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Le Page AK, Johnson EC, Greenberg JH. Is mild dehydration a risk for progression of childhood chronic kidney disease? Pediatr Nephrol 2024:10.1007/s00467-024-06332-6. [PMID: 38632124 DOI: 10.1007/s00467-024-06332-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 02/21/2024] [Accepted: 02/22/2024] [Indexed: 04/19/2024]
Abstract
Children with chronic kidney disease (CKD) can have an inherent vulnerability to dehydration. Younger children are unable to freely access water, and CKD aetiology and stage can associate with reduced kidney concentrating capacity, which can also impact risk. This article aims to review the risk factors and consequences of mild dehydration and underhydration in CKD, with a particular focus on evidence for risk of CKD progression. We discuss that assessment of dehydration in the CKD population is more challenging than in the healthy population, thus complicating the definition of adequate hydration and clinical research in this field. We review pathophysiologic studies that suggest mild dehydration and underhydration may cause hyperfiltration injury and impact renal function, with arginine vasopressin as a key mediator. Randomised controlled trials in adults have not shown an impact of improved hydration in CKD outcomes, but more vulnerable populations with baseline low fluid intake or poor kidney concentrating capacity need to be studied. There is little published data on the frequency of dehydration, and risk of complications, acute or chronic, in children with CKD. Despite conflicting evidence and the need for more research, we propose that paediatric CKD management should routinely include an assessment of individual dehydration risk along with a treatment plan, and we provide a framework that could be used in outpatient settings.
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Affiliation(s)
- Amelia K Le Page
- Department of Nephrology, Monash Children's Hospital, Clayton, VIC, Australia.
- Department of Pediatrics, School of Clinical Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia.
| | - Evan C Johnson
- Division of Kinesiology & Health, College of Health Sciences, University of Wyoming, Laramie, WY, USA
| | - Jason H Greenberg
- Section of Nephrology, Department of Pediatrics, Yale University School of Medicine, New Haven, CT, USA
- Department of Internal Medicine, Clinical and Translational Research Accelerator, Yale University, New Haven, CT, USA
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2
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Zettl J, Jaafar A, Shourick J, Tack I, Vallet M. Alteration of the maximal renal water excretion capacity with kidney function and age in human. Int Urol Nephrol 2024; 56:1429-1438. [PMID: 37794282 DOI: 10.1007/s11255-023-03813-9] [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: 07/26/2023] [Accepted: 09/16/2023] [Indexed: 10/06/2023]
Abstract
PURPOSE The kidney's capability to concentrate and dilute urine is crucial to maintaining body fluid compartments and plasma osmolality. Advanced age and chronic kidney disease (CKD) result in decreased maximal urine concentration. Less is known regarding urine dilution ability. The primary purpose of this study was to determine the relationship between maximal renal water excretion and renal function, age, and gender in humans. METHODS This monocentric retrospective study includes patients referred to the Department of Clinical Physiology in Toulouse University Hospital to measure the glomerular filtration rate (mGFR) between April 2013 and February 2018. mGFR was assessed using inulin renal clearance and required ample hydration. We quantified the effects of age, gender and mGFR have on water excretion ability, which was assessed by minimal urinary osmolality (minUosm) and maximal free water clearance (maxCH2O). RESULTS 666 patients were included (mean age 51 ± 14 years, 53% female). Mean mGFR was 82 ± 25 mL/min/1.73m2. MinUosm after hydration was higher in patients with renal insufficiency while maxCH2O was markedly lower. Age was also, with a weaker effect, associated with decreased in water excretion, independently of mGFR. MaxCH2O clearance was similar in both genders, whereas minUosm was lower in women, possibly resulting from a lower osmotic load. DISCUSSION This study shows a decrease in maximal urinary dilution capacity and free water clearance with CKD and age, without gender difference. These alterations are mild but must be considered when a significant water intake is required or in the case of hyponatremia.
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Affiliation(s)
- Julie Zettl
- Department of Clinical Physiology, Toulouse University Hospital (CHU), Toulouse, France
| | - Acil Jaafar
- Department of Clinical Physiology, Toulouse University Hospital (CHU), Toulouse, France
| | - Jason Shourick
- Department of Epidemiology, Clinical Epidemiology and Public Health, UMR 1027, INSERM-University of Toulouse III, Toulouse University Hospital (CHU), Toulouse, France
| | - Ivan Tack
- Department of Clinical Physiology, Toulouse University Hospital (CHU), Toulouse, France
- Laboratoire de Physiologie, Faculté de Santé, Département Médecine, Université Toulouse III, Toulouse, France
| | - Marion Vallet
- Department of Clinical Physiology, Toulouse University Hospital (CHU), Toulouse, France.
- Laboratoire de Physiologie, Faculté de Santé, Département Médecine, Université Toulouse III, Toulouse, France.
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3
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Armstrong LE, Bergeron MF, Muñoz CX, Kavouras SA. Low daily water intake profile-is it a contributor to disease? Nutr Health 2024:2601060241238826. [PMID: 38515347 DOI: 10.1177/02601060241238826] [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: 03/23/2024]
Abstract
Few previous review articles have focused on the associations between inadequate daily water intake (LOW) or urinary biomarkers of dehydration (UD; low urine volume or high urine osmolality) and multiple diseases. Accordingly, we conducted manual online searches (47 key words) of the PubMed, Embase, and Google Scholar databases with these inclusion criteria: English language, full-text, peer reviewed, no restriction on research design, and three publications minimum. Initially, 3,903 articles were identified based on their titles and abstracts. Evaluations of full length .pdf versions identified 96 studies that were acceptable for inclusion. We concluded that the evidence is insufficient or conflicting for seven disorders or diseases (i.e. suggesting the need for additional clarifying research) and it is lacking for all-cause mortality. Differential characterizations among women and men have been reported in the results of nine studies involving five diseases. Finally, the evidence for associations of LOW or UD is strong for both kidney stones and type 2 diabetes with hyperglycemia. This suggests that great public health value (i.e. reduced disease risk) may result from increased daily water intake-a simple and cost-effective dietary modification.
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Affiliation(s)
- Lawrence E Armstrong
- Human Performance Laboratory and Department of Nutritional Sciences, University of Connecticut, Storrs, CT, USA
| | - Michael F Bergeron
- Performance Health, WTA Women's Tennis Association, St. Petersburg, FL, USA
- Hydration Health Center and Department of Health Sciences, University of Hartford, West Hartford, CT, USA
| | - Colleen X Muñoz
- Hydration Health Center and Department of Health Sciences, University of Hartford, West Hartford, CT, USA
| | - Stavros A Kavouras
- Hydration Science Lab, College of Health Solutions, Arizona State University, Phoenix, AZ, USA
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Yamanaga S, Hidaka Y, Kawabata C, Toyoda M, Tanaka K, Yamamoto Y, Inadome A, Takeda A, Yokomizo H. Water intake, baseline biopsy, and graft function after living donor kidney transplantation. Sci Rep 2024; 14:3715. [PMID: 38355944 PMCID: PMC10866883 DOI: 10.1038/s41598-024-54163-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 02/09/2024] [Indexed: 02/16/2024] Open
Abstract
Increased water intake is recommended for kidney transplant recipients; however, its efficacy remains controversial. We hypothesized that pre-existing histological findings of the allograft might modulate the impact of water intake. We retrospectively analyzed 167 adults with living-donor kidney transplants (April 2011-May 2020; median observation period, 77 months) whose baseline biopsy data were available. We compared the chronic-change group (n = 38) with the control group (n = 129) to assess the impact of self-reported daily water intake on the estimated glomerular filtration rate (eGFR). The range distribution of water intake was as follows: - 1000 ml (n = 4), 1000-1500 ml (n = 23), 1500-2000 ml (n = 64), 2000-2500 ml (n = 57), 2500-3000 ml (n = 16), and 3000 - ml (n = 3). Donor age was significantly higher in the chronic-change group. In the control group, the ΔeGFR/year increase was correlated with water intake. However, the increase in the water intake of the chronic-change group significantly decreased ΔeGFR/year (1000-1500 ml: + 1.95 ml/min/1.73 m2 and > 2000 ml: - 1.92 ml/min/1.73 m2, p = 0.014). This study suggested a potential influence of increased water intake on recipients with marginal grafts in living donor kidney transplantation.
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Affiliation(s)
- Shigeyoshi Yamanaga
- Department of Surgery, Japanese Red Cross Kumamoto Hospital, 2-1-1 Nagamine Minami, Higashi-ku, Kumamoto, 861-8520, Japan.
| | - Yuji Hidaka
- Department of Surgery, Japanese Red Cross Kumamoto Hospital, 2-1-1 Nagamine Minami, Higashi-ku, Kumamoto, 861-8520, Japan
| | - Chiaki Kawabata
- Department of Nephrology, Japanese Red Cross Kumamoto Hospital, Kumamoto, Japan
| | - Mariko Toyoda
- Department of Nephrology, Japanese Red Cross Kumamoto Hospital, Kumamoto, Japan
| | - Kosuke Tanaka
- Department of Surgery, Kyoto University, Kyoto, Japan
| | - Yasuhiro Yamamoto
- Department of Urology, Japanese Red Cross Kumamoto Hospital, Kumamoto, Japan
| | - Akito Inadome
- Department of Urology, Japanese Red Cross Kumamoto Hospital, Kumamoto, Japan
| | - Asami Takeda
- Department of Nephrology, Japanese Red Cross Nagoya Daini Hospital, Aichi, Japan
| | - Hiroshi Yokomizo
- Department of Surgery, Japanese Red Cross Kumamoto Hospital, 2-1-1 Nagamine Minami, Higashi-ku, Kumamoto, 861-8520, Japan
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Abou Taka M, Dugbartey GJ, Richard-Mohamed M, McLeod P, Jiang J, Major S, Arp J, O’Neil C, Liu W, Gabril M, Moussa M, Luke P, Sener A. Evaluating the Effects of Kidney Preservation at 10 °C with Hemopure and Sodium Thiosulfate in a Rat Model of Syngeneic Orthotopic Kidney Transplantation. Int J Mol Sci 2024; 25:2210. [PMID: 38396887 PMCID: PMC10889495 DOI: 10.3390/ijms25042210] [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: 12/08/2023] [Revised: 01/29/2024] [Accepted: 02/02/2024] [Indexed: 02/25/2024] Open
Abstract
Kidney transplantation is preferred for end-stage renal disease. The current gold standard for kidney preservation is static cold storage (SCS) at 4 °C. However, SCS contributes to renal graft damage through ischemia-reperfusion injury (IRI). We previously reported renal graft protection after SCS with a hydrogen sulfide donor, sodium thiosulfate (STS), at 4 °C. Therefore, this study aims to investigate whether SCS at 10 °C with STS and Hemopure (blood substitute), will provide similar protection. Using in vitro model of IRI, we subjected rat renal proximal tubular epithelial cells to hypoxia-reoxygenation for 24 h at 10 °C with or without STS and measured cell viability. In vivo, we preserved 36 donor kidneys of Lewis rats for 24 h in a preservation solution at 10 °C supplemented with STS, Hemopure, or both followed by transplantation. Tissue damage and recipient graft function parameters, including serum creatinine, blood urea nitrogen, urine osmolality, and glomerular filtration rate (GFR), were evaluated. STS-treated proximal tubular epithelial cells exhibited enhanced viability at 10 °C compared with untreated control cells (p < 0.05). Also, STS and Hemopure improved renal graft function compared with control grafts (p < 0.05) in the early time period after the transplant, but long-term function did not reach significance. Overall, renal graft preservation at 10 °C with STS and Hemopure supplementation has the potential to enhance graft function and reduce kidney damage, suggesting a novel approach to reducing IRI and post-transplant complications.
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Affiliation(s)
- Maria Abou Taka
- Department of Microbiology and Immunology, Schulich School of Medicine and Dentistry, Western University, London, ON N6A 5C1, Canada;
- Matthew Mailing Centre for Translational Transplant Studies, London Health Sciences Centre, London, ON N6A 5A5, Canada; (G.J.D.); (M.R.-M.); (P.L.)
| | - George J. Dugbartey
- Matthew Mailing Centre for Translational Transplant Studies, London Health Sciences Centre, London, ON N6A 5A5, Canada; (G.J.D.); (M.R.-M.); (P.L.)
- Multi-Organ Transplant Program, London Health Sciences Centre, London, ON N6A 5A5, Canada
- Department of Pharmacology and Toxicology, School of Pharmacy, College of Health Sciences, University of Ghana, Legon, Accra P.O. Box LG 1181, Ghana
- London Health Sciences Centre, Department of Surgery, Division of Urology, London, ON N6A 5A5, Canada
| | - Mahms Richard-Mohamed
- Matthew Mailing Centre for Translational Transplant Studies, London Health Sciences Centre, London, ON N6A 5A5, Canada; (G.J.D.); (M.R.-M.); (P.L.)
- Multi-Organ Transplant Program, London Health Sciences Centre, London, ON N6A 5A5, Canada
| | - Patrick McLeod
- Matthew Mailing Centre for Translational Transplant Studies, London Health Sciences Centre, London, ON N6A 5A5, Canada; (G.J.D.); (M.R.-M.); (P.L.)
| | - Jifu Jiang
- Matthew Mailing Centre for Translational Transplant Studies, London Health Sciences Centre, London, ON N6A 5A5, Canada; (G.J.D.); (M.R.-M.); (P.L.)
| | - Sally Major
- Matthew Mailing Centre for Translational Transplant Studies, London Health Sciences Centre, London, ON N6A 5A5, Canada; (G.J.D.); (M.R.-M.); (P.L.)
| | - Jacqueline Arp
- Matthew Mailing Centre for Translational Transplant Studies, London Health Sciences Centre, London, ON N6A 5A5, Canada; (G.J.D.); (M.R.-M.); (P.L.)
| | - Caroline O’Neil
- The Molecular Pathology Core, Robarts Research Institute, London, ON N6A 5A5, Canada
| | - Winnie Liu
- London Health Sciences Centre, Department of Pathology and Laboratory Medicine, London, ON N6A 5A5, Canada (M.G.); (M.M.)
| | - Manal Gabril
- London Health Sciences Centre, Department of Pathology and Laboratory Medicine, London, ON N6A 5A5, Canada (M.G.); (M.M.)
| | - Madeleine Moussa
- London Health Sciences Centre, Department of Pathology and Laboratory Medicine, London, ON N6A 5A5, Canada (M.G.); (M.M.)
| | - Patrick Luke
- Matthew Mailing Centre for Translational Transplant Studies, London Health Sciences Centre, London, ON N6A 5A5, Canada; (G.J.D.); (M.R.-M.); (P.L.)
- Multi-Organ Transplant Program, London Health Sciences Centre, London, ON N6A 5A5, Canada
- London Health Sciences Centre, Department of Surgery, Division of Urology, London, ON N6A 5A5, Canada
- London Health Sciences Centre, Department of Pathology and Laboratory Medicine, London, ON N6A 5A5, Canada (M.G.); (M.M.)
| | - Alp Sener
- Department of Microbiology and Immunology, Schulich School of Medicine and Dentistry, Western University, London, ON N6A 5C1, Canada;
- Matthew Mailing Centre for Translational Transplant Studies, London Health Sciences Centre, London, ON N6A 5A5, Canada; (G.J.D.); (M.R.-M.); (P.L.)
- Multi-Organ Transplant Program, London Health Sciences Centre, London, ON N6A 5A5, Canada
- London Health Sciences Centre, Department of Surgery, Division of Urology, London, ON N6A 5A5, Canada
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Le Page AK, Johnstone LM, Kausman JY. Hospital admissions associated with dehydration in childhood kidney transplantation. Pediatr Nephrol 2024; 39:547-557. [PMID: 37555933 PMCID: PMC10728223 DOI: 10.1007/s00467-023-06095-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 07/05/2023] [Accepted: 07/06/2023] [Indexed: 08/10/2023]
Abstract
BACKGROUND Paediatric kidney transplant recipients may be at a particular risk of dehydration due to poor kidney concentrating capacity and illness associated with poor fluid intake or losses. In this population, creatinine rise may be more likely with relatively mild dehydration, which may trigger hospital admission. This study describes hospital admissions in the first 12 months after transplantation with diagnosis of graft dysfunction associated with dehydration due to illness or poor fluid intake. We assess risk factors for these admissions. METHODS Data was extracted from medical records of patients transplanted in two tertiary children hospitals. Following descriptive analysis, multiple failure regression analyses were used to identify factors associated with admission for acute kidney allograft dysfunction associated with dehydration. RESULTS Of 92 children, 42% had at least 1 dehydration admission in the 12 months following transplantation. Almost half of the dehydration admissions were due to poor fluid intake, which accounted for 1/5 of all unplanned hospital admissions. Target fluid intake at first discharge of > 100 ml/kg/day was associated with dehydration admissions of all types (hazard ratio (HR) 2.04 (95% CI 1.13-3.68)). Teen age was associated with poor fluid intake dehydration admissions (HR 4.87 (95% CI 1.19-19.86)), which were more frequent in mid-summer. Use of enteric feeding tube, which correlated with age under 4, associated with contributing illness dehydration admissions (HR 2.18 (95% CI 1.08-4.41)). CONCLUSIONS Dehydration admissions in the 12 months following childhood kidney transplantation are common. Highlighted admission risk factors should prompt further study into optimal fluid intake prescription and hydration advice given to children, teenagers, and their carers following kidney transplantation. Use of an enteric feeding tube may not protect patients from admission with dehydration associated with contributing illness. A highger resolution version of the Graphical abstract is available as Supplementary information.
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Affiliation(s)
- Amelia K Le Page
- Department of Nephrology, Monash Children's Hospital, Clayton, VIC, Australia.
- Department of Pediatrics, School of Clinical Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia.
| | - Lilian M Johnstone
- Department of Nephrology, Monash Children's Hospital, Clayton, VIC, Australia
- Department of Pediatrics, School of Clinical Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
| | - Joshua Y Kausman
- Department of Nephrology, Royal Children's Hospital, Melbourne, Australia
- Murdoch Children's Research Institute, Royal Children's Hospital, Melbourne, Australia
- Department of Paediatrics, University of Melbourne, Melbourne, Australia
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7
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de Berny Q, Saint-Jacques C, Santin A, Mattioni S, Steichen O, Chieze R, Frochot V, Letavernier E, Lionnet F, Haymann JP. Urine concentration impairment in sickle cell anemia: genuine nephrogenic diabetes insipidus or osmotic diuresis? Am J Physiol Renal Physiol 2024; 326:F278-F284. [PMID: 38059298 PMCID: PMC11207532 DOI: 10.1152/ajprenal.00313.2023] [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: 10/09/2023] [Revised: 11/16/2023] [Accepted: 12/03/2023] [Indexed: 12/08/2023] Open
Abstract
The urine concentration impairment responsible for hyposthenuria in sickle cell nephropathy is currently thought to be a consequence of renal medulla lesions, which lead to nephrogenic diabetes insipidus. The objective of the present study was to investigate the mechanism of hyposthenuria in patients with sickle cell anemia. We performed an observational study of patients with homozygous SS sickle cell anemia and data available on the fasting plasma antidiuretic hormone (ADH) concentration. A total of 55 patients were analyzed. The fasting plasma ADH values ranged from 1.2 to 15.4 pg/mL, and 82% of the patients had elevated ADH values and low fasting urine osmolality (<505 mosmol/kgH2O). Plasma ADH was positively associated with plasma tonicity and natremia (P < 0.001). None of the patients experienced polyuria and fasting free water clearance was negative in all cases, thus, ruling out nephrogenic diabetes insipidus. The tertile groups did not differ with regard to fasting urine osmolality, plasma renin level, mGFR, or several hemolysis biomarkers. The negative fasting free water clearance in all cases and the strong association between 24-h osmolal clearance and 24-h diuresis favors the diagnosis of osmotic diuresis due to an impaired medullary gradient, rather than lesions to collecting tubule.NEW & NOTEWORTHY The urine concentration impairment in sickle cell anemia is an osmotic diuresis related to an impaired renal medullary gradient leading to an ADH plateau effect. The fasting plasma ADH was high in the context of a basic state of close-to-maximal urine concentration probably driven by short nephrons maintaining a cortex-outer medullary gradient (about 400 milliosmoles). The patients had a low daily osmoles intake without evidence of thirst dysregulation so no one experienced polyuria.
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Affiliation(s)
- Quentin de Berny
- Service de Néphrologie, Dialyse et Transplantation Rénale, Centre Hospitalier Universitaire d'Amiens, Amiens, France
| | - Camille Saint-Jacques
- Service d'Explorations Fonctionnelles Multidisciplinaires, Hôpital Tenon, Assistance Publique-Hôpitaux de Paris, UMR-S 1155, Médecine Sorbonne Université, Paris, France
| | - Aline Santin
- Service de Médecine Interne, Hôpital Tenon, Assistance Publique Hôpitaux de Paris, Médecine Sorbonne Université, Paris, France
| | - Sarah Mattioni
- Service de Médecine Interne, Hôpital Tenon, Assistance Publique Hôpitaux de Paris, Médecine Sorbonne Université, Paris, France
| | - Olivier Steichen
- Service de Médecine Interne, Hôpital Tenon, Assistance Publique Hôpitaux de Paris, Médecine Sorbonne Université, Paris, France
| | - Rémi Chieze
- Service d'Explorations Fonctionnelles Multidisciplinaires, Hôpital Tenon, Assistance Publique-Hôpitaux de Paris, UMR-S 1155, Médecine Sorbonne Université, Paris, France
| | - Vincent Frochot
- Service d'Explorations Fonctionnelles Multidisciplinaires, Hôpital Tenon, Assistance Publique-Hôpitaux de Paris, UMR-S 1155, Médecine Sorbonne Université, Paris, France
| | - Emmanuel Letavernier
- Service d'Explorations Fonctionnelles Multidisciplinaires, Hôpital Tenon, Assistance Publique-Hôpitaux de Paris, UMR-S 1155, Médecine Sorbonne Université, Paris, France
| | - François Lionnet
- Service de Médecine Interne, Hôpital Tenon, Assistance Publique Hôpitaux de Paris, Médecine Sorbonne Université, Paris, France
| | - Jean-Philippe Haymann
- Service d'Explorations Fonctionnelles Multidisciplinaires, Hôpital Tenon, Assistance Publique-Hôpitaux de Paris, UMR-S 1155, Médecine Sorbonne Université, Paris, France
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Lievre L, Dupont V, Kanagaratnam L, Faroux L, Debrumetz A, Rieu P, Wynckel A. Urine-to-plasma creatinine ratio and fractional excretion of urea performance in acute-on-chronic kidney disease patients. J Nephrol 2023; 36:2661-2663. [PMID: 37402076 DOI: 10.1007/s40620-023-01700-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Accepted: 06/09/2023] [Indexed: 07/05/2023]
Affiliation(s)
- Loïc Lievre
- Department of Nephrology, University Hospital of Reims, Reims, France.
- French Intensive Care Renal Network (FIRN), Reims, France.
| | - Vincent Dupont
- Department of Nephrology, University Hospital of Reims, Reims, France
- French Clinical Research Infrastructure Network, Investigation Network Initiative-Cardiovascular and Renal Clinical Trialists (F-CRIN INI-CRCT), Reims, France
| | | | - Laurent Faroux
- Department of Cardiology, University Hospital of Reims, Reims, France
| | - Alexandre Debrumetz
- Department of Nephrology, University Hospital of Reims, Reims, France
- French Intensive Care Renal Network (FIRN), Reims, France
| | - Philippe Rieu
- Department of Nephrology, University Hospital of Reims, Reims, France
| | - Alain Wynckel
- Department of Nephrology, University Hospital of Reims, Reims, France
- French Intensive Care Renal Network (FIRN), Reims, France
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Akbari A, McIntyre CW. Recent Advances in Sodium Magnetic Resonance Imaging and Its Future Role in Kidney Disease. J Clin Med 2023; 12:4381. [PMID: 37445416 PMCID: PMC10342976 DOI: 10.3390/jcm12134381] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 06/20/2023] [Indexed: 07/15/2023] Open
Abstract
Sodium imbalance is a hallmark of chronic kidney disease (CKD). Excess tissue sodium in CKD is associated with hypertension, inflammation, and cardiorenal disease. Sodium magnetic resonance imaging (23Na MRI) has been increasingly utilized in CKD clinical trials especially in the past few years. These studies have demonstrated the association of excess sodium tissue accumulation with declining renal function across whole CKD spectrum (early- to end-stage), biomarkers of systemic inflammation, and cardiovascular dysfunction. In this article, we review recent advances of 23Na MRI in CKD and discuss its future role with a focus on the skin, the heart, and the kidney itself.
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Affiliation(s)
- Alireza Akbari
- Robarts Research Institute, Western University, London, ON N6A 3K7, Canada;
- Lilibeth Caberto Kidney Clinic Research Unit, London Health Sciences Centre, London, ON N6A 5W9, Canada
| | - Christopher W. McIntyre
- Robarts Research Institute, Western University, London, ON N6A 3K7, Canada;
- Lilibeth Caberto Kidney Clinic Research Unit, London Health Sciences Centre, London, ON N6A 5W9, Canada
- Departments of Medicine, Pediatrics and Medical Biophysics, Western University, London, ON N6A 3K7, Canada
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10
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Liu J, Bankir L, Verma A, Waikar SS, Palsson R. Association of the Urine-to-Plasma Urea Ratio With CKD Progression. Am J Kidney Dis 2023; 81:394-405. [PMID: 36356680 DOI: 10.1053/j.ajkd.2022.09.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2022] [Accepted: 09/01/2022] [Indexed: 11/09/2022]
Abstract
RATIONALE & OBJECTIVES The urine-to-plasma (U/P) ratio of urea is correlated with urine-concentrating capacity and associated with progression of autosomal dominant polycystic kidney disease. As a proposed biomarker of tubular function, we hypothesized that the U/P urea ratio would also be associated with progression of more common forms of chronic kidney disease (CKD). STUDY DESIGN Observational cohort study. SETTING & PARTICIPANTS 3,723 adults in the United States with estimated glomerular filtration rate (eGFR) of 20-70 mL/min/1.73 m2, enrolled in the Chronic Renal Insufficiency Cohort (CRIC) Study. EXPOSURE U/P urea ratio, calculated from 24-hour urine collections and plasma samples at baseline. OUTCOME Associations of U/P urea ratio with eGFR slope, initiation of kidney replacement therapy (KRT), and CKD progression, defined as 50% decline in eGFR or incident KRT. ANALYTICAL APPROACH Multivariable linear mixed-effects models tested associations with eGFR slope. Cox proportional hazards models tested associations with dichotomous CKD outcomes. RESULTS The median U/P urea ratio was 14.8 (IQR, 9.5-22.2). Compared with participants in the highest U/P urea ratio quintile, those in the lowest quintile had a greater eGFR decline by 1.06 mL/min/1.73 m2 per year (P < 0.001) over 7.0 (IQR, 3.0-11.0) years of follow-up observation. Each 1-SD lower natural log-transformed U/P urea ratio was independently associated with CKD progression (HR, 1.22 [95% CI, 1.12-1.33]) and incident KRT (HR, 1.22 [95% CI, 1.10-1.33]). Associations differed by baseline eGFR (P interaction = 0.009). Among those with an eGFR ≥30 mL/min/1.73 m2, each 1-SD lower in ln(U/P urea ratio) was independently associated with CKD progression (HR, 1.30 [95% CI, 1.18-1.45]), but this was not significant among those with eGFR <30 mL/min/1.73 m2 (HR, 1.00 [95% CI, 0.84-1.20]). LIMITATIONS Possibility of residual confounding. Single baseline 24-hour urine collection for U/P urea ratio. CONCLUSIONS In a large and diverse cohort of patients with common forms of CKD, U/P urea was independently associated with disease progression and incident kidney failure. Associations were not significant among those with advanced CKD at baseline.
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Affiliation(s)
- Jing Liu
- Kidney Research Institute, Renal Division, West China Hospital of Sichuan University, Chengdu, People's Republic of China; Section of Nephrology, Boston Medical Center and Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts
| | - Lise Bankir
- Centre de Recherche des Cordeliers, INSERM, Sorbonne Université, Université de Paris, Paris, France; CNRS, ERL 8228, Laboratoire de Physiologie Rénale et Tubulopathies, Paris, France
| | - Ashish Verma
- Section of Nephrology, Boston Medical Center and Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts
| | - Sushrut S Waikar
- Section of Nephrology, Boston Medical Center and Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts
| | - Ragnar Palsson
- Division of Nephrology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts; Medical School, Harvard University, Boston, Massachusetts.
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11
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Ascher SB, Garimella PS, Ix JH. Urine-to-Plasma Urea Ratio: Disentangling Tubular Concentrating Ability From GFR. Am J Kidney Dis 2023; 81:382-383. [PMID: 36529560 DOI: 10.1053/j.ajkd.2022.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 10/22/2022] [Indexed: 12/23/2022]
Affiliation(s)
- Simon B Ascher
- Kidney Health Research Collaborative, Department of Medicine, San Francisco Veterans Affairs Health Care System and University of California, San Francisco, San Francisco, California; Division of Hospital Medicine, University of California, Davis, Sacramento, California
| | - Pranav S Garimella
- Division of Nephrology-Hypertension, Department of Medicine, University of California, San Diego, San Diego, California
| | - Joachim H Ix
- Division of Nephrology-Hypertension, Department of Medicine, University of California, San Diego, San Diego, California; Nephrology Section, Veterans Affairs San Diego Healthcare System, San Diego, California.
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12
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Tabibzadeh N, Crambert G. Mechanistic insights into the primary and secondary alterations of renal ion and water transport in the distal nephron. J Intern Med 2023; 293:4-22. [PMID: 35909256 PMCID: PMC10087581 DOI: 10.1111/joim.13552] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The kidneys, by equilibrating the outputs to the inputs, are essential for maintaining the constant volume, pH, and electrolyte composition of the internal milieu. Inability to do so, either because of internal kidney dysfunction (primary alteration) or because of some external factors (secondary alteration), leads to pathologies of varying severity, leading to modification of these parameters and affecting the functions of other organs. Alterations of the functions of the collecting duct (CD), the most distal part of the nephron, have been extensively studied and have led to a better diagnosis, better management of the related diseases, and the development of therapeutic tools. Thus, dysfunctions of principal cell-specific transporters such as ENaC or AQP2 or its receptors (mineralocorticoid or vasopressin receptors) caused by mutations or by compounds present in the environment (lithium, antibiotics, etc.) have been demonstrated in a variety of syndromes (Liddle, pseudohypoaldosteronism type-1, diabetes insipidus, etc.) affecting salt, potassium, and water balance. In parallel, studies on specific transporters (H+ -ATPase, anion exchanger 1) in intercalated cells have revealed the mechanisms of related tubulopathies like distal renal distal tubular acidosis or Sjögren syndrome. In this review, we will recapitulate the mechanisms of most of the primary and secondary alteration of the ion transport system of the CD to provide a better understanding of these diseases and highlight how a targeted perturbation may affect many different pathways due to the strong crosstalk and entanglements between the different actors (transporters, cell types).
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Affiliation(s)
- Nahid Tabibzadeh
- Laboratoire de Physiologie Rénale et Tubulopathies, Centre de Recherche des Cordeliers, INSERM, Sorbonne Université, Université Paris Cité, Paris, France.,EMR 8228 Unité Métabolisme et Physiologie Rénale, CNRS, Paris, France.,Assistance Publique Hôpitaux de Paris, Hôpital Bichât, Paris, France
| | - Gilles Crambert
- Laboratoire de Physiologie Rénale et Tubulopathies, Centre de Recherche des Cordeliers, INSERM, Sorbonne Université, Université Paris Cité, Paris, France.,EMR 8228 Unité Métabolisme et Physiologie Rénale, CNRS, Paris, France
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13
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Kakeshita K, Koike T, Imamura T, Fujioka H, Yamazaki H, Kinugawa K. Prognostic impact of urine cyclic AMP levels in patients with chronic kidney disease. Clin Exp Nephrol 2022; 26:1194-1199. [PMID: 35999301 DOI: 10.1007/s10157-022-02264-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Accepted: 08/06/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND Urine cyclic adenosine monophosphate (cAMP) is a biomarker to assess the residual function of the collecting duct in the kidney. Prognostic implication of urine cAMP levels in patients with chronic kidney disease (CKD) remains unknown. METHODS Patients who were followed at our specific outpatient clinic to treat their CKD between December 2015 and December 2019 were included in this prospective study. The impact of urine cAMP levels on the composite of dialysis administration, cardiovascular death, and doubling of serum creatinine concentration was investigated. RESULTS A total of 106 patients (median 72 years old, 80 men, and median estimated glomerular filtration rate 28.4 mL/min/1.73 m2) were included. Urine cAMP levels ranged widely between 0.35 and 4.08 nmol/mg of creatinine with a median value of 1.99 nmol/mg of creatinine. A urine cAMP level was an independent predictor of the primary endpoint with a hazard ratio of 0.41 (95% confidence interval 0.18-0.91, p = 0.029) adjusted for 5 potential confounders with a cutoff of 1.55 nmol/mg of creatinine. CONCLUSIONS A lower urine cAMP is an independent predictor of renal deterioration and cardiovascular death in patients with CKD.
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Affiliation(s)
- Kota Kakeshita
- The Second Department of Internal Medicine, University of Toyama, Sugitani, 2630, Toyama, Toyama, 930-0194, Japan
| | - Tsutomu Koike
- The Second Department of Internal Medicine, University of Toyama, Sugitani, 2630, Toyama, Toyama, 930-0194, Japan
| | - Teruhiko Imamura
- The Second Department of Internal Medicine, University of Toyama, Sugitani, 2630, Toyama, Toyama, 930-0194, Japan.
| | - Hayato Fujioka
- The Second Department of Internal Medicine, University of Toyama, Sugitani, 2630, Toyama, Toyama, 930-0194, Japan
| | - Hidenori Yamazaki
- The Second Department of Internal Medicine, University of Toyama, Sugitani, 2630, Toyama, Toyama, 930-0194, Japan
| | - Koichiro Kinugawa
- The Second Department of Internal Medicine, University of Toyama, Sugitani, 2630, Toyama, Toyama, 930-0194, Japan
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14
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Beunon P, Barat M, Dohan A, Cheddani L, Males L, Fernandez P, Etain B, Bellivier F, Marlinge E, Vrtovsnik F, Vidal-Petiot E, Khalil A, Haymann JP, Flamant M, Tabibzadeh N. MRI-based kidney radiomic analysis during chronic lithium treatment. Eur J Clin Invest 2022; 52:e13756. [PMID: 35104368 DOI: 10.1111/eci.13756] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2021] [Revised: 01/11/2022] [Accepted: 01/23/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Lithium therapy during bipolar disorder is associated with an increased risk of chronic kidney disease (CKD) that is slowly progressive and undetectable at early stages. We aimed at identifying kidney image texture features as possible imaging biomarkers of decreased measured glomerular filtration rate (mGFR) using radiomics of T2-weighted magnetic resonance imaging (MRI). METHODS One hundred and eight patients treated with lithium were evaluated including mGFR and kidney MRI, with T2-weighted sequence single-shot fast spin-echo. Computed radiomic analysis was performed after kidney segmentation. Significant features were selected to build a radiomic signature using multivariable Cox analysis to detect an mGFR <60 ml/min/1.73 m². The texture index was validated using a training and a validation cohort. RESULTS Texture analysis index was able to detect an mGFR decrease, with an AUC of 0.85 in the training cohort and 0.71 in the validation cohort. Patients with a texture index below the median were older (59 [42-66] vs. 46 [34-54] years, p = .001), with longer treatment duration (10 [3-22] vs. 6 [2-10] years, p = .02) and a lower mGFR (66 [46-84] vs. 83 [71-94] ml/min/1.73m², p < .001). Texture analysis index was independently and negatively associated with age (β = -.004 ± 0.001, p < .001), serum vasopressin (-0.005 ± 0.002, p = .02) and lithium treatment duration (-0.01 ± 0.003, p = .001), with a significant interaction between lithium treatment duration and mGFR (p = .02). CONCLUSIONS A renal texture index was developed among patients treated with lithium associated with a decreased mGFR. This index might be relevant in the diagnosis of lithium-induced renal toxicity.
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Affiliation(s)
- Paul Beunon
- Sorbonne Université, Paris, France.,Radiologie A, APHP.Centre Hôpital Cochin, Paris, France
| | - Maxime Barat
- Radiologie A, APHP.Centre Hôpital Cochin, Paris, France.,Université de Paris, Paris, France
| | - Anthony Dohan
- Radiologie A, APHP.Centre Hôpital Cochin, Paris, France.,Université de Paris, Paris, France
| | - Lynda Cheddani
- Université Paris Saclay, INSERM U1018, Equipe 5, CESP (Centre de Recherche en Épidémiologie et Santé des Populations), Paris, France.,Nephrologie, APHP Hôpital Ambroise Paré, Paris, France
| | - Lisa Males
- Université de Paris, Paris, France.,Radiologie, APHP.Nord Hôpital Bichat, Paris, France
| | | | - Bruno Etain
- Université de Paris, Paris, France.,Département de Psychiatrie et de Médecine Addictologique, APHP.Nord, GH Lariboisière-Fernand-Widal, DMU Neurosciences, Paris, France
| | - Frank Bellivier
- Université de Paris, Paris, France.,Département de Psychiatrie et de Médecine Addictologique, APHP.Nord, GH Lariboisière-Fernand-Widal, DMU Neurosciences, Paris, France
| | - Emeline Marlinge
- Département de Psychiatrie et de Médecine Addictologique, APHP.Nord, GH Lariboisière-Fernand-Widal, DMU Neurosciences, Paris, France
| | - François Vrtovsnik
- Université de Paris, Paris, France.,Département de Psychiatrie et de Médecine Addictologique, APHP.Nord, GH Lariboisière-Fernand-Widal, DMU Neurosciences, Paris, France.,Néphrologie, APHP.Nord Hôpital Bichat, Paris, France
| | - Emmanuelle Vidal-Petiot
- Université de Paris, Paris, France.,Département de Psychiatrie et de Médecine Addictologique, APHP.Nord, GH Lariboisière-Fernand-Widal, DMU Neurosciences, Paris, France.,Explorations Fonctionnelles, Physiologie, APHP.Nord Hôpital Bichat, Paris, France
| | - Antoine Khalil
- Université de Paris, Paris, France.,Radiologie, APHP.Nord Hôpital Bichat, Paris, France
| | - Jean-Philippe Haymann
- Sorbonne Université, Paris, France.,Explorations Fonctionnelles et laboratoire de la lithiase, APHP. Sorbonne Hôpital Tenon, Paris, France
| | - Martin Flamant
- Université de Paris, Paris, France.,Département de Psychiatrie et de Médecine Addictologique, APHP.Nord, GH Lariboisière-Fernand-Widal, DMU Neurosciences, Paris, France.,Explorations Fonctionnelles, Physiologie, APHP.Nord Hôpital Bichat, Paris, France
| | - Nahid Tabibzadeh
- Explorations Fonctionnelles, Physiologie, APHP.Nord Hôpital Bichat, Paris, France.,Centre de Recherche des Cordeliers, INSERM, Sorbonne Université, Université de Paris, Laboratoire de Physiologie Rénale et Tubulopathies, Paris, France.,CNRS ERL 8228-Unité Métabolisme et Physiologie Rénale, Paris, France
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15
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Chronic lithium therapy and urine concentrating ability in individuals with bipolar disorder: association between daily dose and resistance to vasopressin and polyuria. Kidney Int Rep 2022; 7:1557-1564. [PMID: 35812274 PMCID: PMC9263256 DOI: 10.1016/j.ekir.2022.04.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 03/29/2022] [Accepted: 04/04/2022] [Indexed: 11/29/2022] Open
Abstract
Introduction Lithium treatment can induce nephrogenic diabetes insipidus (NDI), but no consensus intervention is offered to date. We evaluated in these patients patterns of urine concentration and the correlates of 24-hour urine output. Methods Prospective, single-center, observational study of 217 consecutive lithium-treated individuals, with 24-hour urine collection, desmopressin (1-deamino-arginine vasopressin [DDAVP]) concentrating test, fasting plasma vasopressin measurement (copeptin measurement in n = 119), and measured glomerular filtration rate (mGFR). Maximal urine osmolality (MaxUosm) was the highest level during the DDAVP test. Results Of the individuals, 21% displayed polyuria (>3 l/d), but 55% displayed elevated fasting vasopressin level (>5 pg/ml). Uosm was significantly lower and urinary output and free water clearance were significantly higher in individuals treated for >10 years. MaxUosm was >600 mOsm/KgH2O in 128 patients (59%), among which vasopressin was increased in 51%, associated with higher lithium dose (950 [750–1200] vs. 800 [500–1000] mg/d, P < 0.001). All patients with lithium daily dose ≥1400 mg/d had high vasopressin levels. In multivariable analysis, 24-hour urine output was associated with higher lithium daily dose (β 0.49 ± 0.17, P = 0.005), female sex (β −359 ± 123, P = 0.004), daily osmolar intake (β 2.21 ± 0.24, P < 0.001), MaxUosm (β −2.89 ± 0.35, P < 0.001), and plasma vasopressin level (β 10.17 ± 4.76, P = 0.03). Conclusion Higher lithium daily dose was associated with higher vasopressin levels and higher urine output, independently of other factors. Daily osmolar intake was also associated with higher 24-hour urine output. These results suggest that controlled salt and protein intake and lithium dose might reduce polyuria in these patients.
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16
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Kitiwan BK, Vasunilashorn SM, Baer HJ, Mukamal K, Juraschek SP. The association of urine osmolality with decreased kidney function and/or albuminuria in the United States. BMC Nephrol 2021; 22:306. [PMID: 34507548 PMCID: PMC8434733 DOI: 10.1186/s12882-021-02478-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 07/19/2021] [Indexed: 11/23/2022] Open
Abstract
Background Decreased kidney function is commonly caused by hypovolemia. When hypovolemic, the kidney reabsorbs water resulting in concentrated urine. Osmolality is a measure of urine concentration which is more objective than self-reported fluid intake. It has a positive association with hypovolemia. However, it remains controversial whether osmolality is associated with decreased kidney function and/or albuminuria. Methods We conducted a cross-sectional analysis of the 2009–2012 National Health and Nutrition Examination Survey, a standardized survey in the U.S. population. Participants aged 18–70 years old with random urine osmolality were included. Osmolality was categorized as quartiles. Decreased kidney function was defined by estimated glomerular filtration rate (eGFR) < 60 mL/min/1.73m2 and albuminuria was defined by albumin-to-creatinine ratio ≥ 30 mg/gm. We performed multivariable regression via four sequential models. Results Our study sample included 7,373 participants. The mean age was 42.9 ± 0.4 years. Overall, 51.4% were male and 67.3% were white. The mean osmolality was 603.8 mOsm/kg and 629.1 mOsm/kg in those with and without decreased eGFR and/or albuminuria, respectively. The number of cases was 610 (6.7%). The prevalence from the lowest to highest quartiles of osmolality was 116 (6.2%), 213 (8.6%), 179 (7.5%), and 102 (4.3%), respectively (p-value for trend = 0.02). The relationship between osmolality and eGFR appeared nonlinear. After adjustment for demographic, social, cardiovascular, and dietary risk factors, there was no significant association of osmolality quartiles with decreased eGFR and/or albuminuria (odds ratio [OR] 0.77, 95% confidence interval [CI] 0.56, 1.07). In sensitivity analyses, osmolality ≥ 500 mOsm/kg was associated with lower eGFR (adjusted ß -1.13, 95% CI -1.98, -0.28). In pre-specified subgroup analyses, osmolality had a statistically significant negative correlation with eGFR among individuals with eGFR ≥ 60 mL/min/1.73m2, but a positive correlation among those with eGFR < 60 mL/min/1.73m2 (adjusted ß -0.19, 95% CI -0.36, -0.01 versus adjusted ß 0.50, 95% CI 0.05, 0.96; p-value for interaction = 0.016). Conclusions Higher osmolality was significantly associated with lower eGFR among adults with eGFR ≥ 60 mL/min/1.73m2 Future research should examine the relationship between osmolality and change in kidney function over time among adults with normal eGFR. Supplementary Information The online version contains supplementary material available at 10.1186/s12882-021-02478-9.
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Affiliation(s)
- Boonsong K Kitiwan
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA. .,Department of Medicine, Division of Nephrology, Appalachian Regional Healthcare (ARH) Regional Medical Center, 200 Medical Center Drive, Hazard, KY, 41701, USA.
| | - Sarinnapha M Vasunilashorn
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA.,Department of Medicine, Division of General Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Heather J Baer
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA.,Department of Medicine, Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Boston, MA, USA
| | - Kenneth Mukamal
- Harvard Medical School, Boston, MA, USA.,Department of Medicine, Division of General Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Stephen P Juraschek
- Harvard Medical School, Boston, MA, USA.,Department of Medicine, Division of General Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
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17
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Wagner S, Merkling T, Metzger M, Bankir L, Laville M, Frimat L, Combe C, Jacquelinet C, Fouque D, Massy ZA, Stengel B. Water intake and progression of chronic kidney disease: the CKD-REIN cohort study. Nephrol Dial Transplant 2021; 37:730-739. [DOI: 10.1093/ndt/gfab036] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Indexed: 01/30/2023] Open
Abstract
Abstract
Background
Optimal daily water intake to prevent chronic kidney disease (CKD) progression is unknown. Taking the kidney’s urine-concentrating ability into account, we studied the relation of kidney outcomes in patients with CKD to total and plain water intake and urine volume.
Methods
Including 1265 CKD patients [median age 69 years; mean estimated glomerular filtration rate (eGFR) 32 mL/min/1.73 m2] from the Chronic Kidney Disease–Renal Epidemiology and Information Network cohort (2013–19), we assessed fluid intake at baseline interviews, collected 24-h urine volumes and estimated urine osmolarity (eUosm). Using Cox and then linear mixed models, we estimated hazard ratios (HRs) and 95% confidence intervals (CIs) for kidney failure and eGFR decline associated with hydration markers, adjusting for CKD progression risk factors and eUosm.
Results
Patients’ median daily intake was 2.0 L [interquartile range (IQR) 1.6–2.6] for total water and 1.5 L (1–1.7) for plain water, median urine volume was 1.9 L/24 h (IQR 1.6–2.4) and mean eUosm was 374 ± 104 mosm/L. Neither total water intake nor urine volume was associated with either kidney outcome. Kidney failure risk increased significantly with decreasing eUosm ˂292 mosm/L. Adjusted HRs (95% CIs) for kidney failure associated with plain water intake were 1.88 (1.02–3.47), 1.59 (1.06–2.38), 1.76 (0.95–3.24) and 1.55 (1.03–2.32) in patients drinking <0.5, 0.5–1.0, 1.5–2.0 and >2.0 L/day compared with those drinking 1.0–1.5 L/day. High plain water intake was also significantly associated with faster eGFR decline.
Conclusions
In patients with CKD, the relation between plain water intake and progression to kidney failure appears to be U-shaped. Both low and high intake may not be beneficial in CKD.
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Affiliation(s)
- Sandra Wagner
- Université de Lorraine, INSERM CIC 1433, Nancy CHRU, Inserm U1116, FCRIN INI-CRCT, Nancy, France
| | - Thomas Merkling
- Université de Lorraine, INSERM CIC 1433, Nancy CHRU, Inserm U1116, FCRIN INI-CRCT, Nancy, France
| | - Marie Metzger
- Centre de recherche en Epidémiologie et Santé des Populations (CESP), INSERM U1018, Université Paris-Saclay, Université Versailles Saint Quentin, Villejuif, France
| | - Lise Bankir
- Sorbonne Université, INSERM, Centre de Recherche des Cordeliers, Paris, France
| | - Maurice Laville
- Département de Néphrologie, Centre Hospitalier Lyon-Sud, Université de Lyon, UCBL, Carmen, Pierre-Bénite, France
| | - Luc Frimat
- EA4360 Apemac, Université de Lorraine, Université Paris-Descartes, Nancy, France
- Département de Néphrologie, CHU de Nancy, Vandoeuvre-lès-Nancy, France
| | - Christian Combe
- Service de Néphrologie-Transplantation-Dialyse-Aphérèse, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
- INSERM, U1026, Université Bordeaux Segalen, Bordeaux, France
| | - Christian Jacquelinet
- Centre de recherche en Epidémiologie et Santé des Populations (CESP), INSERM U1018, Université Paris-Saclay, Université Versailles Saint Quentin, Villejuif, France
- Agence de Biomédecine, Saint Denis la Plaine, France
| | - Denis Fouque
- Département de Néphrologie, Centre Hospitalier Lyon-Sud, Université de Lyon, UCBL, Carmen, Pierre-Bénite, France
| | - Ziad A Massy
- Centre de recherche en Epidémiologie et Santé des Populations (CESP), INSERM U1018, Université Paris-Saclay, Université Versailles Saint Quentin, Villejuif, France
- Service de Néphrologie, Hôpital Ambroise Paré, AP-HP, Paris, France
| | - Bénédicte Stengel
- Centre de recherche en Epidémiologie et Santé des Populations (CESP), INSERM U1018, Université Paris-Saclay, Université Versailles Saint Quentin, Villejuif, France
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18
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Kreft B, Bergs J, Shahryari M, Danyel LA, Hetzer S, Braun J, Sack I, Tzschätzsch H. Cerebral Ultrasound Time-Harmonic Elastography Reveals Softening of the Human Brain Due to Dehydration. Front Physiol 2021; 11:616984. [PMID: 33505319 PMCID: PMC7830390 DOI: 10.3389/fphys.2020.616984] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 12/09/2020] [Indexed: 01/12/2023] Open
Abstract
Hydration influences blood volume, blood viscosity, and water content in soft tissues - variables that determine the biophysical properties of biological tissues including their stiffness. In the brain, the relationship between hydration and stiffness is largely unknown despite the increasing importance of stiffness as a quantitative imaging marker. In this study, we investigated cerebral stiffness (CS) in 12 healthy volunteers using ultrasound time-harmonic elastography (THE) in different hydration states: (i) during normal hydration, (ii) after overnight fasting, and (iii) within 1 h of drinking 12 ml of water per kg body weight. In addition, we correlated shear wave speed (SWS) with urine osmolality and hematocrit. SWS at normal hydration was 1.64 ± 0.02 m/s and decreased to 1.57 ± 0.04 m/s (p < 0.001) after overnight fasting. SWS increased again to 1.63 ± 0.01 m/s within 30 min of water drinking, returning to values measured during normal hydration (p = 0.85). Urine osmolality at normal hydration (324 ± 148 mOsm/kg) increased to 784 ± 107 mOsm/kg (p < 0.001) after fasting and returned to normal (288 ± 128 mOsm/kg, p = 0.83) after water drinking. SWS and urine osmolality correlated linearly (r = -0.68, p < 0.001), while SWS and hematocrit did not correlate (p = 0.31). Our results suggest that mild dehydration in the range of diurnal fluctuations is associated with significant softening of brain tissue, possibly due to reduced cerebral perfusion. To ensure consistency of results, it is important that cerebral elastography with a standardized protocol is performed during normal hydration.
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Affiliation(s)
- Bernhard Kreft
- Institute of Medical Informatics, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Judith Bergs
- Department of Radiology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Mehrgan Shahryari
- Department of Radiology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | | | - Stefan Hetzer
- Bernstein Center of Advanced Neuroimaging, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Jürgen Braun
- Institute of Medical Informatics, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Ingolf Sack
- Department of Radiology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Heiko Tzschätzsch
- Department of Radiology, Charité-Universitätsmedizin Berlin, Berlin, Germany
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19
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How to assess kidney function in oncology patients. Kidney Int 2020; 97:894-903. [DOI: 10.1016/j.kint.2019.12.023] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Revised: 11/20/2019] [Accepted: 12/17/2019] [Indexed: 12/24/2022]
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20
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Tabibzadeh N, Stengel B, Haymann JP. In Reply to ‘Urinary Concentration Capacity, GFR, and Mortality in the General American Population’. Am J Kidney Dis 2019; 74:572. [DOI: 10.1053/j.ajkd.2019.04.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Accepted: 04/17/2019] [Indexed: 11/11/2022]
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21
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Lee MJ, Chang TI, Lee J, Kim YH, Oh KH, Lee SW, Kim SW, Park JT, Yoo TH, Kang SW, Choi KH, Ahn C, Han SH. Urine Osmolality and Renal Outcome in Patients with Chronic Kidney Disease: Results from the KNOW-CKD. Kidney Blood Press Res 2019; 44:1089-1100. [PMID: 31505490 DOI: 10.1159/000502291] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Accepted: 07/21/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Urine osmolality indicates the ability of the kidney to concentrate the urine and reflects the antidiuretic action of vasopressin. However, results about the association between urine osmolality and adverse renal outcomes in chronic kidney disease (CKD) are conflicting. We investigated the association between urine osmolality and adverse renal outcomes in a nationwide prospective CKD cohort. METHODS A total of 1,999 CKD patients were categorized into 3 groups according to their urine osmolality tertiles. Primary outcome was a composite of 50% decline in the estimated glomerular filtration rate (eGFR), initiation of dialysis, or kidney transplantation. RESULTS During a mean follow-up of 35.2 ± 19.0 months, primary outcome occurred in 432 (21.6%) patients; 240 (36.4%), 162 (24.3%), and 30 (4.5%) in the lowest, middle, and highest tertiles, respectively. Low urine osmolality was independently associated with a greater risk of CKD progression (hazard ratio [HR], 1.71; 95% confidence interval [CI], 1.12-2.59). This association was particularly evident in patients with CKD stages 3-4 (per 10 mosm/kg decrease; HR, 1.02; 95% CI, 1.00-1.03). Adding urine osmolality to a base model with conventional factors significantly increased the ability to predict CKD progression (C-statistics, 0.86; integrated discrimination improvement [IDI], 0.021; both p < 0.001). However, adding both urine osmolality and eGFR did not further improve the predictive ability compared with the addition of eGFR only (C-statistics, p = 0.29; IDI, p = 0.09). CONCLUSIONS Low urine osmolality was an independent risk factor for adverse renal outcomes in CKD patients, but its predictive ability did not surpass eGFR. Thus, kidney function should be considered while interpreting the clinical significance of urine osmolality.
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Affiliation(s)
- Mi Jung Lee
- Department of Internal Medicine, CHA Bundang Medical Center, CHA University, College of Medicine, Seongnam, Republic of Korea
| | - Tae Ik Chang
- Department of Internal Medicine, National Health Insurance Service Medical Center, Ilsan Hospital, Goyangshi, Republic of Korea
| | - Joongyub Lee
- Department of Prevention and Management, Inha University Hospital, Inha University School of Medicine, Incheon, Republic of Korea
| | - Yeong Hoon Kim
- Department of Internal Medicine, Inje University, Pusan Paik Hospital, Busan, Republic of Korea
| | - Kook-Hwan Oh
- Department of Internal Medicine, Seoul National University, Seoul, Republic of Korea
| | - Sung Woo Lee
- Department of Internal Medicine, Nowon Eulji Medical Center, Eulji University, Seoul, Republic of Korea
| | - Soo Wan Kim
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Jung Tak Park
- Department of Internal Medicine, College of Medicine, Institute of Kidney Disease Research, Yonsei University, Seoul, Republic of Korea
| | - Tae-Hyun Yoo
- Department of Internal Medicine, College of Medicine, Institute of Kidney Disease Research, Yonsei University, Seoul, Republic of Korea
| | - Shin-Wook Kang
- Department of Internal Medicine, College of Medicine, Institute of Kidney Disease Research, Yonsei University, Seoul, Republic of Korea
| | - Kyu Hun Choi
- Department of Internal Medicine, College of Medicine, Institute of Kidney Disease Research, Yonsei University, Seoul, Republic of Korea
| | - Curie Ahn
- Department of Internal Medicine, Seoul National University, Seoul, Republic of Korea
| | - Seung Hyeok Han
- Department of Internal Medicine, College of Medicine, Institute of Kidney Disease Research, Yonsei University, Seoul, Republic of Korea,
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22
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Koopman JJE. Urinary Concentration Capacity, GFR, and Mortality in the General American Population. Am J Kidney Dis 2019; 74:570-571. [PMID: 31466738 DOI: 10.1053/j.ajkd.2019.04.028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Accepted: 04/02/2019] [Indexed: 11/11/2022]
Affiliation(s)
- Jacob J E Koopman
- Department of Internal Medicine, Leiden University Medical Center, Leiden, the Netherlands; Division of Renal Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
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23
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Wang K, Kestenbaum B. Urinary Concentration Ability: Time to Bring the Tubules to the Table. Am J Kidney Dis 2019; 73:583-584. [PMID: 30876749 DOI: 10.1053/j.ajkd.2019.01.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Accepted: 01/13/2019] [Indexed: 11/11/2022]
Affiliation(s)
- Ke Wang
- Kidney Research Institute, Division of Nephrology, University of Washington, Seattle, WA
| | - Bryan Kestenbaum
- Kidney Research Institute, Division of Nephrology, University of Washington, Seattle, WA.
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