1
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Sołtysiak J, Skowrońska B, Maćkowiak-Lewandowicz K, Blumczyński A, Elżbieta K, Ostalska-Nowicka D, Zachwieja J. Ambulatory blood pressure parameters and their association with albuminuria in adolescents with type 1 diabetes mellitus. Pediatr Nephrol 2024:10.1007/s00467-024-06416-3. [PMID: 38864872 DOI: 10.1007/s00467-024-06416-3] [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: 08/24/2023] [Revised: 04/26/2024] [Accepted: 05/16/2024] [Indexed: 06/13/2024]
Abstract
BACKGROUND This study aimed to evaluate the blood pressure (BP) status, including arterial stiffness parameters, hemodynamic indicators, circadian profile, and its association with albuminuria in adolescents with type 1 diabetes mellitus (DM1). METHODS The analysis included 46 patients, with diabetes duration of 7.38 ± 3.48 years. Ambulatory blood pressure monitoring (ABPM) was conducted using an oscillometric device, the Mobil-O-Graph, which is a Pulse Wave Analysis Monitor. RESULTS Hypertension (HT) was diagnosed in 31 adolescents (67% of patients), primarily due to isolated nocturnal BP (21 cases, 68% of HT cases). The HT group exhibited significantly increased diastolic load (DL). Pulse wave velocity (PWV, a measure of arterial stiffness) values showed a strong correlation with both peripheral systolic BP (r = 0.954) and central systolic BP (r = 0.838). Additionally, non-dipping status was found in 61% of the HT group. Urinary albumin excretion (UAE) was positively correlated with diastolic BP (particularly nocturnal) peripheral and central BP, DL, heart rate, augmentation index (AIx@75), and nocturnal total vascular resistance (TVR). Diastolic non-dippers exhibited a significant increase in UAE. CONCLUSIONS Hypertension is a common complication in adolescents with type 1 diabetes mellitus, primarily caused by elevated nocturnal diastolic BP. Albuminuria is mainly associated with diastolic BP, especially during the nocturnal period and in cases of diastolic non-dipping status. The association of UAE with AIx@75 and nocturnal TVR suggests the presence of early-stage vascular disease in diabetic adolescents.
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Affiliation(s)
- Jolanta Sołtysiak
- Department of Pediatric Nephrology and Hypertension, Poznan University of Medical Sciences, 27/33 Szpitalna St., 60-572, Poznan, Poland.
| | - Bogda Skowrońska
- Pediatric Diabetes and Obesity, Poznan University of Medical Sciences, 60-572, Poznan, Poland
| | - Katarzyna Maćkowiak-Lewandowicz
- Department of Pediatric Nephrology and Hypertension, Poznan University of Medical Sciences, 27/33 Szpitalna St., 60-572, Poznan, Poland
| | - Andrzej Blumczyński
- Department of Pediatric Nephrology and Hypertension, Poznan University of Medical Sciences, 27/33 Szpitalna St., 60-572, Poznan, Poland
| | - Kaczmarek Elżbieta
- Department of Bioinformatics and Computational Biology, Poznan University of Medical Sciences, 60-572, Poznan, Poland
| | - Danuta Ostalska-Nowicka
- Department of Pediatric Nephrology and Hypertension, Poznan University of Medical Sciences, 27/33 Szpitalna St., 60-572, Poznan, Poland
| | - Jacek Zachwieja
- Department of Pediatric Nephrology and Hypertension, Poznan University of Medical Sciences, 27/33 Szpitalna St., 60-572, Poznan, Poland
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2
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Mancia G, Facchetti R, Grassi G. Risk prediction by ambulatory blood pressure monitoring in non-diabetic and diabetic patients: better than office measurements. Eur Heart J 2024:ehae171. [PMID: 38842583 DOI: 10.1093/eurheartj/ehae171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/07/2024] Open
Affiliation(s)
- Giuseppe Mancia
- University Milano-Bicocca, Piazza dei Daini 4, 20126 Milan, Italy
| | - Rita Facchetti
- University Milano-Bicocca, Piazza dei Daini 4, 20126 Milan, Italy
| | - Guido Grassi
- University Milano-Bicocca, Piazza dei Daini 4, 20126 Milan, Italy
- Clinica Medica, University Milano-Bicocca, Milan, Italy
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3
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Zhang J, Qiu L, Liu Z, Liu J, Yu B, Liu C, Ren B, Zhang J, Li S, Guan Y, Zheng F, Yang G, Chen L. Circadian light/dark cycle reversal exacerbates the progression of chronic kidney disease in mice. J Pineal Res 2024; 76:e12964. [PMID: 38803014 DOI: 10.1111/jpi.12964] [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: 12/26/2023] [Revised: 05/07/2024] [Accepted: 05/08/2024] [Indexed: 05/29/2024]
Abstract
Circadian disruption such as shift work, jet lag, has gradually become a global health issue and is closely associated with various metabolic disorders. The influence and mechanism of circadian disruption on renal injury in chronic kidney disease (CKD) remains inadequately understood. Here, we evaluated the impact of environmental light disruption on the progression of chronic renal injury in CKD mice. By using two abnormal light exposure models to induce circadian disruption, we found that circadian disruption induced by weekly light/dark cycle reversal (LDDL) significantly exacerbated renal dysfunction, accelerated renal injury, and promoted renal fibrosis in mice with 5/6 nephrectomy and unilateral ureteral obstruction (UUO). Mechanistically, RNA-seq analysis revealed significant immune and metabolic disorder in the LDDL-conditioned CKD kidneys. Consistently, renal content of ATP was decreased and ROS production was increased in the kidney tissues of the LDDL-challenged CKD mice. Untargeted metabolomics revealed a significant buildup of lipids in the kidney affected by LDDL. Notably, the level of β-NMN, a crucial intermediate in the NAD+ pathway, was found to be particularly reduced. Moreover, we demonstrated that both β-NMN and melatonin administration could significantly rescue the light-disruption associated kidney dysfunction. In conclusion, environmental circadian disruption may exacerbate chronic kidney injury by facilitating inflammatory responses and disturbing metabolic homeostasis. β-NMN and melatonin treatments may hold potential as promising approaches for preventing and treating light-disruption associated CKD.
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Affiliation(s)
- Jiayang Zhang
- WuHu Hospital, East China Normal University (The Second People's Hospital, Wuhu), Wuhu, China
- Health Science Center, East China Normal University, Shanghai, China
| | - Lejia Qiu
- Health Science Center, East China Normal University, Shanghai, China
| | - Zhaiyi Liu
- Advanced Institute for Medical Sciences, Dalian Medical University, Dalian, China
| | - Jiaxin Liu
- Advanced Institute for Medical Sciences, Dalian Medical University, Dalian, China
| | - Bo Yu
- School of Clinical Medicine, Shanghai University of Medicine and Health Sciences, Shanghai, China
| | - Chengcheng Liu
- Health Science Center, East China Normal University, Shanghai, China
| | - Baoyin Ren
- WuHu Hospital, East China Normal University (The Second People's Hospital, Wuhu), Wuhu, China
- Health Science Center, East China Normal University, Shanghai, China
| | - Jiaqi Zhang
- Health Science Center, East China Normal University, Shanghai, China
| | - Shuyao Li
- Health Science Center, East China Normal University, Shanghai, China
| | - Youfei Guan
- Advanced Institute for Medical Sciences, Dalian Medical University, Dalian, China
| | - Feng Zheng
- WuHu Hospital, East China Normal University (The Second People's Hospital, Wuhu), Wuhu, China
- Health Science Center, East China Normal University, Shanghai, China
| | - Guangrui Yang
- School of Clinical Medicine, Shanghai University of Medicine and Health Sciences, Shanghai, China
| | - Lihong Chen
- WuHu Hospital, East China Normal University (The Second People's Hospital, Wuhu), Wuhu, China
- Health Science Center, East China Normal University, Shanghai, China
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4
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Jorge da Silva Franco R, Antonio Vieira Filho J, Inomata Cardoso da Silva D, Cuadrado Martin L, Alves Silva B, Garcia Zanati Bazan S, Barretti P, Regina Nogueira C. Non-dipping circadian pattern as a predictor of incipient nephropathy in normotensive normoalbuminuric type 1 diabetics. Chronobiol Int 2023; 40:1523-1528. [PMID: 37985469 DOI: 10.1080/07420528.2023.2282471] [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: 02/15/2023] [Accepted: 11/07/2023] [Indexed: 11/22/2023]
Abstract
The objective of this study was to assess the value of the abnormal circadian blood pressure pattern by ambulatory blood pressure monitoring (ABPM) to predict the onset of abnormal albuminuria in normotensive and normoalbuminuric DM1 patients. The participators were submitted to ABPM and followed prospectively until the onset of albuminuria or the end of follow-up. The patients with normal circadian blood pressure pattern were compared with the non-dippers in regard of the time interval free of albuminuria. The survival curves were evaluated by the Kaplan-Meier method. Of 34 patients screened, 10 patients matched the exclusion criteria. Therefore, 24 patients were submitted to ABPM, aged 24 ± 8.3 y, 18 men, and all Caucasian. Elevated levels of albuminuria did not occurin any individual with normal systolic blood pressure dip (>10%) at 54 months of follow-up. Only 22% of patients among non-dippers were free of albuminuria (<30 mg/g maintained for 3 months) at the same time (p = 0.049). Patients that reached the outcome were homogeneous in regard to other clinical and ABPM data evaluated. Abnormal systolic blood pressure circadian pattern predicts the evolution to incipient nephropathy in normotensive normoalbuminuric DM1 patients.
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Affiliation(s)
- Roberto Jorge da Silva Franco
- Nephrology Discipline, Department of Internal Medicine, São Paulo State University (Unesp), Botucatu Medical School, São Paulo, Brazil
| | - José Antonio Vieira Filho
- Nephrology Discipline, Department of Internal Medicine, São Paulo State University (Unesp), Botucatu Medical School, São Paulo, Brazil
| | - Douglas Inomata Cardoso da Silva
- Nephrology Discipline, Department of Internal Medicine, São Paulo State University (Unesp), Botucatu Medical School, São Paulo, Brazil
| | - Luis Cuadrado Martin
- Nephrology Discipline, Department of Internal Medicine, São Paulo State University (Unesp), Botucatu Medical School, São Paulo, Brazil
| | - Bruno Alves Silva
- Nephrology Discipline, Department of Internal Medicine, São Paulo State University (Unesp), Botucatu Medical School, São Paulo, Brazil
| | - Silméia Garcia Zanati Bazan
- Cardiology Discipline, Department of Internal Medicine, São Paulo State University (Unesp), Botucatu Medical School, São Paulo, Brazil
| | - Pasqual Barretti
- Nephrology Discipline, Department of Internal Medicine, São Paulo State University (Unesp), Botucatu Medical School, São Paulo, Brazil
| | - Célia Regina Nogueira
- Endocrinology Discipline, Department of Internal Medicine, São Paulo State University (Unesp), Botucatu Medical School,São Paulo, Brazil
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5
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Brito LCD, Bowles NP, McHill AW, Rice SPM, Butler MP, Emens JS, Shea SA, Thosar SS. Chronological distribution of readings in ambulatory blood pressure monitoring exams affects the nighttime average and the magnitude of blood pressure dipping. Am J Physiol Heart Circ Physiol 2023; 325:H1394-H1399. [PMID: 37861648 PMCID: PMC10908404 DOI: 10.1152/ajpheart.00542.2023] [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: 09/01/2023] [Revised: 10/16/2023] [Accepted: 10/16/2023] [Indexed: 10/21/2023]
Abstract
STUDY OBJECTIVES Averaged nighttime blood pressure (BP) is superior to daytime BP for cardiovascular risk stratification, and the relative change between daytime/nighttime BP (dipping%) significantly predicts cardiovascular risk. Newer reports suggest that 4 measurements at night may be enough for cardiovascular risk stratification. Since BP oscillates across the night, the temporal distribution of measurements across the night may impact nighttime BP and dipping%. Therefore, we compared average nighttime BP and dipping% when using measurements in the first half (1st-half), second (2nd-half), and a combination of both (combined). METHODS Forty-three (17 females and twenty-six males) midlife adults aged 50±10 years old wore an ambulatory BP monitor for 24 hours at home, programmed to measure BP every 20 minutes when scheduled for daytime and every 30 minutes during a self-selected 8-hour nighttime for time-in-bed. We compared the nighttime BP averages and dipping% when using either the first four measurements from the 1st-half or 2nd-half of the nighttime and combined. RESULTS Nighttime Systolic BP was significantly different across 1st-half, 2nd-half, and combined (111±9 vs.107±11 vs. 109±9 mmHg, p<0.01), respectively, with significant pairwise differences across all categories (p<0.01 for each). Systolic BP dipping% was significantly different across 1st-half, 2nd-half, and combined (9.9±5.5 vs.13.5±6.4 vs. 11.7±5.0 %, p<0.01), respectively, with significant pairwise differences across all categories (p<0.01 for each. Diastolic BP and diastolic dipping% were similar across the three different bins. CONCLUSION In midlife adults, systolic nighttime BP and dipping% may depend upon when BP measurements are taken during the night.
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Affiliation(s)
- Leandro Campos de Brito
- Oregon Institute of Occupational Health Sciences, Oregon Health & Science University, Portland, OR, United States
| | | | - Andrew W McHill
- Oregon Health and Science University, Portland, Oregon, United States
| | - Sean P M Rice
- Oregon Institute of Occupational Health Sciences, Oregon Health & Science University, United States
| | - Matthew P Butler
- Oregon Institute of Occupational Health Sciences, Oregon Health & Science University, Portland, OR, United States
| | | | - Steven A Shea
- Oregon Institute of Occupational Health Sciences, Oregon Health & Science University, Portland, OR, United States
| | - Saurabh S Thosar
- Oregon Institute of Occupational Health Sciences, Oregon Health and Science University Hospital, Portland, Oregon, United States
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6
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Peng Z, Liang Y, Liu X, Shao J, Hu N, Zhang X. New insights into the mechanisms of diabetic kidney disease: Role of circadian rhythm and Bmal1. Biomed Pharmacother 2023; 166:115422. [PMID: 37660646 DOI: 10.1016/j.biopha.2023.115422] [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: 06/24/2023] [Revised: 08/30/2023] [Accepted: 08/30/2023] [Indexed: 09/05/2023] Open
Abstract
It is common for diabetic kidney disease (DKD) to be complicated by abnormal blood glucose, blood lipids, and blood pressure rhythms. Thus, it is essential to examine diagnostic and treatment plans from the perspective of circadian disruption. This brief review discusses the clinical relevance of circadian rhythms in DKD and how the core clock gene encoding brain and muscle arnt-like protein 1 (BMAL1) functions owing to the importance of circadian rhythm disruption processes, including the excretion of urinary protein and irregular blood pressure, which occur in DKD. Exploring Bmal1 and its potential mechanisms and signaling pathways in DKD following contact with Sirt1 and NF-κB is novel and important. Finally, potential pharmacological and behavioral intervention strategies for DKD circadian rhythm disturbance are outlined. This review aids in unveiling novel, potential molecular targets for DKD based on circadian rhythms.
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Affiliation(s)
- Zhimei Peng
- Department of Nephrology, The Second Clinical College of Jinan University, Shenzhen People's Hospital, Shenzhen, China; Shenzhen Key Laboratory of Kidney Diseases, Shenzhen People's Hospital (The Second Clinical Medical College, Jinan University, The First Affiliated Hospital, Southern University of Science and Technology), Shenzhen, China.
| | - Yanting Liang
- Department of Nephrology, The Second Clinical College of Jinan University, Shenzhen People's Hospital, Shenzhen, China.
| | - Xueying Liu
- Shenzhen Key Laboratory of Kidney Diseases, Shenzhen People's Hospital (The Second Clinical Medical College, Jinan University, The First Affiliated Hospital, Southern University of Science and Technology), Shenzhen, China.
| | - Jie Shao
- Department of Nephrology, The Second Clinical College of Jinan University, Shenzhen People's Hospital, Shenzhen, China.
| | - Nan Hu
- Shenzhen Key Laboratory of Kidney Diseases, Shenzhen People's Hospital (The Second Clinical Medical College, Jinan University, The First Affiliated Hospital, Southern University of Science and Technology), Shenzhen, China.
| | - Xinzhou Zhang
- Department of Nephrology, The Second Clinical College of Jinan University, Shenzhen People's Hospital, Shenzhen, China; Shenzhen Key Laboratory of Kidney Diseases, Shenzhen People's Hospital (The Second Clinical Medical College, Jinan University, The First Affiliated Hospital, Southern University of Science and Technology), Shenzhen, China.
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7
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Seeman T, Šuláková T, Stabouli S. Masked Hypertension in Healthy Children and Adolescents: Who Should Be Screened? Curr Hypertens Rep 2023; 25:231-242. [PMID: 37639176 PMCID: PMC10491704 DOI: 10.1007/s11906-023-01260-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/31/2023] [Indexed: 08/29/2023]
Abstract
PURPOSE OF REVIEW The goal is to review masked hypertension (MH) as a relatively new phenomenon when patients have normal office BP but elevated out-of-office BP. Firstly, it was described in children in 2004. It has received increased attention in the past decade. RECENT FINDINGS The prevalence of MH in different pediatric populations differs widely between 0 and 60% based on the population studied, definition of MH, or method of out-of-office BP measurement. The highest prevalence of MH has been demonstrated in children with chronic kidney disease (CKD), obesity, diabetes, and after heart transplantation. In healthy children but with risk factors for hypertension such as prematurity, overweight/obesity, diabetes, chronic kidney disease, or positive family history of hypertension, the prevalence of MH is 9%. In healthy children without risk factors for hypertension, the prevalence of MH is very low ranging 0-3%. In healthy children, only patients with the following clinical conditions should be screened for MH: high-normal/elevated office BP, positive family history of hypertension, and those referred for suspected hypertension who have normal office BP in the secondary/tertiary center.
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Affiliation(s)
- Tomáš Seeman
- Department of Pediatrics, Charles University Prague, 2nd Medical Faculty, V Úvalu 84, 15006, Prague, Czech Republic.
- Department of Pediatrics, University Hospital Ostrava, Ostrava, Czech Republic.
| | - Terezie Šuláková
- Department of Pediatrics, University Hospital Ostrava, Ostrava, Czech Republic
- Department of Pediatrics, Medical Faculty, University of Ostrava, Ostrava, Czech Republic
| | - Stella Stabouli
- 1st Department of Pediatrics, School of Medicine, Faculty of Health Sciences, Aristotle University Thessaloniki, Hippokratio Hospital, Thessaloniki, Greece
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8
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Ko YE, Jhee JH. Short-term blood pressure variability as a potential therapeutic target for kidney disease. Clin Hypertens 2023; 29:23. [PMID: 37580839 PMCID: PMC10426225 DOI: 10.1186/s40885-023-00248-3] [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: 02/26/2023] [Accepted: 07/11/2023] [Indexed: 08/16/2023] Open
Abstract
Short-term blood pressure variability (BPV) measured with ambulatory blood pressure (BP) monitoring has been demonstrated to be significant in predicting various clinical outcomes. Short-term BPV is distinguished from long-term BPV based on the time interval in which BP fluctuations are measured. Increased short-term BPV has been linked to detrimental effects on the microvascular structure and contributes to subclinical organ damage in the heart, blood vessels, and kidneys, regardless of the average 24-h BP levels. Short-term BPV can be defined by various measures, including calculated metrics (standard deviation, coefficient of variation, average real variability, weighted standard deviation, variability independent of the mean) or dipping patterns. Nevertheless, the additional role of short-term BPV beyond the predictive value of average 24-h BPs or established risk factors for cardiovascular disease and kidney disease remains unclear. In particular, longitudinal studies that evaluate the association between short-term BPV and kidney function impairment are limited and no conclusive data exist regarding which short-term BPV indicators most accurately reflect the prognosis of kidney disease. The issue of how to treat BPV in clinical practice is another concern that is frequently raised. This paper presents a review of the evidence for the prognostic role of short-term BPV in kidney outcomes. Additionally, this review discusses the remaining concerns about short-term BPV that need to be further investigated as an independent risk modifier.
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Affiliation(s)
- Ye Eun Ko
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jong Hyun Jhee
- Division of Nephrology, Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea.
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9
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Habas E, Akbar RA, Alfitori G, Farfar KL, Habas E, Errayes N, Habas A, Al Adab A, Rayani A, Geryo N, Elzouki ANY. Effects of Nondipping Blood Pressure Changes: A Nephrologist Prospect. Cureus 2023; 15:e42681. [PMID: 37649932 PMCID: PMC10464654 DOI: 10.7759/cureus.42681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/30/2023] [Indexed: 09/01/2023] Open
Abstract
Blood pressure (BP) variations depend on various internal, environmental, and behavioral factors. BP fluctuations occur both in normotensive and hypertensive people. Although it fluctuates over the 24-hr day and night, the morning BP increases after waking up and declines throughout sleep. It is typical for BP to decrease by 10% to 20%, while sleeping, known as dipping BP. However, if there is no decrease in nighttime mean systolic BP or a drop of less than 10 mmHg, it is called nondipping BP. Conversely, reverse dipping BP means an increase in mean systolic BP instead of a drop during the night. Reverse dipping is observed in hypertension (HTN), diabetes mellitus (DM), chronic kidney disease (CKD), and obstructive sleep apnea (OSA) syndrome. The introduction of ambulatory BP monitoring (ABPM) led to the emergence of identifying normal and elevated BP patterns. Non-dipping BP increases the risk of cardiovascular system (CVS) complications such as left ventricular hypertrophy, proteinuria, glomerular filtration rate (GFR) reduction, and CKD progression. A loss or blunting of the normal BP profile is recognized as a deleterious variant, and restoring abnormal BP patterns has been reported to significantly impact end-organ damage, morbidity, and mortality. In this non-systematic clinically-oriented, comprehensive review, we aim to update the BP variables and the pathophysiology of nondipping BP and point out the areas which need more investigation from a nephrology perspective because the nondipping BP increases the risk of proteinuria, GFR reduction, and CKD progression. A literature search of PubMed, Google, EMBASE, and Google Scholar was conducted. Checks of selected papers and relevant reviews complemented the electronic search. With improved BP measurement methods, the physiology of BP profile variations is readily detectable during the day and night. A nondipping BP profile is a distinct BP pattern that may have significant end-organ damage effects and therapeutic importance for nephrologists. The pathophysiology of the nondipping BP variant must be clarified to prevent complications, and further investigations are required. Furthermore, there is debate about the best BP index to utilize: systolic BP, diastolic BP, mean arterial pressure, or a mixture of all. All these areas are important and need new research projects.
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Affiliation(s)
| | - Raza A Akbar
- Internal Medicine, Hamad General Hospital, Doha, QAT
| | | | | | - Eshrak Habas
- Internal Medicine, Tripoli University, Tripoli, LBY
| | - Nada Errayes
- Medical Education, University of Lincoln, Lincoln, GBR
| | - Aml Habas
- Renal and Dialysis, Tripoli Pediatric Hospital, Tripoli, LBY
| | - Aisha Al Adab
- Pulmonary Medicine, Hamad General Hospital, Doha, QAT
| | - Amnna Rayani
- Hemato-Oncology, Tripoli Pediatric Hospital, Tripoli University, Tripoli, LBY
| | - Nagat Geryo
- Internal Medicine, Hamad General Hospital, Doha, QAT
| | - Abdel-Naser Y Elzouki
- Medicine, Hamad General Hospital, Doha, QAT
- Internal Medicine, Hamad Medical Corporation, Doha, QAT
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10
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Warsame F, Chu NM, Hong J, Mathur A, Crews DC, Bayliss G, Segev DL, McAdams-DeMarco MA. Sleep duration and cognitive function among older adults with chronic kidney disease: results from the National Health and Nutrition Examination Survey (2011-2014). Nephrol Dial Transplant 2023; 38:1636-1644. [PMID: 36535636 PMCID: PMC10310518 DOI: 10.1093/ndt/gfac325] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Indexed: 09/25/2023] Open
Abstract
BACKGROUND Short and long sleep durations are associated with cognitive dysfunction. Given the increased prevalence of sleep abnormalities in the chronic kidney disease (CKD) population, we tested whether the association between sleep duration and cognitive function differed between older adults with and without CKD. METHODS This was a study of 3215 older adults (age ≥60 years) enrolled in the National Health and Nutrition Examination Survey (2011-14) evaluating sleep duration, cognitive function (immediate recall, delayed recall, verbal fluency, executive function and processing speed and global cognition) and kidney function. We quantified the association between sleep duration and cognitive function using linear regression and tested whether the associations differed among those with CKD and without using a Wald test for interaction. RESULTS Among 3215 participants, 13.3% reported 2-5 hours of sleep/day, 75.2% reported 6-8 hours, and 11.5% reported ≥9 hours. Persons with CKD were more likely to sleep ≥9 hours [odds ratio 1.73 (95% confidence interval 1.22-2.46)]. Among participants with CKD, those with a sleep duration ≥9 hours demonstrated worse global cognitive function (P for interaction = .01), immediate recall (P for interaction = .01) and verbal fluency (P for interaction = .004) than those with a sleep duration of 6-8 h; no differences were observed for participants with CKD who slept 2-5 hours. Among participants without CKD, sleep was not associated with any measures of cognitive function. CONCLUSIONS Longer sleep duration is associated with worse cognitive function only among persons with CKD, and global cognition, delayed recall and verbal fluency are particularly affected. Studies should identify interventions to improve sleep patterns and quality in this population.
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Affiliation(s)
- Fatima Warsame
- Division of Biology and Medicine, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Nadia M Chu
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jingyao Hong
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Aarti Mathur
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Deidra C Crews
- Division of Nephrology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - George Bayliss
- Division of Biology and Medicine, Warren Alpert Medical School of Brown University, Providence, RI, USA
- Division of Kidney Disease and Hypertension, Brown Medicine, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Dorry L Segev
- Department of Surgery, NYU Grossman School of Medicine and NYU Langone Health, NY, NY, USA
| | - Mara A McAdams-DeMarco
- Department of Surgery, NYU Grossman School of Medicine and NYU Langone Health, NY, NY, USA
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11
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Ayalon-Dangur I, Ofer-Shiber S, Shochat T, Genin I, Arlyuk M, Grossman A. The prevalence of masked hypertension in patients with lone atrial fibrillation: a cross sectional analytical study. Sci Rep 2023; 13:9751. [PMID: 37328567 PMCID: PMC10275900 DOI: 10.1038/s41598-023-36853-3] [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: 05/16/2022] [Accepted: 06/11/2023] [Indexed: 06/18/2023] Open
Abstract
Atrial fibrillation (AF) is prevalent in individuals with essential hypertension (HTN). Masked hypertension occurs in up to 15% of the general population and is associated with adverse clinical outcome. The aim of the current study was to evaluate the prevalence of masked hypertension in apparently normotensive individuals with lone AF. A cross sectional analytical study performed at the Rabin Medical Center included all patients > 18 years who visited the emergency department (ED) in the years 2018-2021 with idiopathic AF, had normal blood pressure (BP) values during their ED visit and did not have a history of hypertension or current use of anti-hypertensives. Ambulatory blood pressure monitoring (ABPM) was performed in all eligible patients within 30 days from ED visit. Data collected included information from the ED visit and data extracted from the monitoring device. A total of 1258 patients were screened for eligibility, of which 40 were included in the analysis. The average age was 53.4 ± 16 years, 28 patients (70%) were males. Overall, 18 individuals (46%) had abnormal BP values according to the 2017 ACC/AHA guidelines for the diagnosis of hypertension. Of these, 12 had abnormal 24-h BP average (≥ 125/75 mmHg), one had isolated daytime abnormal average (≥ 130/80 mmHg) and 11 had isolated night time abnormal average (≥ 110/65 mmHg). Masked hypertension is prevalent in patients with lone AF without a diagnosis of HTN and performing ABPM in such individuals should be strongly considered.
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Affiliation(s)
- Irit Ayalon-Dangur
- Department of Internal Medicine E, Rabin Medical Center, Petah Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shachaf Ofer-Shiber
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Rheumatology, Rabin Medical Center, Petach Tikva, Israel
- The Department of Emergency Medicine, Rabin Medical Center, Beilinson Campus, Israel
| | - Tzippy Shochat
- Bio-Statistical Consultant, Rabin Medical Center, Beilinson Campus, Israel
| | - Irina Genin
- Department of Internal Medicine B, Rabin Medical Center, Petah Tikva, Israel
| | - Maya Arlyuk
- Department of Internal Medicine B, Rabin Medical Center, Petah Tikva, Israel
| | - Alon Grossman
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
- Department of Internal Medicine B, Rabin Medical Center, Petah Tikva, Israel.
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12
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Gao ZX, Wei QC, Shu TT, Li ST, Zhou R, Li MY, Mao ZH, Liu DW, Liu ZS, Wu P. Kir4.1 deletion prevents salt-sensitive hypertension in early streptozotocin-induced diabetic mice via Na + -Cl - cotransporter in the distal convoluted tubule. J Hypertens 2023; 41:958-970. [PMID: 37016934 DOI: 10.1097/hjh.0000000000003419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/06/2023]
Abstract
OBJECTIVES Functional impairment of renal sodium handling and blood pressure (BP) homeostasis is an early characteristic manifestation of type 1 diabetes. However, the underlying mechanisms remain unclear. METHODS Metabolic cages, radio-telemetry, immunoblotting, and electrophysiology were utilized to examine effects of high salt (8% NaCl, HS) intake on Na + /K + balance, BP, Na + -Cl - cotransporter (NCC) function, and basolateral K + channel activity in the distal convoluted tubule (DCT) under diabetic conditions. RESULTS Improper Na + balance, hypernatremia, and a mild but significant increase in BP were found in streptozotocin (STZ)-induced diabetic mice in response to HS intake for 7 days. Compared to the vehicle, STZ mice showed increased Kir4.1 expression and activity in the DCT, a more negative membrane potential, higher NCC abundance, and enhanced hydrochlorothiazide-induced natriuretic effect. However, HS had no significant effect on basolateral Kir4.1 expression/activity and DCT membrane potential, or NCC activity under diabetic conditions, despite a downregulation in phosphorylated NCC abundance. In contrast, HS significantly downregulated the expression of Na + -H + exchanger 3 (NHE3) and cleaved epithelial sodium channel-γ in STZ mice, despite an increase in NHE3 abundance after STZ treatment. Kir4.1 deletion largely abolished STZ-induced upregulation of NCC expression and prevented BP elevation during HS intake. Interestingly, HS causes severe hypokalemia in STZ-treated kidney-specific Kir4.1 knockout (Ks-Kir4.1 KO) mice and lead to death within a few days, which could be attributed to a higher circulating aldosterone level. CONCLUSIONS We concluded that Kir4.1 is required for upregulating NCC activity and may be essential for developing salt-sensitive hypertension in early STZ-induced diabetes.
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Affiliation(s)
- Zhong-Xiuzi Gao
- Traditional Chinese Medicine Integrated Department of Nephrology, The First Affiliated Hospital of Zhengzhou University
- Institute of Nephrology, Zhengzhou University
- Henan Province Clinical Research Center for Kidney Disease
- Key Laboratory of Precision Diagnosis and Treatment for Chronic Kidney Disease in Henan Province, Zhengzhou, China
| | - Qi-Chao Wei
- Traditional Chinese Medicine Integrated Department of Nephrology, The First Affiliated Hospital of Zhengzhou University
- Institute of Nephrology, Zhengzhou University
- Henan Province Clinical Research Center for Kidney Disease
- Key Laboratory of Precision Diagnosis and Treatment for Chronic Kidney Disease in Henan Province, Zhengzhou, China
| | - Ting-Ting Shu
- Traditional Chinese Medicine Integrated Department of Nephrology, The First Affiliated Hospital of Zhengzhou University
- Institute of Nephrology, Zhengzhou University
- Henan Province Clinical Research Center for Kidney Disease
- Key Laboratory of Precision Diagnosis and Treatment for Chronic Kidney Disease in Henan Province, Zhengzhou, China
| | - Shu-Ting Li
- Traditional Chinese Medicine Integrated Department of Nephrology, The First Affiliated Hospital of Zhengzhou University
- Institute of Nephrology, Zhengzhou University
- Henan Province Clinical Research Center for Kidney Disease
- Key Laboratory of Precision Diagnosis and Treatment for Chronic Kidney Disease in Henan Province, Zhengzhou, China
| | - Rui Zhou
- Traditional Chinese Medicine Integrated Department of Nephrology, The First Affiliated Hospital of Zhengzhou University
- Institute of Nephrology, Zhengzhou University
- Henan Province Clinical Research Center for Kidney Disease
- Key Laboratory of Precision Diagnosis and Treatment for Chronic Kidney Disease in Henan Province, Zhengzhou, China
| | - Ming-Yan Li
- Traditional Chinese Medicine Integrated Department of Nephrology, The First Affiliated Hospital of Zhengzhou University
- Institute of Nephrology, Zhengzhou University
- Henan Province Clinical Research Center for Kidney Disease
- Key Laboratory of Precision Diagnosis and Treatment for Chronic Kidney Disease in Henan Province, Zhengzhou, China
| | - Zi-Hui Mao
- Traditional Chinese Medicine Integrated Department of Nephrology, The First Affiliated Hospital of Zhengzhou University
- Institute of Nephrology, Zhengzhou University
- Henan Province Clinical Research Center for Kidney Disease
- Key Laboratory of Precision Diagnosis and Treatment for Chronic Kidney Disease in Henan Province, Zhengzhou, China
| | - Dong-Wei Liu
- Traditional Chinese Medicine Integrated Department of Nephrology, The First Affiliated Hospital of Zhengzhou University
- Institute of Nephrology, Zhengzhou University
- Henan Province Clinical Research Center for Kidney Disease
- Key Laboratory of Precision Diagnosis and Treatment for Chronic Kidney Disease in Henan Province, Zhengzhou, China
| | - Zhang-Suo Liu
- Traditional Chinese Medicine Integrated Department of Nephrology, The First Affiliated Hospital of Zhengzhou University
- Institute of Nephrology, Zhengzhou University
- Henan Province Clinical Research Center for Kidney Disease
- Key Laboratory of Precision Diagnosis and Treatment for Chronic Kidney Disease in Henan Province, Zhengzhou, China
| | - Peng Wu
- Traditional Chinese Medicine Integrated Department of Nephrology, The First Affiliated Hospital of Zhengzhou University
- Institute of Nephrology, Zhengzhou University
- Henan Province Clinical Research Center for Kidney Disease
- Key Laboratory of Precision Diagnosis and Treatment for Chronic Kidney Disease in Henan Province, Zhengzhou, China
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13
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Kearney J, Gnudi L. The Pillars for Renal Disease Treatment in Patients with Type 2 Diabetes. Pharmaceutics 2023; 15:pharmaceutics15051343. [PMID: 37242585 DOI: 10.3390/pharmaceutics15051343] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 04/20/2023] [Accepted: 04/21/2023] [Indexed: 05/28/2023] Open
Abstract
The diabetes epidemic and the increasing number of patients with diabetic chronic vascular complications poses a significant challenge to health care providers. Diabetic kidney disease is a serious diabetes-mediated chronic vascular complication and represents a significant burden for both patients and society in general. Diabetic kidney disease not only represents the major cause of end stage renal disease but is also paralleled by an increase in cardiovascular morbidity and mortality. Any interventions to delay the development and progression of diabetic kidney disease are important to reduce the associated cardiovascular burden. In this review we will discuss five therapeutic tools for the prevention and treatment of diabetic kidney disease: drugs inhibiting the renin-angiotensin-aldosterone system, statins, the more recently recognized sodium-glucose co-transporter-2 inhibitors, glucagon-like peptide 1 agonists, and a novel non-steroidal selective mineralocorticoid receptor antagonist.
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Affiliation(s)
- Jessica Kearney
- Department of Diabetes and Endocrinology, Guy's and St Thomas NHS Foundation Trust, London SE1 9RT, UK
| | - Luigi Gnudi
- Department of Diabetes and Endocrinology, Guy's and St Thomas NHS Foundation Trust, London SE1 9RT, UK
- School of Cardiovascular and Metabolic Medicine & Sciences, British Heart Foundation Centre of Research Excellence, Faculty of Life Sciences & Medicine, King's College London, London WC2R 2LS, UK
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14
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Jhee JH, Oh D, Seo J, Lee CJ, Chung MY, Park JT, Han SH, Kang SW, Park S, Yoo TH. Short-term Blood Pressure Variability and Incident CKD in Patients With Hypertension: Findings From the Cardiovascular and Metabolic Disease Etiology Research Center-High Risk (CMERC-HI) Study. Am J Kidney Dis 2023; 81:384-393.e1. [PMID: 36241008 DOI: 10.1053/j.ajkd.2022.08.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 08/14/2022] [Indexed: 11/05/2022]
Abstract
RATIONALE & OBJECTIVE The association between short-term blood pressure variability (BPV) and kidney outcomes is poorly understood. This study evaluated the association between short-term BPV and kidney disease outcomes in people with hypertension. STUDY DESIGN Prospective observational cohort study. SETTING & PARTICIPANTS 1,173 hypertensive participants in the Cardiovascular and Metabolic Disease Etiology Research Center-High Risk (2013-2018) Study with estimated glomerular filtration rate (eGFR) ≥60mL/min/1.73m2. EXPOSURE Short-term BPV assessed by average real variability (ARV). OUTCOME Composite kidney disease outcome (30% decline in eGFR from baseline, new occurrence of eGFR <60mL/min/1.73m2, or onset of UACR >300mg/g). ANALYTICAL APPROACH Multivariable Cox regression analyses to evaluate the association between systolic and diastolic BP ARV (SBP-ARV and DBP-ARV) and outcomes. RESULTS During a median follow-up of 5.4 [4.1-6.5] years, 271 events of the composite kidney disease outcome occurred (46.5 per 1,000 person-years). Multivariable Cox analysis revealed that the highest SBP-ARV and DBP-ARV tertiles were associated with a higher risk of the composite kidney disease outcome than the lowest tertiles, independent of the 24-hour SBP or DBP levels (HR, 1.64 [95% CI, 1.16-2.33], and 1.60 [95% CI, 1.15-2.24] for SBP-ARV and DBP-ARV, respectively). These associations were consistent when SBP-ARV and DBP-ARV were treated as continuous variables (HR per 1.0-unit greater SBP-ARV, 1.03 [95% CI, 1.01-1.06]; HR per 1.0-unit greater DBP-ARV, 1.04 [95% CI, 1.01-1.08]). These associations were consistent, irrespective of subgroups (age, sex, 24-hour SBP or DBP, and moderate albuminuria). However, other measures of short-term BPV including SD, coefficient of variation, and dipping patterns were not associated with the composite kidney disease outcome. LIMITATIONS Observational study design, the use of single measurement of 24-hour BP, lack of information on changes in antihypertensive medication during the follow-up. CONCLUSIONS Short-term BPV is associated with the development of a composite kidney disease outcome in hypertensive patients.
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Affiliation(s)
- Jong Hyun Jhee
- Division of Nephrology, Department of Internal Medicine, Gangnam Severance Hospital, College of Medicine, Yonsei University, Seoul, South Korea
| | - Donghwan Oh
- Division of Nephrology, Department of Internal Medicine, Gangnam Severance Hospital, College of Medicine, Yonsei University, Seoul, South Korea
| | - Jiwon Seo
- Division of Cardiology, Department of Internal Medicine, Gangnam Severance Hospital, College of Medicine, Yonsei University, Seoul, South Korea
| | - Chan Joo Lee
- Division of Cardiology, Severance Cardiovascular Hospital, College of Medicine, Yonsei University, Seoul, South Korea
| | - Min-Yu Chung
- Personalized Diet Research Group, Korea Food Research Institute, Jeonju, South Korea
| | - Jung Tak Park
- Department of Internal Medicine, Institute of Kidney Disease Research, College of Medicine, Yonsei University, Seoul, South Korea
| | - Seung Hyeok Han
- Department of Internal Medicine, Institute of Kidney Disease Research, College of Medicine, Yonsei University, Seoul, South Korea
| | - Shin-Wook Kang
- Department of Internal Medicine, Institute of Kidney Disease Research, College of Medicine, Yonsei University, Seoul, South Korea
| | - Sungha Park
- Personalized Diet Research Group, Korea Food Research Institute, Jeonju, South Korea.
| | - Tae-Hyun Yoo
- Department of Internal Medicine, Institute of Kidney Disease Research, College of Medicine, Yonsei University, Seoul, South Korea.
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15
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Vakali E, Rigopoulos D, Dinas PC, Drosatos IA, Theodosiadi AG, Vazeou A, Stergiou G, Kollias A. Relationship between Short- and Mid-Term Glucose Variability and Blood Pressure Profile Parameters: A Scoping Review. J Clin Med 2023; 12:jcm12062362. [PMID: 36983362 PMCID: PMC10053380 DOI: 10.3390/jcm12062362] [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: 02/16/2023] [Revised: 03/12/2023] [Accepted: 03/15/2023] [Indexed: 03/30/2023] Open
Abstract
Background. Increased variability of glucose (GV) and blood pressure (BPV) is linked to a higher risk of macro- and microvascular complications and other hard endpoints. This scoping review aims to summarize the existing evidence regarding the association between the parameters of the blood pressure (BP) profile, especially BPV, with indices of short- and mid-term GV. Methods. A literature search was conducted in the MEDLINE/PubMed, Cochrane, Embase, Web of Science, and Wiley Online Library databases. Results. The main findings of this review are as follows: (i) 13 studies were included, mainly with small sample sizes; (ii) there was a considerable degree of heterogeneity in the characteristics of the study participants (age range, individuals with normoglycemia, type 1 or 2 diabetes, normal BP, or hypertension), as well as in the methodologies (mainly in terms of the duration of the data collection period) and variability indices examined (mean amplitude of glycemic excursions and coefficient of glucose variation most frequently reported); and (iii) the results were heterogeneous regarding the association between GV and the parameters of the BP profile. Conclusions. There is a significant lack of evidence on the association between GV and BPV. Future research implementing a standardized methodology should focus on the determinants, association, and clinical relevance of GV and BPV.
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Affiliation(s)
- Elena Vakali
- Hypertension Center STRIDE-7, National and Kapodistrian University of Athens, School of Medicine, Third Department of Medicine, Sotiria Hospital, 11527 Athens, Greece
- Endocrinology-Growth and Development Department, P&A Kyriakou Children's Hospital, 11527 Athens, Greece
| | | | - Petros C Dinas
- FAME Laboratory, Department of Physical Education and Sports Science, University of Thessaly, 42100 Trikala, Greece
| | | | - Aikaterini G Theodosiadi
- Hypertension Center STRIDE-7, National and Kapodistrian University of Athens, School of Medicine, Third Department of Medicine, Sotiria Hospital, 11527 Athens, Greece
| | - Andriani Vazeou
- Diabetes Center, A' Department of Pediatrics, P&A Kyriakou Children's Hospital, 11527 Athens, Greece
| | - George Stergiou
- Hypertension Center STRIDE-7, National and Kapodistrian University of Athens, School of Medicine, Third Department of Medicine, Sotiria Hospital, 11527 Athens, Greece
| | - Anastasios Kollias
- Hypertension Center STRIDE-7, National and Kapodistrian University of Athens, School of Medicine, Third Department of Medicine, Sotiria Hospital, 11527 Athens, Greece
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16
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Lithovius R, Groop PH. The many faces of hypertension in individuals with type 1 diabetes. Diabetes Res Clin Pract 2023; 197:110564. [PMID: 36738830 DOI: 10.1016/j.diabres.2023.110564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 01/20/2023] [Accepted: 01/27/2023] [Indexed: 02/05/2023]
Abstract
Several disturbed blood pressure (BP) patterns, including disparities between office and out-of-office BP measurements (such as white-coat and masked hypertension), disturbed circadian BP variability (such as abnormal dipping patterns and nocturnal hypertension) and treatment-resistant hypertension, are common in individuals with type 1 diabetes. Consequently, office or home BP measurements alone may not reflect real BP variation and may lead to inadequate diagnosis and treatment of hypertension. The early detection of these disturbed BP patterns is especially crucial in individuals with type 1 diabetes, as these patterns may indicate future development of adverse cardiovascular and renal outcomes. In this review we will describe these disturbed BP patterns and discuss recent findings on their prevalence and outcomes. We will also address critical areas for future research to determine the true prevalence and prognosis of disturbed BP patterns, and to optimize and improve the knowledge and management of high-risk individuals with type 1 diabetes and disturbed BP patterns.
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Affiliation(s)
- Raija Lithovius
- Folkhälsan Institute of Genetics, Folkhälsan Research Centre, Helsinki, Finland; Department of Nephrology, University of Helsinki and Helsinki University Hospital, Finland; Research Program for Clinical and Molecular Metabolism, Faculty of Medicine, University of Helsinki, Finland
| | - Per-Henrik Groop
- Folkhälsan Institute of Genetics, Folkhälsan Research Centre, Helsinki, Finland; Department of Nephrology, University of Helsinki and Helsinki University Hospital, Finland; Research Program for Clinical and Molecular Metabolism, Faculty of Medicine, University of Helsinki, Finland; Department of Diabetes, Central Clinical School, Monash University, Melbourne, VIC, Australia.
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17
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Gnudi L. Renal disease in patients with type 2 diabetes: Magnitude of the problem, risk factors and preventive strategies. Presse Med 2023; 52:104159. [PMID: 36565753 DOI: 10.1016/j.lpm.2022.104159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 12/14/2022] [Indexed: 12/24/2022] Open
Affiliation(s)
- Luigi Gnudi
- School of Cardiovascular and Metabolic Medicine & Sciences, Faculty of Life Sciences & Medicine, King's College London, London, United Kingdom.
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18
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Jones NK, Costello HM, Monaghan MT, Stewart K, Binnie D, Marks J, Bailey MA, Culshaw GJ. Sodium-glucose cotransporter 2 inhibition does not improve the acute pressure natriuresis response in rats with type 1 diabetes. Exp Physiol 2023; 108:480-490. [PMID: 36644793 PMCID: PMC10103849 DOI: 10.1113/ep090849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 12/19/2022] [Indexed: 01/17/2023]
Abstract
NEW FINDINGS What is the central question of this study? Sodium-glucose cotransporter 2 (SGLT2) inhibitors reduce cardiovascular risk in patients with both diabetic and non-diabetic kidney disease: can SGLT2 inhibition improve renal pressure natriuresis (PN), an important mechanism for long-term blood pressure control, which is impaired in type 1 diabetes mellitus (T1DM)? What is the main finding and its importance? The SGLT2 inhibitor dapagliflozin did not enhance the acute in vivo PN response in either healthy or T1DM Sprague-Dawley rats. The data suggest that the mechanism underpinning the clinical benefits of SGLT2 inhibitors on health is unlikely to be due to an enhanced natriuretic response to increased blood pressure. ABSTRACT Type 1 diabetes mellitus (T1DM) leads to serious complications including premature cardiovascular and kidney disease. Hypertension contributes importantly to these adverse outcomes. The renal pressure natriuresis (PN) response, a key regulator of blood pressure (BP), is impaired in rats with T1DM as tubular sodium reabsorption fails to down-regulate with increasing BP. We hypothesised that sodium-glucose cotransporter 2 (SGLT2) inhibitors, which reduce cardiovascular risk in kidney disease, would augment the PN response in T1DM rats. Non-diabetic or T1DM (35-50 mg/kg streptozotocin i.p.) adult male Sprague-Dawley rats were anaesthetised (thiopental 50 mg/kg i.p.) and randomised to receive either dapagliflozin (1 mg/kg i.v.) or vehicle. Baseline sodium excretion was measured and then BP was increased by sequential arterial ligations to induce the PN response. In non-diabetic animals, the natriuretic and diuretic responses to increasing BP were not augmented by dapagliflozin. Dapagliflozin induced glycosuria, but this was not influenced by BP. In T1DM rats the PN response was impaired. Dapagliflozin again increased urinary glucose excretion but did not enhance PN. Inhibition of SGLT2 does not enhance the PN response in rats, either with or without T1DM. SGLT2 makes only a minor contribution to tubular sodium reabsorption and does not contribute to the impaired PN response in T1DM.
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Affiliation(s)
- Natalie K. Jones
- British Heart Foundation Centre for Cardiovascular ScienceUniversity of EdinburghEdinburghUK
| | - Hannah M. Costello
- British Heart Foundation Centre for Cardiovascular ScienceUniversity of EdinburghEdinburghUK
| | | | - Kevin Stewart
- British Heart Foundation Centre for Cardiovascular ScienceUniversity of EdinburghEdinburghUK
| | - David Binnie
- British Heart Foundation Centre for Cardiovascular ScienceUniversity of EdinburghEdinburghUK
| | - Joanne Marks
- Department of NeurosciencePhysiology and Pharmacology, Royal Free CampusUniversity College LondonLondonUK
| | - Matthew A. Bailey
- British Heart Foundation Centre for Cardiovascular ScienceUniversity of EdinburghEdinburghUK
| | - Geoffrey J. Culshaw
- British Heart Foundation Centre for Cardiovascular ScienceUniversity of EdinburghEdinburghUK
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19
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Bell DSH. Detecting and treating the protean manifestations of diabetic autonomic neuropathy. Diabetes Obes Metab 2023; 25:1162-1173. [PMID: 36748121 DOI: 10.1111/dom.15004] [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: 12/13/2022] [Revised: 01/17/2023] [Accepted: 02/02/2023] [Indexed: 02/08/2023]
Abstract
The manifestations of diabetic autonomic neuropathy (DAN) are protean and clinically involve multiple systems, including the cardiovascular system, the gastrointestinal system, the genitourinary system as well as the sweat glands (sudomotor dysfunction) and the gallbladder. In addition, cardiac autonomic neuropathy (CAN) is associated with a correctible inability to appreciate and correct hypoglycaemia. While not a clinical problem, pupillary involvement should be the clue and the catalyst to investigate for other manifestations of DAN. This review outlines a practical approach to detecting and investigating the manifestations of DAN. Of particular importance is early detection of cardiovascular involvement where prompt therapy through glycaemic control can decrease the severity of CAN and decelerate the frequency and severity of retinopathy and nephropathy in addition to decreasing cardiovascular events and mortality. CAN also plays a role in accelerating other diabetic complications such as acute ischaemic stroke, heart failure, medial artery calcinosis, foot ulcers, peripheral artery disease and Charcot joints. Many therapies of DAN are available, which should not only decrease morbidity and mortality from DAN, but also improve the patient's quality of life. However, the therapies available are largely symptomatic.
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20
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Bansal N, Raedi WA, Medar SS, Abraham L, Beddows K, Hsu DT, Lamour JM, Mahgerefteh J. Masked Hypertension in Pediatric Heart Transplant Recipients. Pediatr Cardiol 2023; 44:1003-1008. [PMID: 36656319 DOI: 10.1007/s00246-023-03096-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Accepted: 01/10/2023] [Indexed: 01/20/2023]
Abstract
BACKGROUND Masked hypertension (HTN), especially, isolated nocturnal HTN (INH) has been shown to be a risk factor for cardiovascular disease (CVD) but is not studied well in pediatric heart transplant (PHT) patients. Ambulatory blood pressure monitoring (ABPM) is known to identify patients with HTN but is not used routinely in PHT. METHODS A single-center, prospective, cross-sectional study of PHT recipients was performed to observe the incidence of masked HTN using 24-h ABPM. The relationship between ABPM parameters and clinical variables was assessed using Spearman correlation coefficient. p value < 0.05 was considered significant. RESULTS ABPM was performed in 34 patients, mean age 14 ± 5 years, median 5.5 years post-PHT. All patients had normal cardiac function, left ventricular mass index and blood pressure measurements in the clinic. Four patients had known prior HTN and on medications, one of them was uncontrolled. Of the remaining 30 patients, 18 new patients were diagnosed with masked HTN, of which 14 had INH. Diurnal variation was abnormal in 82% (28/34) patients. 24-h diastolic blood pressure (DBP) index correlated with glomerular filtration rate (GFR) (r = - 0.44, p = 0.01). There was no correlation between other ABPM parameters with tacrolimus trough levels. CONCLUSIONS ABPM identified masked HTN in 60% of patients, with majority being INH. Abnormal circadian BP patterns were present in 82% and an association was found between GFR and DBP parameters. HTN, especially INH, is under-recognized in PHT recipients and ABPM has a role in their long-term care.
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Affiliation(s)
- Neha Bansal
- Division of Pediatric Cardiology, Children's Hospital at Montefiore, Albert Einstein College of Medicine, 3415 Bainbridge Ave- R1, Bronx, NY, 10467, USA.
| | - Waheed A Raedi
- Division of Pediatric Cardiology, Children's Hospital at Montefiore, Albert Einstein College of Medicine, 3415 Bainbridge Ave- R1, Bronx, NY, 10467, USA
| | - Shivanand S Medar
- Division of Pediatric Cardiology, Children's Hospital at Montefiore, Albert Einstein College of Medicine, 3415 Bainbridge Ave- R1, Bronx, NY, 10467, USA.,Division of Pediatric Critical Care Medicine, Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Lincy Abraham
- Division of Pediatric Cardiology, Children's Hospital at Montefiore, Albert Einstein College of Medicine, 3415 Bainbridge Ave- R1, Bronx, NY, 10467, USA
| | - Kimberly Beddows
- Division of Pediatric Cardiology, Children's Hospital at Montefiore, Albert Einstein College of Medicine, 3415 Bainbridge Ave- R1, Bronx, NY, 10467, USA
| | - Daphne T Hsu
- Division of Pediatric Cardiology, Children's Hospital at Montefiore, Albert Einstein College of Medicine, 3415 Bainbridge Ave- R1, Bronx, NY, 10467, USA
| | - Jacqueline M Lamour
- Division of Pediatric Cardiology, Children's Hospital at Montefiore, Albert Einstein College of Medicine, 3415 Bainbridge Ave- R1, Bronx, NY, 10467, USA
| | - Joseph Mahgerefteh
- Division of Pediatric Cardiology, Children's Hospital at Montefiore, Albert Einstein College of Medicine, 3415 Bainbridge Ave- R1, Bronx, NY, 10467, USA
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Lurbe E, Mancia G, Calpe J, Drożdż D, Erdine S, Fernandez-Aranda F, Hadjipanayis A, Hoyer PF, Jankauskiene A, Jiménez-Murcia S, Litwin M, Mazur A, Pall D, Seeman T, Sinha MD, Simonetti G, Stabouli S, Wühl E. Joint statement for assessing and managing high blood pressure in children and adolescents: Chapter 1. How to correctly measure blood pressure in children and adolescents. Front Pediatr 2023; 11:1140357. [PMID: 37138561 PMCID: PMC10150446 DOI: 10.3389/fped.2023.1140357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Accepted: 03/13/2023] [Indexed: 05/05/2023] Open
Abstract
The joint statement is a synergistic action between HyperChildNET and the European Academy of Pediatrics about the diagnosis and management of hypertension in youth, based on the European Society of Hypertension Guidelines published in 2016 with the aim to improve its implementation. The first and most important requirement for the diagnosis and management of hypertension is an accurate measurement of office blood pressure that is currently recommended for screening, diagnosis, and management of high blood pressure in children and adolescents. Blood pressure levels should be screened in all children starting from the age of 3 years. In those children with risk factors for high blood pressure, it should be measured at each medical visit and may start before the age of 3 years. Twenty-four-hour ambulatory blood pressure monitoring is increasingly recognized as an important source of information as it can detect alterations in circadian and short-term blood pressure variations and identify specific phenotypes such as nocturnal hypertension or non-dipping pattern, morning blood pressure surge, white coat and masked hypertension with prognostic significance. At present, home BP measurements are generally regarded as useful and complementary to office and 24-h ambulatory blood pressure for the evaluation of the effectiveness and safety of antihypertensive treatment and furthermore remains more accessible in primary care than 24-h ambulatory blood pressure. A grading system of the clinical evidence is included.
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Affiliation(s)
- Empar Lurbe
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Madrid, Spain
- Department of Pediatric, Consorcio Hospital General, University of Valencia, Valencia, Spain
- Correspondence: Empar Lurbe Elke Wühl Adamos Hadjipanayis
| | | | | | - Dorota Drożdż
- Department of Pediatric Nephrology and Hypertension, Pediatric Institute, Jagiellonian University Medical College, Kraków, Poland
| | - Serap Erdine
- Istanbul University-Cerrahpaşa, Cerrahpaşa Faculty of Medicine, Istanbul, Turkey
| | - Fernando Fernandez-Aranda
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Madrid, Spain
- University Hospital of Bellvitge-IDIBELL, Barcelona, Spain
- Department of Clinical Sciences, University of Barcelona, Barcelona, Spain
| | - Adamos Hadjipanayis
- School of Medicine, European University Cyprus, Nicosia, Cyprus
- Department of Paediatrics, Larnaca General Hospital, Larnaca, Cyprus
- Correspondence: Empar Lurbe Elke Wühl Adamos Hadjipanayis
| | - Peter F. Hoyer
- Department of Pediatrics II, University Hospital Essen, Essen, Germany
| | - Augustina Jankauskiene
- Pediatric Center, Institute of Clinical Medicine, Vilnius University, Vilnius, Lithuania
| | - Susana Jiménez-Murcia
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Madrid, Spain
- University Hospital of Bellvitge-IDIBELL, Barcelona, Spain
- Department of Clinical Sciences, University of Barcelona, Barcelona, Spain
| | - Mieczysław Litwin
- Department of Nephrology, Kidney Transplantation and Hypertension, The Children's Memorial Health Institute, Warsaw, Poland
| | - Artur Mazur
- Institute of Medical Sciences, Medical College, Rzeszów University, Rzeszow, Poland
| | - Denes Pall
- Department of Medical Clinical Pharmacology, University of Debrecen, Debrecen, Hungary
- Department of Medicine, University of Debrecen, Debrecen, Hungary
| | - Tomas Seeman
- Division of Pediatric Nephrology, University Children’s Hospital, Charles University, Prague, Czechia
- Department of Pediatrics, University Hospital Ostrava, Ostrava, Czechia
| | - Manish D. Sinha
- Department of Paediatric Nephrology, Evelina London Children's Hospital, Guy's and St Thomas’ NHS Foundation Trust, London, United Kingdom
| | - Giacomo Simonetti
- Institute of Pediatrics of Southern Switzerland, Ente Ospedaliero Cantonale (EOC), Bellinzona, Switzerland
| | - Stella Stabouli
- 1st Department of Pediatrics, Aristotle University of Thessaloniki, Hippokratio General Hospital of Thessaloniki, Thessaloniki, Greece
| | - Elke Wühl
- Division of Pediatric Nephrology, Center for Pediatrics and Adolescent Medicine, Heidelberg University Hospital, Heidelberg, Germany
- Correspondence: Empar Lurbe Elke Wühl Adamos Hadjipanayis
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22
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Ruilope LM, Ortiz A, Lucia A, Miranda B, Alvarez-Llamas G, Barderas MG, Volpe M, Ruiz-Hurtado G, Pitt B. Prevention of cardiorenal damage: importance of albuminuria. Eur Heart J 2022; 44:1112-1123. [PMID: 36477861 DOI: 10.1093/eurheartj/ehac683] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Revised: 10/20/2022] [Accepted: 11/09/2022] [Indexed: 12/12/2022] Open
Abstract
Abstract
Chronic kidney disease (CKD) is projected to become a leading global cause of death by 2040, and its early detection is critical for effective and timely management. The current definition of CKD identifies only advanced stages, when kidney injury has already destroyed >50% of functioning kidney mass as reflected by an estimated glomerular filtration rate <60 mL/min/1.73 m2 or a urinary albumin/creatinine ratio >six-fold higher than physiological levels (i.e. > 30 mg/g). An elevated urinary albumin-excretion rate is a known early predictor of future cardiovascular events. There is thus a ‘blind spot’ in the detection of CKD, when kidney injury is present but is undetectable by current diagnostic criteria, and no intervention is made before renal and cardiovascular damage occurs. The present review discusses the CKD ‘blind spot’ concept and how it may facilitate a holistic approach to CKD and cardiovascular disease prevention and implement the call for albuminuria screening implicit in current guidelines. Cardiorenal risk associated with albuminuria in the high-normal range, novel genetic and biochemical markers of elevated cardiorenal risk, and the role of heart and kidney protective drugs evaluated in recent clinical trials are also discussed. As albuminuria is a major risk factor for cardiovascular and renal disease, starting from levels not yet considered in the definition of CKD, the implementation of opportunistic or systematic albuminuria screening and therapy, possibly complemented with novel early biomarkers, has the potential to improve cardiorenal outcomes and mitigate the dismal 2040 projections for CKD and related cardiovascular burden.
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Affiliation(s)
- Luis M Ruilope
- Cardiorenal Translational Laboratory, Institute of Research Imas12, Hospital Universitario , 12 de Octubre, Avenida de Córdoba s/n , Spain
- CIBER-CV, Hospital Universitario , Av. de Córdoba s/n, 28041, Madrid , Spain
- Faculty of Sport Sciences, Universidad Europea de Madrid , Tajo, s/n, 28670 Villaviciosa de Odón, Madrid , Spain
| | - Alberto Ortiz
- IIS-Fundación Jiménez Díaz, Universidad Autónoma de Madrid , Av. de los Reyes Católicos, 2, 28040 Madrid , Spain
- RICORS2040, Hospital Universitario Fundación Jiménez Díaz , Madrid , Spain
| | - Alejandro Lucia
- Faculty of Sport Sciences, Universidad Europea de Madrid , Tajo, s/n, 28670 Villaviciosa de Odón, Madrid , Spain
| | - Blanca Miranda
- Fundación Renal Íñigo Álvarez de Toledo , José Abascal, 42, 28003 Madrid , Spain
| | - Gloria Alvarez-Llamas
- IIS-Fundación Jiménez Díaz, Universidad Autónoma de Madrid , Av. de los Reyes Católicos, 2, 28040 Madrid , Spain
- RICORS2040, Hospital Universitario Fundación Jiménez Díaz , Madrid , Spain
| | - Maria G Barderas
- Department of Vascular Physiopathology, Hospital Nacional de Parapléjicos (HNP), SESCAM , FINCA DE, Carr. de la Peraleda, S/N, 45004 Toledo , Spain
| | - Massimo Volpe
- Cardiology, Department of Clinical and Molecular Medicine, Sapienza University of Rome and IRCCS San Raffaele Rome , Sant'Andrea Hospital, Rome , Italy
| | - Gema Ruiz-Hurtado
- Cardiorenal Translational Laboratory, Institute of Research Imas12, Hospital Universitario , 12 de Octubre, Avenida de Córdoba s/n , Spain
- CIBER-CV, Hospital Universitario , Av. de Córdoba s/n, 28041, Madrid , Spain
| | - Bertram Pitt
- Division of Cardiology, University of Michigan School of Medicine , Ann Arbor, MI , USA
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23
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Narkiewicz K, Kjeldsen SE, Egan BM, Kreutz R, Burnier M. Masked hypertension in type 2 diabetes: never take normotension for granted and always assess out-of-office blood pressure. Blood Press 2022; 31:207-209. [PMID: 35941816 DOI: 10.1080/08037051.2022.2107483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Affiliation(s)
- Krzysztof Narkiewicz
- Department of Hypertension and Diabetology, Medical University of Gdansk, Gdansk, Poland
| | - Sverre E Kjeldsen
- Department of Cardiology and Nephrology, Ullevaal Hospital, University of Oslo, Oslo, Norway
| | - Brent M Egan
- American Medical Association, University of South Carolina, Greenville, South Carolina, USA
| | - Reinhold Kreutz
- Institute of Clinical Pharmacology and Toxicology, Universitatsmedizin Berlin Institut fur Medizin- Pflegepadagogik und Pflegewissenschaft, Berlin, Germany
| | - Michel Burnier
- Department of Nephrology, University of Lausanne, Lausanne, Switzerland
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24
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Morić BV, Šamija I, Sabolić LLG, Stipančić G. Is there a characteristic pattern of ambulatory blood pressure profile in type 1 diabetic children and adolescents? Ann Pediatr Endocrinol Metab 2022; 27:300-307. [PMID: 36200311 PMCID: PMC9816465 DOI: 10.6065/apem.2244022.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 02/28/2022] [Indexed: 01/13/2023] Open
Abstract
PURPOSE To examine the characteristics of ambulatory blood pressure (ABP) including blood pressure variability (BPV) and its association with albuminuria in type 1 diabetic (T1D) children and to identify potential predictors of high-normal albuminuria and microalbuminuria. METHODS ABP monitoring was performed in 201 T1D children and adolescents (mean age, 14.7±3.8 years) with T1D duration over 1 year. The level of albuminuria was assessed as the albumin/creatinine ratio (ACR) and patients were further classified as low-normal, high-normal or microalbuminuria. RESULTS Fifteen T1D children (7.5%) were hypertensive using office blood pressure (BP) and 10 (5%) according to ABP. T1D subjects had elevated 24-hour systolic BP (SBP) and diastolic BP (DBP) (+0.2 and + 0.3 standard deviation score [SDS]) and nighttime SBP and DBP (+0.6 and +0.8 SDS) compared to reference values. Patients with microalbuminuria had significantly higher 24-hour, daytime and nighttime DBP compared to normoalbuminuric subjects. There was a high percentage of nondippers (74.1%). Nighttime diastolic BPV was significantly higher in subjects with high-normal compared to low-normal albuminuria (p=0.01). A weak correlation was found between ACR and daytime DBP SDS (r=0.29, p<0.001 and nighttime DBP SDS (r=0.21, p=0.003). Age and nighttime diastolic BPV were predictors of high-normal albuminuria while nighttime DBP was a strong predictor for microalbuminuria. CONCLUSION T1D children have impaired BP regulation although most of them do not fulfill the criteria for sustained hypertension. There is an association between diastolic ABP and diastolic BPV with rising levels of albuminuria pointing to a clear connection between BP and incipient diabetic nephropathy.
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Affiliation(s)
- Bernardica Valent Morić
- Department of Pediatrics, Sestre Milosrdnice University Hospital Center, Zagreb, Croatia,Address for correspondence: Bernardica Valent Morić Department of Pediatrics, Sestre milosrdnice University Hospital Center, Vinogradska 29, 10000 Zagreb, Croatia
| | - Ivan Šamija
- Department of Oncology and Nuclear Medicine, Sestre milosrdnice University Hospital Center, Zagreb, Croatia
| | | | - Gordana Stipančić
- Department of Pediatrics, Sestre Milosrdnice University Hospital Center, Zagreb, Croatia
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25
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Bjornstad P, Dart A, Donaghue KC, Dost A, Feldman EL, Tan GS, Wadwa RP, Zabeen B, Marcovecchio ML. ISPAD Clinical Practice Consensus Guidelines 2022: Microvascular and macrovascular complications in children and adolescents with diabetes. Pediatr Diabetes 2022; 23:1432-1450. [PMID: 36537531 DOI: 10.1111/pedi.13444] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 10/27/2022] [Indexed: 12/24/2022] Open
Affiliation(s)
- Petter Bjornstad
- Section of Endocrinology, Department of Pediatrics, Division of Renal Diseases and Hypertension, Department of Medicine, University of Colorado School of Medicine, Denver, Colorado, USA
| | - Allison Dart
- Department of Pediatrics, Divison of Nephrology, Children's Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada
| | - Kim C Donaghue
- Department of Pediatrics, Division of Endocrinology, The Children's Hospital at Westmead, Sydney, New South Wales, Australia.,Discipline of Child and Adolescent Health, University of Sydney, Sydney, New South Wales, Australia
| | - Axel Dost
- Department of Pediatrics, Division of Endocrinology, Jena University Hospital, Jena, Germany
| | - Eva L Feldman
- Department of Medicine, Division of Neurology, University of Michigan School of Medicine, Ann Arbor, Michigan, USA
| | - Gavin S Tan
- Singapore Eye Research Institute, Singapore National Eye Center, Singapore.,Department of Ophthalmology and Visual Sciences, Duke-NUS Medical School, National University of Singapore, Singapore
| | - R Paul Wadwa
- Section of Endocrinology, Department of Pediatrics, Division of Renal Diseases and Hypertension, Department of Medicine, University of Colorado School of Medicine, Denver, Colorado, USA
| | - Bedowra Zabeen
- Department of Paediatrics and Changing Diabetes in Children Program, Bangladesh Institute of Research and Rehabilitation in Diabetes Endocrine and Metabolic Disorders, Dhaka, Bangladesh
| | - M Loredana Marcovecchio
- Department of Paediatrics, University of Cambridge, and Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
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26
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Izmailova O, Kabaliei A, Shynkevych V, Shlykova O, Kaidashev I. PPARG agonist pioglitazone influences diurnal kidney medulla mRNA expression of core clock, inflammation-, and metabolism-related genes disrupted by reverse feeding in mice. Physiol Rep 2022; 10:e15535. [PMID: 36511486 PMCID: PMC9746034 DOI: 10.14814/phy2.15535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 11/17/2022] [Accepted: 11/21/2022] [Indexed: 06/17/2023] Open
Abstract
This study examined the influence of PPARG activation by pioglitazone (PG) on the mRNA of core clock, inflammation- and metabolism-related genes in the mouse kidney medulla as well as urinary sodium/potassium excretion rhythms disrupted by reverse feeding. Mice were assigned to daytime feeding and nighttime feeding groups. PG 20 mg/kg was administered at 7 am or 7 pm. On day 8 of the feeding intervention, mice were killed at noon and midnight. Kidney medulla expression of Arntl, Clock, Nr1d1, Cry1, Cry2, Per1, Per2, Nfe2l2, Pparg, and Scnn1g was determined by qRT PCR. We measured urinary K+ , Na+ , urine volume, food, and H2 O intake. The reverse feeding uncoupled the peripheral clock gene rhythm in mouse kidney tissues. It was accompanied by a decreased expression of Nfe2l2 and Pparg as well as an increased expression of Rela and Scnn1g. These changes in gene expressions concurred with an increase in urinary Na+ , K+ , water excretion, microcirculation disorders, and cell loss, especially in distal tubules. PG induced the restoration of diurnal core clock gene expression as well as Nfe2l2, Pparg, Scnn1g mRNA, and decreased Rela expressions, stimulating Na+ reabsorption and inhibiting K+ excretion. PG intake at 7 pm was more effective than at 7 am.
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27
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Chiriacò M, Sacchetta L, Forotti G, Leonetti S, Nesti L, Taddei S, Natali A, Solini A, Tricò D. Prognostic value of 24-hour ambulatory blood pressure patterns in diabetes: A 21-year longitudinal study. Diabetes Obes Metab 2022; 24:2127-2137. [PMID: 35676796 PMCID: PMC9796931 DOI: 10.1111/dom.14798] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 05/25/2022] [Accepted: 06/06/2022] [Indexed: 01/07/2023]
Abstract
AIMS To establish the long-term prognostic value of abnormal circadian blood pressure (BP) patterns in diabetes. MATERIALS AND METHODS We retrospectively examined a cohort of 349 outpatients with diabetes who were screened for microvascular complications and followed up for 21 years. Dipping, nondipping and reverse-dipping status were defined based on 24-hour ambulatory BP monitoring (ABPM) as ≥10% reduction, <10% reduction, and any increase in average nighttime versus daytime systolic BP (SBP), respectively. RESULTS After 6251 person-years of follow-up (median [range] follow-up 21.0 [1.1-22.0] years, 52% women, age 57.1 ± 11.9 years, 81.4% type 2 diabetes and 18.6% type 1 diabetes), a total of 136 deaths (39%) occurred. Compared with dippers, the nondippers and reverse dippers showed progressively higher prevalence of chronic kidney disease (CKD), cardiac autonomic neuropathy (CAN) and postural hypotension. Reverse dippers showed a 13.4% (2.5-year) reduction in mean overall survival and a twofold increased risk of all-cause mortality after adjustment for traditional risk factors (hazard ratio 2.2 [95% confidence interval 1.3-3.8]). Each 1% decrease in nighttime versus daytime SBP ratio was independently associated with a 4% reduction in 20-year mortality risk. CONCLUSIONS In patients with diabetes, reverse dipping is associated with a higher prevalence of CKD and CAN and more than doubled the adjusted risk of all-cause mortality over a 21-year observation.
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Affiliation(s)
- Martina Chiriacò
- Metabolism, Nutrition, and Atherosclerosis LaboratoryUniversity of PisaPisaItaly
- Department of Clinical and Experimental MedicineUniversity of PisaPisaItaly
| | - Luca Sacchetta
- Metabolism, Nutrition, and Atherosclerosis LaboratoryUniversity of PisaPisaItaly
- Department of Clinical and Experimental MedicineUniversity of PisaPisaItaly
| | | | - Simone Leonetti
- Metabolism, Nutrition, and Atherosclerosis LaboratoryUniversity of PisaPisaItaly
| | - Lorenzo Nesti
- Metabolism, Nutrition, and Atherosclerosis LaboratoryUniversity of PisaPisaItaly
- Unit of Internal Medicine 5University Hospital of PisaPisaItaly
| | - Stefano Taddei
- Department of Clinical and Experimental MedicineUniversity of PisaPisaItaly
| | - Andrea Natali
- Metabolism, Nutrition, and Atherosclerosis LaboratoryUniversity of PisaPisaItaly
- Department of Clinical and Experimental MedicineUniversity of PisaPisaItaly
| | - Anna Solini
- Department of Surgical, Medical and Molecular Pathology and Critical Care MedicineUniversity of PisaPisaItaly
| | - Domenico Tricò
- Metabolism, Nutrition, and Atherosclerosis LaboratoryUniversity of PisaPisaItaly
- Department of Clinical and Experimental MedicineUniversity of PisaPisaItaly
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28
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Costello HM, Johnston JG, Juffre A, Crislip GR, Gumz ML. Circadian clocks of the kidney: function, mechanism, and regulation. Physiol Rev 2022; 102:1669-1701. [PMID: 35575250 PMCID: PMC9273266 DOI: 10.1152/physrev.00045.2021] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 05/03/2022] [Accepted: 05/07/2022] [Indexed: 11/22/2022] Open
Abstract
An intrinsic cellular circadian clock is located in nearly every cell of the body. The peripheral circadian clocks within the cells of the kidney contribute to the regulation of a variety of renal processes. In this review, we summarize what is currently known regarding the function, mechanism, and regulation of kidney clocks. Additionally, the effect of extrarenal physiological processes, such as endocrine and neuronal signals, on kidney function is also reviewed. Circadian rhythms in renal function are an integral part of kidney physiology, underscoring the importance of considering time of day as a key biological variable. The field of circadian renal physiology is of tremendous relevance, but with limited physiological and mechanistic information on the kidney clocks this is an area in need of extensive investigation.
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Affiliation(s)
- Hannah M Costello
- Department of Physiology and Functional Genomics, University of Florida, Gainesville, Florida
- Division of Nephrology, Hypertension, and Renal Transplantation, Department of Medicine, University of Florida, Gainesville, Florida
| | - Jermaine G Johnston
- Division of Nephrology, Hypertension, and Renal Transplantation, Department of Medicine, University of Florida, Gainesville, Florida
- North Florida/South Georgia Malcom Randall Department of Veterans Affairs Medical Center, Gainesville, Florida
| | - Alexandria Juffre
- Department of Physiology and Functional Genomics, University of Florida, Gainesville, Florida
- Division of Nephrology, Hypertension, and Renal Transplantation, Department of Medicine, University of Florida, Gainesville, Florida
- Department of Biochemistry and Molecular Biology, University of Florida, Gainesville, Florida
| | - G Ryan Crislip
- Department of Physiology and Functional Genomics, University of Florida, Gainesville, Florida
- Division of Nephrology, Hypertension, and Renal Transplantation, Department of Medicine, University of Florida, Gainesville, Florida
| | - Michelle L Gumz
- Department of Physiology and Functional Genomics, University of Florida, Gainesville, Florida
- Division of Nephrology, Hypertension, and Renal Transplantation, Department of Medicine, University of Florida, Gainesville, Florida
- North Florida/South Georgia Malcom Randall Department of Veterans Affairs Medical Center, Gainesville, Florida
- Department of Biochemistry and Molecular Biology, University of Florida, Gainesville, Florida
- Center for Integrative Cardiovascular and Metabolic Diseases, University of Florida, Gainesville, Florida
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29
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Velayutham V, Benitez-Aguirre P, Craig M, Cho YH, Liew G, Donaghue K. Cardiac Autonomic Nerve Dysfunction Predicts Incident Retinopathy and Early Kidney Dysfunction in Adolescents With Type 1 Diabetes. Diabetes Care 2022; 45:2391-2395. [PMID: 35997303 DOI: 10.2337/dc22-0349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Accepted: 07/10/2022] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Cardiac autonomic neuropathy (CAN) may contribute to vascular complications in diabetes. We hypothesized that adolescents with CAN are at greater risk of diabetic retinopathy and early kidney dysfunction. RESEARCH DESIGN AND METHODS In this prospective longitudinal study of 725 adolescents with type 1 diabetes without retinopathy and albuminuria at baseline, early CAN was defined as one or more abnormalities in seven heart rate tests derived from a 10-min electrocardiogram. Retinopathy was defined as the presence of one or more microaneurysms, early kidney dysfunction as an albumin excretion rate (AER) >7.5 μg/min, and albuminuria as an AER >20 μg/min. Multivariable generalized estimating equations were used to examine the association between CAN and retinopathy or early kidney dysfunction. Cox proportional hazards regression analysis was used to assess cumulative risks of incident retinopathy and albuminuria. RESULTS At baseline, the mean age of the sample was 13.6 ± 2.6 years, 52% were male, and mean diabetes duration was 6.1 ± 3.3 years. Over a median follow-up of 3.8 (interquartile range 2.2-7.5) years, the complication rate 27% for retinopathy, 16% for early kidney dysfunction, and 3% for albuminuria. The mean study HbA1c was 72.3 ± 16 mmol/mmol (8.6 ± 1.4%). CAN predicted incident retinopathy (odds ratio 2.0 [95% CI 1.4, 2.9]) and early kidney dysfunction (1.4 [1.0, 2.0]) after adjusting for HbA1c and diabetes duration. CAN also predicted retinopathy (hazard ratio 1.57 [95% CI 1.09, 2.26]) and albuminuria (2.30 [1.05, 5.04]) independently of HbA1c. CONCLUSIONS CAN predicted incident retinopathy and kidney dysfunction in adolescents with type 1 diabetes, likely reflecting autonomic microvascular dysregulation contributing to complications. Therefore, screening and interventions to reduce CAN may influence the risk of complications.
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Affiliation(s)
- Vallimayil Velayutham
- The Children's Hospital at Westmead, Sydney, New South Wales, Australia.,Discipline of Child and Adolescent Health, Faculty of Medicine and Health, University of Sydney, New South Wales, Australia.,Campbelltown Hospital, Campbelltown, New South Wales, Australia
| | - Paul Benitez-Aguirre
- The Children's Hospital at Westmead, Sydney, New South Wales, Australia.,Discipline of Child and Adolescent Health, Faculty of Medicine and Health, University of Sydney, New South Wales, Australia
| | - Maria Craig
- The Children's Hospital at Westmead, Sydney, New South Wales, Australia.,Discipline of Child and Adolescent Health, Faculty of Medicine and Health, University of Sydney, New South Wales, Australia.,School of Women's and Children's Health, University of New South Wales, Kensington, New South Wales, Australia
| | - Yoon Hi Cho
- The Children's Hospital at Westmead, Sydney, New South Wales, Australia.,Discipline of Child and Adolescent Health, Faculty of Medicine and Health, University of Sydney, New South Wales, Australia
| | - Gerald Liew
- Centre for Vision Research, Department of Ophthalmology, and Westmead Institute for Medical Research, University of Sydney, Sydney, New South Wales, Australia
| | - Kim Donaghue
- The Children's Hospital at Westmead, Sydney, New South Wales, Australia.,Discipline of Child and Adolescent Health, Faculty of Medicine and Health, University of Sydney, New South Wales, Australia
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30
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Yang M, Chen W, He L, Liu D, Zhao L, Wang X. Intermittent Fasting—A Healthy Dietary Pattern for Diabetic Nephropathy. Nutrients 2022; 14:nu14193995. [PMID: 36235648 PMCID: PMC9571963 DOI: 10.3390/nu14193995] [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: 08/15/2022] [Revised: 09/20/2022] [Accepted: 09/23/2022] [Indexed: 11/17/2022] Open
Abstract
Diabetic nephropathy (DN), a metabolic disease, is characterized by severe systemic metabolic disorders. A unique dietary pattern, such as intermittent fasting (IF) has shown promising protective effects on various metabolic diseases, such as diabetes and cardiovascular and nervous system diseases. However, its role in regulating kidney disease, especially in DN, is still being investigated. Here, we summarize the current research progress, highlighting the relationship between IF and the risk factors for the progression of DN, and discuss the potential mechanisms by which IF improves renal injury in DN. Finally, we propose IF as a potential strategy to prevent and delay DN progression. Abbreviation: DN: Diabetic nephropathy; IF: Intermittent fasting; CPT1A: Carnitine palmitoyltransferase 1A; L-FABP: Liver-type fatty acid-binding protein; STZ: Streptozotocin; LDL: Low-density lipoproteins; HIIT: High-intensity interval training; CKD: Chronic kidney disease; ACEI: Angiotensin-converting enzyme inhibitors; ARB: Angiotensin receptor blockers; MDA: Malondialdehyde; mtDNA: Mitochondrial DNA; UCP3: Uncoupling protein-3; MAM: Mitochondria-associated endoplasmic reticulum membrane; PBMCs: Peripheral blood mononuclear cells; ERK1/2: Extracellular signal-regulated kinase 1/2; DRP1: Dynamin-related protein 1; β-HB: β-Hydroxybutyrate; AcAc: Acetoacetate; GEO: Gene Expression Omnibus; NCBI: National Center for Biotechnology Information; mTORC1: Mechanistic target of rapamycin complex 1; HMGCS2: 3-Hydroxy-3-methylglutaryl-CoA synthase 2; GSK3β: Glycogen synthase kinase 3β; AKI: Acute kidney injury; CMA: Chaperone-mediated autophagy; FGF21: Fibroblast growth factor 21.
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Affiliation(s)
- Ming Yang
- Department of Nutrition, Xiangya Hospital, Central South University, Changsha 410008, China
- Department of Nephrology, The Second Xiangya Hospital of Central South University, Changsha 410011, China
| | - Wei Chen
- Department of Nephrology, The Second Xiangya Hospital of Central South University, Changsha 410011, China
| | - Liyu He
- Department of Nephrology, The Second Xiangya Hospital of Central South University, Changsha 410011, China
| | - Di Liu
- Department of Nephrology, The Second Xiangya Hospital of Central South University, Changsha 410011, China
| | - Li Zhao
- Department of Reproduction and Genetics, The First Affiliated Hospital of Kunming Medical University, Kunming 650032, China
| | - Xi Wang
- Department of Nutrition, Xiangya Hospital, Central South University, Changsha 410008, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha 410008, China
- Correspondence:
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31
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Navarro J, Sanchez A, Ba Aqeel SH, Ye M, Rehman MZ, Wysocki J, Rademaker A, Molitch ME, Batlle D. Urinary Angiotensinogen in Patients With Type 1 Diabetes With Microalbuminuria: Gender Differences and Effect of Intensive Insulin Therapy. Kidney Int Rep 2022; 7:2657-2667. [PMID: 36506234 PMCID: PMC9727532 DOI: 10.1016/j.ekir.2022.09.010] [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: 07/20/2022] [Revised: 08/25/2022] [Accepted: 09/12/2022] [Indexed: 12/15/2022] Open
Abstract
Introduction Angiotensinogen (AOG) is the precursor of peptides of the renin angiotensin system (RAS). Because insulin up-regulates transcriptional factors that normally repress kidney AOG synthesis, we evaluated urinary AOG (uAOG) in patients with type 1 diabetes (T1D) and microalbuminuria who are receiving either intensive or conventional insulin therapy. Methods Urine samples from participants of the Diabetes Control and Complications Trial (DCCT) were used for the following: (i) uAOG/creatinine measurements in 103 patients with microalbuminuria and 103 patients with normoalbuminuria, matched for age, gender, disease duration, and allocation to insulin therapy; and (ii) uAOG/creatinine measurements from patients with microalbuminuria allocated to intensive insulin therapy (n = 58) or conventional insulin therapy (n = 41) after 3 years on each modality. Results uAOG was higher in patients who started with microalbuminuria than in those with normoalbuminuria (6.65 vs. 4.0 ng/mg creatinine, P < 0.01). uAOG was higher in females than in males with microalbuminuria (11.7 vs. 5.4 ng/mg creatinine, P = 0.015). uAOG was lower in patients with microalbuminuria allocated to intensive insulin therapy than in conventional insulin therapy (3.98 vs. 7.42 ng/mg creatinine, P < 0.01). These differences in uAOG were observed though albumin excretion rate (AER) was not significantly different. Conclusion In patients with T1D and microalbuminuria, uAOG is increased and varies with gender and the type of insulin therapy independently of AER. This suggests that AOG production is increased in females and it is decreased by intensive insulin therapy. The reduction in uAOG with intensive insulin therapy, by kidney RAS downregulation, may contribute to the known renoprotective action associated with intensive insulin and improved glycemic control.
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Affiliation(s)
- Jessica Navarro
- Division of Nephrology and Hypertension, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Alejandro Sanchez
- Division of Nephrology and Hypertension, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Sheeba H. Ba Aqeel
- Division of Nephrology and Hypertension, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Minghao Ye
- Division of Nephrology and Hypertension, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Mohammed Z. Rehman
- Division of Nephrology and Hypertension, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Jan Wysocki
- Division of Nephrology and Hypertension, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Alfred Rademaker
- Division of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Mark E. Molitch
- Division of Endocrinology, Metabolism and Molecular Medicine, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Daniel Batlle
- Division of Nephrology and Hypertension, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA,Correspondence: Daniel Batlle, Division of Nephrology and Hypertension, Department of Medicine, The Feinberg School of Medicine, Northwestern University, 320 E Superior, Chicago, Illinois 60611, USA.
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Larkins NG. Expanding insights into the role of nocturnal blood pressure variation in children. Kidney Int Rep 2022; 7:2327-2328. [DOI: 10.1016/j.ekir.2022.09.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022] Open
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Bedtime dosing of antihypertensive medications: systematic review and consensus statement: International Society of Hypertension position paper endorsed by World Hypertension League and European Society of Hypertension. J Hypertens 2022; 40:1847-1858. [PMID: 35983870 DOI: 10.1097/hjh.0000000000003240] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Antihypertensive drug therapy is one of the most efficient medical interventions for preventing disability and death globally. Most of the evidence supporting its benefits has been derived from outcome trials with morning dosing of medications. Accumulating evidence suggests an adverse prognosis associated with night-time hypertension, nondipping blood pressure (BP) profile and morning BP surge, with increased incidence of cardiovascular events during the first few morning hours. These observations provide justification for complete 24-h BP control as being the primary goal of antihypertensive treatment. Bedtime administration of antihypertensive drugs has also been proposed as a potentially more effective treatment strategy than morning administration. This Position Paper by the International Society of Hypertension reviewed the published evidence on the clinical relevance of the diurnal variation in BP and the timing of antihypertensive drug treatment, aiming to provide consensus recommendations for clinical practice. Eight published outcome hypertension studies involved bedtime dosing of antihypertensive drugs, and all had major methodological and/or other flaws and a high risk of bias in testing the impact of bedtime compared to morning treatment. Three ongoing, well designed, prospective, randomized controlled outcome trials are expected to provide high-quality data on the efficacy and safety of evening or bedtime versus morning drug dosing. Until that information is available, preferred use of bedtime drug dosing of antihypertensive drugs should not be routinely recommended in clinical practice. Complete 24-h control of BP should be targeted using readily available, long-acting antihypertensive medications as monotherapy or combinations administered in a single morning dose.
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Muntean C, Starcea IM, Banescu C. Diabetic kidney disease in pediatric patients: A current review. World J Diabetes 2022; 13:587-599. [PMID: 36159227 PMCID: PMC9412860 DOI: 10.4239/wjd.v13.i8.587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Revised: 06/13/2022] [Accepted: 07/11/2022] [Indexed: 02/05/2023] Open
Abstract
In the last decades, a significant increase in the incidence of diabetic kidney disease (DKD) was observed concomitant with rising diabetes mellitus (DM) incidence. Kidney disease associated with DM in children and adolescents is represented by persistent albuminuria, arterial hypertension, progressive decline in estimated glomerular filtration rate to end-stage renal disease and increased cardiovascular and all-cause morbidity and mortality of these conditions. In medical practice, the common and still the “gold standard” marker for prediction and detection of diabetic kidney involvement in pediatric diabetes is represented by microalbuminuria screening even if it has low specificity to detect early stages of DKD. There are some known limitations in albuminuria value as a predictor biomarker for DKD, as not all diabetic children with microalbuminuria or macroalbuminuria will develop end-stage renal disease. As tubular damage occurs before the glomerular injury, tubular biomarkers are superior to the glomerular ones. Therefore, they may serve for early detection of DKD in both type 1 DM and type 2 DM. Conventional and new biomarkers to identify diabetic children and adolescents at risk of renal complications at an early stage as well as renoprotective strategies are necessary to delay the progression of kidney disease to end-stage kidney disease. New biomarkers and therapeutic strategies are discussed as timely diagnosis and therapy are critical in the pediatric diabetic population.
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Affiliation(s)
- Carmen Muntean
- Department of Pediatrics I, “George Emil Palade” University of Medicine, Pharmacy, Sciences and Technology of Târgu Mures, Târgu Mures 540142, Romania
| | - Iuliana Magdalena Starcea
- Department of IVth Pediatrics, University of Medicine and Pharmacy “Grigore T. Popa”, Iasi 700115, Romania
| | - Claudia Banescu
- Center for Advanced Medical and Pharmaceutical Research, University of Medicine, Pharmacy, Sciences and Technology of Târgu Mureș, Mureș, Târgu Mures 540142, Romania
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Oliveira MI, Dickson SA, Blake R, Pereira YM, Culshaw G. Validation of heart rate spot-check protocol to measure circadian variation and heart rate in healthy dogs and dogs with atrial fibrillation. J Vet Cardiol 2022; 43:41-54. [DOI: 10.1016/j.jvc.2022.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 07/09/2022] [Accepted: 07/18/2022] [Indexed: 11/28/2022]
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Rivetti G, Hursh BE, Miraglia Del Giudice E, Marzuillo P. Acute and chronic kidney complications in children with type 1 diabetes mellitus. Pediatr Nephrol 2022; 38:1449-1458. [PMID: 35896816 PMCID: PMC10060299 DOI: 10.1007/s00467-022-05689-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 07/05/2022] [Accepted: 07/05/2022] [Indexed: 01/09/2023]
Abstract
Children with type 1 diabetes mellitus (T1DM) have an increased risk of developing kidney involvement. Part of the risk establishes at the beginning of T1DM. In fact, up to 65% of children during T1DM onset may experience an acute kidney injury (AKI) which predisposes to the development of a later chronic kidney disease (CKD). The other part of the risk establishes during the following course of T1DM and could be related to a poor glycemic control and the subsequent development of diabetic kidney disease. In this review, we discuss the acute and chronic effects of T1DM on the kidneys, and the implications of these events on the long-term prognosis of kidney function.
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Affiliation(s)
- Giulio Rivetti
- Department of Woman, Child and of General and Specialized Surgery, Università degli Studi della Campania "Luigi Vanvitelli", Via Luigi De Crecchio 2, 80138, Naples, Italy
| | - Brenden E Hursh
- Department of Pediatrics, Division of Endocrinology, British Columbia Children's Hospital and University of British Columbia, 4480 Oak Street, Vancouver, BC, V6H 3V4, Canada
| | - Emanuele Miraglia Del Giudice
- Department of Woman, Child and of General and Specialized Surgery, Università degli Studi della Campania "Luigi Vanvitelli", Via Luigi De Crecchio 2, 80138, Naples, Italy
| | - Pierluigi Marzuillo
- Department of Woman, Child and of General and Specialized Surgery, Università degli Studi della Campania "Luigi Vanvitelli", Via Luigi De Crecchio 2, 80138, Naples, Italy.
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Şaylık F, Çınar T, Selçuk M, Akbulut T. Triglyceride-to-glucose index to detect a non-dipping circadian pattern in newly diagnosed hypertensive patients. J Cardiovasc Thorac Res 2022; 14:147-152. [PMID: 36398051 PMCID: PMC9617059 DOI: 10.34172/jcvtr.2022.20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Accepted: 05/21/2022] [Indexed: 01/27/2024] Open
Abstract
Introduction: In this investigation, we aimed to explore the relationship between the triglyceride-glucose (TyG) index and the non-dipping blood pressure (BP) pattern in newly diagnosed hypertensive patients. Methods: In this retrospective study, 216 consecutive newly diagnosed hypertensive patients who had undergone 24-hour ambulatory blood pressure (ABPM) monitoring and had not received anti-hypertensive drugs were included. Non-dipping status was evaluated by a 24-h ABPM monitoring in all patients. We categorized the patients into two groups as; dippers (n=104 cases) and non-dippers (n=112 cases). The TyG index was derived from the fasting triglyceride and fasting glucose levels using the formula; ln[fasting triglyceride (mg/dL) × fasting glucose (mg/dL)/2]. Results: Non-dipper group had a higher TyG index than the dipper group. The TyG was an independent predictor of non-dipping BP in hypertensive individuals, according to multivariable analysis. The TyG index was negatively associated with a decrease in both systolic and diastolic BP during the nighttime. The ideal cutoff value of the TyG index in detecting non-dipping status was≥9.01 with 74.1% sensitivity and 71.2% specificity. A ROC comparison indicated that the area under the curve value of TyG index was superior to fasting triglyceride, fasting glucose, and homeostasis model assessment of IR (HOMA-IR) in detecting non-dipping BP. Conclusion: The TyG index was an independent predictor of non-dipping status in newly diagnosed hypertensive patients who had undergone 24-hour ABPM monitoring and had not received anti-hypertensive drugs. As a simple and easily obtained parameter, the TyG index can be used to detect such pattern among these patients.
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Affiliation(s)
- Faysal Şaylık
- Department of Cardiology, Van Training and Research Hospital, 65100, Van, Turkey
| | - Tufan Çınar
- Department of Cardiology, Sultan 2. Abdulhamid Han Training and Research Hospital, 34100, Istanbul, Turkey
| | - Murat Selçuk
- Department of Cardiology, Sultan 2. Abdulhamid Han Training and Research Hospital, 34100, Istanbul, Turkey
| | - Tayyar Akbulut
- Department of Cardiology, Van Training and Research Hospital, 65100, Van, Turkey
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Akkoc G, Duzova A, Korkmaz A, Oguz B, Yigit S, Yurdakok M. Long-term follow-up of patients after acute kidney injury in the neonatal period: abnormal ambulatory blood pressure findings. BMC Nephrol 2022; 23:116. [PMID: 35321692 PMCID: PMC8941738 DOI: 10.1186/s12882-022-02735-5] [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: 10/30/2021] [Accepted: 03/11/2022] [Indexed: 11/25/2022] Open
Abstract
Background Data on the long-term effects of neonatal acute kidney injury (AKI) are limited. Methods We invited 302 children who had neonatal AKI and survived to hospital discharge; out of 95 patients who agreed to participate in the study, 23 cases were excluded due to primary kidney, cardiac, or metabolic diseases. KDIGO definition was used to define AKI. When a newborn had no previous serum creatinine, AKI was defined as serum creatinine above the mean plus two standard deviations (SD) (or above 97.5th percentile) according to gestational age, weight, and postnatal age. Clinical and laboratory features in the neonatal AKI period were recorded for 72 cases; at long-term evaluation (2–12 years), kidney function tests with glomerular filtration rate (eGFR) by the Schwartz formula, microalbuminuria, office and 24-h ambulatory blood pressure monitoring (ABPM), and kidney ultrasonography were performed. Results Forty-two patients (58%) had stage I AKI during the neonatal period. Mean age at long-term evaluation was 6.8 ± 2.9 years (range: 2.3–12.0); mean eGFR was 152.3 ± 26.5 ml/min/1.73 m2. Office hypertension (systolic and/or diastolic BP ≥ 95th percentile), microalbuminuria (> 30 mg/g creatinine), and hyperfiltration (> 187 ml/min/1.73 m2) were present in 13.0%, 12.7%, and 9.7% of patients, respectively. ABPM was performed on 27 patients, 18.5% had hypertension, and 40.7% were non-dippers; 48.1% had abnormal findings. Female sex was associated with microalbuminuria; low birth weight (< 1,500 g) and low gestational age (< 32 weeks) were associated with hypertension by ABPM. Twenty-three patients (33.8%) had at least one sign of microalbuminuria, office hypertension, or hyperfiltration. Among 27 patients who had ABPM, 16 (59.3%) had at least one sign of microalbuminuria, abnormal ABPM (hypertension and/or non-dipping), or hyperfiltration. Conclusion Even children who experienced stage 1 and 2 neonatal AKI are at risk for subclinical kidney dysfunction. Non-dipping is seen in four out of 10 children. Long-term follow-up of these patients is necessary.
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Affiliation(s)
- Gulsen Akkoc
- Department of Pediatric Infectious Disease, University of Health Sciences, Haseki Training and Research Hospital Istanbul, Istanbul, Turkey
| | - Ali Duzova
- Division of Pediatric Nephrology, Faculty of Medicine, Hacettepe University, Ankara, Turkey.
| | - Ayse Korkmaz
- Section of Neonatology, Department of Pediatrics, School of Medicine, Acıbadem University, Istanbul, Turkey
| | - Berna Oguz
- Department of Radiology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Sule Yigit
- Division of Neonatology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Murat Yurdakok
- Division of Neonatology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
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Toschi E, Leblanc J, Hafida S, Mehta S, Ritholz M, Gabbay R, Laffel L. Caring for Young Adults With Diabetes in the Adult Care Setting: Summary of a Multidisciplinary Roundtable. FRONTIERS IN CLINICAL DIABETES AND HEALTHCARE 2022; 3:830183. [PMID: 36992759 PMCID: PMC10012109 DOI: 10.3389/fcdhc.2022.830183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 01/31/2022] [Indexed: 01/09/2023]
Abstract
AimsA multidisciplinary team of clinicians and researchers, patients and family members, and representative from national advocacy groups and research organization met to review the literature, highlight gaps, and identify best practices to improve adult care delivery for young adults (YA) with diabetes.MethodsThe participants prepared presentations in advance, rotated through sessions, and contributed to group discussions in three areas: physical health, mental health, and quality of life (QoL). Session moderators and scribes used thematic analysis to summarize discussions for each topic.ResultsThematic analysis revealed four foci for addressing physical health, mental health and QoL: 1) best practices to facilitate the process of transfer; 2) age-specific curricula and guidelines for prevention and management of comorbidities and complications; 3) collaboration with behavioral health clinicians to address diabetes distress and mental health disorders; and 4) research on the impact of diabetes on QoL in YA.ConclusionThere was substantial interest and need among adult clinicians to work in concert with pediatric and mental health professionals to identify best practices and future directions to improve healthcare process and diabetes-related outcome measures in YA with diabetes.
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Affiliation(s)
- Elena Toschi
- Joslin Diabetes Center, Harvard Medical School, Boston, MA, United States
- Section on Clinical, Behavioral, and Outcomes Research, Joslin Diabetes Center, Harvard Medical School, Boston, MA, United States
- *Correspondence: Elena Toschi,
| | - Jennifer Leblanc
- Joslin Diabetes Center, Harvard Medical School, Boston, MA, United States
| | - Samar Hafida
- Joslin Diabetes Center, Harvard Medical School, Boston, MA, United States
| | - Sanjeev Mehta
- Joslin Diabetes Center, Harvard Medical School, Boston, MA, United States
| | - Marilyn Ritholz
- Joslin Diabetes Center, Harvard Medical School, Boston, MA, United States
| | - Robert Gabbay
- American Diabetes Association, Alexandria, VA, United States
| | - Lori Laffel
- Joslin Diabetes Center, Harvard Medical School, Boston, MA, United States
- Section on Clinical, Behavioral, and Outcomes Research, Joslin Diabetes Center, Harvard Medical School, Boston, MA, United States
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Seeman T, Pfaff M, Sethna CB. Isolated nocturnal hypertension in pediatric kidney transplant recipients. Pediatr Transplant 2022; 26:e14192. [PMID: 34845793 DOI: 10.1111/petr.14192] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 10/29/2021] [Accepted: 10/31/2021] [Indexed: 12/30/2022]
Abstract
BACKGROUND Isolated nocturnal hypertension (INH) is defined as nighttime hypertension in the setting of normal daytime blood pressure (BP), diagnosed by ambulatory BP monitoring (ABPM). METHODS AND RESULTS Hypertension affects 60%-80% of pediatric kidney transplant recipients, and INH is the most common type of ambulatory hypertension. INH is associated with an increased prevalence of hypertension-mediated target organ damage such as left ventricular hypertrophy in adults and in pediatric kidney transplant recipients. CONCLUSION Ambulatory BP monitoring should be performed annually in all pediatric kidney transplant recipients to diagnose hypertension phenotypes that are not detectable by office BP such as masked hypertension, white-coat hypertension, or INH. Isolated nocturnal hypertension in pediatric transplant patients requires study as a treatment target.
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Affiliation(s)
- Tomáš Seeman
- Department of Pediatrics, Dr. von Hauner Children's Hospital, University Hospital, Munich, Germany.,Department of Pediatrics, 2nd Faculty of Medicine, Charles University Prague, Prague, Czech Republic
| | - Mairead Pfaff
- Department of Pediatrics, Division of Pediatric Nephrology, Cohen Children's Medical Center, Northwell Health, New Hyde Park, New York, USA
| | - Christine B Sethna
- Department of Pediatrics, Division of Pediatric Nephrology, Cohen Children's Medical Center, Northwell Health, New Hyde Park, New York, USA.,Zucker School of Medicine at Hofstra/Northwell, Uniondale, New York, USA
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Maimaitiming M, Liang P, Bai M, Liu H, Liang X. Study on the related factors affecting the circadian rhythm of blood pressure in patients with essential hypertension. BIOL RHYTHM RES 2022. [DOI: 10.1080/09291016.2022.2044630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Affiliation(s)
- Muyesaier Maimaitiming
- Department of Hypertension, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China
| | - Ping Liang
- Department of Hypertension, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China
| | - Mengpo Bai
- Department of Hypertension, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China
| | - Huijuan Liu
- Department of Hypertension, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China
| | - Xiaohui Liang
- Department of Hypertension, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China
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Gaddam RR, Dhuri K, Kim YR, Jacobs JS, Kumar V, Li Q, Irani K, Bahal R, Vikram A. γ Peptide Nucleic Acid-Based miR-122 Inhibition Rescues Vascular Endothelial Dysfunction in Mice Fed a High-Fat Diet. J Med Chem 2022; 65:3332-3342. [PMID: 35133835 PMCID: PMC8883473 DOI: 10.1021/acs.jmedchem.1c01831] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
![]()
The blood levels
of microRNA-122 (miR-122) is associated with the
severity of cardiovascular disorders, and targeting it with efficient
and safer miR inhibitors could be a promising approach. Here, we report
the generation of a γ-peptide nucleic acid (γPNA)-based
miR-122 inhibitor (γP-122-I) that rescues vascular endothelial
dysfunction in mice fed a high-fat diet. We synthesized diethylene
glycol-containing γP-122-I and found that its systemic administration
counteracted high-fat diet (HFD)-feeding-associated increase in blood
and aortic miR-122 levels, impaired endothelial function, and reduced
glycemic control. A comprehensive safety analysis established that
γP-122-I affects neither the complete blood count nor biochemical
tests of liver and kidney functions during acute exposure. In addition,
long-term exposure to γP-122-I did not change the overall adiposity,
or histology of the kidney, liver, and heart. Thus, γP-122-I
rescues endothelial dysfunction without any evidence of toxicity in vivo and demonstrates the suitability of γPNA technology
in generating efficient and safer miR inhibitors.
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Affiliation(s)
- Ravinder Reddy Gaddam
- Department of Internal Medicine, Carver College of Medicine University of Iowa, Iowa City, Iowa 52242, United States
| | - Karishma Dhuri
- Department of Pharmaceutical Sciences, University of Connecticut, Storrs, Connecticut 06269, United States
| | - Young-Rae Kim
- Department of Internal Medicine, Carver College of Medicine University of Iowa, Iowa City, Iowa 52242, United States
| | - Julia S Jacobs
- Department of Internal Medicine, Carver College of Medicine University of Iowa, Iowa City, Iowa 52242, United States
| | - Vikas Kumar
- Department of Pharmaceutical Sciences, University of Connecticut, Storrs, Connecticut 06269, United States
| | - Qiuxia Li
- Department of Internal Medicine, Carver College of Medicine University of Iowa, Iowa City, Iowa 52242, United States
| | - Kaikobad Irani
- Department of Internal Medicine, Carver College of Medicine University of Iowa, Iowa City, Iowa 52242, United States
| | - Raman Bahal
- Department of Pharmaceutical Sciences, University of Connecticut, Storrs, Connecticut 06269, United States
| | - Ajit Vikram
- Department of Internal Medicine, Carver College of Medicine University of Iowa, Iowa City, Iowa 52242, United States
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Abstract
The reality of life in modern times is that our internal circadian rhythms are often out of alignment with the light/dark cycle of the external environment. This is known as circadian disruption, and a wealth of epidemiological evidence shows that it is associated with an increased risk for cardiovascular disease. Cardiovascular disease remains the top cause of death in the United States, and kidney disease in particular is a tremendous public health burden that contributes to cardiovascular deaths. There is an urgent need for new treatments for kidney disease; circadian rhythm-based therapies may be of potential benefit. The goal of this Review is to summarize the existing data that demonstrate a connection between circadian rhythm disruption and renal impairment in humans. Specifically, we will focus on chronic kidney disease, lupus nephritis, hypertension, and aging. Importantly, the relationship between circadian dysfunction and pathophysiology is thought to be bidirectional. Here we discuss the gaps in our knowledge of the mechanisms underlying circadian dysfunction in diseases of the kidney. Finally, we provide a brief overview of potential circadian rhythm-based interventions that could provide benefit in renal disease.
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Affiliation(s)
- Rajesh Mohandas
- Department of Medicine, Division of Nephrology.,Center for Integrative Cardiovascular and Metabolic Diseases
| | | | - Yogesh Scindia
- Department of Medicine, Division of Nephrology.,Department of Medicine, Division of Pulmonary, Critical Care, and Sleep Medicine.,Department of Pathology, and
| | - Michelle L Gumz
- Department of Medicine, Division of Nephrology.,Center for Integrative Cardiovascular and Metabolic Diseases.,Department of Biochemistry and Molecular Biology.,Department of Physiology and Functional Genomics, University of Florida, Gainesville, Florida, USA
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Banerjee D, Winocour P, Chowdhury TA, De P, Wahba M, Montero R, Fogarty D, Frankel AH, Karalliedde J, Mark PB, Patel DC, Pokrajac A, Sharif A, Zac-Varghese S, Bain S, Dasgupta I. Management of hypertension and renin-angiotensin-aldosterone system blockade in adults with diabetic kidney disease: Association of British Clinical Diabetologists and the Renal Association UK guideline update 2021. BMC Nephrol 2022; 23:9. [PMID: 34979961 PMCID: PMC8722287 DOI: 10.1186/s12882-021-02587-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 10/28/2021] [Indexed: 12/31/2022] Open
Abstract
People with type 1 and type 2 diabetes are at risk of developing progressive chronic kidney disease (CKD) and end-stage kidney failure. Hypertension is a major, reversible risk factor in people with diabetes for development of albuminuria, impaired kidney function, end-stage kidney disease and cardiovascular disease. Blood pressure control has been shown to be beneficial in people with diabetes in slowing progression of kidney disease and reducing cardiovascular events. However, randomised controlled trial evidence differs in type 1 and type 2 diabetes and different stages of CKD in terms of target blood pressure. Activation of the renin-angiotensin-aldosterone system (RAAS) is an important mechanism for the development and progression of CKD and cardiovascular disease. Randomised trials demonstrate that RAAS blockade is effective in preventing/ slowing progression of CKD and reducing cardiovascular events in people with type 1 and type 2 diabetes, albeit differently according to the stage of CKD. Emerging therapy with sodium glucose cotransporter-2 (SGLT-2) inhibitors, non-steroidal selective mineralocorticoid antagonists and endothelin-A receptor antagonists have been shown in randomised trials to lower blood pressure and further reduce the risk of progression of CKD and cardiovascular disease in people with type 2 diabetes. This guideline reviews the current evidence and makes recommendations about blood pressure control and the use of RAAS-blocking agents in different stages of CKD in people with both type 1 and type 2 diabetes.
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Affiliation(s)
- D Banerjee
- St George's Hospitals NHS Foundation Trust, London, UK
| | - P Winocour
- ENHIDE, East and North Herts NHS Trust, Stevenage, UK
| | | | - P De
- City Hospital, Birmingham, UK
| | - M Wahba
- St Helier Hospital, Carshalton, UK
| | | | - D Fogarty
- Belfast Health and Social Care Trust, Belfast, UK
| | - A H Frankel
- Imperial College Healthcare NHS Trust, London, UK
| | | | - P B Mark
- University of Glasgow, Glasgow, UK
| | - D C Patel
- Royal Free London NHS Foundation Trust, London, UK
| | - A Pokrajac
- West Hertfordshire Hospitals, London, UK
| | - A Sharif
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | | | - S Bain
- Swansea University, Swansea, UK
| | - I Dasgupta
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.
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Falkner B, Lurbe E. Primary Hypertension Beginning in Childhood and Risk for Future Cardiovascular Disease. J Pediatr 2021; 238:16-25. [PMID: 34391765 DOI: 10.1016/j.jpeds.2021.08.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 07/28/2021] [Accepted: 08/06/2021] [Indexed: 12/30/2022]
Affiliation(s)
- Bonita Falkner
- Departments of Medicine and Pediatrics, Thomas Jefferson University, Philadelphia, PA.
| | - Empar Lurbe
- Department of Pediatrics, CIBER Fisiopatologia Obesidad y Nutricion, Instituto de Salud Carlos III, University of Valencia, Valencia, Spain
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Bakhoum CY, Vuong KT, Carter CE, Gabbai FB, Ix JH, Garimella PS. Proteinuria and nocturnal blood pressure dipping in hypertensive children and adolescents. Pediatr Res 2021; 90:876-881. [PMID: 33504962 PMCID: PMC8313642 DOI: 10.1038/s41390-020-01315-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 11/17/2020] [Accepted: 11/22/2020] [Indexed: 01/30/2023]
Abstract
BACKGROUND The absence of nocturnal blood pressure dipping is associated with adverse cardiovascular outcomes in adults, and proteinuria is a risk factor for non-dipping in this population. Risk factors for non-dipping in children are largely unknown. METHODS We retrospectively identified patients aged 5-19 years who underwent 24-h ambulatory blood pressure monitoring (ABPM) from August 2018 to January 2019 and had a spot urine protein-to-creatinine ratio (PCR) within 1 year of their ABPM. Dipping was defined as ≥10% reduction in systolic and diastolic blood pressure from day to night. Multivariable logistic and linear regression models evaluated the association of proteinuria with non-dipping. RESULTS Among 77 children identified, 27 (35.1%) were non-dippers. Each two-fold higher urine PCR was associated with 38% higher odds of non-dipping, after adjusting for body mass index (BMI). Higher urine PCR was also associated with a lower diastolic dipping percentage by 1.33 (95% confidence interval 0.31-2.34), after adjusting for BMI, age, and estimated glomerular filtration rate. CONCLUSIONS Limitations of this study include its retrospective design and the time lapse between urine PCR and ABPM. Proteinuria appears to be associated with blood pressure non-dipping in children. This finding needs to be confirmed in prospective studies. IMPACT Our study demonstrates the association of proteinuria with non-dipping of blood pressure in children. This association has been explored in adults, but to our knowledge, this is the first time it is evaluated in children referred for evaluation of elevated blood pressure. Non-dipping is a modifiable risk factor for kidney function decline and cardiovascular disease in adulthood, and thus early identification in children is important. The association between proteinuria and non-dipping in children will allow us to more readily identify those at risk, with a future focus on interventions to modify blood pressure dipping patterns.
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Affiliation(s)
- Christine Y. Bakhoum
- Division of Pediatric Nephrology, Rady Children’s Hospital, San Diego, California,Department of Pediatrics, University of California San Diego, La Jolla, California
| | - Kim T. Vuong
- Department of Pediatrics, University of California San Diego, La Jolla, California
| | - Caitlin E. Carter
- Division of Pediatric Nephrology, Rady Children’s Hospital, San Diego, California,Department of Pediatrics, University of California San Diego, La Jolla, California,Division of Nephrology and Hypertension, Department of Medicine, University of California San Diego, La Jolla, California
| | - Francis B. Gabbai
- Division of Nephrology and Hypertension, Department of Medicine, University of California San Diego, La Jolla, California.,Nephrology Section, Medicine Service, Veterans Affairs San Diego Healthcare System, La Jolla, California
| | - Joachim H. Ix
- Division of Nephrology and Hypertension, Department of Medicine, University of California San Diego, La Jolla, California.,Nephrology Section, Medicine Service, Veterans Affairs San Diego Healthcare System, La Jolla, California
| | - Pranav S. Garimella
- Division of Nephrology and Hypertension, Department of Medicine, University of California San Diego, La Jolla, California
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Abstract
Circadian disruption is pervasive and can occur at multiple organizational levels, contributing to poor health outcomes at individual and population levels. Evidence points to a bidirectional relationship, in that circadian disruption increases disease severity and many diseases can disrupt circadian rhythms. Importantly, circadian disruption can increase the risk for the expression and development of neurologic, psychiatric, cardiometabolic, and immune disorders. Thus, harnessing the rich findings from preclinical and translational research in circadian biology to enhance health via circadian-based approaches represents a unique opportunity for personalized/precision medicine and overall societal well-being. In this Review, we discuss the implications of circadian disruption for human health using a bench-to-bedside approach. Evidence from preclinical and translational science is applied to a clinical and population-based approach. Given the broad implications of circadian regulation for human health, this Review focuses its discussion on selected examples in neurologic, psychiatric, metabolic, cardiovascular, allergic, and immunologic disorders that highlight the interrelatedness between circadian disruption and human disease and the potential of circadian-based interventions, such as bright light therapy and exogenous melatonin, as well as chronotherapy to improve and/or modify disease outcomes.
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Affiliation(s)
- Anna B Fishbein
- Department of Pediatrics, Division of Pediatric Allergy and Immunology, Ann & Robert H. Lurie Children's Hospital, and
| | - Kristen L Knutson
- Department of Neurology and Center for Circadian and Sleep Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Phyllis C Zee
- Department of Neurology and Center for Circadian and Sleep Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
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48
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Does ambulatory blood pressure monitoring contribute anything to clinic blood pressure in paediatric patients with type 1 diabetes? An Pediatr (Barc) 2021; 95:269-271. [PMID: 34483072 DOI: 10.1016/j.anpede.2020.12.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2020] [Accepted: 12/15/2020] [Indexed: 11/21/2022] Open
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49
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The association of nighttime sleep duration and quality with chronic kidney disease in middle-aged and older Chinese: a cohort study. Sleep Med 2021; 86:25-31. [PMID: 34455367 DOI: 10.1016/j.sleep.2021.08.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 07/20/2021] [Accepted: 08/05/2021] [Indexed: 11/24/2022]
Abstract
OBJECTIVE This cohort study aimed to assess the associations between sleep duration and quality with the risk of incident chronic kidney disease (CKD) in middle-aged and older Chinese. METHODS We used the 2011 and 2015 surveys of the China Health and Retirement Longitudinal Study (CHARLS). Nighttime sleep duration was categorized into five groups: ≤4, (4-6], (6-8], (8-10], and >10 h/night. Sleep quality was assessed by restless days in the past week (<1, 1-2, 3-4, and 5-7 days/week). Multivariate logistic regression was used to assess the association between sleep duration and quality with incident CKD. RESULTS A total of 11,339 participants free of CKD at baseline were included in this study. After four years follow-up, the incidence of CKD was 7.8%. There was a "U-shaped" association between sleep duration and risk of CKD. Compared to 6-8 h of nighttime sleep duration, those who slept ≤4 h/night (RR: 1.639, 95% CI: 1.287-2.087) or >10 h/night (RR: 2.342, 95% CI: 1.007-5.451) had increased risk of developing CKD after adjustment for confounders. Participants with 5-7 restless days per week had significantly increased risk of CKD (adjusted RR: 1.686, 95% CI: 1.352-2.102), compared to those who rarely or never had a restless sleep. CONCLUSIONS Extreme nighttime sleep duration and poor sleep quality were associated with increased risk of CKD in middle-aged and older Chinese. Obtaining an optimal nighttime sleep duration and better sleep quality might reduce the risk of CKD.
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50
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Francesca S, Rattazzi M, Faggin E, Palatini P, Puato M. Carotid elasticity is impaired in stage 1 hypertensive patients with well-controlled blood pressure levels. J Hum Hypertens 2021; 36:898-903. [PMID: 34354251 DOI: 10.1038/s41371-021-00584-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 07/19/2021] [Accepted: 07/21/2021] [Indexed: 11/09/2022]
Abstract
Whether impaired arterial elasticity in stage 1 hypertension can be brought back to normal by antihypertensive treatment is unknown. Aim of this study was to evaluate the impact of long-term well-controlled blood pressure (BP) on carotid artery elasticity and endothelial function in stage 1 hypertensive patients. We studied 40 middle-age hypertensives (mean age 49.7 years) whose BP had been kept at target by pharmacological treatment and/or lifestyle modifications for a mean of 7.5 years. Carotid compliance coefficient (CC) and distensibility coefficient (DC) were measured by B-mode ultrasound system. Measurement of carotid intima-media thickness (IMT) was performed in each carotid artery segment, bilaterally. Endothelial function was evaluated by post-occlusion flow mediated dilation (FMD). Forty normotensive subjects matched for age and sex served as controls. In the hypertensive subjects, BP levels were well controlled throughout the study period (mean office BP 133.7 ± 9.0/81.27 ± 7.0 mmHg). However, compared to controls, significantly higher office BP levels and waist circumference were present. Compared to normotensives, carotid elasticity (DC 24.5 ± 9.0 vs 37.0 ± 8.5 10-3/kPa, and CC 0.92 ± 0.34 vs 1.28 ± 0.36 mm2/kPa, p < 0.0005 for both) as well as endothelial function (FMD 5.7 ± 2.4% vs 9.2 ± 2.9%, p < 0.0005) were significantly impaired in hypertensives. In a logistic regression, hypertensive patients had increased risk of impaired carotid vascular stiffness (odds ratio, 95% CI: 13.04 (2.27-74.96), p = 0.004). Despite the "pseudo-normalization" of BP levels, hypertensive patients with long-term well-controlled BP according to current standards exhibited increased local arterial stiffness and endothelial dysfunction suggesting that lower BP targets should be sought.
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Affiliation(s)
- Saladini Francesca
- Cardiology Unit, Cittadella Town Hospital, Cittadella, Padova, Italy. .,Department of Medicine, DIMED, University of Padova, Padova, Italy.
| | - Marcello Rattazzi
- Department of Medicine, DIMED, University of Padova, Padova, Italy.,Medicina Interna I^, Ca' Foncello Hospital, Treviso, Italy
| | | | - Paolo Palatini
- Department of Medicine, DIMED, University of Padova, Padova, Italy
| | - Massimo Puato
- Medicine Unit, Mirano Town Hospital, Mirano, Venezia, Italy
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