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Spahia N, Rroji M, Idrizi A, Spasovski G, Barbullushi M. Sodium and water dynamics in the progression of chronic kidney disease: mechanisms and clinical significance. Int Urol Nephrol 2024; 56:1953-1963. [PMID: 38200365 DOI: 10.1007/s11255-023-03903-8] [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: 09/06/2023] [Accepted: 12/01/2023] [Indexed: 01/12/2024]
Abstract
AIM Lifestyle modifications can postpone the progression of chronic kidney disease toward its terminal stage. This mini-review aims to explore the impact of salt and water intake on the progression of chronic kidney disease (CKD) and provide insights into the optimal consumption levels to preserve the glomerular filtration rate. METHODS We reviewed relevant literature to examine the association between salt and water consumption and CKD progression. Our analysis includes discussions on the pathophysiology, findings from clinical trials, and recommended intake guidelines. RESULTS Sodium intake, often linked to cardiovascular risk and CKD progression, has shown a complex J-shaped association in some studies, leading to uncertainty about the ideal salt intake level. Sodium and fluid retention are key factors contributing to hypertension, a well-established risk factor for CKD progression. Low-sodium diets have demonstrated promise in reducing blood pressure and enhancing the effects of renin-angiotensin-aldosterone system inhibitors in non-dialysis CKD patients. However, a debate persists regarding the independent effect of salt restriction on CKD progression. Despite medical recommendations, salt consumption remains high among CKD patients. Additionally, the role of water consumption in CKD remains controversial despite its established benefits for CKD prevention in the general population. CONCLUSION Lifestyle modifications involving salt and water intake can influence the progression of CKD. While low-sodium diets have shown potential for mitigating hypertension and proteinuria in non-dialysis CKD patients, their independent impact on CKD progression warrants further investigation. The role of water consumption in CKD remains uncertain, and there is a need for additional research in this area. Clinicians should consider individualized dietary recommendations for CKD patients to help preserve the glomerular filtration rate and improve overall outcomes.
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Affiliation(s)
- Nereida Spahia
- Department of Nephrology, University Hospital Center "Mother Teresa", Tirana, Albania.
| | - Merita Rroji
- Department of Nephrology, University Hospital Center "Mother Teresa", Tirana, Albania
| | - Alma Idrizi
- Department of Nephrology, University Hospital Center "Mother Teresa", Tirana, Albania
| | - Goce Spasovski
- Department of Nephrology, Medical Faculty, University Sts. Cyril and Methodius, Skopje, North Macedonia
| | - Myftar Barbullushi
- Department of Nephrology, University Hospital Center "Mother Teresa", Tirana, Albania
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2
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Kang SC, Kang M, Ryu H, Kim S, Kim JH, Kang E, Jeong Y, Kim J, Kim YS, Kim SW, Kim YH, Oh KH. Measured sodium excretion is associated with cardiovascular outcomes in non-dialysis CKD patients: results from the KNOW-CKD study. FRONTIERS IN NEPHROLOGY 2023; 3:1236177. [PMID: 37675361 PMCID: PMC10479682 DOI: 10.3389/fneph.2023.1236177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 08/03/2023] [Indexed: 09/08/2023]
Abstract
Background There are insufficient studies on the effect of dietary salt intake on cardiovascular (CV) outcomes in chronic kidney disease (CKD) patients, and there is no consensus on the sodium (Na) intake level that increases the risk of CV disease in CKD patients. Therefore, we investigated the association between dietary salt intake and CV outcomes in CKD patients. Methods In the Korean cohort study for Outcome in patients with CKD (KNOW-CKD), 1,937 patients were eligible for the study, and their dietary Na intake was estimated using measured 24h urinary Na excretion. The primary outcome was a composite of CV events and/or all-cause death. The secondary outcome was a major adverse cardiac event (MACE). Results Among 1,937 subjects, there were 205 (10.5%) events for the composite outcome and 110 (5.6%) events for MACE. Compared to the reference group (urinary Na excretion< 2.0g/day), the group with the highest measured 24h urinary Na excretion (urinary Na excretion ≥ 8.0g/day) was associated with increased risk of both the composite outcome (hazard ratio 3.29 [95% confidence interval 1.00-10.81]; P = 0.049) and MACE (hazard ratio 6.28 [95% confidence interval 1.45-27.20]; P = 0.013) in a cause-specific hazard model. Subgroup analysis also showed a pronounced association between dietary salt intake and the composite outcome in subgroups of patients with abdominal obesity, female, lower estimated glomerular filtration rate (< 60 ml/min per 1.73m2), no overt proteinuria, or a lower urinary potassium-to-creatinine ratio (< 46 mmol/g). Conclusion A high-salt diet is associated with CV outcomes in non-dialysis CKD patients.
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Affiliation(s)
- Seong Cheol Kang
- Department of Medical Sciences, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Minjung Kang
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Hyunjin Ryu
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Seonmi Kim
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Ji Hye Kim
- Department of Internal Medicine, Chungbuk National University Hospital, Cheongju, Republic of Korea
| | - Eunjeong Kang
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
- Transplantation Center, Seoul National University Hospital, Seoul, Republic of Korea
| | - Yujin Jeong
- Department of Biostatistics, Korea University College of Medicine, Seoul, Republic of Korea
| | - Jayoun Kim
- Medical Research Collaborating Center, Seoul National University Hospital, Seoul, Republic of Korea
| | - Yong-Soo Kim
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Soo Wan Kim
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Yeong Hoon Kim
- Department of Internal Medicine, Inje University Busan Paik Hospital, Busan, Republic of Korea
| | - Kook-Hwan Oh
- Kidney Research Institute, Seoul National University Medical Research Center, Seoul, Republic of Korea
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
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Elsurer Afsar R, Afsar B, Ikizler TA. Sodium Management in Kidney Disease: Old Stories, New Tricks. Semin Nephrol 2023; 43:151407. [PMID: 37639931 DOI: 10.1016/j.semnephrol.2023.151407] [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] [Indexed: 08/31/2023]
Abstract
Excessive dietary sodium intake is associated with an increased risk of hypertension, especially in the setting of chronic kidney disease (CKD). Although implementation of a low-sodium diet in patients with CKD generally is recommended, data supporting the efficacy of this practice is mostly opinion-based. Few controlled studies have investigated the specific association of dietary sodium intake and cardiovascular events and mortality in CKD. Furthermore, in epidemiologic studies, the association of sodium intake with CKD progression, cardiovascular risk, and mortality is not homogeneous, and both low- and high-sodium intake has been associated with adverse health outcomes in different studies. In general, the adverse effects of high dietary sodium intake are more apparent in the setting of advanced CKD. However, there is no established definitive target level of dietary sodium intake in different CKD stages based on glomerular filtration rate and albuminuria/proteinuria. This review discusses the current challenges regarding the rationale of sodium restriction, target levels and assessment of sodium intake, and interventions for sodium restrictions in CKD in relation to clinical outcomes.
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Affiliation(s)
- Rengin Elsurer Afsar
- Division of Nephrology and Hypertension, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN; Department of Nephrology, Suleyman Demirel University Faculty of Medicine, Isparta, Turkey
| | - Baris Afsar
- Division of Nephrology and Hypertension, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN; Department of Nephrology, Suleyman Demirel University Faculty of Medicine, Isparta, Turkey
| | - Talat Alp Ikizler
- Division of Nephrology and Hypertension, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN; Division of Nephrology and Hypertension, Vanderbilt O'Brien Center for Kidney Disease, Nashville, TN; Department of Veteran Affairs, Tennessee Valley Healthcare System, Nashville, TN.
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4
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Dawson J, McLean C. Nutrition in Conservative Kidney Management: From Evidence to Practice. Semin Nephrol 2023; 43:151399. [PMID: 37506469 DOI: 10.1016/j.semnephrol.2023.151399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/30/2023]
Abstract
Conservative kidney management (CKM) is a treatment option for kidney failure, particularly for the elderly and those with co-morbidities. Dietitians can play an important role in the provision of CKM by enhancing patients' quality of life through the management of nutrition impact symptoms (symptoms that result in decreased eating, including anorexia, nausea, dry mouth, and taste changes), as well as symptoms that result from malnutrition, including fatigue, weakness, activity intolerance, slow wound healing, and low mood. There are many gaps in the literature regarding optimal nutritional recommendations for patients on CKM. More research is needed on symptom management and interventions to delay or slow the progression of malnutrition and frailty. This article provides an overview of important nutritional considerations, a synthesis of the current literature, and recommendations for application of evidence into the practice of CKM.
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Affiliation(s)
- Jessica Dawson
- Department of Nutrition and Dietetics, St George Hospital, Sydney, New South Wales, Australia; NHMRC Clinical Trials Centre, University of Sydney, Sydney, New South Wales, Australia.
| | - Cameron McLean
- Department of Nutrition and Dietetics, St George Hospital, Sydney, New South Wales, Australia; School of Medical, Indigenous and Health Sciences, University of Wollongong, Wollongong, New South Wales, Australia
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Low dialysate sodium in children and young adults on maintenance hemodialysis: a prospective, randomized, crossover study. Pediatr Nephrol 2022; 38:1599-1607. [PMID: 36315274 DOI: 10.1007/s00467-022-05792-y] [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: 08/31/2022] [Revised: 09/29/2022] [Accepted: 10/12/2022] [Indexed: 03/01/2023]
Abstract
BACKGROUND The optimal dialysate sodium concentration (dNa) in children on hemodialysis (HD) is unknown. The aim of this study was to compare the effect on interdialytic weight gain (IDWG) and blood pressure (BP) of a low (135 mmol/l) and standard dNa (138 mmol/l) in children and young adults on maintenance HD. METHODS This prospective single-blind randomized crossover study consisted of a randomized sequence of two phases: "standard dNa" of 138 mmol/L and "low dNa" of 135 mmol/L. Each phase lasted 4 weeks. Inclusion criteria were age < 25 years, hypertension, pre-HD serum Na (sNa) ≥ 130 mmol/L, and occurrence of symptoms in less than 25% of sessions. Primary outcomes were pre-HD systolic and diastolic BP and IDWG. RESULTS Fifteen patients were recruited, mean age 17.8 ± 4.4 years. Pre-HD SBP and DBP were not different between the two treatments. Mean IDWG was significantly lower with low dNa than with standard dNa: 2.12 ± 1.39% vs. 2.77 ± 1.53%, respectively (p = 0.008). The first-hour refill index (a volume index based on blood-volume monitoring) was significantly lower with dNa 135 mmol/L (p = 0.018). The mean Na gradient (dNa-sNa) was - 2.53 ± 2.4 mmol/L with dNa 135 mmol/L and 0.17 ± 2.8 mmol/L with dNa 138 mmol/L (p = 0.0001). The incidence of symptomatic sessions was similar (1.0% vs. 1.0%). CONCLUSIONS In a selected population of hypertensive pediatric and young adult HD patients, a dNa of 135 mmol/L was associated with a significant reduction of IDWG compared with a dNa of 138 mmol/L. Furthermore, long-term studies are needed to investigate the effect of lowering dNa on BP. A higher resolution version of the Graphical abstract is available as Supplementary information.
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Tan SY, Tuli P, Thio G, Noel B, Marshall B, Yu Z, Torelli R, Fitzgerald S, Chan M, Tucker RM. A Systematic Review of Salt Taste Function and Perception Impairments in Adults with Chronic Kidney Disease. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph191912632. [PMID: 36231932 PMCID: PMC9564527 DOI: 10.3390/ijerph191912632] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 09/27/2022] [Accepted: 09/29/2022] [Indexed: 05/15/2023]
Abstract
Individuals with chronic kidney disease (CKD) experience physiological changes that likely impair salt taste function and perception. Sodium restriction is a cornerstone of CKD management but dietary sodium plays an important role in food enjoyment and may interfere with compliance to this intervention. Therefore, confirming that taste deficits are present in CKD will improve our understanding of how taste deficits can affect intake, and inform dietary counselling in the future. A systematic review was conducted. Studies that included adults with CKD and healthy controls, and assessed salt taste sensitivity, perceived intensity, and/or hedonic ratings were included. Study quality was assessed using the Academy of Nutrition and Dietetics Evidence Analysis Library Quality Criteria Checklist: Primary Research. Of the 16 studies, the majority reported decreased salt taste sensitivity, but no consistent differences in intensity or hedonic ratings were observed. Higher recognition thresholds in CKD patients were associated with higher sodium intake, but results should be interpreted with caution as the measures used were subject to error in this population. In conclusion, salt taste sensitivity is decreased in CKD, but intensity and hedonic evaluations appear to be more robust. Given that hedonic assessments are better predictors of intake, and that salt taste preferences can be changed over time, dietary counselling for low-sodium intake is likely to be effective for this population.
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Affiliation(s)
- Sze-Yen Tan
- School of Exercise and Nutrition Sciences, Deakin University, 221 Burwood Highway, Burwood, VIC 3125, Australia
- Institute for Physical Activity and Nutrition (IPAN), Deakin University, 221 Burwood Highway, Burwood, VIC 3125, Australia
- Correspondence:
| | - Paridhi Tuli
- School of Exercise and Nutrition Sciences, Deakin University, 221 Burwood Highway, Burwood, VIC 3125, Australia
| | - Giecella Thio
- School of Exercise and Nutrition Sciences, Deakin University, 221 Burwood Highway, Burwood, VIC 3125, Australia
| | - Breannah Noel
- School of Exercise and Nutrition Sciences, Deakin University, 221 Burwood Highway, Burwood, VIC 3125, Australia
| | - Bailey Marshall
- School of Exercise and Nutrition Sciences, Deakin University, 221 Burwood Highway, Burwood, VIC 3125, Australia
| | - Zhen Yu
- School of Exercise and Nutrition Sciences, Deakin University, 221 Burwood Highway, Burwood, VIC 3125, Australia
| | - Rachael Torelli
- School of Exercise and Nutrition Sciences, Deakin University, 221 Burwood Highway, Burwood, VIC 3125, Australia
| | - Sarah Fitzgerald
- School of Exercise and Nutrition Sciences, Deakin University, 221 Burwood Highway, Burwood, VIC 3125, Australia
| | - Maria Chan
- Department of Nutrition and Dietetics, The St. George Hospital, Kogarah, NSW 2217, Australia
- Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, NSW 2522, Australia
| | - Robin M. Tucker
- Department of Food Science and Human Nutrition, Michigan State University, 2110 Anthony Hall, 474 S Shaw Lane, East Lansing, MI 48824, USA
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Tsuboi Y, Ichida Y, Murai A, Maeda A, Iida M, Kato A, Ohtomo S, Horiba N. EOS789, pan-phosphate transporter inhibitor, ameliorates the progression of kidney injury in anti-GBM-induced glomerulonephritis rats. Pharmacol Res Perspect 2022; 10:e00973. [PMID: 35621227 PMCID: PMC9137114 DOI: 10.1002/prp2.973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 05/09/2022] [Indexed: 11/08/2022] Open
Abstract
Hyperphosphatemia associated with chronic kidney disease (CKD) not only dysregulates mineral metabolism and bone diseases, but also strongly contributes to the progression of kidney disease itself. We have identified a novel drug for hyperphosphatemia, EOS789, that interacts with several sodium-dependent phosphate transporters (NaPi-IIb, PiT-1, and PiT-2) known to contribute to intestinal phosphate absorption. In this study, we investigated whether EOS789 could ameliorate kidney disease progression in glomerulonephritis rats. Anti-glomerular basement membrane (GBM) nephritis was induced in rats by intravenously administering two types of anti-rat GBM antibodies. We evaluated the effect of EOS789 administered in food admixture on hyperphosphatemia and kidney disease progression. In an anti-GBM nephritis rats, which exhibit a significant increase in serum phosphate and a decline in renal function, EOS789 dose-dependently improved hyperphosphatemia and EOS789 at 0.3% food admixture significantly ameliorated kidney dysfunction as shown in the decline of serum creatinine and BUN. Renal histopathology analysis showed that EOS789 significantly decreased crescent formation in glomeruli. To elucidate the mechanism underlying glomerular disease progression, human mesangial cells were used. High phosphate concentration in media significantly increased the expression of Collagen 1A1, 3A1, and αSMA mRNA in human mesangial cells and EOS789 dose-dependently suppressed these fibrotic markers. These results indicate that EOS789 prevented glomerular crescent formation caused by mesangial fibrosis by ameliorating hyperphosphatemia. In conclusion, EOS789 would not only be useful against hyperphosphatemia but may also have the potential to relieve mesangial proliferative glomerulonephritis with crescent formation.
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Affiliation(s)
- Yoshinori Tsuboi
- Research DivisionChugai Pharmaceutical Co., Ltd.GotembaShizuokaJapan
| | - Yasuhiro Ichida
- Research DivisionChugai Pharmaceutical Co., Ltd.GotembaShizuokaJapan
| | - Atsuko Murai
- Translational Research DivisionChugai Pharmaceutical Co., Ltd.GotembaShizuokaJapan
| | - Akira Maeda
- Research DivisionChugai Pharmaceutical Co., Ltd.GotembaShizuokaJapan
| | - Manami Iida
- Research DivisionChugai Pharmaceutical Co., Ltd.GotembaShizuokaJapan
| | - Atsuhiko Kato
- Translational Research DivisionChugai Pharmaceutical Co., Ltd.GotembaShizuokaJapan
| | - Shuichi Ohtomo
- Translational Research DivisionChugai Pharmaceutical Co., Ltd.GotembaShizuokaJapan
| | - Naoshi Horiba
- Research DivisionChugai Pharmaceutical Co., Ltd.GotembaShizuokaJapan
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8
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Zhang H, Zhu B, Chang L, Ye X, Tian R, He L, Yu D, Chen H, Wang Y. Efficacy and safety of a low-sodium diet and spironolactone in patients with stage 1-3a chronic kidney disease: a pilot study. BMC Nephrol 2022; 23:95. [PMID: 35247964 PMCID: PMC8897863 DOI: 10.1186/s12882-022-02711-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Accepted: 02/20/2022] [Indexed: 12/03/2022] Open
Abstract
Background Excessive salt intake is associated with the deterioration of chronic kidney disease (CKD). Aldosterone is also known as an independent risk factor for kidney injury. Dietary sodium intake acts as a main stimulator in aldosterone-mediated kidney injury. Hence, this study aimed to further investigate the renal protective effects and safety of a low-sodium diet in combination with spironolactone (SPL) in stage 1-3a CKD. Methods This single-center, SPL-blinded randomized controlled trial recruited patients with stage 1-3a CKD, randomized into three groups, low-sodium (3 g/d salt) + placebo, medium-sodium (5 g/d salt) + SPL, and low-sodium (3 g/d salt) + SPL. Patients received 12 weeks of intervention. The primary and secondary endpoints were 24-h urine protein and estimated glomerular filtration rate (eGFR) at the end of the intervention, respectively. Results A total of 74 patients were analyzed eventually. Significantly decreased 24-h urine protein was found in all three groups, from 0.37 to 0.23 g/d (P = 0.004) in the low-sodium+placebo group, from 0.44 to 0.29 g/d (P = 0.020) in the medium-sodium+SPL group, and from 0.35 to 0.31 g/d (P = 0.013) in the low-sodium +SPL group. There were no significant differences among the three groups in 24-h urine protein amount change after intervention from pre-treatment values (P = 0.760, ITT set). The results of the 24-h urine protein by using PP set analysis was similar to the ITT set. No significant differences in eGFR, nutritional, metabolic, inflammatory, and other biomarkers were observed across all three groups (P > 0.05). No safety signal was observed. Conclusion No additional benefit was observed when SPL was prescribed to patients already on a low-sodium diet (3.0 g/d). Still, small doses of SPL may benefit patients with poor sodium restriction. A combination of short-term low-dose SPL and ARB is safe for patients with stage 1-3a CKD, but blood potassium must be regularly monitored. Trial registration Name of the registry: Chinese clinical trial registry. Trial registration number: ChiCTR1900026991. Date of registration: Retrospectively registered 28 October 2019. URL of trial registry record: http://www.chictr.org.cn/searchproj.aspx?title=&officialname=&subjectid=&secondaryid=&applier=&studyleader=ðicalcommitteesanction=&spo Supplementary Information The online version contains supplementary material available at 10.1186/s12882-022-02711-z.
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Ogata S, Akashi Y, Sakusabe T, Yoshizaki S, Maeda Y, Nishimura K, Maeda K, Nakai S. A multiple 24-hour urine collection study indicates that kidney function decline is related to urinary sodium and potassium excretion in patients with chronic kidney disease. Kidney Int 2021; 101:164-173. [PMID: 34774553 DOI: 10.1016/j.kint.2021.10.030] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 10/12/2021] [Accepted: 10/18/2021] [Indexed: 11/28/2022]
Abstract
Multiple 24-hour urine collections are necessary to adequately assess sodium and potassium intake. Here, we assessed kidney function decline for four years after baseline in relation to seven-time averaged 24-hour urinary sodium and potassium excretion (UNaV, UKV), their UNaV/UKV ratio, and their categorical combination in outpatients with chronic kidney disease (CKD). This retrospective cohort study was based on 240 outpatients with baseline CKD stages 3-5, baseline age 20 years or more (median age 72.0 years), and a median follow-up (with interquartile range) of 2.9 (1.4-4.0) years. Outcome was the percentage change in annual slope of estimated glomerular filtration rate (delta eGFR per year). In linear mixed models, percentage changes in delta eGFR per year were -3.26% (95% confidence interval -5.85 to -0.60), +5.20% (2.34 to 8.14), and -5.20% (-7.64 to -2.69), respectively, per one standard deviation increase in the seven-time averaged UNaV and UKV, and their UNaV/UKV ratio. Additionally, percentage changes per year in delta eGFR per year were -16.27% (-23.57 to -8.27) in the middle-to-high UNaV and low UKV group, compared with the low UNaV and middle-to high UKV group. Thus, our study reinforces the observation of opposite associations between GFR decline and urinary excretion rates of sodium (positive) and potassium (negative), respectively. Whether changes in dietary sodium and potassium intake slow GFR decline still requires further study.
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Affiliation(s)
- Soshiro Ogata
- Department of Nephrology, Fujita Health University School of Medicine, Aichi, Japan; Department of Preventive Medicine and Epidemiology, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Yuumi Akashi
- Faculty of Nursing, Fujita Health University School of Health Sciences, Aichi, Japan
| | - Takaya Sakusabe
- Faculty of Clinical Engineering, Fujita Health University School of Medical Sciences, Aichi, Japan
| | | | | | - Kunihiro Nishimura
- Department of Nephrology, Fujita Health University School of Medicine, Aichi, Japan; Department of Preventive Medicine and Epidemiology, National Cerebral and Cardiovascular Center, Osaka, Japan
| | | | - Shigeru Nakai
- Faculty of Clinical Engineering, Fujita Health University School of Medical Sciences, Aichi, Japan.
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10
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Gong N, Zhou C, Hu J, Zhong X, Yi Z, Zhang T, Yang C, Lin Y, Tian J, Qin X, Hu L, Jiang J. High-Salt Diet Accelerated the Decline of Residual Renal Function in Patients With Peritoneal Dialysis. Front Med (Lausanne) 2021; 8:728009. [PMID: 34595194 PMCID: PMC8477204 DOI: 10.3389/fmed.2021.728009] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Accepted: 08/12/2021] [Indexed: 12/24/2022] Open
Abstract
Objective: This study aims to investigate the relationship between dietary salt intake and residual renal function in peritoneal dialysis (PD) patients. Methods: The daily salt intake of the patients was calculated based on a 3 day dietary record. Sixty-two patients were divided into three groups: 33 patients in the low salt intake group (salt intake <6.0 g/day), 17 in the medium salt intake group (salt intake 6.0 to <8.0 g/day), and 12 in the high salt intake group (salt intake ≥8.0 g/day). Regular follow-up was conducted every 3 months. Urine volume, peritoneal ultrafiltration volume, and other clinical indicators were recorded. Biochemical indexes were detected to evaluate the changes in residual renal function and peritoneal function during follow-up. Results: A positive correlation between dietary sodium intake and sodium excretion was found. During 12-month follow-up, a decrease of residual renal function showed a significant difference among the three groups (p = 0.041) (15.3 ± 27.5 vs. 12.5 ± 11.5 vs. 32.9 ± 18.4 L/W/1.73 m2 in the low-, medium-, and high salt intake groups, respectively). Consistently, a higher decline of residual renal function (adjusted β, 20.37; 95% CI, 2.83, 37.91) was found in participants with high salt intake (salt intake ≥8 g/day) compared with those in non-high salt intake. Conclusion: Our study showed that the sodium excretion by peritoneal dialysis was positively correlated with dietary sodium intake in PD patients. The high salt intake diet (salt intake ≥8 g/day) may lead to a faster decline of residual renal function in PD patients.
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Affiliation(s)
- Nirong Gong
- State Key Laboratory for Organ Failure Research, Division of Nephrology, National Clinical Research Center for Kidney Disease, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Chun Zhou
- State Key Laboratory for Organ Failure Research, Division of Nephrology, National Clinical Research Center for Kidney Disease, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Jianxia Hu
- Division of Nephrology, Tungwah Hospital Affiliated to Sun Yat-Sen University, Dongguan, China
| | - Xiaohong Zhong
- State Key Laboratory for Organ Failure Research, Division of Nephrology, National Clinical Research Center for Kidney Disease, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Zhixiu Yi
- State Key Laboratory for Organ Failure Research, Division of Nephrology, National Clinical Research Center for Kidney Disease, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Tingting Zhang
- State Key Laboratory for Organ Failure Research, Division of Nephrology, National Clinical Research Center for Kidney Disease, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Cong Yang
- State Key Laboratory for Organ Failure Research, Division of Nephrology, National Clinical Research Center for Kidney Disease, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Yanhong Lin
- State Key Laboratory for Organ Failure Research, Division of Nephrology, National Clinical Research Center for Kidney Disease, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Jianwei Tian
- State Key Laboratory for Organ Failure Research, Division of Nephrology, National Clinical Research Center for Kidney Disease, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Xianhui Qin
- State Key Laboratory for Organ Failure Research, Division of Nephrology, National Clinical Research Center for Kidney Disease, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Liping Hu
- State Key Laboratory for Organ Failure Research, Division of Nephrology, National Clinical Research Center for Kidney Disease, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Jianping Jiang
- State Key Laboratory for Organ Failure Research, Division of Nephrology, National Clinical Research Center for Kidney Disease, Nanfang Hospital, Southern Medical University, Guangzhou, China.,Guangzhou Regenerative Medicine and Health Guangdong Laboratory, Guangdong Provincial Key Laboratory of Renal Failure Research, Guangzhou, China
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11
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Lou Arnal LM, Vercet Tormo A, Caverní Muñoz A, Medrano Villarroya C, Lou Calvo E, Munguía Navarro P, Sanz París A. Association between ultrapocessed food and chronic kidney disease. Nefrologia 2021; 41:489-501. [PMID: 36165132 DOI: 10.1016/j.nefroe.2021.11.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Accepted: 11/19/2020] [Indexed: 06/16/2023] Open
Abstract
The modern diet is closely linked to the consumption of processed foods, causing an increase in the intake of salt, simple sugars, phosphorus and added potassium. This excess intake is associated with an increased risk of obesity, diabetes, hypertension and chronic kidney disease (CKD). CKD, which according to data from the ENRICA study affects 15% of the population, magnifies its impact due to the higher prevalence of diabetes and hypertension and due to limitations in the management of sodium and phosphorus. The intake of these products far exceeds the established recommendations, assuming 72% of total sodium, 25%-35% of phosphorus, 12%-18% of potassium and exceeding 10% of the caloric intake in simple sugars. Measures are necessary to reduce their contribution through nutritional advice, labeling review, education campaigns on healthy habits, fees and institutional actions that involve food safety agencies, industry, distribution and scientific societies.
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Affiliation(s)
| | - Antonio Vercet Tormo
- Departamento de tecnología de los alimentos, Facultad de las Ciencias de la Salud y el Deporte, Universidad de Zaragoza, Zaragoza, Spain
| | - Alberto Caverní Muñoz
- Grupo de Nutrición de la SEN, España; Servicio de Dietética, Asociación de Enfermos Renales Alcer Ebro, Zaragoza, Spain
| | | | - Elena Lou Calvo
- Medicina Familiar y Comunitaria, Centro de Salud Torrero-La Paz, Zaragoza, Spain
| | | | - Alejandro Sanz París
- Servicio de Endocrinología y Nutrición, Hospital Universitario Miguel Servet, Zaragoza, Spain
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Ohta Y, Yamaguchi M, Yoshimoto M, Kanesaki M, Nosaka H, Tsuruta H, Nakamura H, Fukuhara M, Kawano Y. Relationship between salt intake and sleep disordered breathing in dialysis patients. Clin Exp Nephrol 2021; 25:1354-1359. [PMID: 34224007 DOI: 10.1007/s10157-021-02106-8] [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: 08/12/2020] [Accepted: 06/21/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND The prevalence of sleep disordered breathing is high in patients with end-stage renal disease. Salt intake is related to the severity of obstructive sleep apnea in patients with resistant hypertension and hyperaldosteronism. We investigated the relationship between salt intake and sleep disordered breathing in patients on maintenance hemodialysis. PATIENTS AND METHODS We studied 128 dialysis outpatients (mean age 63 ± 11 years) who were followed at Kokura Daiichi Hospital. We estimated each patient's salt intake using an InBody S10 body composition analyzer and measured the 3% oxygen desaturation index (ODI) during sleep using a Pulsewatch: PMP-200 GplusX. RESULTS The average estimated salt intake was 8.0 ± 2.6 g/day, and the median value of that was 7.5 g/day. Blood pressure (BP) before and after dialysis were 140 ± 18/78 ± 11 and 127 ± 13/72 ± 8 mmHg, respectively. The geometric average number of 3% ODI was 7.1, and sleep disordered breathing was detected in 30% of all subjects. The patients with ≥ 7.5 g/day salt intake were younger and more frequently male and had higher body mass index (BMI) and BP before dialysis compared to those with salt intakes < 7.5 g/day. Patients with ≥ 7.5 g/day salt intake had a significantly higher geometric average number of 3% ODI; however, this relationship became weaker after adjusting for BMI. The same relationship was obtained for the prevalence of sleep disordered breathing. CONCLUSION The prevalence of sleep disordered breathing in patients on maintenance hemodialysis was high, and the sleep disordered breathing was associated with salt intake and BMI.
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Affiliation(s)
- Yuko Ohta
- Division of General Internal Medicine, Kyushu Dental University, Manazuru 2-6-1, Kokurakita-ku, Kitakyushu, Fukuoka, 803-8580, Japan. .,Kokura Daiichi Hospital, Kitakyushu, Fukuoka, Japan.
| | | | | | | | | | | | | | - Masayo Fukuhara
- Division of General Internal Medicine, Kyushu Dental University, Manazuru 2-6-1, Kokurakita-ku, Kitakyushu, Fukuoka, 803-8580, Japan
| | - Yuhei Kawano
- Department of Medical Technology, Teikyo University Fukuoka, Omuta, Fukuoka, Japan
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Lou Arnal LM, Vercet Tormo A, Caverní Muñoz A, Medrano Villarroya C, Lou Calvo E, Munguía Navarro P, Sanz París A. Association between ultrapocessed food and chronic kidney disease. Nefrologia 2021. [PMID: 33714628 DOI: 10.1016/j.nefro.2020.11.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
The modern diet is closely linked to the consumption of processed foods, causing an increase in the intake of salt, simple sugars, phosphorus and added potassium. This excess intake is associated with an increased risk of obesity, diabetes, hypertension and chronic kidney disease (CKD). CKD, which according to data from the ENRICA study affects 15% of the population, magnifies its impact due to the higher prevalence of diabetes and hypertension and due to limitations in the management of sodium and phosphorus. The intake of these products far exceeds the established recommendations, assuming 72% of total sodium, 25-35% of phosphorus, 12-18% of potassium and exceeding 10% of the caloric intake in simple sugars. Measures are necessary to reduce their contribution through nutritional advice, labeling review, education campaigns on healthy habits, fees and institutional actions that involve food safety agencies, industry, distribution and scientific societies.
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Affiliation(s)
| | - Antonio Vercet Tormo
- Departamento de tecnología de los alimentos, Facultad de las Ciencias de la Salud y el Deporte, Universidad de Zaragoza, Zaragoza, España
| | - Alberto Caverní Muñoz
- Grupo de Nutrición de la SEN, España; Servicio de Dietética, Asociación de Enfermos Renales Alcer Ebro, Zaragoza, España
| | | | - Elena Lou Calvo
- Medicina Familiar y Comunitaria, Centro de Salud Torrero-La Paz, Zaragoza, España
| | | | - Alejandro Sanz París
- Servicio de Endocrinología y Nutrición, Hospital Universitario Miguel Servet, Zaragoza, España
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康 瀚, 王 羽, 钟 晓, 殷 伟, 李 芳, 蒋 建. [Effect of salt intake on residual renal function in rats receiving peritoneal dialysis]. NAN FANG YI KE DA XUE XUE BAO = JOURNAL OF SOUTHERN MEDICAL UNIVERSITY 2021; 41:264-271. [PMID: 33624601 PMCID: PMC7905259 DOI: 10.12122/j.issn.1673-4254.2021.02.15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Indexed: 01/23/2023]
Abstract
OBJECTIVE To assess the effect of salt intake on residual renal function in rats and explore the possible mechanism. OBJECTIVE SD rats were 5/6-nephrectomized to induce chronic renal failure followed by peritoneal dialysis for 4 weeks (n=18) or without dialysis treatment (control group; n=18). In both groups, the rats were divided into 3 subgroups and were given lowsalt diet (0.02% NaCl), normal salt diet (0.4% NaCl), and high-salt diet (4% NaCl). After 8 and 12weeks, blood pressure and creatinine and sodium levels in the blood, urine, and peritoneal dialysate of the rats were examined. Glomerular sclerosis, tubulointerstitial fibrosis, and protein expression levels of RAS components (ACE-1, AGT, and AT-1) in renal cortical tissue of the rats were evaluated. OBJECTIVE The residual renal function of the rats all decreased especially in rats with high salt intake for 8and 12 weeks. In peritoneal dialysis group, the rats with high-salt diet showed signficiantly increased renal interstitial fibrosis score (P=0.036), glomerular sclerosis index (P=0.045), systolic blood pressure (P=0.004), diastolic blood pressure (P=0.048), and renal expressions of AGT, ACE-1, and AT1 (P < 0.05) as compared with those with normal salt intake. In the rats fed the same high-salt diet, the renal interstitial fibrosis score, glomerular sclerosis index, diastolic blood pressure increase, and renal AGT and ACE-1 expression levels were significantly lower in the peritoneal dialysis group than in the control group (P < 0.05). A positive correlation was noted between the reduction of residual renal function and sodium intake in the rats. OBJECTIVE In rats with chronic renal failure, high salt intake promotes the activation of the renal RAS system, increases blood pressure, and agrevates renal fibrosis to accelerate the decline of residual renal function, and peritoneal dialysis partially reduces the damage of residual renal function induced by high-salt diets by removing excessive sodium.
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Affiliation(s)
- 瀚 康
- 南方医科大学南方医院肾内科,广东 广州 510515Department of Nephrology, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
| | - 羽 王
- 南方医科大学南方医院肾内科,广东 广州 510515Department of Nephrology, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
| | - 晓红 钟
- 南方医科大学南方医院肾内科,广东 广州 510515Department of Nephrology, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
| | - 伟 殷
- 南方医科大学动物实验管理中心,广东 广州 510515Laboratory Animal Center, Southern Medical University, Guangzhou 510515, China
| | - 芳 李
- 南方医科大学南方医院肾内科,广东 广州 510515Department of Nephrology, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
| | - 建平 蒋
- 南方医科大学南方医院肾内科,广东 广州 510515Department of Nephrology, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
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15
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Liu Y, Dai X, Yang S, Peng Y, Hou F, Zhou Q. High salt aggravates renal inflammation via promoting pro-inflammatory macrophage in 5/6-nephrectomized rat. Life Sci 2021; 274:119109. [PMID: 33513393 DOI: 10.1016/j.lfs.2021.119109] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 01/11/2021] [Accepted: 01/17/2021] [Indexed: 12/22/2022]
Abstract
The increasing incident of chronic kidney disease (CKD) in recent years might be related to a change in dietary habits, known as excessive salt intake. Given excessive salt promotes pathogenic T cells responses. Since the importance of macrophage in the development of CKD, we addressed the effect of high salt loading on in a rat CKD model. We observed that 5/6Nx rats receiving a high salt diet showed strongly enhanced macrophage infiltration and activation in the renal tissue accompanied by deteriorated renal inflammation. Then we used the microarray expression profiling to detect the effect of additional Nacl on peritoneal macrophage derived from 5/6Nx. The NaCl treatment of macrophage extracted from 5/6Nx rat elicited a strong pro-inflammatory phenotype characterized by enhanced proinflammatory cytokine production, increased expression of molecules mainly involved in immune response process. This NaCl-induced pro-inflammatory macrophage phenotype was accompanied by increased phosphorylation of STAT1. Taken together, our study demonstrated that high salt intake promotes immune activation of macrophages through the STAT1 independently and exacerbates the kidney accompanied by promotion of inflammation. Thus, changes in diet may provide a novel strategy for the prevention or amelioration of CKD.
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Affiliation(s)
- Yang Liu
- State Key Laboratory of Organ Failure Research, National Clinical Research Center of Kidney Disease, Division of Nephrology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Xiaoyan Dai
- State Key Laboratory of Organ Failure Research, National Clinical Research Center of Kidney Disease, Division of Nephrology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Shaohua Yang
- State Key Laboratory of Organ Failure Research, National Clinical Research Center of Kidney Disease, Division of Nephrology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Yan Peng
- State Key Laboratory of Organ Failure Research, National Clinical Research Center of Kidney Disease, Division of Nephrology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Fanfan Hou
- State Key Laboratory of Organ Failure Research, National Clinical Research Center of Kidney Disease, Division of Nephrology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Qiugen Zhou
- State Key Laboratory of Organ Failure Research, National Clinical Research Center of Kidney Disease, Division of Nephrology, Nanfang Hospital, Southern Medical University, Guangzhou, China.
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16
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Boslooper-Meulenbelt K, van Vliet IMY, Gomes-Neto AW, de Jong MFC, Bakker SJL, Jager-Wittenaar H, Navis GJ. Malnutrition according to GLIM criteria in stable renal transplant recipients: Reduced muscle mass as predominant phenotypic criterion. Clin Nutr 2020; 40:3522-3530. [PMID: 33341314 DOI: 10.1016/j.clnu.2020.11.034] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 11/24/2020] [Accepted: 11/30/2020] [Indexed: 01/10/2023]
Abstract
BACKGROUND & AIMS Malnutrition has a negative impact on quality of life and survival in renal transplant recipients (RTR). Therefore, malnutrition detection is important in RTR, but this may be hampered by concomitant presence of weight gain and overweight. Recently, the Global Leadership Initiative on Malnutrition (GLIM) developed a set of diagnostic criteria for malnutrition. We aimed to assess the prevalence of malnutrition according to the GLIM criteria and the distribution of phenotypic criteria in RTR. Additionally, we examined the potential value of 24-h urinary creatinine excretion rate (CER) as alternative measure for the criterion reduced muscle mass. METHODS We used data from stable outpatient RTR included in the TransplantLines Cohort and Biobank Study (NCT02811835). Presence of weight loss and reduced intake or assimilation were derived from Patient-Generated Subjective Global Assessment (PG-SGA) item scores. Reduced muscle mass was assessed by multi-frequency bio-electrical impedance analysis (MF-BIA) and defined as an appendicular skeletal muscle mass index (ASMI) < 7 kg/m2 for men and <5.5 kg/m2 for women, and in additional analysis defined as creatinine-height index (CHI, based on 24 h urine CER) < 80%. Inflammation was present if C-reactive protein (CRP) was >5 mg/L. Malnutrition was defined as presence of at least one phenotypic (weight loss and/or low BMI and/or reduced muscle mass) and one etiologic criterion (reduced intake/assimilation and/or disease burden/inflammation). RESULTS We included 599 RTR (55 ± 13 years old, 62% male, BMI 27.2 ± 4.7 kg/m2) at a median of 3.1 years after transplantation. According to GLIM criteria, 14% was malnourished, of which 91% met the phenotypic criterion for reduced muscle mass. Similar results were found by using CHI as measure for muscle mass (13% malnutrition of which 79% with reduced muscle mass). CONCLUSIONS Malnutrition is present in one in 7 stable RTR, with reduced muscle mass as the predominant phenotypic criterion. Assessment of nutritional status, most importantly muscle status, is warranted in routine care, to prevent malnutrition in RTR from remaining undetected and untreated. The diagnostic value of 24-h urinary CER in this regard requires further investigation.
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Affiliation(s)
- K Boslooper-Meulenbelt
- Department of Internal Medicine, Division of Nephrology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.
| | - Iris M Y van Vliet
- Department of Dietetics, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - António W Gomes-Neto
- Department of Internal Medicine, Division of Nephrology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Margriet F C de Jong
- Department of Internal Medicine, Division of Nephrology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Stephan J L Bakker
- Department of Internal Medicine, Division of Nephrology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Harriët Jager-Wittenaar
- Department of Oral and Maxillofacial Surgery, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands; Research Group Healthy Ageing, Allied Health Care and Nursing, Hanze University of Applied Sciences, Groningen, the Netherlands
| | - Gerjan J Navis
- Department of Internal Medicine, Division of Nephrology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
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17
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Panuccio V, Mallamaci F, Pizzini P, Tripepi R, Garofalo C, Parlongo G, Caridi G, Provenzano M, Mafrica A, Simone G, Cutrupi S, D'Arrigo G, Porto G, Tripepi G, Nardellotto A, Meneghel G, Dattolo P, Pizzarelli F, Rapisarda F, Ricchiuto A, Fatuzzo P, Verdesca S, Gallieni M, Gesualdo L, Conte G, Plebani M, Zoccali C. Reducing salt intake by urine chloride self-measurement in non-compliant patients with chronic kidney disease followed in nephrology clinics: a randomized trial. Nephrol Dial Transplant 2020; 36:gfaa262. [PMID: 33291142 DOI: 10.1093/ndt/gfaa262] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Indexed: 02/24/2024] Open
Abstract
BACKGROUND Adherence to low salt diets and control of hypertension remain unmet clinical needs in chronic kidney disease (CKD) patients. METHODS We performed a 6-month multicentre randomized trial in non-compliant patients with CKD followed in nephrology clinics testing the effect of self-measurement of urinary chloride (69 patients) as compared with standard care (69 patients) on two primary outcome measures, adherence to a low sodium (Na) diet (<100 mmol/day) as measured by 24-h urine Na (UNa) excretion and 24-h ambulatory blood pressure (ABPM) monitoring. RESULTS In the whole sample (N = 138), baseline UNa and 24-h ABPM were143 ± 64 mmol/24 h and 131 ± 18/72 ± 10 mmHg, respectively, and did not differ between the two study arms. Patients in the active arm of the trial used >80% of the chloride strips provided to them at the baseline visit and at follow-up visits. At the third month, UNa was 35 mmol/24 h (95% CI 10.8-58.8 mmol/24 h; P = 0.005) lower in the active arm than the control arm, whereas at 6 months the between-arms difference in UNa decreased and was no longer significant [23 mmol/24 h (95% CI -5.6-50.7); P = 0.11]. The 24-h ABPM changes as well as daytime and night-time BP changes at 3 and 6 months were similar in the two study arms (Month 3, P = 0.69-0.99; Month 6, P = 0.73-0.91). Office BP, the use of antihypertensive drugs, estimated Glomerular Filtration Rate (eGFR) and proteinuria remained unchanged across the trial. CONCLUSIONS The application of self-measurement of urinary chloride to guide adherence to a low salt diet had a modest effect on 24-h UNa and no significant effect on 24-h ABPM.
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Affiliation(s)
- Vincenzo Panuccio
- Nephrology, Dialysis and Transplantation Unit, Grande Ospedale Metropolitano, Reggio Calabria, Italy
| | - Francesca Mallamaci
- Nephrology, Dialysis and Transplantation Unit, Grande Ospedale Metropolitano, Reggio Calabria, Italy
- Institute of Clinical Physiology (IFC), Clinical Epidemiology of Renal Diseases and Hypertension Unit, Reggio Calabria, Italy
| | - Patrizia Pizzini
- Institute of Clinical Physiology (IFC), Clinical Epidemiology of Renal Diseases and Hypertension Unit, Reggio Calabria, Italy
| | - Rocco Tripepi
- Institute of Clinical Physiology (IFC), Clinical Epidemiology of Renal Diseases and Hypertension Unit, Reggio Calabria, Italy
| | - Carlo Garofalo
- Division of Nephrology Azienda, Ospedaliera Universitaria Napoli, Naples, Italy
| | - Giovanna Parlongo
- Nephrology, Dialysis and Transplantation Unit, Grande Ospedale Metropolitano, Reggio Calabria, Italy
| | - Graziella Caridi
- Nephrology, Dialysis and Transplantation Unit, Grande Ospedale Metropolitano, Reggio Calabria, Italy
| | - Michele Provenzano
- Division of Nephrology Azienda, Ospedaliera Universitaria Napoli, Naples, Italy
| | - Angela Mafrica
- Nephrology, Dialysis and Transplantation Unit, Grande Ospedale Metropolitano, Reggio Calabria, Italy
| | - Giuseppina Simone
- Division of Nephrology, Azienda Ospedaliera "Santa Maria Annunziata" Firenze, Florence, Italy
| | - Sebastiano Cutrupi
- Nephrology, Dialysis and Transplantation Unit, Grande Ospedale Metropolitano, Reggio Calabria, Italy
| | - Graziella D'Arrigo
- Nephrology, Dialysis and Transplantation Unit, Grande Ospedale Metropolitano, Reggio Calabria, Italy
| | - Gaetana Porto
- Nephrology, Dialysis and Transplantation Unit, Grande Ospedale Metropolitano, Reggio Calabria, Italy
| | - Giovanni Tripepi
- Nephrology, Dialysis and Transplantation Unit, Grande Ospedale Metropolitano, Reggio Calabria, Italy
| | | | - Gina Meneghel
- Division of Nephrology, Ospedale Dolo, Mirano-Venezia, Italy
| | - Piero Dattolo
- Division of Nephrology, Azienda Ospedaliera "Santa Maria Annunziata" Firenze, Florence, Italy
| | - Francesco Pizzarelli
- Division of Nephrology, Azienda Ospedaliera "Santa Maria Annunziata" Firenze, Florence, Italy
| | - Francesco Rapisarda
- Department of Medicine, Nephrology Unit, Policlinico Universitario Vittorio Emanuele, Catania, Italy
| | - Anna Ricchiuto
- Division of Nephrology, Ospedale Universitario Sacco, Milano, Italy
| | - Pasquale Fatuzzo
- Department of Medicine, Nephrology Unit, Policlinico Universitario Vittorio Emanuele, Catania, Italy
| | - Simone Verdesca
- Department of Laboratory Medicine, University-Hospital of Padova, Padua, Italy
| | - Maurizio Gallieni
- Division of Nephrology, Università Consorziale Policlinico, Bari, Italy
| | - Loreto Gesualdo
- Division of Nephrology, Università Consorziale Policlinico, Bari, Italy
| | - Giuseppe Conte
- Division of Nephrology Azienda, Ospedaliera Universitaria Napoli, Naples, Italy
| | - Mario Plebani
- Department of Medicine-DIMED, University of Padova and Department of Laboratory Medicine, University Hospital of Padova, Italy
| | - Carmine Zoccali
- Institute of Clinical Physiology (IFC), Clinical Epidemiology of Renal Diseases and Hypertension Unit, Reggio Calabria, Italy
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Wang W, Chonchol M, Seals DR, Nowak KL. Dietary sodium restriction decreases urinary NGAL in older adults with moderately elevated systolic blood pressure free from chronic kidney disease. J Investig Med 2020; 68:1271-1275. [PMID: 32699180 DOI: 10.1136/jim-2020-001343] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/23/2020] [Indexed: 01/22/2023]
Abstract
Increased aortic stiffness may contribute to kidney damage by transferring excessive flow pulsatility to susceptible renal microvasculature, leading to constriction or vessel loss. We previously demonstrated that 5 weeks of dietary sodium restriction (DSR) reduces large-elastic artery stiffness as well as blood pressure in healthy middle-aged/older adults with moderately elevated systolic blood pressure (SBP) who are free from chronic kidney disease (CKD). We hypothesized that DSR in this cohort would also reduce urinary concentrations of renal tubular injury biomarkers, which predict incident CKD in the general population. We performed a post hoc analysis using stored 24 hours urine samples collected in 13 participants as part of a randomized, double-blind, crossover clinical trial of DSR (low sodium (LS) target: 50 mmol/day; normal sodium (NS) target: 150 mmol/day). Participants were 61±2 (mean±SEM) years (8 M/5 F) with a baseline blood pressure of 139±2/82±2 mm Hg and an estimated glomerular filtration rate of 79±3 mL/min/1.73 m2 Twenty-four hour urinary sodium excretion was reduced from 149±7 to 66±8 mmol/day during week 5. Despite having preserved kidney function, participants had a 31% reduction in urinary neutrophil gelatinase-associated lipocalin concentrations with just 5 weeks of DSR (LS: 2.8±0.6 vs NS: 4.2±0.8 ng/mL, p<0.05). Results were similar when normalized to urinary creatinine (urinary creatinine did not change between conditions). Concentrations of another kidney tubular injury biomarker, kidney injury molecule-1, were below the detectable limit in all but one sample. In conclusion, DSR reduces an established clinical biomarker of kidney tubular damage in adults with moderately elevated SBP who are free from prevalent kidney disease.
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Affiliation(s)
- Wei Wang
- Division of Renal Diseases and Hypertension, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Michel Chonchol
- Division of Renal Diseases and Hypertension, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Douglas R Seals
- Department of Integrative Physiology, University of Colorado Boulder, Boulder, Colorado, USA
| | - Kristen L Nowak
- Division of Renal Diseases and Hypertension, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
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Panuccio V, Pizzini P, Parlongo G, Caridi G, Tripepi R, Mafrica A, Cutrupi S, D'Arrigo G, Porto G, Garofalo C, Provenzano M, Tripepi G, Mallamaci F, Plebani M, Zoccali C. Urine chloride self-measurement to monitor sodium chloride intake in patients with chronic kidney disease. Clin Chem Lab Med 2020; 57:1162-1168. [PMID: 30753154 DOI: 10.1515/cclm-2018-1227] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Accepted: 01/08/2019] [Indexed: 11/15/2022]
Abstract
Background Excessive sodium intake is a risk factor for hypertension, cardiovascular disease and the risk for kidney failure in chronic kidney disease (CKD) patients. Methods We tested the diagnostic performance and the feasibility of an inexpensive method based on urine chloride strips for self-monitoring sodium intake in a series of 72 CKD patients. Results Twenty-four hour urinary chloride as measured by the reactive strips and 24 h urinary sodium were interrelated (r=0.59, p<0.001). Forty-nine out of 72 patients (78%) had a 24 h urinary sodium >100 mmol/24 h, i.e. the upper limit recommended by current CKD guidelines. The strip method had 75.5% sensitivity and 82.6% specificity to correctly classify patients with urine sodium >100 mmol/24 h. The positive and the negative predictive values were 90.2% and 61.3%, respectively. The overall accuracy (ROC curve analysis) of urine chloride self-measurement for the >100 mmol/24 h sodium threshold was 87% (95% CI: 77%-97%). The large majority of patients (97%) perceived the test as useful to help compliance with the prescribed dietary sodium and considered the test as simple and of immediate application (58%) or feasible but requiring attention (39%). Conclusions A simple and inexpensive test for urine chloride measurement has a fairly good performance for the diagnosis of excessive sodium intake. The test is feasible and it is perceived by CKD patients as helpful for enhancing compliance to the dietary sodium recommendations. The usefulness of this test for improving hypertension control in CKD patients will be tested in a clinical trial (Clinicaltrials.gov RF-2010-2314890).
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Affiliation(s)
- Vincenzo Panuccio
- Nephrology, Dialysis and Transplantation Unit, Reggio Calabria, Italy
| | - Patrizia Pizzini
- Institute of Clinical Physiology (IFC), Research Unit of Reggio Calabria, Reggio Calabria, Italy
| | - Giovanna Parlongo
- Nephrology, Dialysis and Transplantation Unit, Reggio Calabria, Italy
| | - Graziella Caridi
- Nephrology, Dialysis and Transplantation Unit, Reggio Calabria, Italy
| | - Rocco Tripepi
- Institute of Clinical Physiology (IFC), Research Unit of Reggio Calabria, Reggio Calabria, Italy
| | - Angela Mafrica
- Nephrology, Dialysis and Transplantation Unit, Reggio Calabria, Italy
| | | | | | - Gaetana Porto
- Nephrology, Dialysis and Transplantation Unit, Reggio Calabria, Italy
| | - Carlo Garofalo
- Division of Nephrology, University of Campania "Luigi Vanvitelli", Napoli, Italy
| | - Michele Provenzano
- Division of Nephrology, University of Campania "Luigi Vanvitelli", Napoli, Italy
| | - Giovanni Tripepi
- Nephrology, Dialysis and Transplantation Unit, Reggio Calabria, Italy
| | - Francesca Mallamaci
- Nephrology, Dialysis and Transplantation Unit, Reggio Calabria, Italy
- Institute of Clinical Physiology (IFC), Research Unit of Reggio Calabria, Reggio Calabria, Italy
| | - Mario Plebani
- Department of Laboratory Medicine, University-Hospital of Padova, Padova, Italy
| | - Carmine Zoccali
- CNR-IFC Research Unit of Reggio Calabria, c/o EUROLINE di Barillà Francesca, Via Vallone Petrara 55-57, 89124 Reggio Calabria, Italy
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Kim KI, Ihm SH, Kim GH, Kim HC, Kim JH, Lee HY, Lee JH, Park JM, Park S, Pyun WB, Shin J, Chae SC. 2018 Korean society of hypertension guidelines for the management of hypertension: part III-hypertension in special situations. Clin Hypertens 2019; 25:19. [PMID: 31388452 PMCID: PMC6670160 DOI: 10.1186/s40885-019-0123-y] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Accepted: 06/14/2019] [Indexed: 01/05/2023] Open
Abstract
Treatment of hypertension improves cardiovascular, renal, and cerebrovascular outcomes. However, the benefit of treatment may be different according to the patients' characteristics. Additionally, the target blood pressure or initial drug choice should be customized according to the special conditions of the hypertensive patients. In this part III, we reviewed previous data and presented recommendations for some special populations such as diabetes mellitus, chronic kidney disease, elderly people, and cardio-cerebrovascular disease.
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Affiliation(s)
- Kwang-il Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Sang-Hyun Ihm
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Gheun-Ho Kim
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Hyeon Chang Kim
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Ju Han Kim
- Department of Internal Medicine, School of Medicine, Chonnam University, GwangJu, Korea
| | - Hae-Young Lee
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Jang Hoon Lee
- Department of Internal Medicine, Kyungpook National University, School of Medicine, 130 Dongdeok-ro, Jung-gu, Daegu, Korea
| | - Jong-Moo Park
- Department of Neurology, Nowon Eulji Medical Center, Eulji University, Seoul, Korea
| | - Sungha Park
- Department of Internal Medicine Division of Cardiology, Yonsei University College of Medicine, Seoul, Korea
| | - Wook Bum Pyun
- Department of Internal Medicine, School of Medicine, Ewha Womans University, Seoul, Korea
| | - Jinho Shin
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Shung Chull Chae
- Department of Internal Medicine, Kyungpook National University, School of Medicine, 130 Dongdeok-ro, Jung-gu, Daegu, Korea
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Hu J, Hu L, Gong N, Zhang L, Tian J, Jiang J. [Effect of dietary sodium intake on residual renal function in patients undergoing peritoneal dialysis: a prospective study of 33 cases]. NAN FANG YI KE DA XUE XUE BAO = JOURNAL OF SOUTHERN MEDICAL UNIVERSITY 2019; 39:657-664. [PMID: 31270043 DOI: 10.12122/j.issn.1673-4254.2019.06.05] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To explore the impact of dietary sodium-intake on residual renal function in patients undergoing peritoneal dialysis (PD). METHODS Thirty-three patients on PD with stable dialysis were regularly followed up for 12 months. The daily sodium intake of the patients was calculated based on the 3-day dietary record. Based on the mean daily sodium intake, the patients enrolled were divided into low-salt group (sodium intake≤3.0 g/day, 19 patients) and high-salt group (sodium intake>3.0 g/day, 14 patients). The baseline data of the patients were recorded, and the indicators of residual renal function and peritoneal function were regularly tested. The patients were followed-up at 3-month intervals, and their urine volume, peritoneal ultrafiltration volume and other clinical indicators were recorded and the biochemical indexes were detected to evaluate the changes in the residual renal function and peritoneal function. RESULTS There was a positive correlation between the total sodium excretion and dietary sodium intake in these patients (r=0.536, P=0.0013), and sodium excretion by dialysis was positively correlated with their sodium intake (r=0.901, P=0.000). Regression analysis suggested that the total sodium excretion was correlated with dietary sodium intake (β=0.416, 95% CI: 0.170-0.666; P < 0.0018); sodium excretion by dialysis was associated with dietary sodium intake (β=0.489, 95% CI: 0.395-0.582; P < 0.001). The residual renal function was reduced by 17.48±11.22 L /(w·1.73 m2) in the low-salt group, as compared to 30.20±18.30 L /(w·1.73 m2) in the high-salt group (P=0.032). The reduction in the residual renal function was correlated with sodium intake in the PD patients (r=0.409, P=0.018). Multivariate regression analysis showed that sodium intake was an independent factor contributing to the reduction of residual renal function (β=14.646, 95% CI 7.426-21.866, P < 0.001). CONCLUSIONS Sodium excretion by PD in patients with continuous ambulatory PD is positively correlated with their dietary sodium intake, which contribute to the decrease of residual renal function. A high dietary sodium intake may accelerate the reduction of residual renal function in these patients.
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Affiliation(s)
- Jianxia Hu
- 1Department of Nephrology, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China.,Department of Nephrology, Donghua Hospital Affiliated to Sun Yat-sen University, Dongguan 523000, China
| | - Liping Hu
- 1Department of Nephrology, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
| | - Nirong Gong
- 1Department of Nephrology, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
| | - Lei Zhang
- 1Department of Nephrology, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
| | - Jianwei Tian
- 1Department of Nephrology, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
| | - Jianping Jiang
- 1Department of Nephrology, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
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Okamura K, Kuroda R, Nagata K, Urata H. Prospective single-arm observational study of human chymase inhibitor Polygonum hydropiper L in subjects with hypertension. Clin Exp Hypertens 2018; 41:717-725. [PMID: 30582370 DOI: 10.1080/10641963.2018.1545847] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Background and Purpose: Human chymase (h-chymase) is a serine protease that forms local angiotensin II and has been proven to be related to onset of hypertension, arteriosclerosis, and post myocardial infarction cardiac remodeling. Since no chymase inhibitor was clinically available, an extensive screening for inhibition of h-chymase in three different extracts (water, hot water, and ethanol) of approximately 800 food ingredients had been performed and we identified Polygonum hydropiper L (Polygonum). Using a dried and powdered Polygonum, we conducted a prospective, single-arm, pilot study to investigate its safety and antihypertensive effect in subjects with normal high blood pressure to moderate hypertension.Methods: First, a single oral dose of Polygonum powder (4000 mg) was administered to assess acute toxicity. Then, a pilot study was conducted in 11 subjects using the sequence of placebo and Polygonum for 2 weeks each. The dose of Polygonum was increased sequentially (200-2000 mg/day). Home blood pressure and pulse rate were monitored.Results: Oral administration of Polygonum (4000 mg) did not cause any adverse events. In the dose-escalation phase, evening systolic blood pressure was significantly decreased at 800 mg, 2000 mg doses post-treatment (p < 0.05, and p < 0.05, respectively). Depressor responders to Polygonum intake had significantly higher salt intake in spot urine (p < 0.05). No adverse events or reactions occurred.Conclusion: This was the first investigation that an h-chymase inhibitory Polygonum intake for safety and tolerability was proven and, in addition, chymase inhibitory Polygonum appeared to have depressor effect especially in a hypertensive subject with excessive salt intake.
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Affiliation(s)
- Keisuke Okamura
- Department of Cardiovascular Diseases, Fukuoka University Chikushi Hospital, Chikushino, Japan
| | - Rieko Kuroda
- Biotechnology and Food Research Institute Fukuoka Industrial Technology Center, Kurume, Japan
| | | | - Hidenori Urata
- Department of Cardiovascular Diseases, Fukuoka University Chikushi Hospital, Chikushino, Japan
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Bushinsky DA. Tolerance to Sodium in Patients With CKD-Induced Metabolic Acidosis: Does the Accompanying Anion Matter? Am J Kidney Dis 2018; 73:858-865. [PMID: 30518477 DOI: 10.1053/j.ajkd.2018.09.004] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Accepted: 09/07/2018] [Indexed: 11/11/2022]
Abstract
Patients with chronic kidney disease (CKD) continue to produce endogenous acids but have a reduction in net acid excretion, resulting in a primary decrease in serum bicarbonate concentration, which is termed chronic metabolic acidosis. Recent prospective studies, along with retrospective cohort analyses, demonstrate a higher risk for CKD progression with untreated metabolic acidosis. To normalize serum bicarbonate levels, acidemic patients are often treated with sodium bicarbonate (NaHCO3) or sodium citrate, which have been shown to slow the progression of CKD. However, studies using this approach have routinely excluded patients with common sodium-sensitive comorbid conditions, such as poorly controlled hypertension, congestive heart failure, volume overload, or edema. This article examines the effect of the anion that accompanies sodium delivered with these therapies. Do the negative effects on blood pressure (BP) and sodium retention, as measured by an increase in edema, weight gain, and congestive heart failure, observed with oral administration of sodium chloride (NaCl) differ when a similar amount of sodium is given with bicarbonate or citrate in this patient population? A review of the literature suggests that NaHCO3 does not increase BP or sodium retention when administered to patients with CKD during a concurrent severe NaCl dietary restriction (∼10 mEq/d). However, this degree of NaCl restriction is feasible only under strict control in clinical research environments. In contrast, when NaHCO3 is given to patients without severe dietary NaCl restriction, there is an increase in BP and sodium retention. Thus, unless patients with CKD can tolerate a diet virtually devoid of NaCl, additional sodium, regardless of the accompanying anion, appears to increase BP and sodium retention.
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Affiliation(s)
- David A Bushinsky
- University of Rochester School of Medicine and Dentistry, Rochester, NY.
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Pitt B, Zann V, Roe C, Jacobs JW, Davidson JP, Dowd C, Kumaraswamy P, Lin F, Korner P, Blanks RC, Rosenbaum DP. An Evaluation of the Pharmacodynamics, Safety, and Tolerability of the Potassium Binder RDX7675. J Clin Pharmacol 2018; 58:1035-1043. [DOI: 10.1002/jcph.1102] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Accepted: 01/18/2018] [Indexed: 01/14/2023]
Affiliation(s)
- Bertram Pitt
- Department of Medicine; University of Michigan School of Medicine; Ann Arbor MI USA
| | | | - Chris Roe
- Quotient Clinical; Ruddington Nottingham UK
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Parvanova A, Trillini M, Podestà MA, Iliev IP, Ruggiero B, Abbate M, Perna A, Peraro F, Diadei O, Rubis N, Gaspari F, Carrara F, Stucchi N, Belviso A, Bossi AC, Trevisan R, Remuzzi G, de Borst M, Ruggenenti P. Moderate salt restriction with or without paricalcitol in type 2 diabetes and losartan-resistant macroalbuminuria (PROCEED): a randomised, double-blind, placebo-controlled, crossover trial. Lancet Diabetes Endocrinol 2018; 6:27-40. [PMID: 29104158 DOI: 10.1016/s2213-8587(17)30359-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Revised: 09/12/2017] [Accepted: 09/19/2017] [Indexed: 01/24/2023]
Abstract
BACKGROUND Macroalbuminuria predicts renal and cardiovascular events in patients with type 2 diabetes. We aimed to assess the albuminuria-lowering effects of salt restriction, paricalcitol therapy, or both, in this population. METHODS In this randomised, double-blind, placebo-controlled, crossover trial, we recruited adult patients with type 2 diabetes from six diabetology outpatient clinics in northern Italy, with 24 h albuminuria of more than 300 mg despite 100 mg per day losartan therapy, blood pressure of less than 140/90 mm Hg, serum creatinine concentration of less than 2 mg/dL, stable renal function on stable renin-angiotensin system inhibitor therapy with a fixed dose of losartan, parathyroid hormone concentration of 20 pg/mL to <110 pg/mL, serum calcium concentration of less than 9·5 mg/dL, and serum phosphate concentration of less than 5 mg/dL, who had been more than 80% compliant with placebo treatment during a 1 month placebo run-in. We allocated patients 1:1 with computer-generated randomisation to an open-label 3 month high-sodium (>200 mEq [4·8 g] per day) or low-sodium (<100 mEq [2·4 g] per day) diet and, within each diet group, to a 1 month double-blind treatment period of oral paricalcitol (2 μg per day) or placebo, followed by 1 month of placebo washout and then a further 1 month double-blind treatment period of paricalcitol or placebo in which patients crossed over to the opposite treatment period. The primary outcome was 24 h albuminuria (median of three consecutive measurements). Analyses were modified intention-to-treat (including all randomly allocated patients who took at least one dose of study drug and had an efficacy measurement after the first treatment period). Patients and investigators were masked to paricalcitol and placebo assignment. Those assessing outcomes were masked to both study drug and diet assignment. This study is registered with ClinicalTrials.gov, number NCT01393808, and the European Union Clinical Trials Register, number 2011-001713-14. FINDINGS Between Dec 13, 2011, and Feb 17, 2015, we randomly allocated 57 (50%) patients to a low-sodium diet (28 [49%] to paricalcitol then placebo and 29 [51%] to placebo then paricalcitol) and 58 (50%) to a high-sodium diet (29 [50%] to paricalcitol then placebo and 29 [50%] to placebo then paricalcitol). In the low-sodium group (30 mEq of daily sodium intake reduction, equivalent to approximately 1·7-1·8 g per day), 24 h albuminuria was reduced by 36·6% (95% CI 28·5-44·9) from 724 mg (441-1233) at baseline to 481 mg (289-837) at month 3 (p<0·0001), but no significant change occurred in the high-sodium group (from 730 mg [416-1227] to 801 mg [441-1365]; 2·9% [-16·8 to 16·4] increase; p=0·50). Changes between diet groups differed by 32·4% (17·2-48·8; p<0·0001) and correlated with changes in natriuresis (r=0·43; p<0·0001). On the high-sodium diet, paricalcitol reduced the salt-induced albuminuria increase by 17·8% (3·9-32·3) over the month of treatment compared with placebo (p=0·02), whereas on the low-sodium diet, paricalcitol did not have a significant effect versus placebo (increase of 4·1% [-9·3 to 21·6]; p=0·59). During placebo treatment, albuminuria decreased with the low-sodium diet (p=0·0002) and did not significantly change with the high-sodium diet, but changes were significantly different between diet groups (p=0·0004). Treatment was well tolerated and no patients withdrew from the study because of treatment-related effects. 67 adverse events occurred in 52 (45%) patients during paricalcitol treatment and 44 events occurred in 36 (31%) patients during placebo treatment. During paricalcitol therapy, 14 cases of hypercalciuria, six cases of hypercalcaemia, and five cases of hyperphosphataemia were reported in one patient each, all of which were possibly treatment related. One case of hypercalciuria was reported in one patient during the placebo treatment period. One stroke and one coronary event occurred during paricalcitol therapy. No patients died during the study. INTERPRETATION In patients with macroalbuminuria and type 2 diabetes, moderate salt restriction enhances the antialbuminuric effect of losartan, an effect that could be nephroprotective and cardioprotective in the long term. The finding that paricalcitol prevents a sodium-induced increase in albuminuria provides support for trials to test the long-term risk-benefit profile of paricalcitol add-on therapy in patients with type 2 diabetes and macroalbuminuria refractory to dietary salt restriction, including patients refractory to even moderate salt restriction. FUNDING AbbVie.
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Affiliation(s)
- Aneliya Parvanova
- Istituto di Ricovero e Cura a Carattere Scientifico-Istituto di Ricerche Farmacologiche Mario Negri, Centro Anna Maria Astori, Science and Technology Park Kilometro Rosso, Bergamo, Italy
| | - Matias Trillini
- Istituto di Ricovero e Cura a Carattere Scientifico-Istituto di Ricerche Farmacologiche Mario Negri, Centro Anna Maria Astori, Science and Technology Park Kilometro Rosso, Bergamo, Italy
| | - Manuel A Podestà
- Istituto di Ricovero e Cura a Carattere Scientifico-Istituto di Ricerche Farmacologiche Mario Negri, Centro Anna Maria Astori, Science and Technology Park Kilometro Rosso, Bergamo, Italy; Department of Medicine, Unit of Nephrology and Dialysis, Azienda Socio-Sanitaria Territoriale Papa Giovanni XXIII, Bergamo, Italy
| | - Ilian Petrov Iliev
- Istituto di Ricovero e Cura a Carattere Scientifico-Istituto di Ricerche Farmacologiche Mario Negri, Centro Anna Maria Astori, Science and Technology Park Kilometro Rosso, Bergamo, Italy
| | - Barbara Ruggiero
- Istituto di Ricovero e Cura a Carattere Scientifico-Istituto di Ricerche Farmacologiche Mario Negri, Centro Anna Maria Astori, Science and Technology Park Kilometro Rosso, Bergamo, Italy
| | - Manuela Abbate
- Istituto di Ricovero e Cura a Carattere Scientifico-Istituto di Ricerche Farmacologiche Mario Negri, Centro Anna Maria Astori, Science and Technology Park Kilometro Rosso, Bergamo, Italy
| | - Annalisa Perna
- Istituto di Ricovero e Cura a Carattere Scientifico-Istituto di Ricerche Farmacologiche Mario Negri, Centro Anna Maria Astori, Science and Technology Park Kilometro Rosso, Bergamo, Italy
| | - Francesco Peraro
- Istituto di Ricovero e Cura a Carattere Scientifico-Istituto di Ricerche Farmacologiche Mario Negri, Centro Anna Maria Astori, Science and Technology Park Kilometro Rosso, Bergamo, Italy
| | - Olimpia Diadei
- Istituto di Ricovero e Cura a Carattere Scientifico-Istituto di Ricerche Farmacologiche Mario Negri, Centro Anna Maria Astori, Science and Technology Park Kilometro Rosso, Bergamo, Italy
| | - Nadia Rubis
- Istituto di Ricovero e Cura a Carattere Scientifico-Istituto di Ricerche Farmacologiche Mario Negri, Centro Anna Maria Astori, Science and Technology Park Kilometro Rosso, Bergamo, Italy
| | - Flavio Gaspari
- Istituto di Ricovero e Cura a Carattere Scientifico-Istituto di Ricerche Farmacologiche Mario Negri, Centro Anna Maria Astori, Science and Technology Park Kilometro Rosso, Bergamo, Italy
| | - Fabiola Carrara
- Istituto di Ricovero e Cura a Carattere Scientifico-Istituto di Ricerche Farmacologiche Mario Negri, Centro Anna Maria Astori, Science and Technology Park Kilometro Rosso, Bergamo, Italy
| | - Nadia Stucchi
- Istituto di Ricovero e Cura a Carattere Scientifico-Istituto di Ricerche Farmacologiche Mario Negri, Centro Anna Maria Astori, Science and Technology Park Kilometro Rosso, Bergamo, Italy
| | - Antonio Belviso
- Diabetes Clinic, Azienda Socio-Sanitaria Territoriale Bergamo Ovest, Brembate Sopra, Italy
| | - Antonio C Bossi
- Endocrine Diseases and Diabetes Unit, Azienda Socio-Sanitaria Territoriale Bergamo Ovest, Treviglio-Caravaggio-Romano, Italy
| | - Roberto Trevisan
- Unit of Diabetology, Azienda Socio-Sanitaria Territoriale Papa Giovanni XXIII, Bergamo, Italy
| | - Giuseppe Remuzzi
- Istituto di Ricovero e Cura a Carattere Scientifico-Istituto di Ricerche Farmacologiche Mario Negri, Centro Anna Maria Astori, Science and Technology Park Kilometro Rosso, Bergamo, Italy; Department of Medicine, Unit of Nephrology and Dialysis, Azienda Socio-Sanitaria Territoriale Papa Giovanni XXIII, Bergamo, Italy; Department of Biomedical and Clinical Science, L Sacco, University of Milan, Milan, Italy.
| | - Martin de Borst
- Department of Nephrology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Piero Ruggenenti
- Istituto di Ricovero e Cura a Carattere Scientifico-Istituto di Ricerche Farmacologiche Mario Negri, Centro Anna Maria Astori, Science and Technology Park Kilometro Rosso, Bergamo, Italy; Department of Medicine, Unit of Nephrology and Dialysis, Azienda Socio-Sanitaria Territoriale Papa Giovanni XXIII, Bergamo, Italy
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Abstract
: The burden of chronic kidney disease (CKD) is rising both in this country and worldwide. An estimated 10% to 15% of U.S. adults are currently living with CKD. Reducing the CKD burden requires a systematic, interdisciplinary approach to care. The greatest opportunities to reduce the impact of CKD arise early, when most patients are being followed in primary care; yet many clinicians are inadequately educated on this disease. Nurses are well positioned to facilitate the implementation of collaborative care. This two-part article aims to provide nurses with the basic information necessary to assess and manage patients with CKD. Part 1 offers an overview of the disease, describes identification and etiology, and discusses ways to slow disease progression. Part 2, which will appear next month, addresses disease complications and treatment of kidney failure.
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Zann V, McDermott J, Jacobs JW, Davidson JP, Lin F, Korner P, Blanks RC, Rosenbaum DP. Palatability and physical properties of potassium-binding resin RDX7675: comparison with sodium polystyrene sulfonate. DRUG DESIGN DEVELOPMENT AND THERAPY 2017; 11:2663-2673. [PMID: 28919716 PMCID: PMC5593397 DOI: 10.2147/dddt.s143461] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Background Hyperkalemia is a potentially life-threatening condition that patients with heart failure or chronic kidney disease, especially those taking renin–angiotensin–aldosterone system inhibitors, are at high risk of developing. Sodium polystyrene sulfonate (SPS), a current treatment, binds potassium within the gastrointestinal tract to reduce potassium absorption. However, poor palatability limits its long-term use. RDX7675, a novel potassium binder in development for the treatment of hyperkalemia, is a calcium salt of a reengineered polystyrene sulfonate-based resin designed to have enhanced palatability. Here, the physical properties and palatability of RDX7675 and SPS are compared. Methods RDX7675 and SPS particle sizes were measured using wet dispersion laser diffraction. Palatability was assessed in a randomized, crossover, healthy volunteer study with two visits. At visit 1 (open label), volunteers evaluated high-viscosity, intermediate-viscosity, and water-reconstituted formulations of RDX7675 (all vanilla flavor), and an equivalent reconstituted SPS (Resonium A®). At visit 2 (single-blind), volunteers evaluated RDX7675 as a high-viscosity formulation in vanilla, citrus, and mint flavors, and as intermediate-viscosity, low-viscosity, and reconstituted formulations in citrus flavor. Volunteers used a “sip and spit” technique to rate overall acceptability and seven individual characteristics from 1 (“dislike everything”) to 9 (“like extremely”). Results RDX7675 particles were smaller than SPS particles, with a narrower size range (RDX7675, 80%, 14–52 µm; SPS, 11.3–124.2 µm), and had a smooth, spherical shape, in contrast to the shard-like SPS particles. Reconstituted RDX7675 was considered superior to SPS for five of the seven palatability characteristics and for overall acceptability (median, visit 1: reconstituted RDX7675, 5.0; SPS, 4.0). High-viscosity vanilla was the most highly rated RDX7675 formulation (median overall acceptability, visit 2: 7.0). Conclusion The smaller, more uniformly shaped, spherical particles of RDX7675 resulted in improved palatability over SPS when reconstituted in water. The overall results are promising for future patient acceptability of RDX7675 treatment.
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Yu L, Li S, Zhao J, Zhang J, Wang L, Wang K. Secular trends in salt and soy sauce intake among Chinese adults, 1997–2011. Int J Food Sci Nutr 2017; 69:215-222. [DOI: 10.1080/09637486.2017.1344203] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Lianlong Yu
- Institution of Food and Nutrition, Shandong Center for Disease Control and Prevention, Ji'nan, China
| | - Suyun Li
- Institution of Food and Nutrition, Shandong Center for Disease Control and Prevention, Ji'nan, China
| | - Jinshan Zhao
- Institution of Food and Nutrition, Shandong Center for Disease Control and Prevention, Ji'nan, China
| | - Junli Zhang
- Institution of Food and Nutrition, Shandong Center for Disease Control and Prevention, Ji'nan, China
| | - Liansen Wang
- Institution of Food and Nutrition, Shandong Center for Disease Control and Prevention, Ji'nan, China
| | - Kebo Wang
- Institution of Food and Nutrition, Shandong Center for Disease Control and Prevention, Ji'nan, China
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Hallow KM, Gebremichael Y. A Quantitative Systems Physiology Model of Renal Function and Blood Pressure Regulation: Application in Salt-Sensitive Hypertension. CPT-PHARMACOMETRICS & SYSTEMS PHARMACOLOGY 2017; 6:393-400. [PMID: 28556624 PMCID: PMC5488119 DOI: 10.1002/psp4.12177] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Revised: 01/05/2017] [Accepted: 01/23/2017] [Indexed: 01/13/2023]
Abstract
Salt‐sensitivity (SS) refers to changes in blood pressure in response to changes in sodium intake. SS individuals are at greater risk for developing kidney disease, and also respond differently to antihypertensive therapies compared to salt‐resistant (SR) individuals. In this study we used a systems pharmacology model of renal function (presented in a companion article) to evaluate the ability of proposed mechanisms to produce salt‐sensitivity. The model reproduced previously published data on renal functional changes in response to salt‐intake, and also predicted that glomerular pressure, a variable that is not easily evaluated clinically but is a key factor in renal injury, increases with salt intake in SS hypertension. We then used the model to generate mechanistic insight into the differential blood pressure and glomerular pressure responses to angiotensin converting enzyme (ACE) inhibitors, thiazide diuretics, and calcium channel blockers observed in SS and SR hypertension.
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Affiliation(s)
- K M Hallow
- University of Georgia, Athens, Georgia, USA
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Petrykiv S, Sjöström CD, Greasley PJ, Xu J, Persson F, Heerspink HJ. Differential Effects of Dapagliflozin on Cardiovascular Risk Factors at Varying Degrees of Renal Function. Clin J Am Soc Nephrol 2017; 12:751-759. [PMID: 28302903 PMCID: PMC5477216 DOI: 10.2215/cjn.10180916] [Citation(s) in RCA: 104] [Impact Index Per Article: 14.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2016] [Accepted: 02/13/2017] [Indexed: 12/25/2022]
Abstract
BACKGROUND AND OBJECTIVE Sodium glucose cotransporter 2 inhibition with dapagliflozin decreases hemoglobin A1c (HbA1c), body weight, BP, and albuminuria (urinary albumin-to-creatinine ratio). Dapagliflozin also modestly increases hematocrit, likely related to osmotic diuresis/natriuresis. Prior studies suggest that the HbA1c-lowering effects of dapagliflozin attenuate at lower eGFR. However, effects on other cardiovascular risk factors at different eGFR levels are incompletely understood. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS This pooled analysis of 11 phase 3 clinical trials assessed changes in HbA1c, body weight, BP, hematocrit, and urinary albumin-to-creatinine ratio with placebo (n=2178) or dapagliflozin 10 mg (n=2226) over 24 weeks in patients with type 2 diabetes according to baseline eGFR (eGFR≥45 to <60 ml/min per 1.73 m2, eGFR≥60 to <90 ml/min per 1.73 m2, and eGFR≥90 ml/min per 1.73 m2). RESULTS Compared with placebo, reductions in HbA1c with dapagliflozin were 0.6%, 0.5%, and 0.3%, respectively, for each consecutive lower eGFR subgroup (P value interaction <0.001). Effects of dapagliflozin on hematocrit, body weight, and BP were similar regardless of baseline eGFR, suggesting that effects potentially related to volume and natriuresis are eGFR independent. Moreover, among individuals with baseline urinary albumin-to-creatinine ratio ≥30 mg/g, placebo-adjusted reductions in urinary albumin-to-creatinine ratio were larger in the lowest eGFR subgroup (P value interaction <0.001). Adverse events occurred more frequently in the lowest eGFR subgroup; this was true for both dapagliflozin- and placebo-treated patients. CONCLUSIONS The HbA1c-lowering effects of dapagliflozin decrease as renal function declines. However, dapagliflozin consistently decreases body weight, BP, and urinary albumin-to-creatinine ratio regardless of eGFR. These effects in conjunction with the finding of similar effects on hematocrit, a proxy for volume contraction, suggest that the effects of dapagliflozin are partly mediated via nonglucosuric-dependent mechanisms.
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Affiliation(s)
- Sergei Petrykiv
- Department of Clinical Pharmacy and Pharmacology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | | | | | - John Xu
- AstraZeneca, Gaithersburg, Maryland; and
| | | | - Hiddo J.L. Heerspink
- Department of Clinical Pharmacy and Pharmacology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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Meuleman Y, Hoekstra T, Dekker FW, Navis G, Vogt L, van der Boog PJ, Bos WJW, van Montfrans GA, van Dijk S, van Dijk S, Meuleman Y, Dekker FW, Hoekstra T, Navis G, Vogt L, van der Boog PJ, Bos WJW, van Montfrans GA, Boeschoten EW, Verduijn M, ten Brinke L, Spijker A, Kwakernaak AJ, Humalda JK, van Hirtum T, Bokelaar R, Loos ML, Bakker-Edink A, Poot C, Ciere Y, Zwaard S, Veldscholte G, Heuveling L, Storm M, Prantl K. Sodium Restriction in Patients With CKD: A Randomized Controlled Trial of Self-management Support. Am J Kidney Dis 2017; 69:576-586. [DOI: 10.1053/j.ajkd.2016.08.042] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Accepted: 08/25/2016] [Indexed: 11/11/2022]
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Abstract
: Coping with chronic kidney disease (CKD) is challenging for many people, since symptoms often don't appear until the disease is advanced and the patient is close to requiring dialysis. This two-part article aims to provide nurses with the basic information necessary to assess and manage patients with CKD. Part 1, which appeared last month, offered an overview of the disease, described identification and etiology, and discussed ways to slow disease progression. Part 2 addresses disease complications and treatment for kidney failure.
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Miyashita T, Inamoto R, Fukuda S, Hoshikawa H, Hitomi H, Kiyomoto H, Nishiyama A, Mori N. Hormonal changes following a low-salt diet in patients with Ménière's disease. Auris Nasus Larynx 2017; 44:52-57. [DOI: 10.1016/j.anl.2016.03.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2016] [Revised: 02/14/2016] [Accepted: 03/07/2016] [Indexed: 12/18/2022]
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Jiang S, He H, Tan L, Wang L, Su Z, Liu Y, Zhu H, Zhang M, Hou FF, Li A. Proteomic and phosphoproteomic analysis of renal cortex in a salt-load rat model of advanced kidney damage. Sci Rep 2016; 6:35906. [PMID: 27775022 PMCID: PMC5075906 DOI: 10.1038/srep35906] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Accepted: 10/07/2016] [Indexed: 12/21/2022] Open
Abstract
Salt plays an essential role in the progression of chronic kidney disease and hypertension. However, the mechanisms underlying pathogenesis of salt-induced kidney damage remain largely unknown. Here, Sprague-Dawley rats, that underwent 5/6 nephrectomy (5/6Nx, a model of advanced kidney damage) or sham operation, were treated for 2 weeks with a normal or high-salt diet. We employed aTiO2 enrichment, iTRAQ labeling and liquid-chromatography tandem mass spectrometry strategy for proteomic and phosphoproteomic profiling of the renal cortex. We found 318 proteins differentially expressed in 5/6Nx group relative to sham group, and 310 proteins significantly changed in response to salt load in 5/6Nx animals. Totally, 1810 unique phosphopeptides corresponding to 550 phosphoproteins were identified. We identified 113 upregulated and 84 downregulated phosphopeptides in 5/6Nx animals relative to sham animals. Salt load induced 78 upregulated and 91 downregulated phosphopeptides in 5/6Nx rats. The differentially expressed phospholproteins are important transporters, structural molecules, and receptors. Protein-protein interaction analysis revealed that the differentially phosphorylated proteins in 5/6Nx group, Polr2a, Srrm1, Gsta2 and Pxn were the most linked. Salt-induced differential phosphoproteins, Myh6, Lmna and Des were the most linked. Altered phosphorylation levels of lamin A and phospholamban were validated. This study will provide new insight into pathogenetic mechanisms of chronic kidney disease and salt sensitivity.
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Affiliation(s)
- Shaoling Jiang
- State Key Laboratory of Organ Failure Research, National Clinical Research Center of Kidney Disease, Division of Nephrology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Hanchang He
- The First People's Foshan Hospital, Foshan, China
| | - Lishan Tan
- State Key Laboratory of Organ Failure Research, National Clinical Research Center of Kidney Disease, Division of Nephrology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Liangliang Wang
- Division of Nephrology, First Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine, Guangzhou 510405, P.R. China
| | - Zhengxiu Su
- State Key Laboratory of Organ Failure Research, National Clinical Research Center of Kidney Disease, Division of Nephrology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Yufeng Liu
- State Key Laboratory of Organ Failure Research, National Clinical Research Center of Kidney Disease, Division of Nephrology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Hongguo Zhu
- State Key Laboratory of Organ Failure Research, National Clinical Research Center of Kidney Disease, Division of Nephrology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Menghuan Zhang
- State Key Laboratory of Organ Failure Research, National Clinical Research Center of Kidney Disease, Division of Nephrology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Fan Fan Hou
- State Key Laboratory of Organ Failure Research, National Clinical Research Center of Kidney Disease, Division of Nephrology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Aiqing Li
- State Key Laboratory of Organ Failure Research, National Clinical Research Center of Kidney Disease, Division of Nephrology, Nanfang Hospital, Southern Medical University, Guangzhou, China
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Norton JM, Moxey-Mims MM, Eggers PW, Narva AS, Star RA, Kimmel PL, Rodgers GP. Social Determinants of Racial Disparities in CKD. J Am Soc Nephrol 2016; 27:2576-95. [PMID: 27178804 PMCID: PMC5004663 DOI: 10.1681/asn.2016010027] [Citation(s) in RCA: 190] [Impact Index Per Article: 23.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Significant disparities in CKD rates and outcomes exist between black and white Americans. Health disparities are defined as health differences that adversely affect disadvantaged populations, on the basis of one or more health outcomes. CKD is the complex result of genetic and environmental factors, reflecting the balance of nature and nurture. Social determinants of health have an important role as environmental components, especially for black populations, who are disproportionately disadvantaged. Understanding the social determinants of health and appreciating the underlying differences associated with meaningful clinical outcomes may help nephrologists treat all their patients with CKD in an optimal manner. Altering the social determinants of health, although difficult, may embody important policy and research efforts, with the ultimate goal of improving outcomes for patients with kidney diseases, and minimizing the disparities between groups.
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Affiliation(s)
- Jenna M Norton
- Division of Kidney, Urologic, and Hematologic Diseases, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland
| | - Marva M Moxey-Mims
- Division of Kidney, Urologic, and Hematologic Diseases, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland
| | - Paul W Eggers
- Division of Kidney, Urologic, and Hematologic Diseases, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland
| | - Andrew S Narva
- Division of Kidney, Urologic, and Hematologic Diseases, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland
| | - Robert A Star
- Division of Kidney, Urologic, and Hematologic Diseases, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland
| | - Paul L Kimmel
- Division of Kidney, Urologic, and Hematologic Diseases, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland
| | - Griffin P Rodgers
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland Office of the Director and
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Dougher CE, Rifkin DE, Anderson CA, Smits G, Persky MS, Block GA, Ix JH. Spot urine sodium measurements do not accurately estimate dietary sodium intake in chronic kidney disease. Am J Clin Nutr 2016; 104:298-305. [PMID: 27357090 PMCID: PMC4962156 DOI: 10.3945/ajcn.115.127423] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2015] [Accepted: 05/23/2016] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Sodium intake influences blood pressure and proteinuria, yet the impact on long-term outcomes is uncertain in chronic kidney disease (CKD). Accurate assessment is essential for clinical and public policy recommendations, but few large-scale studies use 24-h urine collections. Recent studies that used spot urine sodium and associated estimating equations suggest that they may provide a suitable alternative, but their accuracy in patients with CKD is unknown. OBJECTIVE We compared the accuracy of 4 equations [the Nerbass, INTERSALT (International Cooperative Study on Salt, Other Factors, and Blood Pressure), Tanaka, and Kawasaki equations] that use spot urine sodium to estimate 24-h sodium excretion in patients with moderate to advanced CKD. DESIGN We evaluated the accuracy of spot urine sodium to predict mean 24-h urine sodium excretion over 9 mo in 129 participants with stage 3-4 CKD. Spot morning urine sodium was used in 4 estimating equations. Bias, precision, and accuracy were assessed and compared across each equation. RESULTS The mean age of the participants was 67 y, 52% were female, and the mean estimated glomerular filtration rate was 31 ± 9 mL · min(-1) · 1.73 m(-2) The mean ± SD number of 24-h urine collections was 3.5 ± 0.8/participant, and the mean 24-h sodium excretion was 168.2 ± 67.5 mmol/d. Although the Tanaka equation demonstrated the least bias (mean: -8.2 mmol/d), all 4 equations had poor precision and accuracy. The INTERSALT equation demonstrated the highest accuracy but derived an estimate only within 30% of mean measured sodium excretion in only 57% of observations. Bland-Altman plots revealed systematic bias with the Nerbass, INTERSALT, and Tanaka equations, underestimating sodium excretion when intake was high. CONCLUSION These findings do not support the use of spot urine specimens to estimate dietary sodium intake in patients with CKD and research studies enriched with patients with CKD. The parent data for this study come from a clinical trial that was registered at clinicaltrials.gov as NCT00785629.
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Affiliation(s)
| | - Dena E Rifkin
- School of Medicine, Division of Nephrology-Hypertension, and Department of Family Medicine and Public Health, University of California San Diego, San Diego, CA; Veterans Affairs San Diego Healthcare System, San Diego, CA; and
| | - Cheryl Am Anderson
- School of Medicine, Department of Family Medicine and Public Health, University of California San Diego, San Diego, CA
| | | | | | | | - Joachim H Ix
- School of Medicine, Division of Nephrology-Hypertension, and Department of Family Medicine and Public Health, University of California San Diego, San Diego, CA; Veterans Affairs San Diego Healthcare System, San Diego, CA; and
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37
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Chin HJ, Kim DK, Park JH, Shin SJ, Lee SH, Choi BS, Kim S, Lim CS. Effect of urine urea nitrogen and protein intake adjusted by using the estimated urine creatinine excretion rate on the antiproteinuric effect of angiotensin II type I receptor blockers. Nutrition 2015; 31:1333-8. [DOI: 10.1016/j.nut.2015.05.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2015] [Revised: 04/11/2015] [Accepted: 05/09/2015] [Indexed: 10/23/2022]
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Ustundag S, Yilmaz G, Sevinc C, Akpinar S, Temizoz O, Sut N, Ustundag A. Carotid intima media thickness is independently associated with urinary sodium excretion in patients with chronic kidney disease. Ren Fail 2015; 37:1285-92. [DOI: 10.3109/0886022x.2015.1073526] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
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39
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Wasser WG, Gil A, Skorecki KL. The Envy of Scholars: Applying the Lessons of the Framingham Heart Study to the Prevention of Chronic Kidney Disease. Rambam Maimonides Med J 2015; 6:RMMJ.10214. [PMID: 26241225 PMCID: PMC4524402 DOI: 10.5041/rmmj.10214] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
During the past 50 years, a dramatic reduction in the mortality rate associated with cardiovascular disease has occurred in the US and other countries. Statistical modeling has revealed that approximately half of this reduction is the result of risk factor mitigation. The successful identification of such risk factors was pioneered and has continued with the Framingham Heart Study, which began in 1949 as a project of the US National Heart Institute (now part of the National Heart, Lung, and Blood Institute). Decreases in total cholesterol, blood pressure, smoking, and physical inactivity account for 24%, 20%, 12%, and 5% reductions in the mortality rate, respectively. Nephrology was designated as a recognized medical professional specialty a few years later. Hemodialysis was first performed in 1943. The US Medicare End-Stage Renal Disease (ESRD) Program was established in 1972. The number of patients in the program increased from 5,000 in the first year to more than 500,000 in recent years. Only recently have efforts for risk factor identification, early diagnosis, and prevention of chronic kidney disease (CKD) been undertaken. By applying the approach of the Framingham Heart Study to address CKD risk factors, we hope to mirror the success of cardiology; we aim to prevent progression to ESRD and to avoid the cardiovascular complications associated with CKD. In this paper, we present conceptual examples of risk factor modification for CKD, in the setting of this historical framework.
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Affiliation(s)
- Walter G. Wasser
- Division of Nephrology, Mayanei HaYeshua Medical Center, Bnei Brak, Israel
- Division of Nephrology, Rambam Health Care Campus, Haifa, Israel
- To whom correspondence should be addressed. E-mail:
| | - Amnon Gil
- Division of Nephrology, Carmel Medical Center, Haifa, Israel
| | - Karl L. Skorecki
- Division of Nephrology, Rambam Health Care Campus, Haifa, Israel
- Ruth & Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
- Director of Medical and Research Development, Rambam Health Care Campus, Haifa, Israel
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40
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Broekman KE, Sinkeler SJ, Waanders F, Bartels GL, Navis G, Janssen WMT. Volume control in treatment-resistant congestive heart failure: role for peritoneal dialysis. Heart Fail Rev 2015; 19:709-16. [PMID: 24442648 DOI: 10.1007/s10741-014-9421-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Chronic congestive heart failure (HF) has a rising prevalence and increasing impact on health care systems. Current treatment consists of diuretics, renin-angiotensin-aldosterone system blockers, and restriction of salt and fluids. This strategy is often hampered by a drop in effective circulating volume and hence renal perfusion and function, triggering harmful counter regulatory mechanisms. Slow ultrafiltration by peritoneal dialysis (PD) might be an effective treatment strategy to relieve fluid overload without compromising cardiac output and thereby renal function. In this review, we discuss the (patho)physiological mechanisms of the cardiorenal interaction and the current literature on PD strategies in congestive HF.
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Affiliation(s)
- K E Broekman
- Department of Internal Medicine, Martini Hospital, Van Swietenplein 1, 9700 RM, Groningen, The Netherlands,
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41
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Shin J, Park JB, Kim KI, Kim JH, Yang DH, Pyun WB, Kim YG, Kim GH, Chae SC. 2013 Korean Society of Hypertension guidelines for the management of hypertension: part III-hypertension in special situations. Clin Hypertens 2015; 21:3. [PMID: 26893917 PMCID: PMC4750807 DOI: 10.1186/s40885-014-0014-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2014] [Accepted: 12/23/2014] [Indexed: 12/11/2022] Open
Abstract
Different treatment strategies are suggested for special situations. Hypertension is common in the elderly and frequently accompanied by or complicates other clinical conditions such as metabolic syndrome, coronary artery disease, heart failure, stroke, diabetes mellitus and chronic kidney disease.
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Affiliation(s)
- Jinho Shin
- />Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Jeong Bae Park
- />Division of Cardiology, Department of Medicine, Cheil General Hospital, Dankook University College of Medicine, Seoul, Korea
| | - Kwang-il Kim
- />Department of Internal Medicine, School of Medicine, Seoul National University, Bundang, Korea
| | - Ju Han Kim
- />Department of Internal Medicine, School of Medicine, Chonnam University, GwangJu, Korea
| | - Dong Heon Yang
- />Division of Cardiology, Department of Internal Medicine, Kyungpook National University School of Medicine, 130 Dongdeok-ro, Jung-gu, Daegu, 700-721 Korea
| | - Wook Bum Pyun
- />Division of Cardiology, Department of Internal Medicine, Ewha Womans University School of Medicine, Seoul, Korea
| | - Young Gweon Kim
- />Division of Cardiology, Department of Internal Medicine, Dongkuk University College of Medicine, Ilsan, Korea
| | - Gheun-Ho Kim
- />Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Shung Chull Chae
- />Division of Cardiology, Department of Internal Medicine, Kyungpook National University School of Medicine, 130 Dongdeok-ro, Jung-gu, Daegu, 700-721 Korea
| | - The Guideline Committee of the Korean Society of Hypertension
- />Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
- />Division of Cardiology, Department of Medicine, Cheil General Hospital, Dankook University College of Medicine, Seoul, Korea
- />Department of Internal Medicine, School of Medicine, Seoul National University, Bundang, Korea
- />Department of Internal Medicine, School of Medicine, Chonnam University, GwangJu, Korea
- />Division of Cardiology, Department of Internal Medicine, Kyungpook National University School of Medicine, 130 Dongdeok-ro, Jung-gu, Daegu, 700-721 Korea
- />Division of Cardiology, Department of Internal Medicine, Ewha Womans University School of Medicine, Seoul, Korea
- />Division of Cardiology, Department of Internal Medicine, Dongkuk University College of Medicine, Ilsan, Korea
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42
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Schwenk MH, Hirsch JS, Bomback AS. Aldosterone blockade in CKD: emphasis on pharmacology. Adv Chronic Kidney Dis 2015; 22:123-32. [PMID: 25704349 DOI: 10.1053/j.ackd.2014.08.003] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2014] [Accepted: 08/11/2014] [Indexed: 12/16/2022]
Abstract
Besides its epithelial effect on sodium retention and potassium excretion in the distal tubule, aldosterone promotes inflammation and fibrosis in the heart, kidneys, and blood vessels. As glomerular filtration rate falls, aldosterone is inappropriately elevated relative to extracellular fluid expansion. In addition, studies in CKD patients on angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, and/or direct renin inhibitors have shown that aldosterone levels paradoxically rise in approximately 30% to 40% of patients on these renin-angiotensin system-blocking drugs. Hence, there is interest in using mineralocorticoid receptor blockers that directly target the inflammatory and fibrotic effects of aldosterone in CKD patients. This interest, however, is tempered by a number of unresolved issues, including the safety of using such drugs in advanced CKD and ESRD populations, and the potential for differences in drug efficacy according to race and ethnicity of patient populations. A better understanding of mineralocorticoid receptor blocker pharmacology should help inform future research directions and clinical practice decisions as to how best to use these agents in CKD.
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43
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Palm F. ET-1 increases reactive oxygen species in hypoxic glomeruli during high salt intake. Acta Physiol (Oxf) 2015; 213:559-60. [PMID: 25535871 DOI: 10.1111/apha.12443] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- F. Palm
- Department of Medical Cell Biology; Uppsala University; Uppsala Sweden
- Department of Medical and Health Sciences; Linköping University; Linköping Sweden
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44
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Cao W, Li A, Wang L, Zhou Z, Su Z, Bin W, Wilcox CS, Hou FF. A Salt-Induced Reno-Cerebral Reflex Activates Renin-Angiotensin Systems and Promotes CKD Progression. J Am Soc Nephrol 2015; 26:1619-33. [PMID: 25635129 DOI: 10.1681/asn.2014050518] [Citation(s) in RCA: 79] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2014] [Accepted: 09/10/2014] [Indexed: 12/30/2022] Open
Abstract
Salt intake promotes progression of CKD by uncertain mechanisms. We hypothesized that a salt-induced reno-cerebral reflex activates a renin-angiotensin axis to promote CKD. Sham-operated and 5/6-nephrectomized rats received a normal-salt (0.4%), low-salt (0.02%), or high-salt (4%) diet for 2 weeks. High salt in 5/6-nephrectomized rats increased renal NADPH oxidase, inflammation, BP, and albuminuria. Furthermore, high salt activated the intrarenal and cerebral, but not the systemic, renin-angiotensin axes and increased the activity of renal sympathetic nerves and neurons in the forebrain of these rats. Renal fibrosis was increased 2.2-fold by high versus low salt, but intracerebroventricular tempol, losartan, or clonidine reduced this fibrosis by 65%, 69%, or 59%, respectively, and renal denervation or deafferentation reduced this fibrosis by 43% or 38%, respectively (all P<0.05). Salt-induced fibrosis persisted after normalization of BP with hydralazine. These data suggest that the renal and cerebral renin-angiotensin axes are interlinked by a reno-cerebral reflex that is activated by salt and promotes oxidative stress, fibrosis, and progression of CKD independent of BP.
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Affiliation(s)
- Wei Cao
- State Key Laboratory of Organ Failure Research, National Clinical Research Center for Kidney Disease, Nanfang Hospital, Southern Medical University, Guangzhou, People's Republic of China; and
| | - Aiqing Li
- State Key Laboratory of Organ Failure Research, National Clinical Research Center for Kidney Disease, Nanfang Hospital, Southern Medical University, Guangzhou, People's Republic of China; and
| | - Liangliang Wang
- State Key Laboratory of Organ Failure Research, National Clinical Research Center for Kidney Disease, Nanfang Hospital, Southern Medical University, Guangzhou, People's Republic of China; and
| | - Zhanmei Zhou
- State Key Laboratory of Organ Failure Research, National Clinical Research Center for Kidney Disease, Nanfang Hospital, Southern Medical University, Guangzhou, People's Republic of China; and
| | - Zhengxiu Su
- State Key Laboratory of Organ Failure Research, National Clinical Research Center for Kidney Disease, Nanfang Hospital, Southern Medical University, Guangzhou, People's Republic of China; and
| | - Wei Bin
- State Key Laboratory of Organ Failure Research, National Clinical Research Center for Kidney Disease, Nanfang Hospital, Southern Medical University, Guangzhou, People's Republic of China; and
| | - Christopher S Wilcox
- Center for Hypertension, Kidney, and Vascular Research, Georgetown University, Washington, DC
| | - Fan Fan Hou
- State Key Laboratory of Organ Failure Research, National Clinical Research Center for Kidney Disease, Nanfang Hospital, Southern Medical University, Guangzhou, People's Republic of China; and
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45
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Gutiérrez OM. Contextual poverty, nutrition, and chronic kidney disease. Adv Chronic Kidney Dis 2015; 22:31-8. [PMID: 25573510 DOI: 10.1053/j.ackd.2014.05.005] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2014] [Revised: 05/07/2014] [Accepted: 05/22/2014] [Indexed: 12/18/2022]
Abstract
Nutrition plays an important role in CKD outcomes. One of the strongest factors that affects nutrition is socioeconomic status as evidenced by the large body of epidemiologic data showing that income and education are directly associated with diet quality. Apart from individual-level markers of socioeconomic status such as income and education, contextual factors such as availability of and transportation to food outlets that provide healthy food options and the density of fast-food restaurants within particular regions markedly affect the ability of individuals to comply with nutrition recommendations. This is particularly true for nutrition guidelines most specific to individuals with CKD such as the consumption of protein, saturated fat, sodium, and phosphorus, all of which have been shown to affect CKD health and are influenced by the availability of healthy food options within individual neighborhood food environments. Because of the strong association of contextual poverty with the diet quality, any serious attempt to improve the diet of CKD patients must include a discussion of the environmental barriers that each individual faces in trying to access healthy foods, and health care providers should take account of these barriers when tailoring specific recommendations.
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46
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Nerbass FB, Pecoits-Filho R, McIntyre NJ, McIntyre CW, Taal MW. Development of a formula for estimation of sodium intake from spot urine in people with chronic kidney disease. Nephron Clin Pract 2014; 128:61-6. [PMID: 25342580 DOI: 10.1159/000363297] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2013] [Accepted: 04/25/2014] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND/AIMS High sodium intake is associated with adverse cardiovascular and renal outcomes in people with chronic kidney disease (CKD), and simple methods to facilitate assessment of sodium intake are required. The objective of this study was to develop a new formula to estimate 24-hour urinary sodium (24hUNa) excretion from urinary Na concentration measured on an early morning urine specimen (EM UNa). METHODS Seventy participants from a prospective cohort of patients with CKD stage 3 in primary care, the Renal Risk in Derby (RRID) study, agreed to collect an additional EM UNa on the day after completing a 24-hour urine collection. A formula to estimate 24hUNa from EM UNa and body weight was developed using the coefficients from a multivariable linear regression equation. The accuracy of the formula was tested by calculating the P30 (proportion of estimates within 30% of measured sodium exection), and the ability of the estimated 24hUNa to discriminate between measured sodium intake above or below 100 mmol/day was assessed by receiver operating characteristic (ROC) curve. A Bland-Altman plot was used to estimate the bias and limits of agreement between estimated and measured 24hUNa. Seventy-four additional paired 24hUNa and EM UNa from 50 CKD stage 3 patients in the RRID study were used to validate the formula. RESULTS The mean difference between measured and estimated 24hUNa was 2.08 mmol/day. Measured and estimated 24hUNa were significantly correlated (r = 0.55; p < 0.001) but accuracy of estimated 24hUNa was low (P30 = 60%). Analysis of the ROC curve with a cut-off point >100 mmol/day yielded an area under the curve of 0.668, sensitivity of 0.85 and specificity of 0.52. CONCLUSIONS We have developed a simple formula to identify people with a high sodium intake from EM UNa, suitable for use in large-cohort or population studies.
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Affiliation(s)
- Fabiana B Nerbass
- School of Medicine, Pontificia Universidade Católica do Paraná, Curitiba, Brazil
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Meuleman Y, ten Brinke L, Kwakernaak AJ, Vogt L, Rotmans JI, Bos WJW, van der Boog PJM, Navis G, van Montfrans GA, Hoekstra T, Dekker FW, van Dijk S. Perceived Barriers and Support Strategies for Reducing Sodium Intake in Patients with Chronic Kidney Disease: a Qualitative Study. Int J Behav Med 2014; 22:530-9. [DOI: 10.1007/s12529-014-9447-x] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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High sodium intake is associated with important risk factors in a large cohort of chronic kidney disease patients. Eur J Clin Nutr 2014; 69:786-90. [PMID: 25293433 DOI: 10.1038/ejcn.2014.215] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2014] [Revised: 08/04/2014] [Accepted: 09/01/2014] [Indexed: 01/06/2023]
Abstract
BACKGROUND/OBJECTIVES An increased risk of mortality and cardiovascular disease (CVD) is observed in people with chronic kidney disease (CKD) even in early stages. Dietary sodium intake has been associated with important CVD and CKD progression risk factors such as hypertension and proteinuria in this population. We aimed to investigate the relationship between sodium intake and CVD or CKD progression risk factors in a large cohort of patients with CKD stage 3 recruited from primary care. SUBJECTS/METHODS A total of 1733 patients with previous estimated glomerular filtration rate (eGFR) of 30-59 ml/min/1.73m(2), with a mean age 72.9±9.0 years, were recruited from 32 general practices in primary care in England. Medical history was obtained and participants underwent clinical assessment, urine and serum biochemistry testing. Sodium intake was estimated from three early-morning urine specimens using an equation validated for this study population. RESULTS Sixty percent of participants who had estimated sodium intake above recommendation (>100 mmol/day or 6 g salt/day) also had higher diastolic blood pressure, mean arterial pressure (MAP), urinary albumin-to-creatinine ratio, high-sensitive C-reactive protein and uric acid and used a greater number of anti-hypertensive drugs. In multivariable regression analysis, excessive sodium intake was an independent predictor of MAP (B=1.57, 95% confidence interval (CI) 0.41-2.72; P=0.008) and albuminuria (B=1.35, 95% CI 1.02-1.79; P=0.03). CONCLUSIONS High sodium intake was associated with CVD and CKD progression risk factors in patients with predominantly early stages of CKD followed up in primary care. This suggests that dietary sodium intake could afffect CVD risk even in early or mild CKD. Intervention studies are warranted to investigate the potential benefit of dietary advice to reduce sodium intake in this population.
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Ahn SY, Kim S, Kim DK, Park JH, Shin SJ, Lee SH, Choi BS, Lim CS, Kim S, Chin HJ. Urinary sodium excretion has positive correlation with activation of urinary renin angiotensin system and reactive oxygen species in hypertensive chronic kidney disease. J Korean Med Sci 2014; 29 Suppl 2:S123-30. [PMID: 25317016 PMCID: PMC4194282 DOI: 10.3346/jkms.2014.29.s2.s123] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2014] [Accepted: 06/26/2014] [Indexed: 01/13/2023] Open
Abstract
It is not well described the pathophysiology of renal injuries caused by a high salt intake in humans. The authors analyzed the relationship between the 24-hr urine sodium-to-creatinine ratio (24HUna/cr) and renal injury parameters such as urine angiotensinogen (uAGT/cr), monocyte chemoattractant peptide-1 (uMCP1/cr), and malondialdehyde-to-creatinine ratio (uMDA/cr) by using the data derived from 226 hypertensive chronic kidney disease patients. At baseline, the 24HUna/cr group or levels had a positive correlation with uAGT/cr and uMDA/cr adjusted for related factors (P<0.001 for each analysis). When we estimated uAGT/cr in the 24HUna/cr groups by ANCOVA, the uAGT/cr in patients with ≥200 mEq/g cr was higher than in patients with <100 mEq/g cr (708 [95% CI, 448-967] vs. 334 [95% CI, 184-483] pg/mg cr, P=0.014). Similarly, uMDA/cr was estimated as 0.17 (95% CI, 0.14-0.21) pM/mg cr in patients with <100 mEq/g cr and 0.27 (95% CI, 0.20-0.33) pM/mg cr in patients with ≥200 mEq/g cr (P=0.016). During the 16-week follow-up period, an increase in urinary sodium excretion predicted an increase in urinary angiotensinogen excretion. In conclusion, high salt intake increases renal renin-angiotensin-system (RAS) activation, primarily, and directly or indirectly affects the production of reactive oxygen species through renal RAS activation.
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Affiliation(s)
- Shin-Young Ahn
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
- Department of Immunology, Seoul National University Postgraduate School, Seoul, Korea
| | - Sejoong Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Dong Ki Kim
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Jung Hwan Park
- Department of Internal Medicine, Konkuk University School of Medicine, Seoul, Korea
| | - Sung Joon Shin
- Department of Internal Medicine, Dongguk University Ilsan Hospital, Goyang, Korea
| | - Sang Ho Lee
- Department of Internal Medicine, Kyung Hee University Medical Center, Seoul, Korea
| | - Bum Soon Choi
- Department of Internal Medicine, Seoul St. Mary's Hospital, Seoul, Korea
| | - Chun Soo Lim
- Department of Internal Medicine, Seoul National University Boramae Medical Center, Seoul, Korea
| | - Suhnggwon Kim
- Research Institute of Salt and Health, Seoul, Korea
- Seoul K-Clinic, Seoul, Korea
| | - Ho Jun Chin
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
- Department of Immunology, Seoul National University Postgraduate School, Seoul, Korea
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Sinnakirouchenan R, Kotchen TA. Role of Sodium Restriction and Diuretic Therapy for “Resistant” Hypertension in Chronic Kidney Disease. Semin Nephrol 2014; 34:514-9. [DOI: 10.1016/j.semnephrol.2014.08.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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