat, which might be important for mediating the neurohumoral dysfunction exhibited in this CKD model. We speculate that the uraemic state might serve to sensitize the central actions of other sympathoexcitatory factors, including renal afferent nerve inputs to the CNS and angiotensin II, by way of recruiting convergent superoxide-dependent and pro-inflammatory pathways.
Collapse
Affiliation(s)
- C. F. Underwood
- Department of Biomedical Sciences; Macquarie University; Sydney NSW Australia
| | - C. M. Hildreth
- Department of Biomedical Sciences; Macquarie University; Sydney NSW Australia
| | - B. F. Wyse
- Department of Biomedical Sciences; Macquarie University; Sydney NSW Australia
| | - R. Boyd
- Department of Biomedical Sciences; Macquarie University; Sydney NSW Australia
| | - A. K. Goodchild
- Department of Biomedical Sciences; Macquarie University; Sydney NSW Australia
| | - J. K. Phillips
- Department of Biomedical Sciences; Macquarie University; Sydney NSW Australia
| |
Collapse
|
25
|
Adachi S, Miura SI, Shiga Y, Arimura T, Morii J, Kuwano T, Kitajima K, Iwata A, Morito N, Fujimi K, Yahiro E, Nishikawa H, Saku K. Effects of Tolvaptan With or Without the Pre-Administration of Renin-Angiotensin System Blockers in Hospitalized Patients With Acute Decompensated Heart Failure. Int Heart J 2017; 58:385-392. [DOI: 10.1536/ihj.16-220] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Sen Adachi
- Department of Cardiology, Fukuoka University School of Medicine
| | - Shin-ichiro Miura
- Department of Cardiology, Fukuoka University School of Medicine
- Department of Molecular Cardiovascular Therapeutics, Fukuoka University School of Medicine
| | - Yuhei Shiga
- Department of Cardiology, Fukuoka University School of Medicine
| | - Tadaaki Arimura
- Department of Cardiology, Fukuoka University School of Medicine
| | - Joji Morii
- Department of Cardiology, Fukuoka University School of Medicine
| | - Takashi Kuwano
- Department of Cardiology, Fukuoka University School of Medicine
| | - Ken Kitajima
- Department of Cardiology, Fukuoka University School of Medicine
| | - Atsushi Iwata
- Department of Cardiology, Fukuoka University School of Medicine
| | - Natsumi Morito
- Department of Cardiology, Fukuoka University School of Medicine
| | - Kanta Fujimi
- Department of Cardiology, Fukuoka University School of Medicine
| | - Eiji Yahiro
- Department of Cardiology, Fukuoka University School of Medicine
| | | | - Keijiro Saku
- Department of Cardiology, Fukuoka University School of Medicine
- Department of Molecular Cardiovascular Therapeutics, Fukuoka University School of Medicine
| |
Collapse
|
26
|
Hilliard LM, Colafella KMM, Bulmer LL, Puelles VG, Singh RR, Ow CPC, Gaspari T, Drummond GR, Evans RG, Vinh A, Denton KM. Chronic recurrent dehydration associated with periodic water intake exacerbates hypertension and promotes renal damage in male spontaneously hypertensive rats. Sci Rep 2016; 6:33855. [PMID: 27653548 PMCID: PMC5032121 DOI: 10.1038/srep33855] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2016] [Accepted: 09/05/2016] [Indexed: 01/12/2023] Open
Abstract
Epidemiological evidence links recurrent dehydration associated with periodic water intake with chronic kidney disease (CKD). However, minimal attention has been paid to the long-term impact of periodic water intake on the progression of CKD and underlying mechanisms involved. Therefore we investigated the chronic effects of recurrent dehydration associated with periodic water restriction on arterial pressure and kidney function and morphology in male spontaneously hypertensive rats (SHR). Arterial pressure increased and glomerular filtration rate decreased in water-restricted SHR. This was observed in association with cyclic changes in urine osmolarity, indicative of recurrent dehydration. Additionally, water-restricted SHR demonstrated greater renal fibrosis and an imbalance in favour of pro-inflammatory cytokine-producing renal T cells compared to their control counterparts. Furthermore, urinary NGAL levels were greater in water-restricted than control SHR. Taken together, our results provide significant evidence that recurrent dehydration associated with chronic periodic drinking hastens the progression of CKD and hypertension, and suggest a potential role for repetitive bouts of acute renal injury driving renal inflammatory processes in this setting. Further studies are required to elucidate the specific pathways that drive the progression of recurrent dehydration-induced kidney disease.
Collapse
Affiliation(s)
- Lucinda M Hilliard
- Cardiovascular Disease Program, Biomedicine Discovery Institute and Department of Physiology, Monash University, Melbourne, Victoria, 3800, Australia
| | - Katrina M Mirabito Colafella
- Cardiovascular Disease Program, Biomedicine Discovery Institute and Department of Physiology, Monash University, Melbourne, Victoria, 3800, Australia
| | - Louise L Bulmer
- Cardiovascular Disease Program, Biomedicine Discovery Institute and Department of Physiology, Monash University, Melbourne, Victoria, 3800, Australia
| | - Victor G Puelles
- Department of Anatomy and Developmental Biology, Monash University, Melbourne, Victoria, 3800, Australia
| | - Reetu R Singh
- Cardiovascular Disease Program, Biomedicine Discovery Institute and Department of Physiology, Monash University, Melbourne, Victoria, 3800, Australia
| | - Connie P C Ow
- Cardiovascular Disease Program, Biomedicine Discovery Institute and Department of Physiology, Monash University, Melbourne, Victoria, 3800, Australia
| | - Tracey Gaspari
- Department of Pharmacology, Monash University, Melbourne, Victoria, 3800 Australia
| | - Grant R Drummond
- Department of Pharmacology, Monash University, Melbourne, Victoria, 3800 Australia
| | - Roger G Evans
- Cardiovascular Disease Program, Biomedicine Discovery Institute and Department of Physiology, Monash University, Melbourne, Victoria, 3800, Australia
| | - Antony Vinh
- Department of Pharmacology, Monash University, Melbourne, Victoria, 3800 Australia
| | - Kate M Denton
- Cardiovascular Disease Program, Biomedicine Discovery Institute and Department of Physiology, Monash University, Melbourne, Victoria, 3800, Australia
| |
Collapse
|
27
|
Effects of Long-term Blockade of Vasopressin Receptor Types 1a and 2 on Cardiac and Renal Damage in a Rat Model of Hypertensive Heart Failure. J Cardiovasc Pharmacol 2016; 66:487-96. [PMID: 26248278 DOI: 10.1097/fjc.0000000000000300] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The effects of chronic blockade of vasopressin type 1a receptors (V1aR) and the additive effects of a type 2 receptor (V2R) antagonist on the treatment of hypertension-induced heart failure and renal injury remain to be unknown. In this study, Dahl salt-sensitive hypertensive rats were chronically treated with a vehicle (CONT), a V1aR antagonist (OPC21268; OPC), a V2R antagonist (tolvaptan; TOLV), or a combination of OPC21268 and tolvaptan (OPC/TOLV) from the pre-hypertrophic stage (6 weeks). No treatment altered blood pressure during the study. Significant improvements were seen in median survival for the OPC and TOLV, and the OPC/TOLV showed a further improvement in Kaplan-Meier analysis. Echocardiography showed suppressed left ventricular hypertrophy in the OPC and OPC/TOLV at 11 weeks with improved function in all treatment groups by 17 weeks. In all treatment groups, improvements were seen in the following: myocardial histological changes, creatinine clearance, urinary albumin excretion, and renal histopathologic damage. Also, key mRNA levels were suppressed (eg, endothelin-1 and collagen). In conclusion, chronic V1aR blockade ameliorated disease progression in this rat model, with additive benefits from the combination of V1aR and V2R antagonists. It was associated with protection of both myocardial and renal damage, independent of blood pressure.
Collapse
|
28
|
Clark WF, Sontrop JM, Moist L, Huang SH. Increasing Water Intake in Chronic Kidney Disease: Why? Safe? Possible? ANNALS OF NUTRITION AND METABOLISM 2015; 66 Suppl 3:18-21. [DOI: 10.1159/000381241] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Increased water intake may slow the progression of chronic kidney disease by lowering vasopressin levels. Prior to initiating a large randomized controlled trial on the effect of increased water intake on renal decline, we conducted a six-week pilot study to examine the safety and feasibility of asking adults with chronic kidney disease to increase their water intake. We randomly assigned 29 patients to either a hydration or a control group. The hydration group was asked to increase water intake by 1 to 1.5 l/day relative to their weight, gender, and 24 h urine osmolality, in addition to usual consumed beverages; the control group was asked to continue with usual fluid intake. After six weeks, the change in urine volume was significantly different between groups (0.9 l/day; p = 0.002) with no change in serum sodium and no serious adverse effects. Similarly, preliminary results of our large clinical trial of the same intervention (489 patients enrolled to date) demonstrated a significant separation between groups on 24 h urine volume (at 12 months the mean difference between groups was 1.2 l/day; p < 0.001) with no serious adverse effects. Serum sodium has remained stable in both groups over follow-up. To our knowledge, this trial is currently the largest of its kind to date; the significant separation between groups with respect to urine volume indicates that we will have scientifically reliable data on the effect of increased fluid intake on renal decline. The analysis of primary and secondary outcomes will be conducted at the conclusion of follow-up in July 2016.
Collapse
|
29
|
Han SW, Tilea A, Gillespie BW, Finkelstein FO, Kiser MA, Eisele G, Kotanko P, Levin N, Saran R. Serum sodium levels and patient outcomes in an ambulatory clinic-based chronic kidney disease cohort. Am J Nephrol 2015; 41:200-9. [PMID: 25871915 DOI: 10.1159/000381193] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2013] [Accepted: 02/21/2014] [Indexed: 12/18/2022]
Abstract
BACKGROUND Chronic kidney disease (CKD) patients are prone to both hypo- and hypernatremia. Little has been published on the epidemiology of hypo- and hypernatremia in ambulatory patients with non-dialysis CKD. METHODS Data collected in two contemporaneous CKD cohort studies, the Renal Research Institute (RRI)-CKD study (n = 834) and the Study of Treatment of Renal Insufficiency: Data and Evaluation (STRIDE) (n = 1,348) were combined and analyzed to study the association between serum sodium (Na(+)) and clinical outcomes. RESULTS Baseline estimated glomerular filtration rate (eGFR) and Na(+) were 26 ± 11 ml/min/1.73 m(2) and 140.2 ± 3.4 mEq/l, respectively. The prevalence of Na(+) ≤135 mEq/l and ≥144 mEq/l was 6 and 16%, respectively. Higher baseline Na(+) was significantly associated with male sex, older age, systolic blood pressure, BMI, serum albumin, presence of heart failure, and lower eGFR. The risk of end-stage renal disease (ESRD) was marginally significantly higher among patients with Na(+) ≤135 mEq/l, compared with 140< Na(+) <144 mEq/l (referent), in time-dependent models (adjusted hazard ratio, HR = 1.52, p = 0.06). Mortality risk was significantly greater at 135< Na(+) ≤140 mEq/l (adjusted HR = 1.68, p = 0.02) and Na(+) ≥144 mEq/l (adjusted HR = 2.01, p = 0.01). CONCLUSION CKD patients with Na(+) ≤135 mEq/l were at a higher risk for progression to ESRD, whereas both lower and higher Na(+) levels were associated with a higher risk of mortality. While caring for CKD patients, greater attention to serum sodium levels by clinicians is warranted and could potentially help improve patient outcomes.
Collapse
Affiliation(s)
- Sang-Woong Han
- Division of Nephrology, Department of Internal Medicine, Hanyang University Guri Hospital, Guri, Korea
| | | | | | | | | | | | | | | | | |
Collapse
|
30
|
Abstract
The synthesis of nonpeptide orally bioavailable vasopressin antagonists devoid of agonistic activity (vaptans) has made possible the selective blockade of vasopressin receptor subtypes for therapeutic purposes. Vaptans acting on the vasopressin V2 receptors (aquaretics) have attracted attention as a possible therapy for heart failure and polycystic kidney disease. Despite a solid rationale and encouraging preclinical testing, aquaretics have not improved clinical outcomes in randomized clinical trials for heart failure. Additional clinical trials with select population targets, more flexible dosing schedules, and possibly a different drug type or combination (balanced V1a/V2 receptor antagonism) may be warranted. Aquaretics are promising for the treatment of autosomal dominant polycystic kidney disease and have been approved in Japan for this indication. More studies are needed to better define their long-term safety and efficacy and optimize their utilization.
Collapse
Affiliation(s)
- Vicente E Torres
- Division of Nephrology and Hypertension, Mayo Clinic College of Medicine, Rochester, Minnesota 55905;
| |
Collapse
|
31
|
Cernaro V, Trifirò G, Lorenzano G, Lucisano S, Buemi M, Santoro D. New therapeutic strategies under development to halt the progression of renal failure. Expert Opin Investig Drugs 2014; 23:693-709. [DOI: 10.1517/13543784.2014.899352] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
|
32
|
Plischke M, Kohl M, Bankir L, Shayganfar S, Handisurya A, Heinze G, Haas M. Urine osmolarity and risk of dialysis initiation in a chronic kidney disease cohort--a possible titration target? PLoS One 2014; 9:e93226. [PMID: 24675963 PMCID: PMC3968127 DOI: 10.1371/journal.pone.0093226] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2013] [Accepted: 03/01/2014] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Increasing evidence is linking fluid intake, vasopressin suppression and osmotic control with chronic kidney disease progression. Interestingly, the association between urine volume, urine osmolarity and risk of dialysis initiation has not been studied in chronic kidney disease patients before. OBJECTIVE To study the relationship between urine volume, urine osmolarity and the risk of initiating dialysis in chronic kidney disease. DESIGN In a retrospective cohort analysis of 273 patients with chronic kidney disease stage 1-4 we assessed the association between urine volume, urine osmolarity and the risk of dialysis by a multivariate proportional sub-distribution hazards model for competing risk data according to Fine and Gray. Co-variables were selected via the purposeful selection algorithm. RESULTS Dialysis was reached in 105 patients over a median follow-up period of 92 months. After adjustment for age, baseline creatinine clearance, other risk factors and diuretics, a higher risk for initiation of dialysis was found in patients with higher urine osmolarity. The adjusted sub-distribution hazard ratio for initiation of dialysis was 2.04 (95% confidence interval, 1.06 to 3.92) for each doubling of urine osmolarity. After 72 months, the estimated adjusted cumulative incidence probabilities of dialysis were 15%, 24%, and 34% in patients with a baseline urine osmolarity of 315, 510, and 775 mosm/L, respectively. CONCLUSIONS We conclude that higher urine osmolarity is associated with a higher risk of initiating dialysis. As urine osmolarity is a potentially modifiable risk factor, it thus deserves further, prospective research as a potential target in chronic kidney disease progression.
Collapse
Affiliation(s)
- Max Plischke
- Division of Nephrology and Dialysis, Department of Internal Medicine III, Medical University Vienna, Vienna, Austria
| | - Maria Kohl
- Section for Clinical Biometrics, Center of Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, Vienna, Austria
| | - Lise Bankir
- INSERM UMRS 1138, Equipe 2, Centre de Recherche des Cordeliers, Paris, France
| | - Sascha Shayganfar
- Division of Cardiology, Pulmonology, and Vascular Medicine, Medical Faculty, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Ammon Handisurya
- Division of Nephrology and Dialysis, Department of Internal Medicine III, Medical University Vienna, Vienna, Austria
| | - Georg Heinze
- Section for Clinical Biometrics, Center of Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, Vienna, Austria
| | - Martin Haas
- Division of Nephrology and Dialysis, Department of Internal Medicine III, Medical University Vienna, Vienna, Austria
- * E-mail:
| |
Collapse
|
33
|
Palmer SC, Wong G, Iff S, Yang J, Jayaswal V, Craig JC, Rochtchina E, Mitchell P, Wang JJ, Strippoli GFM. Fluid intake and all-cause mortality, cardiovascular mortality and kidney function: a population-based longitudinal cohort study. Nephrol Dial Transplant 2014; 29:1377-84. [PMID: 24398890 DOI: 10.1093/ndt/gft507] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Drinking eight glasses of fluid or water each day is widely believed to improve health, but evidence is sparse and conflicting. We aimed to investigate the association between fluid consumption and long-term mortality and kidney function. METHODS We conducted a longitudinal analysis within a prospective, population-based cohort study of 3858 men and women aged 49 years or older residing in Australia. Daily fluid intake from food and beverages not including water was measured using a food frequency questionnaire. We did multivariable adjusted Cox proportional hazard models for all-cause and cardiovascular mortality and a boot-strapping procedure for estimated glomerular filtration rate (eGFR). RESULTS Upper and lower quartiles of daily fluid intake corresponded to >3 L and <2 L, respectively. During a median follow-up of 13.1 years (total 43 093 years at risk), 1127 deaths (26.1 per 1000 years at risk) including 580 cardiovascular deaths (13.5 per 1000 years at risk) occurred. Daily fluid intake (per 250 mL increase) was not associated with all-cause [adjusted hazard ratio (HR) 0.99 (95% CI 0.98-1.01)] or cardiovascular mortality [HR 0.98 (95% CI 0.95-1.01)]. Overall, eGFR reduced by 2.2 mL/min per 1.73 m(2) (SD 10.9) in the 1207 (31%) participants who had repeat creatinine measurements and this was not associated with fluid intake [adjusted regression coefficient 0.06 mL/min/1.73 m(2) per 250 mL increase (95% CI -0.03 to 0.14)]. CONCLUSIONS Fluid intake from food and beverages excluding water is not associated with improved kidney function or reduced mortality.
Collapse
Affiliation(s)
- Suetonia C Palmer
- Department of Medicine, University of Otago, Christchurch, New Zealand
| | - Germaine Wong
- School of Public Health, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia
| | - Samuel Iff
- Centre for Kidney Research, Children's Hospital at Westmead, Westmead, NSW, Australia
| | - Jean Yang
- School of Mathematics and Statistics, The University of Sydney, Sydney, NSW, Australia
| | - Vivek Jayaswal
- School of Mathematics and Statistics, The University of Sydney, Sydney, NSW, Australia
| | - Jonathan C Craig
- School of Public Health, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia Centre for Kidney Research, Children's Hospital at Westmead, Westmead, NSW, Australia
| | - Elena Rochtchina
- Centre for Vision Research, Westmead Millennium Institute and Clinical Ophthalmology and Eye Health, Westmead Clinical School, The University of Sydney, C24 - Westmead Hospital, Sydney, NSW, Australia
| | - Paul Mitchell
- Centre for Vision Research, Westmead Millennium Institute and Clinical Ophthalmology and Eye Health, Westmead Clinical School, The University of Sydney, C24 - Westmead Hospital, Sydney, NSW, Australia
| | - Jie Jin Wang
- Centre for Vision Research, Westmead Millennium Institute and Clinical Ophthalmology and Eye Health, Westmead Clinical School, The University of Sydney, C24 - Westmead Hospital, Sydney, NSW, Australia
| | - Giovanni F M Strippoli
- School of Public Health, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia Department of Clinical Pharmacology and Epidemiology, Consorzio Mario Negri Sud, S. Maria Imbaro 66030, Italy Diaverum Scientific Office, Lund, Sweden Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy
| |
Collapse
|
34
|
Affiliation(s)
- Nadine Bouby
- INSERM, UMRS 1138, Centre de Recherche des Cordeliers, Paris, France
| | | | | | | | | |
Collapse
|
35
|
Clark WF, Sontrop JM, Huang SH, Gallo K, Moist L, House AA, Weir MA, Garg AX. The chronic kidney disease Water Intake Trial (WIT): results from the pilot randomised controlled trial. BMJ Open 2013; 3:e003666. [PMID: 24362012 PMCID: PMC3884598 DOI: 10.1136/bmjopen-2013-003666] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Increased water intake may benefit kidney function. Prior to initiating a larger randomised controlled trial (RCT), we examined the safety and feasibility of asking adults with chronic kidney disease (CKD) to increase their water intake. DESIGN, SETTING, PARTICIPANTS AND MEASUREMENTS Beginning in October 2012, we randomly assigned 29 adults with stage 3 CKD (estimated glomerular filtration rate (eGFR) 30-60 mL/min/1.73 m(2) and albuminuria) to one of the two groups of water intake: hydration (n=18) or standard (n=11). We asked the hydration group to increase their water intake by 1.0-1.5 L/day (in addition to usual intake, depending on sex and weight) for 6 weeks, while the control group carried on with their usual intake. Participants collected a 24 h urine sample at baseline and at 2 and 6 weeks after randomisation. Our primary outcome was the between-group difference in change in 24 h urine volume from baseline to 6 weeks. RESULTS (63%)of participants were men, 81% were Caucasians and the average age was 61 years (SD 14 years). The average baseline eGFR was 40 mL/min/1.73 m(2) (SD 11 mL/min/1.73 m(2)); the median albumin to creatinine ratio was 19 mg/mmol (IQR 6-74 mg/mmol). Between baseline and 6-week follow-up, the hydration group's average 24 h urine volume increased by 0.7 L/day (from 2.3 to 3.0 L/day) and the control group's 24 h urine decreased by 0.3 L/day (from 2.0 to 1.7 L/day; between-group difference in change: 0.9 L/day (95% CI 0.4 to 1.5; p=0.002)). We found no significant changes in urine, serum osmolality or electrolyte concentrations, or eGFR. No serious adverse events or changes in quality of life were reported. CONCLUSIONS A pilot RCT indicates adults with stage 3 CKD can successfully and safely increase water intake by up to 0.7 L/day in addition to usual fluid intake. TRIAL REGISTRATION REGISTERED WITH CLINICAL TRIALSGOVERNMENT IDENTIFIER: NCT01753466.
Collapse
Affiliation(s)
- William F Clark
- Division of Nephrology, Department of Medicine, London Health Sciences Centre, London, Ontario, Canada
| | - Jessica M Sontrop
- Division of Nephrology, Department of Medicine, London Health Sciences Centre, London, Ontario, Canada
- Department of Epidemiology & Biostatistics, Western University, London, Ontario, Canada
| | - Shih-Han Huang
- Division of Nephrology, Department of Medicine, London Health Sciences Centre, London, Ontario, Canada
| | - Kerri Gallo
- Department of Epidemiology & Biostatistics, Western University, London, Ontario, Canada
| | - Louise Moist
- Division of Nephrology, Department of Medicine, London Health Sciences Centre, London, Ontario, Canada
- Department of Epidemiology & Biostatistics, Western University, London, Ontario, Canada
| | - Andrew A House
- Division of Nephrology, Department of Medicine, London Health Sciences Centre, London, Ontario, Canada
| | - Matthew A Weir
- Division of Nephrology, Department of Medicine, London Health Sciences Centre, London, Ontario, Canada
| | - Amit X Garg
- Division of Nephrology, Department of Medicine, London Health Sciences Centre, London, Ontario, Canada
- Department of Epidemiology & Biostatistics, Western University, London, Ontario, Canada
| |
Collapse
|
36
|
Ta MHT, Harris DCH, Rangan GK. Role of interstitial inflammation in the pathogenesis of polycystic kidney disease. Nephrology (Carlton) 2013; 18:317-30. [DOI: 10.1111/nep.12045] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/20/2013] [Indexed: 12/12/2022]
Affiliation(s)
- Michelle HT Ta
- Centre for Transplant and Renal Research; Westmead Millennium Institute; The University of Sydney; Sydney; New South Wales; Australia
| | - David CH Harris
- Centre for Transplant and Renal Research; Westmead Millennium Institute; The University of Sydney; Sydney; New South Wales; Australia
| | - Gopala K Rangan
- Centre for Transplant and Renal Research; Westmead Millennium Institute; The University of Sydney; Sydney; New South Wales; Australia
| |
Collapse
|
37
|
Sontrop JM, Dixon SN, Garg AX, Buendia-Jimenez I, Dohein O, Huang SHS, Clark WF. Association between water intake, chronic kidney disease, and cardiovascular disease: a cross-sectional analysis of NHANES data. Am J Nephrol 2013; 37:434-42. [PMID: 23594828 DOI: 10.1159/000350377] [Citation(s) in RCA: 120] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2013] [Accepted: 02/28/2013] [Indexed: 11/19/2022]
Abstract
BACKGROUND Evidence from animal and human studies suggests a protective effect of higher water intake on kidney function and cardiovascular disease (CVD). Here the associations between water intake, chronic kidney disease (CKD) and CVD were examined in the general population. METHODS We conducted a cross-sectional analysis of the 2005-2006 National Health and Nutrition Examination Survey. Non-pregnant adults with an estimated glomerular filtration rate (eGFR) ≥30 ml/min/1.73 m(2) who were not taking diuretics were included. Total water intake from foods and beverages was categorized as low (<2.0 l/day), moderate (2.0-4.3 l/day) and high (>4.3 l/day). We examined associations between low total water intake and CKD (eGFR 30-60 ml/min/1.73 m(2)) and self-reported CVD. RESULTS Of 3,427 adults (mean age 46 (range 20-84); mean eGFR 95 ml/min/1.73 m(2) (range 30-161)), 13% had CKD and 18% had CVD. CKD was higher among those with the lowest (<2.0 l/day) vs. highest total water intake (>4.3 l/day) (adjusted odds ratio (OR) 2.52; 95% confidence interval (CI) 0.91-6.96). When stratified by intake of (1) plain water and (2) other beverages, CKD was associated with low intake of plain water: adjusted OR 2.36 (95% CI 1.10-5.06), but not other beverages: adjusted OR 0.87 (95% CI 0.30-2.50). There was no association between low water intake and CVD (adjusted OR 0.76; 95% CI 0.37-1.59). CONCLUSIONS Our results provide additional evidence suggesting a potentially protective effect of higher total water intake, particularly plain water, on the kidney.
Collapse
Affiliation(s)
- Jessica M Sontrop
- Department of Medicine, Kidney Clinical Research Unit, Division of Nephrology, London Health Sciences Centre, London, Ont., Canada
| | | | | | | | | | | | | |
Collapse
|
38
|
Dietrich A, Mathia S, Kaminski H, Mutig K, Rosenberger C, Mrowka R, Bachmann S, Paliege A. Chronic activation of vasopressin V2 receptor signalling lowers renal medullary oxygen levels in rats. Acta Physiol (Oxf) 2013; 207:721-31. [PMID: 23347696 DOI: 10.1111/apha.12067] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2012] [Revised: 12/27/2012] [Accepted: 01/17/2013] [Indexed: 12/17/2022]
Abstract
AIM In the present study, we aimed to elucidate the effects of chronic vasopressin administration on renal medullary oxygen levels. METHODS Adult Sprague Dawley or vasopressin-deficient Brattleboro rats were treated with the vasopressin V2 receptor agonist, desmopressin (5 ng/h; 3d), or its vehicle via osmotic minipumps. Immunostaining for pimonidazole and the transcription factor HIF-1α (hypoxia-inducible factor-1α) were used to identify hypoxic areas. Activation of HIF-target gene expression following desmopressin treatment was studied by microarray analysis. RESULTS Pimonidazole staining was detected in the outer and inner medulla of desmopressin-treated rats, whereas staining in control animals was weak or absent. HIF-1α immunostaining demonstrated nuclear accumulation in the papilla of desmopressin-treated animals, whereas no staining was observed in the controls. Gene expression analysis revealed significant enrichment of HIF-target genes in the group of desmopressin-regulated gene products (P = 2.6*10(-21) ). Regulated products included insulin-like growth factor binding proteins 1 and 3, angiopoietin 2, fibronectin, cathepsin D, hexokinase 2 and cyclooxygenase 2. CONCLUSION Our results demonstrate that an activation of the renal urine concentrating mechanism by desmopressin causes renal medullary hypoxia and an upregulation of hypoxia-inducible gene expression.
Collapse
Affiliation(s)
- A. Dietrich
- Department of Anatomy; Charité-Universitätsmedizin Berlin; Berlin; Germany
| | - S. Mathia
- Department of Nephrology; Charité-Universitätsmedizin Berlin; Berlin; Germany
| | - H. Kaminski
- Department of Anatomy; Charité-Universitätsmedizin Berlin; Berlin; Germany
| | - K. Mutig
- Department of Anatomy; Charité-Universitätsmedizin Berlin; Berlin; Germany
| | - C. Rosenberger
- Department of Nephrology; Charité-Universitätsmedizin Berlin; Berlin; Germany
| | - R. Mrowka
- Experimentelle Nephrologie; KIM III; Universitästsklinikum Jena; Jena; Germany
| | - S. Bachmann
- Department of Anatomy; Charité-Universitätsmedizin Berlin; Berlin; Germany
| | | |
Collapse
|
39
|
Bankir L, Bouby N, Ritz E. Vasopressin: a novel target for the prevention and retardation of kidney disease? Nat Rev Nephrol 2013; 9:223-39. [PMID: 23438973 DOI: 10.1038/nrneph.2013.22] [Citation(s) in RCA: 136] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
After several decades during which little attention was paid to vasopressin and/or urine concentration in clinical practice, interest in vasopressin has renewed with the availability of new, potent, orally active vasopressin-receptor antagonists--the vaptans--and with the results of epidemiological studies evaluating copeptin (a surrogate marker of vasopressin) in large population-based cohorts. Several experimental studies in rats and mice had previously shown that vasopressin, acting via vasopressin V2 antidiuretic receptors, contributes to the progression of chronic kidney disease; in particular, to autosomal dominant polycystic kidney disease. New epidemiological studies now suggest a role for vasopressin in the pathogenesis of diabetes mellitus and metabolic disorders via activation of hepatic V1a and/or pancreatic islet V1b receptors. The first part of this Review describes the adverse effects of vasopressin, as revealed by clinical and experimental studies in kidney diseases, hypertension, diabetes and the metabolic syndrome. The second part provides insights into vasopressin physiology and pathophysiology that may be relevant to the understanding of these adverse effects and that are linked to the excretion of concentrated nitrogen wastes and associated hyperfiltration. Collectively, the studies reviewed here suggest that more attention should be given to the vasopressin-thirst-urine concentration axis in clinical investigations and in patient care. Whether selective blockade of the different vasopressin receptors may provide therapeutic benefits beyond their present indication in hyponatraemia requires new clinical trials.
Collapse
Affiliation(s)
- Lise Bankir
- INSERM UMRS 872, Equipe 2, Centre de Recherche des Cordeliers, Paris, France.
| | | | | |
Collapse
|
40
|
Hori K, Nagai T, Izumi Y, Kimura M, Hasuike Y, Nakayama Y, Nanami M, Tokuyama M, Otaki Y, Kuragano T, Kohda Y, Obinata M, Kawahara K, Tanoue A, Tomita K, Nakanishi T, Nonoguchi H. Vasopressin V1a receptor is required for nucleocytoplasmic transport of mineralocorticoid receptor. Am J Physiol Renal Physiol 2012; 303:F1080-8. [PMID: 22811487 DOI: 10.1152/ajprenal.00052.2012] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
We previously reported that a deficiency in the vasopressin V1a receptor (V1aR) results in type 4 renal tubular acidosis, which suggests that vasopressin exerts direct effects on the physiological actions of aldosterone. We investigated the role of vasopressin for nucleocytoplasmic transport of mineralocorticoid receptor (MR) in the intercalated cells. Vasopressin V1aR-deficient (V1aR(-/-)) mice showed largely decreased expression of MR and 11β-hydroxysteroid dehydrogenase type 2 (11βHSD2) in the medulla of the kidney, which was partially ameliorated by fludrocortisone treatment. The incubation of IN-IC cells, an intercalated cell line established from temperature-sensitive SV40 large T antigen-expressing rats, with aldosterone or vasopressin increased the nuclear-to-cytoplasmic ratio of the MR from 11.2 to 47.2% and from 18.7 to 61.2%, respectively, in 30 min without any changes in MR expression from the whole cell extract. The immunohistochemistry analysis of the IN-IC cells revealed the nuclear accumulation of MRs after a 30-min incubation with aldosterone or vasopressin. These effects were accompanied by an increase in regulator of chromosome condensation-1 (RCC-1) due to aldosterone and a decrease in Ran GTPase-activating protein 1 (Ran Gap1) due to vasopressin. RNA interference against V1aR abolished the nuclear accumulation of MR induced by aldosterone or vasopressin. Vasopressin increased PKCα and -β(1) expression, and aldosterone increased PKCδ and -ζ expression, but these effects were abolished with a V1aR knockdown. These results suggest that vasopressin directly regulates the nucleocytoplasmic transport of MRs via the V1aR in the intercalated cells of the collecting ducts.
Collapse
Affiliation(s)
- Kahori Hori
- Dept. of Internal Medicine, Kitasao Univ. Kitasato Institute Medical Center Hospital, 6-100 Arai, Kitamoto, Saitama 364-8501, Japan
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
41
|
Enhörning S, Bankir L, Bouby N, Struck J, Hedblad B, Persson M, Morgenthaler NG, Nilsson PM, Melander O. Copeptin, a marker of vasopressin, in abdominal obesity, diabetes and microalbuminuria: the prospective Malmö Diet and Cancer Study cardiovascular cohort. Int J Obes (Lond) 2012; 37:598-603. [PMID: 22614056 DOI: 10.1038/ijo.2012.88] [Citation(s) in RCA: 133] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND High plasma copeptin (copeptin), the C-terminal fragment of arginine vasopressin pro-hormone, has been associated with the metabolic syndrome (MetS), diabetes mellitus (DM) development and nephropathy. Here we tested whether elevated copeptin level is associated with later development of the MetS, its individual components and microalbuminuria. METHODS We analysed copeptin at baseline (1991-1994) in the population-based Malmö Diet and Cancer Study cardiovasular cohort and re-examined 2064 subjects 15.8 years later (mean age 72.8 years, 59% women) with oral glucose tolerance test and measurement of MetS and its individual components. RESULTS After age and sex adjustment, increasing quartiles of copeptin at baseline (the lowest quartile as reference) were associated with MetS (P for trend=0.008), incident abdominal obesity (P for trend=0.002), DM (P for trend=0.001) and microalbuminuria (P for trend=0.002). After additional adjustment for all the MetS components at baseline, increasing copeptin quartiles predicted incident abdominal obesity (odds ratios 1.55, 1.30 and 1.59; P for trend=0.04), DM (odds ratios 1.18, 1.32 and 1.46; P for trend=0.04) and microalbuminuria (odds ratios 1.05, 1.08 and 1.65; P for trend=0.02) but not MetS (P for trend=0.19) at the reexamination. Further, the relationship between copeptin and microalbuminuria was independent of baseline C-reactive protein, incident DM and incident hypertension. CONCLUSION Copeptin independently predicts DM and abdominal obesity but not the cluster of MetS. Apart from predicting DM and abdominal obesity, elevated copeptin signals increased risk of microalbuminuria. Interestingly, the association between copeptin and later microalbuminuria was independent of both prevalent and incident DM and hypertension. Our findings suggest a relationship between a dysregulated vasopressin system and cardiometabolic risk, which could have implications for risk assessment and novel preventive treatments.
Collapse
Affiliation(s)
- S Enhörning
- Department of Clinical Sciences, Lund University, Clinical Research Center (CRC), Malmö University Hospital, Malmö, Sweden
| | | | | | | | | | | | | | | | | |
Collapse
|
42
|
Mao YN, Liu W, Li YG, Jia GC, Zhang Z, Guan YJ, Zhou XF, Liu YF. Urinary angiotensinogen levels in relation to renal involvement of Henoch-Schonlein purpura in children. Nephrology (Carlton) 2012; 17:53-7. [PMID: 21854508 DOI: 10.1111/j.1440-1797.2011.01515.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
AIM To investigate whether urinary angiotensinogen (UAGT) levels are correlated with renal involvement of Henoch-Schonlein purpura (HSP) in children, and to explore whether UAGT has any relation to the severity of HSP. METHODS The study sample consisted of 107 patients (50 boys and 57 girls, 6.68±2.41 years) with clinical diagnosis of HSP. A 24 h urine sample was collected before treatment. UAGT levels were measured in patients with HSP in the acute and convalescent phases by enzyme linked immunosorbent assay. RESULTS Urinary angiotensinogen/urinary concentration of creatinine levels were significantly higher in proteinuric HSP in the acute phase and the convalescent phase (32.02±3.95 and 25.31±4.11 µg/g) compared with those with HSP without renal involvement (17.26±2.60 and 15.14±3.81 µg/g) and those with hematuric HSP (19.70±2.21 and 17.28±3.62 µg/g) (P<0.0001 and P<0.01, respectively). Using matched urine samples from the same patients, UAGT/urinary concentration of creatinine (UCr) levels of proteinuric HSP patients were significantly lower in the convalescent phase (25.31 ± 4.11 µg/g, P<0.01) than in the acute phase (32.02±3.95 µg/g). UAGT/UCr levels showed positive correlation with 24 h urine protein or serum creatinine in both hematuric HSP and proteinuric HSP groups during the acute phase (P<0.05). CONCLUSIONS Urinary angiotensinogen levels were remarkably high in the acute phase in the patients with proteinuric HSP, suggesting increased UAGT may indicate a series of functional changes in the kidney and it may be used as a potential biomarker of severity of HSP to monitor the progression of HSP with renal involvement.
Collapse
Affiliation(s)
- Yan Na Mao
- Pediatrics Department of The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | | | | | | | | | | | | | | |
Collapse
|
43
|
Cernaro V, Lacquaniti A, Donato V, Fazio MR, Buemi A, Buemi M. Fibrosis, regeneration and cancer: what is the link? Nephrol Dial Transplant 2011; 27:21-7. [DOI: 10.1093/ndt/gfr567] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
|
44
|
Rocchetti MT, Tamma G, Lasorsa D, Suriano IV, D'Apollo A, Papale M, Mastrofrancesco L, Grandaliano G, Svelto M, Valenti G, Gesualdo L, Di Paolo S. Altered urinary excretion of aquaporin 2 in IgA nephropathy. Eur J Endocrinol 2011; 165:657-64. [PMID: 21824900 DOI: 10.1530/eje-11-0512] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE The intrarenal renin-angiotensin system (RAS) activation plays a pivotal role in immunoglobulin A nephropathy (IgAN) pathogenesis, which is still largely undefined. Recently, vasopressin (AVP) has been advocated to contribute to the genesis and progression of chronic kidney diseases (CKD) directly, and indirectly, via RAS activation. Our aim is to explore the intrarenal activity of AVP, its relationship with RAS activity, as well as its modulation by therapies in IgAN. DESIGN In this observational study, we measured plasma copeptin, a surrogate marker of AVP, the urine excretion of aquaporin 2 (AQP2), a protein reflecting renal AVP action, and angiotensinogen (AGT), a parameter of renal RAS activation, and their relationship with renal function in 44 IgAN patients at the time of renal biopsy, without any drug therapy, and after 6-month treatment with ACEi or steroid+ACEi. Twenty-one patients with other CKD and 40 healthy subjects were recruited as controls. METHODS ELISAs were used to measure all variables of interest. RESULTS At baseline, IgAN patients showed higher urinary levels of AQP2, compared with controls and patients with other CKD. Urinary AQP2 and AGT levels strongly correlated with the presence of arterial hypertension. Steroids+ACEi caused the decrease of all the variables examined. The fall of urinary AQP2 and AGT following drug treatments was associated with the decrease of daily proteinuria. CONCLUSION Our findings would support the involvement of AVP-AQP2 axis, interacting with the RAS, in the progression of IgAN and candidate AQP2 as a possible novel marker of the disease.
Collapse
Affiliation(s)
- Maria Teresa Rocchetti
- Section of Nephrology and Bioagromed, Department of Biomedical Sciences, University of Foggia, 71122 Foggia, Italy
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
45
|
Izumi Y, Hori K, Nakayama Y, Kimura M, Hasuike Y, Nanami M, Kohda Y, Otaki Y, Kuragano T, Obinata M, Kawahara K, Tanoue A, Tomita K, Nakanishi T, Nonoguchi H. Aldosterone requires vasopressin V1a receptors on intercalated cells to mediate acid-base homeostasis. J Am Soc Nephrol 2011; 22:673-80. [PMID: 21415155 DOI: 10.1681/asn.2010050468] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Both aldosterone and luminal vasopressin may contribute to the maintenance of acid-base homeostasis, but the functional relationship between these hormones is not well understood. The effects of luminal vasopressin likely result from its interaction with V1a receptors on the luminal membranes of intercalated cells in the collecting duct. Here, we found that mice lacking the V1a receptor exhibit type 4 renal tubular acidosis. The administration of the mineralocorticoid agonist fludrocortisone ameliorated the acidosis by restoring excretion of urinary ammonium via increased expression of Rhcg and H-K-ATPase and decreased expression of H-ATPase. In a cell line of intercalated cells established from transgenic rats expressing the mineralocorticoid and V1a receptors, but not V2 receptors, knockdown of the V1a receptor gene abrogated the effects of aldosterone on H-K-ATPase, Rhcg, and H-ATPase expression. These data suggest that defects in the vasopressin V1a receptor in intercalated cells can cause type 4 renal tubular acidosis and that the tubular effects of aldosterone depend on a functional V1a receptor in the intercalated cells.
Collapse
Affiliation(s)
- Yuichiro Izumi
- Department of Nephrology, Graduate School of Faculty of Life Science, Kumamoto University, Kumamoto, Japan
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
46
|
Patyar S, Prakash A, Medhi B. Dual inhibition: a novel promising pharmacological approach for different disease conditions. ACTA ACUST UNITED AC 2011; 63:459-71. [PMID: 21401597 DOI: 10.1111/j.2042-7158.2010.01236.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
To overcome the problems associated with polypharmacy, which include medication non compliance, adverse drug reactions, drug-drug interactions and increased pill-burden, various strategies, such as sustained-release drugs and fixed-dose combination regimens (polypills), have been developed. Out of these, a novel and very much promising approach is the use of dual-action drugs. Amongst the dual-action drugs, there is a class of compounds known as dual inhibitors, which possess the dual inhibitory activity. The most common examples of dual inhibitors are rivastigmine, ladostigil, asenapine, phenserine, amitriptyline, clomipramine, doxepin and desipramine. This review article focuses on the conventional drugs used in different diseases which possess dual inhibition activity as well as those which are still in the preclinical/clinical phase.
Collapse
Affiliation(s)
- Sazal Patyar
- Department of Pharmacology, Postgraduate Institute of Medical Education and Research, Chandigarh, Delhi, India
| | | | | |
Collapse
|
47
|
Meijer E, Boertien W, Zietse R, Gansevoort R. Potential Deleterious Effects of Vasopressin in Chronic Kidney Disease and Particularly Autosomal Dominant Polycystic Kidney Disease. ACTA ACUST UNITED AC 2011; 34:235-44. [DOI: 10.1159/000326902] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
|
48
|
|
49
|
Torres VE. Vasopressin in chronic kidney disease: an elephant in the room? Kidney Int 2009; 76:925-8. [PMID: 19829311 DOI: 10.1038/ki.2009.325] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Perico et al. report that a dual arginine vasopressin (AVP) V(2) and V(1a) receptor antagonist lowers blood pressure, proteinuria, and glomerulosclerosis in 5/6 nephrectomized rats, pointing to its potential value in the treatment of chronic kidney disease (CKD). AVP likely contributes to CKD progression by its effects on renal hemodynamics, blood pressure, and mesangial and/or epithelial cells, but the relative contributions of V(2) and V(1a) receptors and potential usefulness of V(2) and V(1a) receptor antagonists remain ill defined.
Collapse
|
50
|
Ostan R, Bucci L, Capri M, Salvioli S, Scurti M, Pini E, Monti D, Franceschi C. Immunosenescence and immunogenetics of human longevity. Neuroimmunomodulation 2008; 15:224-40. [PMID: 19047800 DOI: 10.1159/000156466] [Citation(s) in RCA: 124] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
At present, individuals can live up to 80-120 years, a time much longer than that of our ancestors, as a consequence of the improvements in life conditions and medical care. Thus, the human immune system has to cope with a lifelong and evolutionarily unpredicted exposure to a variety of antigens, which are at the basis of profound age-related changes globally indicated as immunosenescence, a multifaceted phenomenon that increases morbidity and mortality due to infections and age-related pathologies. The major changes occurring during immunosenescence are the result of the accumulation of cellular, molecular defects and involutive phenomena (such as thymic involution) occurring concomitantly to a hyperstimulation of both innate and adaptive immunity (accumulation of expanded clones of memory and effector T cells, shrinkage of the T cell receptor repertoire, progressive activation of macrophages), and resulting in a low-grade, chronic state of inflammation defined as inflammaging. It is unknown whether inflammaging, which represents a risk factor for most age-related pathologies, is a cause or rather an effect of the aging process. In this complex scenario, the role of genetic background likely represents a fundamental variable to attain successful aging and longevity. Accordingly, centenarians seem to be equipped with gene variants that allow them to optimize the balance between pro- and anti-inflammatory molecules, and thus to minimize the effects of the lifelong exposure to environmental insults and stressors. The remarkable features of the genetics of aging and longevity are reviewed, stressing the unexpected and unusual results obtained regarding such a postreproductive type of genetics.
Collapse
Affiliation(s)
- R Ostan
- Department of Experimental Pathology and Oncology, University of Florence, Florence, Italy
| | | | | | | | | | | | | | | |
Collapse
|