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Jafar TH, Feng L. Understanding the BP-Lowering Mechanism of Chlorthalidone in Advanced Kidney Disease. Clin J Am Soc Nephrol 2024:01277230-990000000-00422. [PMID: 38980722 DOI: 10.2215/cjn.0000000000000520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/11/2024]
Affiliation(s)
- Tazeen H Jafar
- Program in Health Services and Systems Research, Duke-NUS Medical School, Singapore
- Department of Renal Medicine, Singapore General Hospital, Singapore
- Duke Global Health Institute, Durham, North Carolina
| | - Liang Feng
- Program in Health Services and Systems Research, Duke-NUS Medical School, Singapore
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2
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Dauw J, Meekers E, Martens P, Deferm S, Dhont S, Marchal W, Mesotten L, Dupont M, Nijst P, Tang WHW, Janssens SP, Mullens W. Sodium loading in ambulatory patients with heart failure with reduced ejection fraction: Mechanistic insights into sodium handling. Eur J Heart Fail 2024. [PMID: 38247136 DOI: 10.1002/ejhf.3131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Revised: 11/17/2023] [Accepted: 12/25/2023] [Indexed: 01/23/2024] Open
Abstract
AIMS Sodium restriction was not associated with improved outcomes in heart failure patients in recent trials. The skin might act as a sodium buffer, potentially explaining tolerance to fluctuations in sodium intake without volume overload, but this is insufficiently understood. Therefore, we studied the handling of an increased sodium load in patients with heart failure with reduced ejection fraction (HFrEF). METHODS AND RESULTS Twenty-one ambulatory, stable HFrEF patients and 10 healthy controls underwent a 2-week run-in phase, followed by a 4-week period of daily 1.2 g (51 mmol) sodium intake increment. Clinical, echocardiographic, 24-h urine collection, and bioelectrical impedance data were collected every 2 weeks. Blood volume, skin sodium content, and skin glycosaminoglycan content were assessed before and after sodium loading. Sodium loading did not significantly affect weight, blood pressure, congestion score, N-terminal pro-brain natriuretic peptide, echocardiographic indices of congestion, or total body water in HFrEF (all p > 0.09). There was no change in total blood volume (4748 ml vs. 4885 ml; p = 0.327). Natriuresis increased from 150 mmol/24 h to 173 mmol/24 h (p = 0.024), while plasma renin decreased from 286 to 88 μU/L (p = 0.002). There were no significant changes in skin sodium content, total glycosaminoglycan content, or sulfated glycosaminoglycan content (all p > 0.265). Healthy controls had no change in volume status, but a higher increase in natriuresis without any change in renin. CONCLUSIONS Selected HFrEF patients can tolerate sodium loading, with increased renal sodium excretion and decreased neurohormonal activation.
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Affiliation(s)
- Jeroen Dauw
- Ziekenhuis Oost-Limburg, Department of Cardiology, Genk, Belgium
- UHasselt - Hasselt University, Doctoral School for Medicine and Life Sciences, LCRC, Diepenbeek, Belgium
| | - Evelyne Meekers
- Ziekenhuis Oost-Limburg, Department of Cardiology, Genk, Belgium
- UHasselt - Hasselt University, Doctoral School for Medicine and Life Sciences, LCRC, Diepenbeek, Belgium
| | - Pieter Martens
- Ziekenhuis Oost-Limburg, Department of Cardiology, Genk, Belgium
| | - Sébastien Deferm
- Ziekenhuis Oost-Limburg, Department of Cardiology, Genk, Belgium
| | - Sebastiaan Dhont
- Ziekenhuis Oost-Limburg, Department of Cardiology, Genk, Belgium
- UHasselt - Hasselt University, Doctoral School for Medicine and Life Sciences, LCRC, Diepenbeek, Belgium
| | - Wouter Marchal
- UHasselt - Hasselt University, Institute for Materials Research (IMO-IMOMEC), Diepenbeek, Belgium
| | - Liesbeth Mesotten
- Ziekenhuis Oost-Limburg, Department of Nuclear Medicine, Genk, Belgium
| | - Matthias Dupont
- Ziekenhuis Oost-Limburg, Department of Cardiology, Genk, Belgium
| | - Petra Nijst
- Ziekenhuis Oost-Limburg, Department of Cardiology, Genk, Belgium
| | | | - Stefan P Janssens
- Department of Cardiovascular Diseases, University Hospitals Leuven, KU Leuven, Leuven, Belgium
| | - Wilfried Mullens
- Ziekenhuis Oost-Limburg, Department of Cardiology, Genk, Belgium
- Faculty of Medicine and Life Sciences, LCRC, UHasselt - Hasselt University, Biomedical Research Institute, Diepenbeek, Belgium
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3
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Kim BS, Yu MY, Shin J. Effect of low sodium and high potassium diet on lowering blood pressure and cardiovascular events. Clin Hypertens 2024; 30:2. [PMID: 38163867 PMCID: PMC10759559 DOI: 10.1186/s40885-023-00259-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 11/30/2023] [Indexed: 01/03/2024] Open
Abstract
Incorporating aggressive lifestyle modifications along with antihypertensive medication therapy is a crucial treatment strategy to enhance the control rate of hypertension. Dietary modification is one of the important lifestyle interventions for hypertension, and it has been proven to have a clear effect. Among food ingredients, sodium and potassium have been found to have the strongest association with blood pressure. The blood pressure-lowering effect of a low sodium diet and a high potassium diet has been well established, especially in hypertensive population. A high intake of potassium, a key component of the Dietary Approaches to Stop Hypertension (DASH) diet, has also shown a favorable impact on the risk of cardiovascular events. Additionally, research conducted with robust measurement methods has shown cardiovascular benefits of low-sodium intake. In this review, we aim to discuss the evidence regarding the relationship between the low sodium and high potassium diet and blood pressure and cardiovascular events.
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Affiliation(s)
- Byung Sik Kim
- Division of Cardiology, Department of Internal Medicine, Hanyang University Guri Hospital, Guri, South Korea
| | - Mi-Yeon Yu
- Division of Nephrology, Department of Internal Medicine, Hanyang University College of Medicine, Seoul, South Korea
| | - Jinho Shin
- Division of Cardiology, Department of Internal Medicine, Hanyang University Medical Center, Hanyang University College of Medicine, 222, Wangsimni-ro, Sungdong-gu, Seoul, 04763, South Korea.
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4
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Soleilhavoup S, Essig M, Levassort H. [Hydrosodium balance in aging]. SOINS. GERONTOLOGIE 2024; 29:21-30. [PMID: 38331521 DOI: 10.1016/j.sger.2023.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/10/2024]
Abstract
One of the kidney's major functions is to adjust the water and sodium balance in order to maintain a state of equilibrium. In the course of aging, even in the absence of renal pathology, changes are observed not only in renal macrostructure (reduction in kidney size, increase in the number of cysts), but also in microstructure (arteriosclerosis, glomerulosclerosis, fibrosis and tubular atrophy). All these changes can disrupt the homeostasis of water and sodium balances. The aim of this article is to review the physiology of water and sodium stores, and to assess the impact of aging on the regulatory loops of these different systems.
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Affiliation(s)
- Sébastien Soleilhavoup
- Service de néphrologie, Université Paris-Saclay, Site Ambroise-Paré, AP-HP, 9 avenue Charles-de-Gaulle, 92100 Boulogne-Billancourt, France
| | - Marie Essig
- Service de néphrologie, Université Paris-Saclay, Site Ambroise-Paré, AP-HP, 9 avenue Charles-de-Gaulle, 92100 Boulogne-Billancourt, France; Inserm UMRS 1018, Équipe épidémiologie clinique, Université Paris-Saclay, UVSQ, CESP, Villejuif, France
| | - Hélène Levassort
- Service de néphrologie, Université Paris-Saclay, Site Ambroise-Paré, AP-HP, 9 avenue Charles-de-Gaulle, 92100 Boulogne-Billancourt, France; Inserm UMRS 1018, Équipe épidémiologie clinique, Université Paris-Saclay, UVSQ, CESP, Villejuif, France; Service de gériatrie, Université Paris-Saclay, Site Ambroise-Paré, AP-HP, 9 avenue Charles-de-Gaulle, 92100 Boulogne-Billancourt, France.
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5
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Schneditz D, Hofmann P, Krenn S, Waller M, Mussnig S, Hecking M. Day-to-day variability in euvolemic body mass. Ren Fail 2023; 45:2273421. [PMID: 37955103 PMCID: PMC10653631 DOI: 10.1080/0886022x.2023.2273421] [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: 08/17/2023] [Accepted: 10/16/2023] [Indexed: 11/14/2023] Open
Abstract
Short-term variability in body mass is a common, everyday phenomenon; however, data on body mass variability are scarce. While the physiological variability of body mass is negligible in healthy individuals, it could have implications for therapy in patients with impaired volume homeostasis, for example, patients with kidney failure undergoing kidney replacement therapy. We analyzed a long-term dataset comprising 9521 days of standardized body mass measurements from one healthy male individual and assessed the variability in body mass as a positive or negative relative difference in body mass measured on subsequent days. The average and median relative differences were zero, with a standard deviation (SD) of 0.53% for the one-day interval, increasing to 0.69% for the 7-day interval, and this variability was constant throughout the observation period. A body mass variability of approximately 0.6% (±450 mL in a 75-kg patient) should be taken into consideration when weight-dependent treatment prescriptions, e.g. the ultrafiltration rates in patients on hemodialysis, are being set. Consequently, a "soft target weight", considering the longitudinal variation of volume markers, such as body mass, might improve treatment quality.
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Affiliation(s)
- Daniel Schneditz
- Otto Loewi Research Center, Division of Physiology, Medical University of Graz, Graz, Austria
| | - Peter Hofmann
- Institute of Human Movement Science, Sport & Health; Exercise Physiology, Training & Training Therapy Research Group, University of Graz, Graz, Austria
| | - Simon Krenn
- Center for Health and Bioresources, Medical Signal Analysis, AIT Austrian Institute of Technology, Vienna, Austria
- Center for Public Health, Department of Epidemiology, Medical University of Vienna, Vienna, Austria
| | - Maximilian Waller
- Center for Public Health, Department of Epidemiology, Medical University of Vienna, Vienna, Austria
| | - Sebastian Mussnig
- Center for Public Health, Department of Epidemiology, Medical University of Vienna, Vienna, Austria
| | - Manfred Hecking
- Center for Public Health, Department of Epidemiology, Medical University of Vienna, Vienna, Austria
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6
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Pereira‐Acácio A, Veloso‐Santos JPM, Alves‐Bezerra D, Costa‐Sarmento G, Muzi‐Filho H, Vieyra A. Different antihypertensive and metabolic responses to rostafuroxin in undernourished and normonourished male rats: Outcomes on bodily Na + handling. Physiol Rep 2023; 11:e15820. [PMID: 37667414 PMCID: PMC10477346 DOI: 10.14814/phy2.15820] [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: 07/28/2023] [Revised: 08/23/2023] [Accepted: 08/24/2023] [Indexed: 09/06/2023] Open
Abstract
Hypertension is a pandemic nowadays. We aimed to investigate whether chronic undernutrition modifies the response to the antihypertensive drug rostafuroxin in juvenile hypertensive rats. Chronic undernutrition was induced in male rats using a multideficient diet known as the Regional Basic Diet (RBD), mimicking alimentary habits in impoverished regions worldwide. Animals were given RBD-or a control/CTRL normal diet for rodents-from weaning to 90 days, and rostafuroxin (1 mg/kg body mass) was orally administered from day 60 onwards. For the last 2 days, the rats were hosted in metabolic cages to measure food/energy, water, Na+ ingestion, and urinary volume. Rostafuroxin increased food/energy/Na+ intake in CTRL and RBD rats but had opposite effects on Na+ balance (intake minus urinary excretion). The drug normalized the decreased plasma Na+ concentration in RBD rats, increased urinary volume in RBD but not in CTRL, and decreased and increased urinary Na+ concentration in the RBD and CTRL groups, respectively. Rostafuroxin decreased the ouabain-sensitive (Na+ +K+ )ATPase and increased the ouabain-resistant Na+ -ATPase from proximal tubule cells in both groups and normalized the systolic blood pressure in RBD without effect in CTRL rats. We conclude that chronic undernutrition modifies the response of blood pressure and metabolic responses to rostafuroxin.
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Affiliation(s)
- Amaury Pereira‐Acácio
- Graduate Program of Translational Biomedicine/BIOTRANSUniversity of Grande RioDuque de CaxiasBrazil
- Carlos Chagas Filho Institute of BiophysicsFederal University of Rio de JaneiroRio de JaneiroBrazil
- National Center for Structural Biology and Bioimaging/CENABIOFederal University of Rio de JaneiroRio de JaneiroBrazil
- National Institute of Science and Technology for Regenerative Medicine/REGENERARio de JaneiroBrazil
| | - João P. M. Veloso‐Santos
- Carlos Chagas Filho Institute of BiophysicsFederal University of Rio de JaneiroRio de JaneiroBrazil
- National Center for Structural Biology and Bioimaging/CENABIOFederal University of Rio de JaneiroRio de JaneiroBrazil
- National Institute of Science and Technology for Regenerative Medicine/REGENERARio de JaneiroBrazil
| | - Danilo Alves‐Bezerra
- Graduate Program of Translational Biomedicine/BIOTRANSUniversity of Grande RioDuque de CaxiasBrazil
- National Center for Structural Biology and Bioimaging/CENABIOFederal University of Rio de JaneiroRio de JaneiroBrazil
- National Institute of Science and Technology for Regenerative Medicine/REGENERARio de JaneiroBrazil
| | - Glória Costa‐Sarmento
- Carlos Chagas Filho Institute of BiophysicsFederal University of Rio de JaneiroRio de JaneiroBrazil
- National Center for Structural Biology and Bioimaging/CENABIOFederal University of Rio de JaneiroRio de JaneiroBrazil
- National Institute of Science and Technology for Regenerative Medicine/REGENERARio de JaneiroBrazil
| | - Humberto Muzi‐Filho
- Carlos Chagas Filho Institute of BiophysicsFederal University of Rio de JaneiroRio de JaneiroBrazil
- National Center for Structural Biology and Bioimaging/CENABIOFederal University of Rio de JaneiroRio de JaneiroBrazil
- National Institute of Science and Technology for Regenerative Medicine/REGENERARio de JaneiroBrazil
| | - Adalberto Vieyra
- Graduate Program of Translational Biomedicine/BIOTRANSUniversity of Grande RioDuque de CaxiasBrazil
- Carlos Chagas Filho Institute of BiophysicsFederal University of Rio de JaneiroRio de JaneiroBrazil
- National Center for Structural Biology and Bioimaging/CENABIOFederal University of Rio de JaneiroRio de JaneiroBrazil
- National Institute of Science and Technology for Regenerative Medicine/REGENERARio de JaneiroBrazil
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7
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Bernhardt A, Krause A, Reichardt C, Steffen H, Isermann B, Völker U, Hammer E, Geffers R, Philipsen L, Dhjamandi K, Ahmad S, Brandt S, Lindquist JA, Mertens PR. Excessive sodium chloride ingestion promotes inflammation and kidney fibrosis in aging mice. Am J Physiol Cell Physiol 2023; 325:C456-C470. [PMID: 37399499 DOI: 10.1152/ajpcell.00230.2023] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 06/21/2023] [Indexed: 07/05/2023]
Abstract
In aging kidneys, a decline of function resulting from extracellular matrix (ECM) deposition and organ fibrosis is regarded as "physiological." Whether a direct link between high salt intake and fibrosis in aging kidney exists autonomously from arterial hypertension is unclear. This study explores kidney intrinsic changes (inflammation, ECM derangement) induced by a high-salt diet (HSD) in a murine model lacking arterial hypertension. The contribution of cold shock Y-box binding protein (YB-1) as a key orchestrator of organ fibrosis to the observed differences is determined by comparison with a knockout strain (Ybx1ΔRosaERT+TX). Comparisons of tissue from mice fed with normal-salt diet (NSD, standard chow) or high-salt diet (HSD, 4% NaCl in chow; 1% NaCl in water) for up to 16 mo revealed that with HSD tubular cell numbers decrease and tubulointerstitial scarring [periodic acid-Schiff (PAS), Masson's trichrome, Sirius red staining] prevails. In Ybx1ΔRosaERT+TX animals tubular cell damage, a loss of cell contacts with profound tubulointerstitial alterations, and tubular cell senescence was seen. A distinct tubulointerstitial distribution of fibrinogen, collagen type VI, and tenascin-C was detected under HSD, transcriptome analyses determined patterns of matrisome regulation. Temporal increase of immune cell infiltration was seen under HSD of wild type, but not Ybx1ΔRosaERT+TX animals. In vitro Ybx1ΔRosaERT+TX bone marrow-derived macrophages exhibited a defect in polarization (IL-4/IL-13) and abrogated response to sodium chloride. Taken together, HSD promotes progressive kidney fibrosis with premature cell aging, ECM deposition, and immune cell recruitment that is exacerbated in Ybx1ΔRosaERT+TX animals.NEW & NOTEWORTHY Short-term experimental studies link excessive sodium ingestion with extracellular matrix accumulation and inflammatory cell recruitment, yet long-term data are scarce. Our findings with a high-salt diet over 16 mo in aging mice pinpoints to a decisive tipping point after 12 mo with tubular stress response, skewed matrisome transcriptome, and immune cell infiltration. Cell senescence was aggravated in knockout animals for cold shock Y-box binding protein (YB-1), suggesting a novel protective protein function.
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Affiliation(s)
- Anja Bernhardt
- Clinic of Nephrology and Hypertension, Diabetes and Endocrinology, Otto-von-Guericke University, Magdeburg, Germany
| | - Anna Krause
- Clinic of Nephrology and Hypertension, Diabetes and Endocrinology, Otto-von-Guericke University, Magdeburg, Germany
| | - Charlotte Reichardt
- Clinic of Nephrology and Hypertension, Diabetes and Endocrinology, Otto-von-Guericke University, Magdeburg, Germany
| | - Hannes Steffen
- Clinic of Nephrology and Hypertension, Diabetes and Endocrinology, Otto-von-Guericke University, Magdeburg, Germany
| | - Berend Isermann
- Institute of Laboratory Medicine, Clinical Chemistry and Molecular Diagnostics, University Hospital Leipzig, Leipzig University, Leipzig, Germany
| | - Uwe Völker
- Interfaculty Institute of Genetics and Functional Genomics, University Medicine Greifswald, Greifswald, Germany
| | - Elke Hammer
- Interfaculty Institute of Genetics and Functional Genomics, University Medicine Greifswald, Greifswald, Germany
| | - Robert Geffers
- Genome Analytics Research Group, Helmholtz Centre for Infection Research, Braunschweig, Germany
| | - Lars Philipsen
- Institute of Molecular and Clinical Immunology, Otto-von-Guericke University, Magdeburg, Germany
| | - Kristin Dhjamandi
- Clinic of Nephrology and Hypertension, Diabetes and Endocrinology, Otto-von-Guericke University, Magdeburg, Germany
| | - Sohail Ahmad
- Clinic of Nephrology and Hypertension, Diabetes and Endocrinology, Otto-von-Guericke University, Magdeburg, Germany
| | - Sabine Brandt
- Clinic of Nephrology and Hypertension, Diabetes and Endocrinology, Otto-von-Guericke University, Magdeburg, Germany
| | - Jonathan A Lindquist
- Clinic of Nephrology and Hypertension, Diabetes and Endocrinology, Otto-von-Guericke University, Magdeburg, Germany
| | - Peter R Mertens
- Clinic of Nephrology and Hypertension, Diabetes and Endocrinology, Otto-von-Guericke University, Magdeburg, Germany
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8
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Chattopadhyay A, Tully J, Shan J, Sheikh S, Ohliger M, Gordon JW, Mauro T, Abuabara K. Sodium in the skin: a summary of the physiology and a scoping review of disease associations. Clin Exp Dermatol 2023; 48:733-743. [PMID: 36970766 DOI: 10.1093/ced/llad080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 02/16/2023] [Indexed: 07/20/2023]
Abstract
A large and growing body of research suggests that the skin plays an important role in regulating total body sodium, challenging traditional models of sodium homeostasis that focused exclusively on blood pressure and the kidney. In addition, skin sodium may help to prevent water loss and facilitate macrophage-driven antimicrobial host defence, but may also trigger immune dysregulation via upregulation of proinflammatory markers and downregulation of anti-inflammatory processes. We performed a systematic search of PubMed for published literature on skin sodium and disease outcomes and found that skin sodium concentration is increased in patients with cardiometabolic conditions including hypertension, diabetes and end-stage renal disease; autoimmune conditions including multiple sclerosis and systemic sclerosis; and dermatological conditions including atopic dermatitis, psoriasis and lipoedema. Several patient characteristics are associated with increased skin sodium concentration including older age and male sex. Animal evidence suggests that increased salt intake results in higher skin sodium levels; however, there are conflicting results from small trials in humans. Additionally, limited data suggest that pharmaceuticals such as diuretics and sodium-glucose co-transporter-2 inhibitors approved for diabetes, as well as haemodialysis may reduce skin sodium levels. In summary, emerging research supports an important role for skin sodium in physiological processes related to osmoregulation and immunity. With the advent of new noninvasive magnetic resonance imaging measurement techniques and continued research on skin sodium, it may emerge as a marker of immune-mediated disease activity or a potential therapeutic target.
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Affiliation(s)
- Aheli Chattopadhyay
- Department of Dermatology, University of California San Francisco, San Francisco, CA, USA
| | - Janell Tully
- University of Arizona College of Medicine - Phoenix, Phoenix, AZ, USA
| | - Judy Shan
- Department of Dermatology, University of California San Francisco, San Francisco, CA, USA
| | - Sidra Sheikh
- Kaiser Permanente, Department of Physical Medicine & Rehabilitation, Oakland, CA, USA
| | - Michael Ohliger
- Department of Radiology & Biomedical Imaging, University of California San Francisco, San Francisco, CA, USA
| | - Jeremy W Gordon
- Department of Radiology & Biomedical Imaging, University of California San Francisco, San Francisco, CA, USA
| | - Theodora Mauro
- Department of Dermatology, University of California San Francisco, San Francisco, CA, USA
- Dermatology Service, Veterans Affairs Health Care System, San Francisco, CA, USA
| | - Katrina Abuabara
- Department of Dermatology, University of California San Francisco, San Francisco, CA, USA
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9
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Tang H, Xu C, Zhang P, Luo T, Huang Y, Yang X. A profile of SGLT-2 inhibitors in hyponatremia: The evidence to date. Eur J Pharm Sci 2023; 184:106415. [PMID: 36870579 DOI: 10.1016/j.ejps.2023.106415] [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: 11/27/2022] [Revised: 02/14/2023] [Accepted: 02/27/2023] [Indexed: 03/06/2023]
Abstract
Hyponatremia is the most common electrolyte disorder in clinical practice, which may lead to life-threatening complications. Several lines of evidence suggest that hyponatremia is associated not only with significant increases in length of stay, cost, and financial burden, but also with increased morbidity and mortality. Hyponatremia is also considered to be a negative prognostic factor in patients with heart failure and cancer. Although multiple therapeutic methods are available for treating hyponatremia, most have some limitations, such as poor compliance, rapid correction of serum Na+, other negative side effects and high cost. Given these limitations, identifying novel therapies for hyponatremia is essential. Recent clinical studies have shown that SGLT-2 inhibitors (SGLT 2i) significantly increased serum Na+ levels and were well tolerated by patients who underwent this treatment. Therefore, oral administration of SGLT 2i appears to be an effective treatment for hyponatremia. This article will briefly review the etiology of hyponatremia and integrated control of sodium within the kidney, current therapies for hyponatremia, potential mechanisms and efficacy of SGLT 2i for hyponatremia, and the benefits in cardiovascular, cancer, and kidney disease by regulating sodium and water balance.
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Affiliation(s)
- Hui Tang
- Department of Pharmacy, The Affiliated Hospital of Southwest Medical University, Luzhou 646000, China; School of Pharmacy, Southwest Medical University, Luzhou 646000, China
| | - Changjing Xu
- Department of Pharmacy, The Affiliated Hospital of Southwest Medical University, Luzhou 646000, China
| | - Piao Zhang
- Department of Pharmacy, Ya 'an People's Hospital, Ya 'an, Sichuan 646000, China
| | - Taimin Luo
- Department of pharmacy, Chengdu Seventh People's Hospital, Chengdu, Sichuan 610000, China
| | - Yilan Huang
- Department of Pharmacy, The Affiliated Hospital of Southwest Medical University, Luzhou 646000, China; School of Pharmacy, Southwest Medical University, Luzhou 646000, China.
| | - Xuping Yang
- Department of Pharmacy, The Affiliated Hospital of Southwest Medical University, Luzhou 646000, China; School of Pharmacy, Southwest Medical University, Luzhou 646000, China.
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10
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Chen J, Chew K, Mary S, Boder P, Bagordo D, Rossi G, Touyz R, Delles C, Rossitto G. Skin-specific mechanisms of body fluid regulation in hypertension. Clin Sci (Lond) 2023; 137:239-250. [PMID: 36648486 PMCID: PMC10621731 DOI: 10.1042/cs20220609] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 01/11/2023] [Accepted: 01/16/2023] [Indexed: 01/18/2023]
Abstract
Increasing evidence suggests excess skin Na+ accumulation in hypertension; however, the role of skin-specific mechanisms of local Na+/water regulation remains unclear. We investigated the association between measures of sweat and trans-epidermal water loss (TEWL) with Na+ content in the skin ([Na+]skin) and clinical characteristics in consecutive hypertensive patients. We obtained an iontophoretic pilocarpine-induced sweat sample, a skin punch biopsy for chemical analysis, and measures of TEWL from the upper limbs. Serum vascular endothelial growth factor-c (VEGF-c) and a reflectance measure of haemoglobin skin content served as surrogates of skin microvasculature. In our cohort (n = 90; age 21-86 years; females = 49%), sweat composition was independent of sex and BMI. Sweat Na+ concentration ([Na+]sweat) inversely correlated with [K+]sweat and was higher in patients on ACEIs/ARBs (P < 0.05). A positive association was found between [Na+]sweat and [Na+]skin, independent of sex, BMI, estimated Na+ intake and use of ACEi/ARBs (Padjusted = 0.025); both closely correlated with age (P < 0.01). Office DBP, but not SBP, inversely correlated with [Na+]sweat independent of other confounders (Padjusted = 0.03). Total sweat volume and Na+ loss were lower in patients with uncontrolled office BP (Padjusted < 0.005 for both); sweat volume also positively correlated with serum VEGF-c and TEWL. Lower TEWL was paralleled by lower skin haemoglobin content, which increased less after vasodilatory pilocarpine stimulation when BMI was higher (P = 0.010). In conclusion, measures of Na+ and water handling/regulation in the skin were associated with relevant clinical characteristics, systemic Na+ status and blood pressure values, suggesting a potential role of the skin in body-fluid homeostasis and therapeutic targeting of hypertension.
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Affiliation(s)
- Jun Yu Chen
- School of Cardiovascular & Metabolic Health, University of Glasgow, U.K
| | - Khai Syuen Chew
- School of Cardiovascular & Metabolic Health, University of Glasgow, U.K
| | - Sheon Mary
- School of Cardiovascular & Metabolic Health, University of Glasgow, U.K
| | - Philipp Boder
- School of Cardiovascular & Metabolic Health, University of Glasgow, U.K
| | - Domenico Bagordo
- Emergency Medicine and Hypertension, DIMED, Università degli Studi di Padova, Italy
| | - Gian Paolo Rossi
- Emergency Medicine and Hypertension, DIMED, Università degli Studi di Padova, Italy
| | - Rhian M. Touyz
- Research Institute of McGill University Health Centre, McGill University, Montreal, Canada
| | - Christian Delles
- School of Cardiovascular & Metabolic Health, University of Glasgow, U.K
| | - Giacomo Rossitto
- School of Cardiovascular & Metabolic Health, University of Glasgow, U.K
- Emergency Medicine and Hypertension, DIMED, Università degli Studi di Padova, Italy
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11
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Schneditz D, Mussnig S, Krenn S, Hecking M. Revisiting the concept of constant tissue conductivities for volume estimation in dialysis patients using bioimpedance spectroscopy. Int J Artif Organs 2023; 46:67-73. [PMID: 36550616 DOI: 10.1177/03913988221145457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
RATIONALE Current estimation of body fluid volumes in hemodialysis patients using bioimpedance analysis assumes constant specific electrical characteristics of biological tissues despite a large variation in plasma Na+ concentrations [Na+], ranging from 130 to 150 mmol/L. Here, we examined the potential effect of variable [Na+] on bioimpedance-derived volume overload. METHOD Volumes were calculated from published whole-body extra- and intracellular resistance data and relationships using either "standard" or "revised" specific electrical characteristics modeled as functions of [Na+]. RESULT With "standard" assumptions, volumes increased with increasing [Na+]. The increase in volume overload was about 0.5 dm3 and 3% of extracellular volume per 10 mmol/dm3 of [Na+] in a 75 kg patient. This increase was abolished when the same bioimpedance data were analyzed under "revised" conditions. DISCUSSION The overestimation in extracellular volume overload in the range of 0.5 dm3 per 10 mmol/dm3 [Na+] perfectly matches the positive relationship determined in a large cohort of hemodialysis patients. The bias may be considered moderate when interpreting data of individual patients, but may become important when comparing data of larger patient groups. The bias disappears when analysis of bioimpedance data accounts for differences in tissue electrical properties, using individual [Na+].
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Affiliation(s)
- Daniel Schneditz
- Otto Loewi Research Center, Division of Physiology, Medical University of Graz, Graz, Austria
| | - Sebastian Mussnig
- Department of Medicine III, Division for Nephrology and Dialysis, Medical University of Vienna, Vienna, Austria
| | - Simon Krenn
- Department of Medicine III, Division for Nephrology and Dialysis, Medical University of Vienna, Vienna, Austria.,Center for Health & Bioresources, Medical Signal Analysis, AIT Austrian Institute of Technology GmbH, Vienna, Austria
| | - Manfred Hecking
- Department of Medicine III, Division for Nephrology and Dialysis, Medical University of Vienna, Vienna, Austria
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12
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Chifu I, Weng AM, Burger-Stritt S, Bley TA, Christa M, Köstler H, Hahner S. Non-invasive assessment of tissue sodium content in patients with primary adrenal insufficiency. Eur J Endocrinol 2022; 187:383-390. [PMID: 35895687 PMCID: PMC9346263 DOI: 10.1530/eje-22-0396] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 07/04/2022] [Indexed: 12/03/2022]
Abstract
OBJECTIVE Replacement therapy in primary adrenal insufficiency (PAI) with corticosteroids modulates sodium homeostasis. Serum sodium is, however, prone to osmotic shifts induced by several additional factors besides corticosteroids and does not always reliably reflect treatment quality. Non-osmotic tissue storage can be visualized by sodium MRI (23Na-MRI) and might better reflect corticosteroid activity. DESIGN Longitudinal study of 8 patients with newly diagnosed PAI and cross-sectional study in 22 patients with chronic PAI is reported here. Comparison was made with matched healthy controls. METHODS Using a 23Na-MRI protocol on a 3T scanner, relative sodium signal intensities (rSSI) to signal intensities of the reference vial with 100 mmol/L of sodium were determined in the muscle and skin of the lower calf. RESULTS In newly diagnosed patients, tissue rSSI (median, range) were reduced and significantly increased after treatment initiation reaching levels similar to healthy controls (muscle: from 0.15 (0.08, 0.18) to 0.18 (0.14, 0.27), P = 0.02; skin: from 0.12 (0.09, 0.18) to 0.18 (0.14, 0.28), P < 0.01). Muscle rSSI was significantly higher in patients with chronic PAI compared to controls (0.19 (0.14, 0.27) vs 0.16 (0.12, 0.20), P < 0.01). In chronic PAI, skin rSSI significantly correlated with plasma renin concentration. CONCLUSION 23Na-MRI provides an additional insight into sodium homeostasis, and thus the quality of replacement therapy in PAI, as tissue sodium significantly changes once therapy is initiated. The increased tissue sodium in patients with chronic PAI might be an indication of over-replacement.
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Affiliation(s)
- Irina Chifu
- Division of Endocrinology and Diabetology, Department of Internal Medicine I, University Hospital of Würzburg, University of Würzburg, Würzburg, Germany
- Correspondence should be addressed to I Chifu;
| | - Andreas Max Weng
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Würzburg, Germany
| | - Stephanie Burger-Stritt
- Division of Endocrinology and Diabetology, Department of Internal Medicine I, University Hospital of Würzburg, University of Würzburg, Würzburg, Germany
| | - Thorsten Alexander Bley
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Würzburg, Germany
| | - Martin Christa
- Comprehensive Heart Failure Center, University and University Hospital Würzburg, Würzburg, Germany
- Department of Internal Medicine I, University Hospital Würzburg, Würzburg, Germany
| | - Herbert Köstler
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Würzburg, Germany
| | - Stefanie Hahner
- Division of Endocrinology and Diabetology, Department of Internal Medicine I, University Hospital of Würzburg, University of Würzburg, Würzburg, Germany
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13
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Hogas M, Statescu C, Padurariu M, Ciobica A, Bilha SC, Haisan A, Timofte D, Hogas S. Salt, Not Always a Cardiovascular Enemy? A Mini-Review and Modern Perspective. Medicina (B Aires) 2022; 58:medicina58091175. [PMID: 36143852 PMCID: PMC9504547 DOI: 10.3390/medicina58091175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 08/23/2022] [Accepted: 08/25/2022] [Indexed: 11/16/2022] Open
Abstract
Dietary salt intake is a long-debated issue. Increased sodium intake is associated with high blood pressure, leading to salt-sensitive hypertension. Excessive salt intake leads to arterial stiffness in susceptible individuals via impaired nitric oxide action and increased endothelin-1 expression, overactivity of the renal sympathetic nervous system and also via aldosterone-independent activation of the mineralocorticoid receptor. Salt restriction in such individuals reduces blood pressure (BP) values. The optimal level of salt restriction that leads to improved cardiovascular outcomes is still under debate. Current BP and dietary guidelines recommend low sodium intake for the general population. However, a specific category of patients does not develop arterial hypertension in response to sodium loading. In addition, recent research demonstrates the deleterious effects of aggressive sodium restriction, even in heart failure patients. This mini review discusses current literature data regarding the advantages and disadvantages of salt restriction and how it impacts the overall health status.
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Affiliation(s)
- Mihai Hogas
- Physiology Department, “Grigore T. Popa” University of Medicine and Pharmacy, Universitatii 16, 700115 Iasi, Romania
| | - Cristian Statescu
- Cardiology Department, “Grigore T. Popa” University of Medicine and Pharmacy, Universitatii 16, 700115 Iasi, Romania
| | - Manuela Padurariu
- Psychiatry Department, “Grigore T. Popa” University of Medicine and Pharmacy, Universitatii 16, 700115 Iasi, Romania
| | - Alin Ciobica
- Department of Biology, Faculty of Biology, Alexandru Ioan Cuza University, B dul Carol I, No 11, 700115 Iasi, Romania
- Academy of Romanian Scientists, Splaiul Independentei Nr. 54, Sector 5, 050094 Bucuresti, Romania
- Center of Biomedical Research, Romanian Academy, B dul Carol I, No 8, 700115 Iasi, Romania
| | - Stefana Catalina Bilha
- Endocrinology Department, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania
- Correspondence: (S.C.B.); (A.H.)
| | - Anca Haisan
- Surgery Department, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania
- Correspondence: (S.C.B.); (A.H.)
| | - Daniel Timofte
- Surgery Department, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Simona Hogas
- Nephrology Department, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania
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14
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Pereira-Acácio A, Veloso-Santos JPM, Nossar LF, Costa-Sarmento G, Muzi-Filho H, Vieyra A. Angiotensin-(3–4) normalizes the elevated arterial blood pressure and abnormal Na+/energy handling associated with chronic undernutrition by counteracting the effects mediated by type 1 angiotensin II receptors. PLoS One 2022; 17:e0273385. [PMID: 35984814 PMCID: PMC9390919 DOI: 10.1371/journal.pone.0273385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 08/07/2022] [Indexed: 11/24/2022] Open
Abstract
We investigated the mechanisms by which chronic administration of a multideficient diet after weaning alters bodily Na+ handling, and culminates in high systolic blood pressure (SBP) at a juvenile age. From 28 to 92 days of age, weaned male Wistar rats were given a diet with low content and poor-quality protein, and low lipid, without vitamin supplementation, which mimics the diets consumed in impoverished regions worldwide. We measured food, energy and Na+ ingestion, together with urinary Na+ excretion, Na+ density (Na+ intake/energy intake), plasma Na+ concentration, SBP, and renal proximal tubule Na+-transporting ATPases. Undernourished rats aged 92 days had only one-third of the control body mass, lower plasma albumin, higher SBP, higher energy intake, and higher positive Na+ balance accompanied by decreased plasma Na+ concentration. Losartan or Ang-(3–4) normalized SBP, and the combination of the 2 substances induced an accentuated negative Na+ balance as a result of strong inhibition of Na+ ingestion. Na+ density in undernourished rats was higher than in control, irrespective of the treatment, and they had downregulated (Na++K+)ATPase and upregulated Na+-ATPase in proximal tubule cells, which returned to control levels after Losartan or Ang-(3–4). We conclude that Na+ density, not only Na+ ingestion, plays a central role in the pathophysiology of elevated SBP in chronically undernourished rats. The observations that Losartan and Ang-(3–4) normalized SBP together with negative Na+ balance give support to the proposal that Ang II⇒AT1R and Ang II⇒AT2R axes have opposite roles within the renin-angiotensin-aldosterone system of undernourished juvenile rats.
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Affiliation(s)
- Amaury Pereira-Acácio
- Graduate Program of Translational Biomedicine/BIOTRANS, University of Grande Rio, Duque de Caxias, Brazil
- Leopoldo de Meis Institute of Medical Biochemistry, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
- Carlos Chagas Filho Institute of Biophysics, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
- National Center of Structural Biology and Bioimaging/CENABIO, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - João P. M. Veloso-Santos
- Carlos Chagas Filho Institute of Biophysics, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
- National Center of Structural Biology and Bioimaging/CENABIO, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Luiz F. Nossar
- Carlos Chagas Filho Institute of Biophysics, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Gloria Costa-Sarmento
- Carlos Chagas Filho Institute of Biophysics, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
- National Center of Structural Biology and Bioimaging/CENABIO, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Humberto Muzi-Filho
- Carlos Chagas Filho Institute of Biophysics, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
- National Center of Structural Biology and Bioimaging/CENABIO, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Adalberto Vieyra
- Graduate Program of Translational Biomedicine/BIOTRANS, University of Grande Rio, Duque de Caxias, Brazil
- Carlos Chagas Filho Institute of Biophysics, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
- National Center of Structural Biology and Bioimaging/CENABIO, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
- National Institute of Science and Technology for Regenerative Medicine/REGENERA, Rio de Janeiro, Brazil
- * E-mail:
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15
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Lee CH, Shin J. Effect of low sodium and high potassium diet on lowering blood pressure. JOURNAL OF THE KOREAN MEDICAL ASSOCIATION 2022. [DOI: 10.5124/jkma.2022.65.6.368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Background: Hypertension is the leading factor of cardiovascular mortality and morbidity. Although antihypertensive medical treatment is the cornerstone of blood pressure control, lifestyle modification, including optimal diet therapy, such as dietary approaches to stop hypertension (DASH), cannot be overemphasized.Current Concepts: Due to the mismatch between sodium intake and excretion process being the key mechanisms according to physiologic principles, low sodium and high potassium intakes are the critical components of DASH. If the patient has a sensitive elevation of blood pressure following increased sodium intake, a low sodium diet could be essential for optimal blood pressure control. Salt sensitivity is increased by the activated reninangiotensin system, sympathetic nervous activity, sodium channels disorder, and endothelial dysfunction and frequently observed in the elderly and patients with obesity and chronic kidney disease. Increased potassium intake could attenuate sodium absorption by affecting the intracellular chloride and WNK4 activity, especially in patients with salt sensitivity or high salt intake.Discussion and Conclusion: For low sodium and high potassium intakes, the Na/K diet ratio could be a good target for intervention, and this approach is a critical component of DASH.
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16
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Gohar EY, De Miguel C, Obi IE, Daugherty EM, Hyndman KA, Becker BK, Jin C, Sedaka R, Johnston JG, Liu P, Speed JS, Mitchell T, Kriegel AJ, Pollock JS, Pollock DM. Acclimation to a High-Salt Diet Is Sex Dependent. J Am Heart Assoc 2022; 11:e020450. [PMID: 35191321 PMCID: PMC9075092 DOI: 10.1161/jaha.120.020450] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 08/03/2021] [Indexed: 01/01/2023]
Abstract
Background Premenopausal women are less likely to develop hypertension and salt-related complications than are men, yet the impact of sex on mechanisms regulating Na+ homeostasis during dietary salt challenges is poorly defined. Here, we determined whether female rats have a more efficient capacity to acclimate to increased dietary salt intake challenge. Methods and Results Age-matched male and female Sprague Dawley rats maintained on a normal-salt (NS) diet (0.49% NaCl) were challenged with a 5-day high-salt diet (4.0% NaCl). We assessed serum, urinary, skin, and muscle electrolytes; total body water; and kidney Na+ transporters during the NS and high-salt diet phases. During the 5-day high-salt challenge, natriuresis increased more rapidly in females, whereas serum Na+ and body water concentration increased only in males. To determine if females are primed to handle changes in dietary salt, we asked the question whether the renal endothelin-1 natriuretic system is more active in female rats, compared with males. During the NS diet, female rats had a higher urinary endothelin-1 excretion rate than males. Moreover, Ingenuity Pathway Analysis of RNA sequencing data identified the enrichment of endothelin signaling pathway transcripts in the inner medulla of kidneys from NS-fed female rats compared with male counterparts. Notably, in human subjects who consumed an Na+-controlled diet (3314-3668 mg/day) for 3 days, women had a higher urinary endothelin-1 excretion rate than men, consistent with our findings in NS-fed rats. Conclusions These results suggest that female sex confers a greater ability to maintain Na+ homeostasis during acclimation to dietary Na+ challenges and indicate that the intrarenal endothelin-1 natriuretic pathway is enhanced in women.
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Affiliation(s)
- Eman Y. Gohar
- Section of Cardio‐Renal Physiology & MedicineDivision of NephrologyDepartment of MedicineUniversity of Alabama at BirminghamAL
- Present address:
Division of Nephrology and HypertensionVanderbilt University Medical CenterNashvilleTN
| | - Carmen De Miguel
- Section of Cardio‐Renal Physiology & MedicineDivision of NephrologyDepartment of MedicineUniversity of Alabama at BirminghamAL
| | - Ijeoma E. Obi
- Section of Cardio‐Renal Physiology & MedicineDivision of NephrologyDepartment of MedicineUniversity of Alabama at BirminghamAL
| | - Elizabeth M. Daugherty
- Section of Cardio‐Renal Physiology & MedicineDivision of NephrologyDepartment of MedicineUniversity of Alabama at BirminghamAL
| | - Kelly A. Hyndman
- Section of Cardio‐Renal Physiology & MedicineDivision of NephrologyDepartment of MedicineUniversity of Alabama at BirminghamAL
| | - Bryan K. Becker
- Section of Cardio‐Renal Physiology & MedicineDivision of NephrologyDepartment of MedicineUniversity of Alabama at BirminghamAL
| | - Chunhua Jin
- Section of Cardio‐Renal Physiology & MedicineDivision of NephrologyDepartment of MedicineUniversity of Alabama at BirminghamAL
| | - Randee Sedaka
- Section of Cardio‐Renal Physiology & MedicineDivision of NephrologyDepartment of MedicineUniversity of Alabama at BirminghamAL
| | - Jermaine G. Johnston
- Section of Cardio‐Renal Physiology & MedicineDivision of NephrologyDepartment of MedicineUniversity of Alabama at BirminghamAL
| | - Pengyuan Liu
- Department of PhysiologyMedical College of WisconsinMilwaukeeWI
| | - Joshua S. Speed
- Department of PhysiologyUniversity of Mississippi Medical CenterJacksonMS
| | | | | | - Jennifer S. Pollock
- Section of Cardio‐Renal Physiology & MedicineDivision of NephrologyDepartment of MedicineUniversity of Alabama at BirminghamAL
| | - David M. Pollock
- Section of Cardio‐Renal Physiology & MedicineDivision of NephrologyDepartment of MedicineUniversity of Alabama at BirminghamAL
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17
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Šilhavý J, Mlejnek P, Šimáková M, Liška F, Kubovčiak J, Sticová E, Pravenec M. Sodium Accumulation and Blood Capillary Rarefaction in the Skin Predispose Spontaneously Hypertensive Rats to Salt Sensitive Hypertension. Biomedicines 2022; 10:biomedicines10020376. [PMID: 35203585 PMCID: PMC8962406 DOI: 10.3390/biomedicines10020376] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 02/01/2022] [Accepted: 02/02/2022] [Indexed: 11/16/2022] Open
Abstract
Recent studies in humans and rats suggested that increased Na+ storage in the skin without parallel water retention may predispose to salt-sensitive hypertension. In the current studies, we compared tissue Na+ storage in salt sensitive spontaneously hypertensive rats (SHR) versus salt resistant normotensive Brown Norway (BN-Lx) rats. After salt loading (10 days drinking 1% NaCl solution), the SHR showed significant parallel increase in Na+-to-water as well as (Na++K+)-to-water ratios suggesting increased storage of osmotically inactive Na+ in the skin while no significant changes in skin electrolyte concentrations were observed in BN-Lx rats. SHR rats after salt treatment exhibited a nonsignificant decrease in skin blood capillary number (rarefaction) while BN-Lx rats showed significantly increased skin blood capillary density. Analysis of dermal gene expression profiles in BN-Lx rats after salt treatment showed significant up-regulation of genes involved in angiogenesis and proliferation of endothelial cells contrary to the SHR. Since the skin harbors most of the body’s resistance vessels it is possible that blood capillary rarefaction may lead to increased peripheral resistance and salt sensitivity in the SHR.
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Affiliation(s)
- Jan Šilhavý
- Institute of Physiology, Czech Academy of Sciences, 14220 Prague, Czech Republic; (P.M.); (M.Š.); (F.L.); (M.P.)
- Correspondence:
| | - Petr Mlejnek
- Institute of Physiology, Czech Academy of Sciences, 14220 Prague, Czech Republic; (P.M.); (M.Š.); (F.L.); (M.P.)
| | - Miroslava Šimáková
- Institute of Physiology, Czech Academy of Sciences, 14220 Prague, Czech Republic; (P.M.); (M.Š.); (F.L.); (M.P.)
| | - František Liška
- Institute of Physiology, Czech Academy of Sciences, 14220 Prague, Czech Republic; (P.M.); (M.Š.); (F.L.); (M.P.)
- Institute of Biology and Medical Genetics, First Faculty of Medicine, Charles University, General University Hospital, 12800 Prague, Czech Republic
| | - Jan Kubovčiak
- Laboratory of Genomics and Bioinformatics, Institute of Molecular Genetics, Czech Academy of Sciences, 14220 Prague, Czech Republic;
| | - Eva Sticová
- Institute for Clinical and Experimental Medicine, 14021 Prague, Czech Republic;
- Department of Pathology, Third Faculty of Medicine, Charles University, 10000 Prague, Czech Republic
| | - Michal Pravenec
- Institute of Physiology, Czech Academy of Sciences, 14220 Prague, Czech Republic; (P.M.); (M.Š.); (F.L.); (M.P.)
- Institute of Biology and Medical Genetics, First Faculty of Medicine, Charles University, General University Hospital, 12800 Prague, Czech Republic
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18
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Jhee JH, Park HC, Choi HY. Skin Sodium and Blood Pressure Regulation. Electrolyte Blood Press 2022; 20:1-9. [DOI: 10.5049/ebp.2022.20.1.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 03/22/2022] [Accepted: 03/23/2022] [Indexed: 11/25/2022] Open
Affiliation(s)
- Jong Hyun Jhee
- Division of Nephrology, Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Hyeong Cheon Park
- Division of Nephrology, Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Hoon Young Choi
- Division of Nephrology, Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
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Abstract
Patients on chronic hemodialysis are counseled to reduce dietary sodium intake to limit their thirst and consequent interdialytic weight gain (IDWG), chronic volume overload and hypertension. Low-sodium dietary trials in hemodialysis are sparse and mostly indicate that dietary education and behavioral counseling are ineffective in reducing sodium intake and IDWG. Additional nutritional restrictions and numerous barriers further complicate dietary adherence. A low-sodium diet may also reduce tissue sodium, which is positively associated with hypertension and left ventricular hypertrophy. A potential alternative or complementary approach to dietary counseling is home delivery of low-sodium meals. Low-sodium meal delivery has demonstrated benefits in patients with hypertension and congestive heart failure but has not been explored or implemented in patients undergoing hemodialysis. The objective of this review is to summarize current strategies to improve volume overload and provide a rationale for low-sodium meal delivery as a novel method to reduce volume-dependent hypertension and tissue sodium accumulation while improving quality of life and other clinical outcomes in patients undergoing hemodialysis.
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Affiliation(s)
- Luis M Perez
- Division of Renal Disease and Hypertension, University of Colorado Anschutz Medical Campus, Denver, CO, USA
- Division of Nutritional Sciences, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - Annabel Biruete
- Department of Nutrition and Dietetics, Indiana University-Purdue University Indianapolis, Indianapolis, IN, USA
- Division of Nephrology, Indiana University School of Medicine, Indianapolis, IN, USA
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Shin J, Lee CH. The roles of sodium and volume overload on hypertension in chronic kidney disease. Kidney Res Clin Pract 2021; 40:542-554. [PMID: 34922428 PMCID: PMC8685361 DOI: 10.23876/j.krcp.21.800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 10/18/2021] [Indexed: 11/24/2022] Open
Abstract
Chronic kidney disease (CKD) is associated with increased risk of cardiovascular (CV) events, and the disease burden is rising rapidly. An important contributor to CV events and CKD progression is high blood pressure (BP). The main mechanisms of hypertension in early and advanced CKD are renin-angiotensin system activation and volume overload, respectively. Sodium retention is well known as a factor for high BP in CKD. However, a BP increase in response to total body sodium or volume overload can be limited by neurohormonal modulation. Recent clinical trial data favoring intensive BP lowering in CKD imply that the balance between volume and neurohormonal control could be revisited with respect to the safety and efficacy of strict volume control when using antihypertensive medications. In hemodialysis patients, the role of more liberal use of antihypertensive medications with the concept of functional dry weight for intensive BP control must be studied.
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Affiliation(s)
- Jinho Shin
- Division of Cardiology, Department of Internal Medicine, Hanyang University Medical Center, Seoul, Republic of Korea
| | - Chang Hwa Lee
- Division of Nephrology, Department of Internal Medicine, Hanyang University Medical Center, Seoul, Republic of Korea
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Borrelli S, De Nicola L, De Gregorio I, Polese L, Pennino L, Elefante C, Carbone A, Rappa T, Minutolo R, Garofalo C. Volume-Independent Sodium Toxicity in Peritoneal Dialysis: New Insights from Bench to Bed. Int J Mol Sci 2021; 22:ijms222312804. [PMID: 34884617 PMCID: PMC8657906 DOI: 10.3390/ijms222312804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Revised: 11/23/2021] [Accepted: 11/23/2021] [Indexed: 11/16/2022] Open
Abstract
Sodium overload is common in end-stage kidney disease (ESKD) and is associated with increased cardiovascular mortality that is traditionally considered a result of extracellular volume expansion. Recently, sodium storage was detected by Na23 magnetic resonance imaging in the interstitial tissue of the skin and other tissues. This amount of sodium is osmotically active, regulated by immune cells and the lymphatic system, escapes renal control, and, more importantly, is associated with salt-sensitive hypertension. In chronic kidney disease, the interstitial sodium storage increases as the glomerular filtration rate declines and is related to cardiovascular damage, regardless of the fluid overload. This sodium accumulation in the interstitial tissues becomes more significant in ESKD, especially in older and African American patients. The possible negative effects of interstitial sodium are still under study, though a higher sodium intake might induce abnormal structural and functional changes in the peritoneal wall. Interestingly, sodium stored in the interstial tissue is not unmodifiable, since it is removable by dialysis. Nevertheless, the sodium removal by peritoneal dialysis (PD) remains challenging, and new PD solutions are desirable. In this narrative review, we carried out an update on the pathophysiological mechanisms of volume-independent sodium toxicity and possible future strategies to improve sodium removal by PD.
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22
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Effect of sodium administration on fluid balance and sodium balance in health and the perioperative setting. Extended summary with additional insights from the MIHMoSA and TOPMAST studies. J Crit Care 2021; 67:157-165. [PMID: 34798374 DOI: 10.1016/j.jcrc.2021.10.022] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2021] [Revised: 10/26/2021] [Accepted: 10/26/2021] [Indexed: 12/26/2022]
Abstract
PURPOSE We aimed to provide an extended analysis of the physiological handling of of the sodium burden induced by maintenance fluids. MATERIALS AND METHODS We revisited two studies that demonstrated, in healthy volunteers and in surgical patients, that maintenance fluids with 154 mmol/L of sodium lead to a more positive fluid balance than a regimen containing 54 mmol/L. We report different unpublished data on the renal handling of the imposed sodium burdens with specific attention to the resulting fluid and sodium balances. RESULTS The kidneys adapt to the sodium-rich fluids not only by altering sodium excretion, but also by retaining extra free water by concentrating urine. Realigning urinary sodium excretion with an increased administration takes around one day in health and much longer in the clinical setting. This difference may be explained by the presence of hypovolemia-induced aldosterone secretion in the latter group. Non-osmotic storage of sodium limits an unrestrained fluid retention even when very high amounts of sodium are administered but fluid accumulation will inevitably be further prolonged. CONCLUSIONS Sodium administration induced by sodium-rich maintenance fluids leads, especially in the clinical setting, to prolonged fluid retention when compared with a regimen that resembles a healthy dietary sodium intake, even when kidney function is normal.
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Affiliation(s)
- David H Ellison
- From the Oregon Clinical and Translational Research Institute, Oregon Health and Science University (D.H.E) and the VA Portland Health Care System (D.H.E.) - both in Portland; and LeDucq Transatlantic Network of Excellence (D.H.E., P.W.) and the Departments of Medicine and Physiology, Johns Hopkins University (P.W.) - both in Baltimore
| | - Paul Welling
- From the Oregon Clinical and Translational Research Institute, Oregon Health and Science University (D.H.E) and the VA Portland Health Care System (D.H.E.) - both in Portland; and LeDucq Transatlantic Network of Excellence (D.H.E., P.W.) and the Departments of Medicine and Physiology, Johns Hopkins University (P.W.) - both in Baltimore
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Gattarello S, Pasticci I, Busana M, Lazzari S, Palermo P, Palumbo MM, Romitti F, Steinberg I, Collino F, Vassalli F, Langer T, Moerer O, Saager L, Herrmann P, Cadringher P, Meissner K, Quintel M, Gattinoni L. Role of Fluid and Sodium Retention in Experimental Ventilator-Induced Lung Injury. Front Physiol 2021; 12:743153. [PMID: 34588999 PMCID: PMC8473803 DOI: 10.3389/fphys.2021.743153] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Accepted: 08/20/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Ventilator-induced lung injury (VILI) via respiratory mechanics is deeply interwoven with hemodynamic, kidney and fluid/electrolyte changes. We aimed to assess the role of positive fluid balance in the framework of ventilation-induced lung injury. Methods:Post-hoc analysis of seventy-eight pigs invasively ventilated for 48 h with mechanical power ranging from 18 to 137 J/min and divided into two groups: high vs. low pleural pressure (10.0 ± 2.8 vs. 4.4 ± 1.5 cmH2O; p < 0.01). Respiratory mechanics, hemodynamics, fluid, sodium and osmotic balances, were assessed at 0, 6, 12, 24, 48 h. Sodium distribution between intracellular, extracellular and non-osmotic sodium storage compartments was estimated assuming osmotic equilibrium. Lung weight, wet-to-dry ratios of lung, kidney, liver, bowel and muscle were measured at the end of the experiment. Results: High pleural pressure group had significant higher cardiac output (2.96 ± 0.92 vs. 3.41 ± 1.68 L/min; p < 0.01), use of norepinephrine/epinephrine (1.76 ± 3.31 vs. 5.79 ± 9.69 mcg/kg; p < 0.01) and total fluid infusions (3.06 ± 2.32 vs. 4.04 ± 3.04 L; p < 0.01). This hemodynamic status was associated with significantly increased sodium and fluid retention (at 48 h, respectively, 601.3 ± 334.7 vs. 1073.2 ± 525.9 mmol, p < 0.01; and 2.99 ± 2.54 vs. 6.66 ± 3.87 L, p < 0.01). Ten percent of the infused sodium was stored in an osmotically inactive compartment. Increasing fluid and sodium retention was positively associated with lung-weight (R2 = 0.43, p < 0.01; R2 = 0.48, p < 0.01) and with wet-to-dry ratio of the lungs (R2 = 0.14, p < 0.01; R2 = 0.18, p < 0.01) and kidneys (R2 = 0.11, p = 0.02; R2 = 0.12, p = 0.01). Conclusion: Increased mechanical power and pleural pressures dictated an increase in hemodynamic support resulting in proportionally increased sodium and fluid retention and pulmonary edema.
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Affiliation(s)
- Simone Gattarello
- Department of Anesthesiology, University Medical Centre Göttingen, Göttingen, Germany
| | - Iacopo Pasticci
- Department of Anesthesiology, University Medical Centre Göttingen, Göttingen, Germany
| | - Mattia Busana
- Department of Anesthesiology, University Medical Centre Göttingen, Göttingen, Germany
| | - Stefano Lazzari
- Department of Anesthesiology, University Medical Centre Göttingen, Göttingen, Germany
| | - Paola Palermo
- Department of Anesthesiology, University Medical Centre Göttingen, Göttingen, Germany
| | - Maria Michela Palumbo
- Department of Anesthesiology, University Medical Centre Göttingen, Göttingen, Germany
| | - Federica Romitti
- Department of Anesthesiology, University Medical Centre Göttingen, Göttingen, Germany
| | - Irene Steinberg
- Department of Anesthesiology, University Medical Centre Göttingen, Göttingen, Germany
| | - Francesca Collino
- Department of Anesthesia, Intensive Care and Emergency, "Città della Salute e della Scienza" Hospital, Turin, Italy
| | - Francesco Vassalli
- Department of Anesthesiology, University Medical Centre Göttingen, Göttingen, Germany
| | - Thomas Langer
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy.,Department of Anesthesia and Intensive Care Medicine, Niguarda Ca' Granda, Milan, Italy
| | - Onnen Moerer
- Department of Anesthesiology, University Medical Centre Göttingen, Göttingen, Germany
| | - Leif Saager
- Department of Anesthesiology, University Medical Centre Göttingen, Göttingen, Germany
| | - Peter Herrmann
- Department of Anesthesiology, University Medical Centre Göttingen, Göttingen, Germany
| | - Paolo Cadringher
- Department of Anesthesiology, University Medical Centre Göttingen, Göttingen, Germany
| | - Konrad Meissner
- Department of Anesthesiology, University Medical Centre Göttingen, Göttingen, Germany
| | - Michael Quintel
- Department of Anesthesiology, University Medical Centre Göttingen, Göttingen, Germany.,Department of Anesthesiology, Intensive Care and Emergency Medicine Donau-Isar-Klinikum Deggendorf, Deggendorf, Germany
| | - Luciano Gattinoni
- Department of Anesthesiology, University Medical Centre Göttingen, Göttingen, Germany
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25
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23Na imaging: Worth its salt for understanding multiple sclerosis. Proc Natl Acad Sci U S A 2021; 118:2110799118. [PMID: 34376559 DOI: 10.1073/pnas.2110799118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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26
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Hanson P, Philp CJ, Randeva HS, James S, O’Hare JP, Meersmann T, Pavlovskaya GE, Barber TM. Sodium in the dermis colocates to glycosaminoglycan scaffold, with diminishment in type 2 diabetes mellitus. JCI Insight 2021; 6:145470. [PMID: 34003801 PMCID: PMC8262470 DOI: 10.1172/jci.insight.145470] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Accepted: 05/13/2021] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Dietary sodium intake mismatches urinary sodium excretion over prolonged periods. Our aims were to localize and quantify electrostatically bound sodium within human skin using triple-quantum-filtered (TQF) protocols for MRI and magnetic resonance spectroscopy (MRS) and to explore dermal sodium in type 2 diabetes mellitus (T2D). METHODS We recruited adult participants with T2D (n = 9) and euglycemic participants with no history of diabetes mellitus (n = 8). All had undergone lower limb amputations or abdominal skin reduction surgery for clinical purposes. We used 20 μm in-plane resolution 1H MRI to visualize anatomical skin regions ex vivo from skin biopsies taken intraoperatively, 23Na TQF MRI/MRS to explore distribution and quantification of freely dissolved and bound sodium, and inductively coupled plasma mass spectrometry to quantify sodium in selected skin samples. RESULTS Human dermis has a preponderance (>90%) of bound sodium that colocalizes with the glycosaminoglycan (GAG) scaffold. Bound and free sodium have similar anatomical locations. T2D associates with a severely reduced dermal bound sodium capacity. CONCLUSION We provide the first evidence to our knowledge for high levels of bound sodium within human dermis, colocating to the GAG scaffold, consistent with a dermal "third space repository" for sodium. T2D associates with diminished dermal electrostatic binding capacity for sodium.
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Affiliation(s)
- Petra Hanson
- Warwick Medical School, University of Warwick, Coventry, United Kingdom
- Warwickshire Institute for the Study of Diabetes Endocrinology and Metabolism, University Hospitals Coventry and Warwickshire (UHCW), Clifford Bridge Road, Coventry, United Kingdom
| | | | - Harpal S. Randeva
- Warwick Medical School, University of Warwick, Coventry, United Kingdom
- Warwickshire Institute for the Study of Diabetes Endocrinology and Metabolism, University Hospitals Coventry and Warwickshire (UHCW), Clifford Bridge Road, Coventry, United Kingdom
| | - Sean James
- Warwickshire Institute for the Study of Diabetes Endocrinology and Metabolism, University Hospitals Coventry and Warwickshire (UHCW), Clifford Bridge Road, Coventry, United Kingdom
| | - J. Paul O’Hare
- Warwick Medical School, University of Warwick, Coventry, United Kingdom
- Warwickshire Institute for the Study of Diabetes Endocrinology and Metabolism, University Hospitals Coventry and Warwickshire (UHCW), Clifford Bridge Road, Coventry, United Kingdom
| | - Thomas Meersmann
- Sir Peter Mansfield Imaging Centre (SPMIC), School of Medicine, and
- Nottingham NIHR Biomedical Research Centre, University of Nottingham, Nottingham, United Kingdom
| | - Galina E. Pavlovskaya
- Sir Peter Mansfield Imaging Centre (SPMIC), School of Medicine, and
- Nottingham NIHR Biomedical Research Centre, University of Nottingham, Nottingham, United Kingdom
| | - Thomas M. Barber
- Warwick Medical School, University of Warwick, Coventry, United Kingdom
- Warwickshire Institute for the Study of Diabetes Endocrinology and Metabolism, University Hospitals Coventry and Warwickshire (UHCW), Clifford Bridge Road, Coventry, United Kingdom
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Bellin EY, Hellebrand AM, Kaplan SM, Ledvina JG, Markis WT, Levin NW, Kaufman AM. Epidemiology of nursing home dialysis patients-A hidden population. Hemodial Int 2021; 25:548-559. [PMID: 34132036 PMCID: PMC8596662 DOI: 10.1111/hdi.12943] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Revised: 03/11/2021] [Accepted: 05/23/2021] [Indexed: 11/29/2022]
Abstract
Introduction Dialysis patients are often discharged from hospitals to skilled nursing facilities (SNFs), but little has been published about their natural history. Methods Using electronic medical record data, we conducted a retrospective cohort study of nursing home patients treated with in‐SNF hemodialysis from January 1, 2018 through June 20, 2020 within a dialysis organization across eight states. A dialytic episode began with the first in‐SNF dialysis and was ended by hospitalization, death, transfer, or cessation of treatment. The clinical characteristics and natural history of these patients and their dialytic episodes are described. Findings Four thousand five hundred and ten patients experienced 9274 dialytic episodes. Dialytic episodes had a median duration of 18 days (IQR: 8–38) and were terminated by a hospitalization n = 5747 (62%), transfer n = 2638 (28%), death n = 568 (6%), dialysis withdrawal n = 129 (1.4%), recovered function n = 2 (0.02%), or other cause n = 6 (0.06%). Increased patient mortality was associated with advancing age, low serum creatinine, albumin, or sodium, and low pre‐dialytic systolic blood pressure (sBP). U‐shaped relationships to mortality were observed for intradialytic hypotension frequency and for post‐ > pre‐hemodialysis sBP frequency. Prescription of dialysis five times weekly in the first 2 weeks was associated with better survival in the first 90 days (HR 0.77, CI 0.62–0.96; p < 0.02). Discussion Provision of in‐SNF dialysis by an external dialysis organization enables discharge from the acute care setting for appropriate treatment with increased nursing contact time in an otherwise under‐resourced environment. SNF ESRD patient clinical characteristics and outcomes are extensively characterized for the first time.
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Affiliation(s)
- Eran Y Bellin
- Departments of Epidemiology & Population Health and Medicine, Albert Einstein College of Medicine, Bronx, New York, USA
| | | | | | | | | | - Nathan W Levin
- Internal Medicine, Mount Sinai Icahn School of Medicine, New York, New York, USA
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28
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O'Donnell M, Mente A, Alderman MH, Brady AJB, Diaz R, Gupta R, López-Jaramillo P, Luft FC, Lüscher TF, Mancia G, Mann JFE, McCarron D, McKee M, Messerli FH, Moore LL, Narula J, Oparil S, Packer M, Prabhakaran D, Schutte A, Sliwa K, Staessen JA, Yancy C, Yusuf S. Salt and cardiovascular disease: insufficient evidence to recommend low sodium intake. Eur Heart J 2021; 41:3363-3373. [PMID: 33011774 DOI: 10.1093/eurheartj/ehaa586] [Citation(s) in RCA: 88] [Impact Index Per Article: 29.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Revised: 12/09/2019] [Accepted: 07/10/2020] [Indexed: 12/19/2022] Open
Abstract
Several blood pressure guidelines recommend low sodium intake (<2.3 g/day, 100 mmol, 5.8 g/day of salt) for the entire population, on the premise that reductions in sodium intake, irrespective of the levels, will lower blood pressure, and, in turn, reduce cardiovascular disease occurrence. These guidelines have been developed without effective interventions to achieve sustained low sodium intake in free-living individuals, without a feasible method to estimate sodium intake reliably in individuals, and without high-quality evidence that low sodium intake reduces cardiovascular events (compared with moderate intake). In this review, we examine whether the recommendation for low sodium intake, reached by current guideline panels, is supported by robust evidence. Our review provides a counterpoint to the current recommendation for low sodium intake and suggests that a specific low sodium intake target (e.g. <2.3 g/day) for individuals may be unfeasible, of uncertain effect on other dietary factors and of unproven effectiveness in reducing cardiovascular disease. We contend that current evidence, despite methodological limitations, suggests that most of the world's population consume a moderate range of dietary sodium (2.3-4.6g/day; 1-2 teaspoons of salt) that is not associated with increased cardiovascular risk, and that the risk of cardiovascular disease increases when sodium intakes exceed 5 g/day. While current evidence has limitations, and there are differences of opinion in interpretation of existing evidence, it is reasonable, based upon observational studies, to suggest a population-level mean target of <5 g/day in populations with mean sodium intake of >5 g/day, while awaiting the results of large randomized controlled trials of sodium reduction on incidence of cardiovascular events and mortality.
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Affiliation(s)
- Martin O'Donnell
- HRB-Clinical Research Facility, NUI Galway, Newcastle Road, Galway, Ireland.,Population Health Research Institute, McMaster University, Hamilton, ON, Canada.,Hamilton Health Sciences, Hamilton, ON, Canada
| | - Andrew Mente
- Population Health Research Institute, McMaster University, Hamilton, ON, Canada.,Hamilton Health Sciences, Hamilton, ON, Canada
| | - Michael H Alderman
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
| | | | - Rafael Diaz
- Instituto Cardiovascular de Rosario, Estudios Clínicos Latinoamérica, Rosario, Argentina
| | - Rajeev Gupta
- Academic Research Development Unit, Rajasthan University of Health Sciences, Jaipur, Rajasthan, India
| | - Patricio López-Jaramillo
- Fundación Oftalmológica de Santander, Instituto Masira, Universidad de Santander, Bucaramanga, Santander, Colombia
| | - Friedrich C Luft
- D Experimental and Clinical Research Center, Max-Delbrück Center for Molecular Medicine, Medical Faculty of the Charité, Berlin, Germany
| | - Thomas F Lüscher
- Center for Molecular Cardiology, University of Zurich, Switzerland
| | - Giuseppe Mancia
- Department of Medicine and Surgery, University Milano-Bicocca, Milan, Italy
| | | | | | - Martin McKee
- London School of Hygiene and Tropical Medicine, London, UK
| | | | - Lynn L Moore
- Preventive Medicine and Epidemiology, Department of Medicine, Boston University School of Medicine, Boston, MA, USA
| | - Jagat Narula
- The Mount Sinai Medical Centre, New York, NY, USA
| | - Suzanne Oparil
- Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Milton Packer
- Baylor Hear and Vascular Institute, Baylor University Medical Centre, Dallas, TX, USA
| | - Dorairaj Prabhakaran
- Centre for Chronic Conditions & Injuries, Public Health Foundation of India, Gurugram, India
| | - Alta Schutte
- The George Institute for Global Health, Level 5, 1 King Street, Newtown, New South Wales 2042, Australia
| | - Karen Sliwa
- Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Jan A Staessen
- Department of Cardiovascular Diseases, University of Leuven, Leuven, Belgium
| | - Clyde Yancy
- Division of Cardiology, Department of Medicine, Feinberg School of Medicine, Northwestern University, 676 N Saint Claire, Chicago, IL, USA
| | - Salim Yusuf
- Population Health Research Institute, McMaster University, Hamilton, ON, Canada.,Hamilton Health Sciences, Hamilton, ON, Canada
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Abstract
Two papers, one in 1986 and another one in 1988, reported a strong inverse correlation between urinary anion gap (UAG) and urine ammonia excretion (UNH4) in patients with metabolic acidosis and postulated that UAG could be used as an indirect measure of UNH4 This postulation has persisted until now and is widely accepted. In this review, we discuss factors regulating UAG and examine published evidence to uncover errors in the postulate and the design of the original studies. The essential fact is that, in the steady state, UAG reflects intake of Na, K, and Cl. Discrepancy between intake and urinary output of these electrolytes (i.e, UAG) indicates selective extrarenal loss of these electrolytes or nonsteady state. UNH4 excretion, which depends, in the absence of renal dysfunction, mainly on the daily acid load, has no consistent relationship to UAG either theoretically or in reality. Any correlation between UAG and UNH4, when observed, was a fortuitous correlation and cannot be extrapolated to other situations. Furthermore, the normal value of UAG has greatly increased over the past few decades, mainly due to increases in dietary intake of potassium and widespread use of sodium salts with anions other than chloride as food additives. The higher normal values of UAG must be taken into consideration in interpreting UAG.
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Affiliation(s)
- Jaime Uribarri
- Renal Division, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Man S. Oh
- Renal Division, Department of Medicine, State University of New York at Downstate, Brooklyn, New York
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30
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Kettritz R, Schirmer SH, Heine GH. [Volume Management in Chronic kidney disease]. Dtsch Med Wochenschr 2021; 146:518-524. [PMID: 33853169 DOI: 10.1055/a-1267-5219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Understanding the (patho-)physiology of volume regulation and osmoregulation is fundamental to guide patient advice and therapy in chronic kidney disease (CKD). Volume regulation primarily impacts the amount of sodium in the body, and it mainly affects the extracellular space, while osmoregulation primarily impacts the amount of free water, and it affects both the intra- and extracellular space. The kidneys control water and sodium homeostasis both through their sensor (e. g. tubuloglomerular feedback) and regulator systems (e. g. sodium reabsorption). Many CKD patients are advised by non-nephrologists to a high fluid intake, although they often do not require a daily intake of more than 1.5 litres. Many CKD patients are hypervolemic, and sodium restriction is of key importance in patients' effort to utilize lifestyle changes as therapeutic means. Pharmacologically, (particularly loop) diuretics are the basis of therapy, increasing sodium excretion. Recent developments shift the focus towards classes of drugs ameliorating prognosis in CKD: sodium-glucose linked transporter 2 (SGLT2) inhibitors have proven beneficial in heart and renal failure - by sodium and fluid excretion, among others; additionally, a novel mineralocorticoid receptor antagonist (MRA), finerenone, was recently shown to improve prognosis in CKD.
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Association between Daily Urinary Sodium Excretion, Ratio of Extracellular Water-to-Total Body Water Ratio, and Kidney Outcome in Patients with Chronic Kidney Disease. Nutrients 2021; 13:nu13020650. [PMID: 33671239 PMCID: PMC7922304 DOI: 10.3390/nu13020650] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 01/29/2021] [Accepted: 02/10/2021] [Indexed: 12/20/2022] Open
Abstract
Whether dietary salt intake affects chronic kidney disease (CKD) progression remains unclear. We conducted a retrospective cohort study to analyze the effects of both daily salt intake (DSI) and volume status on renal outcomes in 197 CKD patients. DSI was estimated by 24-h urinary sodium excretion and volume status was assessed by the ratio of extracellular water (ECW) to total body water (TBW) measured by bioelectrical impedance analysis (BIA). We divided patients into two groups according to DSI (6 g/day) or median ECW/TBW (0.475) and compared renal outcomes of each group. Furthermore, we classified and analyzed four groups according to both DSI and ECW/TBW. The higher DSI group showed a 1.69-fold (95% confidence interval (CI) 1.12–2.57, p = 0.01) excess risk of outcome occurrence compared to the lower group. Among the four groups, compared with Group 1 (low DSI and low ECW/TBW), Group 3 (high DSI and low ECW/TBW) showed a 1.84-fold (95% CI 1.03–3.30, p = 0.04) excess risk of outcome occurrence; however, Group 2 (low DSI and high ECW/TBW) showed no significant difference. High salt intake appears to be associated with poor renal outcome independent of blood pressure (BP), proteinuria, and volume status.
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Wild J, Wenzel P. Myeloid cells, tissue homeostasis, and anatomical barriers as innate immune effectors in arterial hypertension. J Mol Med (Berl) 2021; 99:315-326. [PMID: 33443617 PMCID: PMC7899956 DOI: 10.1007/s00109-020-02019-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Accepted: 11/18/2020] [Indexed: 11/29/2022]
Abstract
Although essential hypertension affects a large proportion of the human population and is one of the key drivers of cardiovascular mortality worldwide, we still do not have a complete understanding of its pathophysiology. More than 50 years ago, the immune system has been identified as an important part of the pathogenesis of arterial hypertension. An exceeding variety of recent publications deals with the interplay between the numerous different components of the immune system and mechanisms of arterial hypertension and has substantially contributed to our understanding of the role of immunity and inflammation in the pathogenesis of the disease. In this review, we focus on myeloid cells and anatomical barriers as particular aspects of innate immunity in arterial hypertension. Since it represents a first line of defense protecting against pathogens and maintaining tissue homeostasis, innate immunity provides many mechanistic hinge points in the area of hypertension.
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Affiliation(s)
- Johannes Wild
- Center for Thrombosis and Hemostasis, University Medical Center Mainz, Mainz, Germany.,Center for Cardiology - Cardiology I and CTH Professorship "Vascular Inflammation", University Medical Center Mainz, Langenbeckstr. 1, 55131, Mainz, Germany.,German Center for Cardiovascular Research (DZHK) - Partner site RheinMain, Berlin, Germany
| | - Philip Wenzel
- Center for Thrombosis and Hemostasis, University Medical Center Mainz, Mainz, Germany. .,Center for Cardiology - Cardiology I and CTH Professorship "Vascular Inflammation", University Medical Center Mainz, Langenbeckstr. 1, 55131, Mainz, Germany. .,German Center for Cardiovascular Research (DZHK) - Partner site RheinMain, Berlin, Germany.
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Tangwonglert T, Davenport A. Peritoneal sodium removal compared to glucose absorption in peritoneal dialysis patients treated by continuous ambulatory peritoneal dialysis and automated peritoneal dialysis with and without a daytime exchange. Ther Apher Dial 2021; 25:654-662. [PMID: 33403730 DOI: 10.1111/1744-9987.13619] [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: 11/08/2020] [Revised: 12/18/2020] [Accepted: 01/02/2021] [Indexed: 11/28/2022]
Abstract
Sodium removal in peritoneal dialysis (PD) depends on convective clearance, typically generated by a glucose gradient, but this can result in glucose absorption. We wished to determine which factors determine peritoneal sodium losses to glucose absorption (PD Na/Gluc). Peritoneal sodium losses and glucose absorption were calculated from measured 24-h collections of PD effluent, in patients attending for assessment of peritoneal membrane function. Five hundred and fifty eight patients; 317 (56.8%) males, mean age 56.1 ± 16.0 years, were studied, 281 treated by automated peritoneal dialysis (APD) with a daytime exchange (50.4%); 179 (32.1%) by APD and 98 (17.6%) by continuous ambulatory peritoneal dialysis (CAPD). All patients used glucose containing dialysates, with 352 (63.1%) using icodextrin and 210 (37.6%) hypertonic (22.7 g/L glucose) dialysates. The ratio of PD Na/Gluc was 0.14 (0.02-0.29). Patients using icodextrin had a higher ratio (0.16 (0.03-0.32) versus 0.11 (-0.02-0.26), P < .001), as did those using 22.7 g/L glucose versus 13.6 g/L (0.16 (0.06-0.32) versus 0.13 (-0.01-0.19), P < .01), and CAPD versus APD (0.18 (0.05-0.36) versus 0.11 (0.0-0.27), P < .05), respectively. A multivariable model showed that 24-h ultrafiltration (odds ratio [OR] 7.6 (95% confidence interval [3.9-14.8]), P < .001 was associated with increased PD Na/Gluc, whereas APD (OR 0.19 (0.06-0.62), P < .01 and increased extracellular water to total body water (OR 0.001 [0-0.08], P = .03) were associated with lower ratios. Twenty four-hour peritoneal ultrafiltration was strongly associated with PD Na/Gluc, whereas patients treated with APD cyclers without a daytime icodextrin exchange and those with an increased extracellular water to total body water had lower peritoneal sodium losses but with greater peritoneal glucose absorption.
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Affiliation(s)
- Theerasak Tangwonglert
- Nephrology Division, Department of Medicine, Phramongkutklao Hospital, Bangkok, Thailand
| | - Andrew Davenport
- UCL Department of Nephrology, Royal Free Hospital, University College London Medical School, London, UK
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Short-term changes in dietary sodium intake influence sweat sodium concentration and muscle sodium content in healthy individuals. J Hypertens 2020; 38:159-166. [PMID: 31503134 DOI: 10.1097/hjh.0000000000002234] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE There is increasing evidence that sodium can be stored in the skin and muscles without being osmotically active, yet whether acute changes in dietary sodium intake alter sweat and muscle sodium content has not been investigated previously. METHODS In a cross-over design, we assessed muscle sodium content by Na-MRI in 38 healthy normotensive volunteers (aged 33.5 ± 11.1 years, 76.3% women) after 5 days of high-sodium diet (6 g of salt added to their normal diet) and 5 days of a low-sodium diet. In a subgroup of 18 participants (72.2% women) we conducted quantitative pilocarpine iontophoretic sweat collections and measured the sodium concentration in sweat. Plasma aldosterone and plasma renin activity levels were measured in all participants. RESULTS Under high-sodium diet conditions urinary sodium excretion, muscle sodium content and sweat sodium concentration all increased significantly. Muscle sodium content (rm = 0.47, P = 0.03) and sodium sweat concentration (rm = 0.72, P < 0.001) correlated positively with salt intake as estimated by 24-h urine sodium excretion. Age, sex or the phase of the menstrual cycle did not influence muscle or sweat sodium concentrations or their changes. In contrast, plasma aldosterone levels were negatively associated with both muscle sodium (rs = -0.42, P = 0.0001) and sweat sodium content (rs = -0.52, P = 0.002). Plasma renin activity correlated negatively with sweat sodium (rs = -0.43, P = 0.012) and muscle sodium levels (rs = -0.42, P < 0.001). CONCLUSION Muscle and sweat sodium concentrations are significantly higher on a high-salt intake in healthy male and female individuals, suggesting that muscle and sweat play a role in regulating sodium balance in humans.
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Luft FC. Did you know? Fluid-and-electrolyte replacement and the uncertainty principle. Acta Physiol (Oxf) 2020; 230:e13511. [PMID: 32445605 DOI: 10.1111/apha.13511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Accepted: 05/17/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Friedrich C. Luft
- Experimental and Clinical Research Center Max‐Delbrück Center and Charité Medical Faculty Berlin Germany
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36
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Le bilan du sodium : nouveaux aspects. NUTR CLIN METAB 2020. [DOI: 10.1016/j.nupar.2020.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Evans RDR, Antonelou M, Sathiananthamoorthy S, Rega M, Henderson S, Ceron-Gutierrez L, Barcenas-Morales G, Müller CA, Doffinger R, Walsh SB, Salama AD. Inherited salt-losing tubulopathies are associated with immunodeficiency due to impaired IL-17 responses. Nat Commun 2020; 11:4368. [PMID: 32868758 PMCID: PMC7459119 DOI: 10.1038/s41467-020-18184-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Accepted: 08/10/2020] [Indexed: 02/07/2023] Open
Abstract
Increased extracellular sodium activates Th17 cells, which provide protection from bacterial and fungal infections. Whilst high salt diets have been shown to worsen autoimmune disease, the immunological consequences of clinical salt depletion are unknown. Here, we investigate immunity in patients with inherited salt-losing tubulopathies (SLT). Forty-seven genotyped SLT patients (with Bartter, Gitelman or EAST Syndromes) are recruited. Clinical features of dysregulated immunity are recorded with a standardised questionnaire and immunological investigations of IL-17 responsiveness undertaken. The effects of altering extracellular ionic concentrations on immune responses are then assessed. Patients are hypokalaemic and hypomagnesaemic, with reduced interstitial sodium stores determined by 23Na-magnetic resonance imaging. SLT patients report increased mucosal infections and allergic disease compared to age-matched controls. Aligned with their clinical phenotype, SLT patients have an increased ratio of Th2:Th17 cells. SLT Th17 and Tc17 polarisation is reduced in vitro, yet STAT1 and STAT3 phosphorylation and calcium flux following T cell activation are unaffected. In control cells, the addition of extracellular sodium (+40 mM), potassium (+2 mM), or magnesium (+1 mM) reduces Th2:Th17 ratio and augments Th17 polarisation. Our results thus show that the ionic environment typical in SLT impairs IL-17 immunity, but the intracellular pathways that mediate salt-driven Th17 polarisation are intact and in vitro IL-17 responses can be reinvigorated by increasing extracellular sodium concentration. Whether better correction of extracellular ions can rescue the immunophenotype in vivo in SLT patients remains unknown. Salt levels in culture affect the polarisation of Th17 cells, which normally protect the host from fungal and bacterial infections. Here, the authors study patients with salt-losing tubulopathies (SLT) to find that, while Th17 immunity is dampened in SLT patients, their Th17-inducing signaling pathways are intact and can be reinvigorated by exogenous salt.
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Affiliation(s)
- Rhys D R Evans
- Department of Renal Medicine, University College London, Royal Free Hospital, London, UK.
| | - Marilina Antonelou
- Department of Renal Medicine, University College London, Royal Free Hospital, London, UK
| | | | - Marilena Rega
- Institute of Nuclear Medicine, University College London, University College London Hospital, London, UK
| | - Scott Henderson
- Department of Renal Medicine, University College London, Royal Free Hospital, London, UK
| | | | | | - Christoph A Müller
- Department of Radiology, Medical Physics, Medical Center University of Freiburg, Faculty of Medicine, University of Freiburg, 79106, Freiburg, Germany.,German Consortium for Translational Cancer Research (DKTK), Partner site Freiburg, German Center for Cancer Research (DKFZ), 69120, Heidelberg, Germany
| | - Rainer Doffinger
- Department of Clinical Biochemistry and Immunology, Addenbrookes's Hospital, Cambridge, UK.,National Institute of Health Research (NIHR), Cambridge Biomedical Research Centre, Cambridge, UK
| | - Stephen B Walsh
- Department of Renal Medicine, University College London, Royal Free Hospital, London, UK.
| | - Alan D Salama
- Department of Renal Medicine, University College London, Royal Free Hospital, London, UK.
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38
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Salt sensitivity and hypertension. J Hum Hypertens 2020; 35:184-192. [PMID: 32862203 DOI: 10.1038/s41371-020-00407-1] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Revised: 07/15/2020] [Accepted: 08/18/2020] [Indexed: 12/16/2022]
Abstract
Salt sensitivity refers to the physiological trait present in mammals, including humans, by which the blood pressure (BP) of some members of the population exhibits changes parallel to changes in salt intake. It is commoner in elderly, females, Afro-Americans, patients with chronic kidney disease (CKD) and insulin resistance. Increased salt intake promotes an expansion of extracellular fluid volume and increases cardiac output. Salt-sensitive individuals present an abnormal kidney reaction to salt intake; the kidneys retain most of the salt due to an abnormal over-reactivity of sympathetic nervous system and a blunted suppression of renin-angiotensin axis. Moreover, instead of peripheral vascular resistance falling, salt-sensitive subjects present increased vascular resistance due mainly to impaired nitric oxide synthesis in endothelium. Recent studies have shown that part of the dietary salt loading accumulates in skin. Hypertensive and patients with CKD seem to have more sodium in skin comparing to healthy ones. However, we still have not fully explained the link between skin sodium, BP and salt sensitivity. Finally, although salt sensitivity plays a meaningful role in BP pathophysiology, it cannot be used by the physician in everyday patient's care, mainly due to lack of a simple and practical diagnostic test.
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Cancer Acidity and Hypertonicity Contribute to Dysfunction of Tumor-Associated Dendritic Cells: Potential Impact on Antigen Cross-Presentation Machinery. Cancers (Basel) 2020; 12:cancers12092403. [PMID: 32847079 PMCID: PMC7565485 DOI: 10.3390/cancers12092403] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 08/13/2020] [Accepted: 08/16/2020] [Indexed: 01/21/2023] Open
Abstract
Macrophages (MΦ) and dendritic cells (DC), major players of the mononuclear phagocyte system (MoPh), are potent antigen presenting cells that steadily sense and respond to signals from the surrounding microenvironment, leading to either immunogenic or tolerogenic outcomes. Next to classical MHC-I/MHC-II antigen-presentation pathways described in the vast majority of cell types, a subset of MoPh (CD8+, XCR1+, CLEC9A+, BDCA3+ conventional DCs in human) is endowed with a high competence to cross-present external (engulfed) antigens on MHC-I molecules to CD8+ T-cells. This exceptional DC function is thought to be a crucial crossroad in cytotoxic antitumor immunity and has been extensively studied in the past decades. Biophysical and biochemical fingerprints of tumor micromilieus show significant spatiotemporal differences in comparison to non-neoplastic tissue. In tumors, low pH (mainly due to extracellular lactate accumulation via the Warburg effect and via glutaminolysis) and high oncotic and osmotic pressure (resulting from tumor debris, increased extracellular matrix components but in part also triggered by nutritive aspects) are—despite fluctuations and difficulties in measurement—likely the most constant general hallmarks of tumor microenvironment. Here, we focus on the influence of acidic and hypertonic micromilieu on the capacity of DCs to cross-present tumor-specific antigens. We discuss complex and in part controversial scientific data on the interference of these factors with to date reported mechanisms of antigen uptake, processing and cross-presentation, and we highlight their potential role in cancer immune escape and poor clinical response to DC vaccines.
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40
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Borrelli S, Provenzano M, Gagliardi I, Ashour M, Liberti ME, De Nicola L, Conte G, Garofalo C, Andreucci M. Sodium Intake and Chronic Kidney Disease. Int J Mol Sci 2020; 21:ijms21134744. [PMID: 32635265 PMCID: PMC7369961 DOI: 10.3390/ijms21134744] [Citation(s) in RCA: 51] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Revised: 06/27/2020] [Accepted: 07/01/2020] [Indexed: 12/14/2022] Open
Abstract
In Chronic Kidney Disease (CKD) patients, elevated blood pressure (BP) is a frequent finding and is traditionally considered a direct consequence of their sodium sensitivity. Indeed, sodium and fluid retention, causing hypervolemia, leads to the development of hypertension in CKD. On the other hand, in non-dialysis CKD patients, salt restriction reduces BP levels and enhances anti-proteinuric effect of renin–angiotensin–aldosterone system inhibitors in non-dialysis CKD patients. However, studies on the long-term effect of low salt diet (LSD) on cardio-renal prognosis showed controversial findings. The negative results might be the consequence of measurement bias (spot urine and/or single measurement), reverse epidemiology, as well as poor adherence to diet. In end-stage kidney disease (ESKD), dialysis remains the only effective means to remove dietary sodium intake. The mismatch between intake and removal of sodium leads to fluid overload, hypertension and left ventricular hypertrophy, therefore worsening the prognosis of ESKD patients. This imposes the implementation of a LSD in these patients, irrespective of the lack of trials proving the efficacy of this measure in these patients. LSD is, therefore, a rational and basic tool to correct fluid overload and hypertension in all CKD stages. The implementation of LSD should be personalized, similarly to diuretic treatment, keeping into account the volume status and true burden of hypertension evaluated by ambulatory BP monitoring.
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MESH Headings
- Blood Pressure
- Diet, Sodium-Restricted
- Humans
- Hypertension/diet therapy
- Hypertension/etiology
- Hypertension/physiopathology
- Hypertrophy, Left Ventricular/diet therapy
- Hypertrophy, Left Ventricular/etiology
- Hypertrophy, Left Ventricular/physiopathology
- Kidney Failure, Chronic/complications
- Kidney Failure, Chronic/diet therapy
- Kidney Failure, Chronic/physiopathology
- Prognosis
- Renal Dialysis
- Renal Insufficiency, Chronic/complications
- Renal Insufficiency, Chronic/diet therapy
- Renal Insufficiency, Chronic/physiopathology
- Renin-Angiotensin System/physiology
- Sodium Chloride, Dietary/administration & dosage
- Water-Electrolyte Imbalance/diet therapy
- Water-Electrolyte Imbalance/etiology
- Water-Electrolyte Imbalance/physiopathology
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Affiliation(s)
- Silvio Borrelli
- Nephrology Unit, Advanced Surgical and Medical Sciences Department of University of Campania “Luigi Vanvitelli”, Piazza Miraglia, 80137 Naples, Italy; (M.E.L.); (L.D.N.); (G.C.); (C.G.)
- Correspondence: ; Tel.: +39-081-2549405
| | - Michele Provenzano
- Nephrology Unit, Department of Health Sciences, “Magna Grecia” University, 88100 Catanzaro, Italy; (M.P.); (I.G.); (M.A.); (M.A.)
| | - Ida Gagliardi
- Nephrology Unit, Department of Health Sciences, “Magna Grecia” University, 88100 Catanzaro, Italy; (M.P.); (I.G.); (M.A.); (M.A.)
| | - Michael Ashour
- Nephrology Unit, Department of Health Sciences, “Magna Grecia” University, 88100 Catanzaro, Italy; (M.P.); (I.G.); (M.A.); (M.A.)
| | - Maria Elena Liberti
- Nephrology Unit, Advanced Surgical and Medical Sciences Department of University of Campania “Luigi Vanvitelli”, Piazza Miraglia, 80137 Naples, Italy; (M.E.L.); (L.D.N.); (G.C.); (C.G.)
| | - Luca De Nicola
- Nephrology Unit, Advanced Surgical and Medical Sciences Department of University of Campania “Luigi Vanvitelli”, Piazza Miraglia, 80137 Naples, Italy; (M.E.L.); (L.D.N.); (G.C.); (C.G.)
| | - Giuseppe Conte
- Nephrology Unit, Advanced Surgical and Medical Sciences Department of University of Campania “Luigi Vanvitelli”, Piazza Miraglia, 80137 Naples, Italy; (M.E.L.); (L.D.N.); (G.C.); (C.G.)
| | - Carlo Garofalo
- Nephrology Unit, Advanced Surgical and Medical Sciences Department of University of Campania “Luigi Vanvitelli”, Piazza Miraglia, 80137 Naples, Italy; (M.E.L.); (L.D.N.); (G.C.); (C.G.)
| | - Michele Andreucci
- Nephrology Unit, Department of Health Sciences, “Magna Grecia” University, 88100 Catanzaro, Italy; (M.P.); (I.G.); (M.A.); (M.A.)
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41
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Robert A, Cheddani L, Ebel A, Vilaine E, Seidowsky A, Massy Z, Essig M. Métabolisme du sodium : une mise au point en 2019. Nephrol Ther 2020; 16:77-82. [DOI: 10.1016/j.nephro.2019.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Accepted: 06/10/2019] [Indexed: 11/30/2022]
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42
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Filippone EJ, Ruzieh M, Foy A. Thiazide-Associated Hyponatremia: Clinical Manifestations and Pathophysiology. Am J Kidney Dis 2020; 75:256-264. [DOI: 10.1053/j.ajkd.2019.07.011] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Accepted: 07/05/2019] [Indexed: 11/11/2022]
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43
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Abstract
During tissue inflammation, immune cells infiltrate the interstitial space of target organs, where they sense and adapt to local environmental stimuli. Such stimuli include not only pathogens but also local factors such as the levels of oxygenation, nutrients and electrolytes. An important electrolyte in this regard is sodium (Na+). Recent in vivo findings have shown a role of Na+ storage in the skin for electrolyte homeostasis. Thereby, Na+ intake may influence the activation status of the immune system through direct effects on T helper cell subsets and innate immune cells in tissues such as the skin and other target organs. Furthermore, high Na+ intake has been shown to alter the composition of the intestinal microbiota, with indirect effects on immune cells. The results suggest regulatory roles for Na+ in cardiovascular disease, inflammation, infection and autoimmunity.
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44
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Schröder A, Neubert P, Titze J, Bozec A, Neuhofer W, Proff P, Kirschneck C, Jantsch J. Osteoprotective action of low-salt diet requires myeloid cell-derived NFAT5. JCI Insight 2019; 4:127868. [PMID: 31801906 DOI: 10.1172/jci.insight.127868] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Accepted: 10/29/2019] [Indexed: 12/14/2022] Open
Abstract
Dietary salt consumption leads to cutaneous Na+ storage and is associated with various disorders, including osteopenia. Here, we explore the impact of Na+ and the osmoprotective transcription factor nuclear factor of activated T cell 5 (NFAT5) on bone density and osteoclastogenesis. Compared with treatment of mice with high-salt diet, low-salt diet (LSD) increased bone density, decreased osteoclast numbers, and elevated Na+ content and Nfat5 levels in the BM. This response to LSD was dependent on NFAT5 expressed in myeloid cells. Simulating in vivo findings, we exposed osteoclast precursors and osteoblasts to elevated Na+ content (high-salt conditions; HS¢), resulting in increased NFAT5 binding to the promotor region of RANKL decoy receptor osteoprotegerin (OPG). These data not only demonstrate that NFAT5 in myeloid cells determines the Na+ content in BM, but that NFAT5 is able to govern the expression of the osteoprotective gene OPG. This provides insights into mechanisms of Na+-induced cessation of osteoclastogenesis and offers potentially new targets for treating salt-induced osteopenia.
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Affiliation(s)
| | - Patrick Neubert
- Institute of Clinical Microbiology and Hygiene, University Hospital Regensburg, Regensburg, Germany
| | - Jens Titze
- Duke-National University of Singapore, Singapore
| | - Aline Bozec
- Department of Internal Medicine, FAU Erlangen-Nürnberg, Erlangen, Germany
| | | | | | | | - Jonathan Jantsch
- Institute of Clinical Microbiology and Hygiene, University Hospital Regensburg, Regensburg, Germany
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45
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Welsh CE, Welsh P, Jhund P, Delles C, Celis-Morales C, Lewsey JD, Gray S, Lyall D, Iliodromiti S, Gill JMR, Sattar N, Mark PB. Urinary Sodium Excretion, Blood Pressure, and Risk of Future Cardiovascular Disease and Mortality in Subjects Without Prior Cardiovascular Disease. Hypertension 2019; 73:1202-1209. [PMID: 31067194 DOI: 10.1161/hypertensionaha.119.12726] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Hypertension is a risk factor for cardiovascular disease. Increased urinary sodium excretion, representing dietary sodium intake, is associated with hypertension. Low sodium intake has been associated with increased mortality in observational studies. Further studies should assess whether confounding relationships explain associations between sodium intake and outcomes. We studied UK Biobank participants (n=457 484; mean age, 56.3 years; 44.7% men) with urinary electrolytes and blood pressure data. Estimated daily urinary sodium excretion was calculated using Kawasaki formulae. We analyzed associations between sodium excretion and blood pressure in subjects without cardiovascular disease, treated hypertension, or diabetes mellitus at baseline (n=322 624). We tested relationships between sodium excretion, incidence of fatal and nonfatal cardiovascular disease, heart failure, and mortality. Subjects in higher quintiles of sodium excretion were younger, with more men and higher body mass index. There was a linear relationship between increasing urinary sodium excretion and blood pressure. During median follow-up of 6.99 years, there were 11 932 deaths (1125 cardiovascular deaths) with 10 717 nonfatal cardiovascular events. There was no relationship between quintile of sodium excretion and outcomes. These relationships were unchanged after adjustment for comorbidity or excluding subjects with events during the first 2 years follow-up. No differing risk of incident heart failure (1174 events) existed across sodium excretion quintiles. Urinary sodium excretion correlates with elevated blood pressure in subjects at low cardiovascular risk. No pattern of increased cardiovascular disease, heart failure, or mortality risk was demonstrated with either high or low sodium intake.
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Affiliation(s)
- C E Welsh
- From the Institute of Cardiovascular and Medical Sciences (C.E.W., P.W., P.J., C.D., C.C.-M., S.G., J.M.R.G., N.S., P.B.M.)
| | - Paul Welsh
- From the Institute of Cardiovascular and Medical Sciences (C.E.W., P.W., P.J., C.D., C.C.-M., S.G., J.M.R.G., N.S., P.B.M.)
| | - Pardeep Jhund
- From the Institute of Cardiovascular and Medical Sciences (C.E.W., P.W., P.J., C.D., C.C.-M., S.G., J.M.R.G., N.S., P.B.M.)
| | - Christian Delles
- From the Institute of Cardiovascular and Medical Sciences (C.E.W., P.W., P.J., C.D., C.C.-M., S.G., J.M.R.G., N.S., P.B.M.)
| | - C Celis-Morales
- From the Institute of Cardiovascular and Medical Sciences (C.E.W., P.W., P.J., C.D., C.C.-M., S.G., J.M.R.G., N.S., P.B.M.)
| | - J D Lewsey
- Institute of Health and Wellbeing (J.D.L., D.L.), University of Glasgow, United Kingdom
| | - S Gray
- From the Institute of Cardiovascular and Medical Sciences (C.E.W., P.W., P.J., C.D., C.C.-M., S.G., J.M.R.G., N.S., P.B.M.)
| | - D Lyall
- Institute of Health and Wellbeing (J.D.L., D.L.), University of Glasgow, United Kingdom
| | - S Iliodromiti
- Women's Health Research Division, Queen Mary University of London, United Kingdom (S.I.)
| | - J M R Gill
- From the Institute of Cardiovascular and Medical Sciences (C.E.W., P.W., P.J., C.D., C.C.-M., S.G., J.M.R.G., N.S., P.B.M.)
| | - Naveed Sattar
- From the Institute of Cardiovascular and Medical Sciences (C.E.W., P.W., P.J., C.D., C.C.-M., S.G., J.M.R.G., N.S., P.B.M.)
| | - Patrick B Mark
- From the Institute of Cardiovascular and Medical Sciences (C.E.W., P.W., P.J., C.D., C.C.-M., S.G., J.M.R.G., N.S., P.B.M.)
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46
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[About salt and immunity-a story of Mr. Hyde : The influence of hyperosmolar microenvironment on immune response]. DER PATHOLOGE 2019; 40:259-264. [PMID: 31720747 DOI: 10.1007/s00292-019-00700-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Hyperosmolar micromilieu has been observed in physiologic (kidney medulla, lymphatic tissue) and pathologic (renal allorejection, solid tumors) conditions. Hyperosmolarity can modulate gene expression and alter the stimulatory profile of macrophages and dendritic cells. We have reported that dendritic cells upon exposure to hypertonic stimuli shift their profile towards a macrophage-M2-like phenotype, resulting in attenuated local alloreactivity during acute kidney graft rejection. Moreover, we showed that a hyperosmotic microenvironment affects the cross-priming capacity of dendritic cells. Using ovalbumin as a model antigen, we showed that exposure of dendritic cells to hyperosmolarity strongly inhibits activation of antigen-specific T cells despite enhancement of antigen uptake, processing, and presentation; it can reduce dendritic cell-T cell contact time. We have identified TRIF as key mediator of this phenomenon. Moreover, we detected a hyperosmolarity-triggered, TRIF-dependent clustering of MHC class I‑antigen complexes, but not of unloaded MHCI molecules, providing a possible explanation for a reduced T cell activation. Our findings identify dendritic cells as important players in hyperosmolarity-triggered immune imbalance and suggest that targeting local hyperosmolarity in tumor micromilieu may contribute to an enhanced specific anti-tumor immune response.
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47
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Turck D, Castenmiller J, de Henauw S, Hirsch-Ernst KI, Kearney J, Knutsen HK, Maciuk A, Mangelsdorf I, McArdle HJ, Pelaez C, Pentieva K, Siani A, Thies F, Tsabouri S, Vinceti M, Aggett P, Fairweather-Tait S, Martin A, Przyrembel H, Ciccolallo L, de Sesmaisons-Lecarré A, Valtueña Martinez S, Martino L, Naska A. Dietary reference values for sodium. EFSA J 2019; 17:e05778. [PMID: 32626425 PMCID: PMC7009309 DOI: 10.2903/j.efsa.2019.5778] [Citation(s) in RCA: 67] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Following a request from the European Commission, the EFSA Panel on Nutrition, Novel Foods and Food Allergens (NDA) derived dietary reference values (DRVs) for sodium. Evidence from balance studies on sodium and on the relationship between sodium intake and health outcomes, in particular cardiovascular disease (CVD)-related endpoints and bone health, was reviewed. The data were not sufficient to enable an average requirement (AR) or population reference intake (PRI) to be derived. However, by integrating the available evidence and associated uncertainties, the Panel considers that a sodium intake of 2.0 g/day represents a level of sodium for which there is sufficient confidence in a reduced risk of CVD in the general adult population. In addition, a sodium intake of 2.0 g/day is likely to allow most of the general adult population to maintain sodium balance. Therefore, the Panel considers that 2.0 g sodium/day is a safe and adequate intake for the general EU population of adults. The same value applies to pregnant and lactating women. Sodium intakes that are considered safe and adequate for children are extrapolated from the value for adults, adjusting for their respective energy requirement and including a growth factor, and are as follows: 1.1 g/day for children aged 1-3 years, 1.3 g/day for children aged 4-6 years, 1.7 g/day for children aged 7-10 years and 2.0 g/day for children aged 11-17 years, respectively. For infants aged 7-11 months, an Adequate Intake (AI) of 0.2 g/day is proposed based on upwards extrapolation of the estimated sodium intake in exclusively breast-fed infants aged 0-6 months.
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48
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Milani B, Delacoste J, Burnier M, Pruijm M. Exploring a new method for quantitative sodium MRI in the human upper leg with a surface coil and symmetrically arranged reference phantoms. Quant Imaging Med Surg 2019; 9:985-999. [PMID: 31367553 DOI: 10.21037/qims.2019.06.08] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Background The aim of this study is to validate and evaluate the reproducibility of a new setup for the quantification of the tissue sodium concentration (TSC) in the human upper leg muscles with sodium MRI at 3 Tesla. This setup is making use of an emit and receive single loop surface coil together with a set of square, symmetrically arranged reference phantoms. As a second aim, the performances of two MRI protocols for the TSC quantification in the upper leg muscles are compared: one using an ultra-short echo time (UTE) 3-dimensional radial sequence (UTE-protocol), and the other one using standard gradient echo sequence (GRE-protocol). Methods A validation test of the quantification of sodium concentration is performed in phantoms. The bias of the method is estimated and compared between both protocols. The reproducibility of TSC quantification is assessed in phantoms by the coefficient of variation (CV) and compared between both protocols. The reproducibility is also assessed in 11 health volunteers. Signal to noise ratio (SNR) maps are acquired in phantoms with both protocols in order to compare the resulting SNR. Results The apparatus and post processing were successfully implemented. The bias of the method was smaller than 10% in phantoms (excepted for Na concentration of 10 mmol/L when using the GRE protocol). The reproducibility of the method using symmetrically arranged phantoms was high in phantoms and humans (CV <5%). The GRE-protocol leads to a better SNR than the UTE-protocol in 2D images. Conclusions The use of symmetrically arranged reference phantoms lead to reproducible results in phantoms and humans. Sodium imaging in the human upper leg with a single loop surface coil should be performed with a standard 2-dimensional GRE protocol if an optimal SNR is needed. However, the quantification of the fast and slow decay time constants of the sodium signal, which plays a role in the TSC quantification, still has to be done with a UTE sequence. Moreover, the quantification of sodium concentration is more accurate with the UTE protocol for small sodium concentrations (<20 mmol).
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Affiliation(s)
- Bastien Milani
- Division of Nephrology and Hypertension, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.,Departement de Radiologie, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland.,Center for Biomedical Imaging (CIBM), Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
| | - Jean Delacoste
- Departement de Radiologie, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland.,Center for Biomedical Imaging (CIBM), Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
| | - Michel Burnier
- Division of Nephrology and Hypertension, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Menno Pruijm
- Division of Nephrology and Hypertension, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
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49
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Schröder A, Nazet U, Neubert P, Jantsch J, Spanier G, Proff P, Kirschneck C. Sodium-chloride-induced effects on the expression profile of human periodontal ligament fibroblasts with focus on simulated orthodontic tooth movement. Eur J Oral Sci 2019; 127:386-395. [PMID: 31254476 DOI: 10.1111/eos.12643] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/20/2019] [Indexed: 11/28/2022]
Abstract
Increased salt (NaCl) consumption triggers chronic diseases such as hypertension or osteopenia. Its impact on orthodontic tooth movement and periodontitis, however, has not been investigated, although both processes are related to the immune system, with periodontal ligament fibroblasts (PDLFs) playing a key mediating role. Here, we investigated the impact of NaCl on the expression pattern of PDLFs in a model of simulated compressive orthodontic strain. Periodontal ligament fibroblasts were preincubated for 24 h with additional 0 or 40 mM NaCl and concurrently treated for another 48 h with or without compressive strain of 2 g cm-2 . We analyzed the expression of genes and proteins involved in orthodontic tooth movement by reverse transcription quantitative polymerase chain reaction (RT-qPCR), ELISA, and immunoblot. Co-culture experiments were performed to observe PDLF-mediated osteoclastogenesis. A higher (40 mM) concentration of NaCl in the culture medium resulted in increased secretion of prostaglandin, expression of alkaline phosphatase, and expression of genes involved in extracellular matrix remodeling, but decreased compression-induced expression of the interleukin-6 (IL6) gene. The 40 mM concentration of NaCl also enhanced receptor activator of nuclear factor kappa-B ligand (RANKL) but reduced that of osteoprotegerin (OPG), resulting in upregulated PDLF-mediated osteoclastogenesis. A high NaCl concentration in the periodontal ligament, corresponding to a high-salt diet in vivo, may influence orthodontic tooth movement and periodontitis through increased secretion of prostaglandins by PDLFs and upregulated PDLF-mediated osteoclastogenesis, possibly accelerating orthodontic tooth movement and propagating periodontitis and periodontal bone loss.
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Affiliation(s)
- Agnes Schröder
- Department of Orthodontics, University Hospital Regensburg, Regensburg, Germany
| | - Ute Nazet
- Department of Orthodontics, University Hospital Regensburg, Regensburg, Germany
| | - Patrick Neubert
- Institute of Clinical Microbiology and Hygiene, University Hospital Regensburg, Regensburg, Germany
| | - Jonathan Jantsch
- Institute of Clinical Microbiology and Hygiene, University Hospital Regensburg, Regensburg, Germany
| | - Gerrit Spanier
- Department of Cranio-Maxillo-Facial Surgery, University Hospital Regensburg, Regensburg, Germany
| | - Peter Proff
- Department of Orthodontics, University Hospital Regensburg, Regensburg, Germany
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Lipphardt M, Koziolek MJ, Lehnig LY, Schäfer AK, Müller GA, Lüders S, Wallbach M. Effect of baroreflex activation therapy on renal sodium excretion in patients with resistant hypertension. Clin Res Cardiol 2019; 108:1287-1296. [DOI: 10.1007/s00392-019-01464-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2019] [Accepted: 03/19/2019] [Indexed: 12/29/2022]
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