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Matsueda S, Yamada S, Torisu K, Kitamura H, Ninomiya T, Nakano T, Kitazono T. Vascular Calcification Is Accelerated by Hyponatremia and Low Osmolality. Arterioscler Thromb Vasc Biol 2024; 44:1925-1943. [PMID: 38989577 DOI: 10.1161/atvbaha.123.320069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 06/27/2024] [Indexed: 07/12/2024]
Abstract
BACKGROUND Hyponatremia, frequently observed in patients with chronic kidney disease, is associated with increased cardiovascular morbidity and mortality. Hyponatremia or low osmolality induces oxidative stress and cell death, both of which accelerate vascular calcification (VC), a critical phenotype in patients with chronic kidney disease. Whether hyponatremia or low osmolality plays a role in the pathogenesis of VC is unknown. METHODS Human vascular smooth muscle cells (VSMCs) and mouse aortic rings were cultured in various osmotic conditions and calcifying medium supplemented with high calcium and phosphate. The effects of low osmolality on phenotypic change and oxidative stress in the cultured VSMCs were examined. Microarray analysis was conducted to determine the main signaling pathway of osmolality-related VC. The transcellular sodium and calcium ions flux across the VSMCs were visualized by live imaging. Furthermore, the effect of osmolality on calciprotein particles (CPPs) was investigated. Associations between arterial intimal calcification and hyponatremia or low osmolality were examined by a cross-sectional study using human autopsy specimens obtained in the Hisayama Study. RESULTS Low osmolality exacerbated calcification of the ECM (extracellular matrix) of cultured VSMCs and mouse aortic rings. Oxidative stress and osteogenic differentiation of VSMCs were identified as the underlying mechanisms responsible for low osmolality-induced VC. Microarray analysis showed that low osmolality activated the Rac1 (Ras-related C3 botulinum toxin substrate 1)-Akt (protein kinase B) pathway and reduced NCX1 (Na-Ca exchanger 1) expression. Live imaging showed synchronic calcium ion efflux and sodium ion influx via NCX1 when extracellular sodium ion concentrations were increased. An NCX1 inhibitor promoted calcifying media-induced VC by reducing calcium ion efflux. Furthermore, low osmolality accelerated the generation and maturation steps of CPPs. The cross-sectional study of human autopsy specimens showed that hyponatremia and low osmolality were associated with a greater area of arterial intimal calcification. CONCLUSIONS Hyponatremia and low osmolality promote VC through multiple cellular processes, including the Rac1-Akt pathway activation.
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Affiliation(s)
- Shumei Matsueda
- Departments of Medicine and Clinical Science (M.S., S.Y., K.T., T. Nakano, T.K.), Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Shunsuke Yamada
- Departments of Medicine and Clinical Science (M.S., S.Y., K.T., T. Nakano, T.K.), Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Kumiko Torisu
- Departments of Medicine and Clinical Science (M.S., S.Y., K.T., T. Nakano, T.K.), Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | | | - Toshiharu Ninomiya
- Epidemiology and Public Health (T. Ninomiya), Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Toshiaki Nakano
- Departments of Medicine and Clinical Science (M.S., S.Y., K.T., T. Nakano, T.K.), Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
- Kidney Care Unit, Kyushu University Hospital, Fukuoka, Japan (T. Nakano)
| | - Takanari Kitazono
- Departments of Medicine and Clinical Science (M.S., S.Y., K.T., T. Nakano, T.K.), Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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Pelouto A, Reimer J, Hoorn EJ, Zandbergen AAM, den Hertog HM. Hyponatremia is associated with unfavorable outcomes after reperfusion treatment in acute ischemic stroke. Eur J Neurol 2024; 31:e16156. [PMID: 38015439 PMCID: PMC11236033 DOI: 10.1111/ene.16156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 10/28/2023] [Accepted: 10/31/2023] [Indexed: 11/29/2023]
Abstract
BACKGROUND AND PURPOSE In patients with acute ischemic stroke, hyponatremia (plasma sodium < 136 mmol/L) is common and associated with unfavorable outcomes. However, data are limited for patients who underwent intravenous thrombolysis (IVT) and/or endovascular thrombectomy (EVT). Therefore, our aim was to assess the impact of hyponatremia on postreperfusion outcomes. METHODS We analyzed data of consecutive patients who presented with acute ischemic stroke and were treated with IVT and/or EVT at Isala Hospital, the Netherlands, in 2019 and 2020. The primary outcome measure was the adjusted common odds ratio (acOR) for a worse modified Rankin Scale (mRS) score at 3-month follow-up. Secondary outcomes included symptomatic intracranial hemorrhage, in-hospital mortality, infarct core, and penumbra volumes. RESULTS Of the 680 patients (median age = 73 years, 49% female, median National Institutes of Health Stroke Scale = 5), 430 patients (63%) were treated with IVT, 120 patients (18%) with EVT, and 130 patients (19%) with both. Ninety-two patients (14%) were hyponatremic on admission. Hyponatremia was associated with a worse mRS score at 3 months (acOR = 1.76, 95% confidence interval [CI] = 1.12-2.76) and in-hospital mortality (aOR = 2.39, 95% CI = 1.23-4.67), but not with symptomatic intracranial hemorrhage (OR = 1.17, 95% CI = 0.39-3.47). Hyponatremia was also associated with a larger core (17.2 mL, 95% CI = 2.9-31.5) and core to penumbra ratio (55.0%, 95% CI = 7.1-102.9). CONCLUSIONS Admission hyponatremia in patients with acute ischemic stroke treated with IVT and/or EVT was independently associated with unfavorable postreperfusion outcomes, a larger infarct core, and a larger core to penumbra ratio. Future studies should address whether correction of hyponatremia improves the prognosis.
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Affiliation(s)
- Anissa Pelouto
- Department of Internal Medicine, Erasmus Medical CenterUniversity Medical Center RotterdamRotterdamthe Netherlands
| | - Jorieke Reimer
- Department of NeurologyMedisch Spectrum TwenteEnschedethe Netherlands
| | - Ewout J. Hoorn
- Department of Internal Medicine, Erasmus Medical CenterUniversity Medical Center RotterdamRotterdamthe Netherlands
| | - Adrienne A. M. Zandbergen
- Department of Internal Medicine, Erasmus Medical CenterUniversity Medical Center RotterdamRotterdamthe Netherlands
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Yalta K, Palabıyık O, Gurdogan M, Yetkın E. Hyponatremia and takotsubo syndrome: a review of pathogenetic and clinical implications. Heart Fail Rev 2024; 29:27-44. [PMID: 37698728 DOI: 10.1007/s10741-023-10344-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/01/2023] [Indexed: 09/13/2023]
Abstract
Hyponatremia is a common electrolyte abnormality with important prognostic and therapeutic implications. It might exert detrimental effects on various organ systems including the central nervous system (CNS), bone, and heart along with its potential association with poor quality of life. These adverse effects might be largely mediated through a variety of mechanisms including osmotic stress, dysfunctional transmembrane exchangers, and enhanced oxidative stress.Interestingly, hyponatremia might also have an important association with takotsubo syndrome (TTS) that has been universally considered as a reversible form of cardiomyopathy usually emerging in response to various stressors. In this context, severe hyponatremia was previously reported to serve as a direct trigger of TTS evolution largely through its potential impact on CNS and heart. However, pathogenetic and clinical implications of hyponatremia still need to be thoroughly evaluated in patients with TTS. This paper aims to analyze the clinical features of published cases with TTS primarily triggered by hyponatremia and also aims to discuss the association between hyponatremia and TTS from a broader perspective.
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Affiliation(s)
- Kenan Yalta
- Cardiology Department, School of Medicine, TrakyaUniversity, Balkan Yerleşkesi, 22030, Edirne, Turkey.
| | - Orkide Palabıyık
- Trakya University, Vocational Collage of Health Services, Edirne, Turkey
| | - Muhammet Gurdogan
- Cardiology Department, School of Medicine, TrakyaUniversity, Balkan Yerleşkesi, 22030, Edirne, Turkey
| | - Ertan Yetkın
- Türkiye Hastanesi, Cardiology Department, Istanbul, Turkey
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Tang H, Xu C, Zhang P, Luo T, Huang Y, Yang X. A profile of SGLT-2 inhibitors in hyponatremia: The evidence to date. Eur J Pharm Sci 2023; 184:106415. [PMID: 36870579 DOI: 10.1016/j.ejps.2023.106415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Revised: 02/14/2023] [Accepted: 02/27/2023] [Indexed: 03/06/2023]
Abstract
Hyponatremia is the most common electrolyte disorder in clinical practice, which may lead to life-threatening complications. Several lines of evidence suggest that hyponatremia is associated not only with significant increases in length of stay, cost, and financial burden, but also with increased morbidity and mortality. Hyponatremia is also considered to be a negative prognostic factor in patients with heart failure and cancer. Although multiple therapeutic methods are available for treating hyponatremia, most have some limitations, such as poor compliance, rapid correction of serum Na+, other negative side effects and high cost. Given these limitations, identifying novel therapies for hyponatremia is essential. Recent clinical studies have shown that SGLT-2 inhibitors (SGLT 2i) significantly increased serum Na+ levels and were well tolerated by patients who underwent this treatment. Therefore, oral administration of SGLT 2i appears to be an effective treatment for hyponatremia. This article will briefly review the etiology of hyponatremia and integrated control of sodium within the kidney, current therapies for hyponatremia, potential mechanisms and efficacy of SGLT 2i for hyponatremia, and the benefits in cardiovascular, cancer, and kidney disease by regulating sodium and water balance.
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Affiliation(s)
- Hui Tang
- Department of Pharmacy, The Affiliated Hospital of Southwest Medical University, Luzhou 646000, China; School of Pharmacy, Southwest Medical University, Luzhou 646000, China
| | - Changjing Xu
- Department of Pharmacy, The Affiliated Hospital of Southwest Medical University, Luzhou 646000, China
| | - Piao Zhang
- Department of Pharmacy, Ya 'an People's Hospital, Ya 'an, Sichuan 646000, China
| | - Taimin Luo
- Department of pharmacy, Chengdu Seventh People's Hospital, Chengdu, Sichuan 610000, China
| | - Yilan Huang
- Department of Pharmacy, The Affiliated Hospital of Southwest Medical University, Luzhou 646000, China; School of Pharmacy, Southwest Medical University, Luzhou 646000, China.
| | - Xuping Yang
- Department of Pharmacy, The Affiliated Hospital of Southwest Medical University, Luzhou 646000, China; School of Pharmacy, Southwest Medical University, Luzhou 646000, China.
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Dong L, Shen Z, Chi H, Wang Y, Shi Z, Fang H, Yang Y, Rong J. Research Progress of Chinese Medicine in the Treatment of Myocardial Ischemia-Reperfusion Injury. THE AMERICAN JOURNAL OF CHINESE MEDICINE 2022; 51:1-17. [PMID: 36437553 DOI: 10.1142/s0192415x23500015] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Vascular recanalization is the essential procedure in which severe coronary artery stenosis is diagnosed. However, the blood flow recovery associated with this procedure may cause myocardial ischemia-reperfusion injury (MIRI), which aggravates heart failure. Unfortunately, the mechanism of MIRI has historically been poorly understood. As we now know, calcium overloading, oxidative stress, mitochondrial dysfunction, inflammatory responses, and ferroptosis take part in the process of MIRI. Modern medicine has shown through clinical studies its own limited effects in the case of MIRI, whereas Chinese traditional medicine demonstrates a strong vitality. Multiple-target effects, such as anti-inflammatory, anti-oxidant, and cardio-protection effects, are central to this vitality. In our clinic center, Yixin formula is commonly used in patients with MIRI. This formula contains Astragalus, Ligusticum Wallichii, Salvia, Rhodiola Rosea, Radix Angelicae Sinensis, Cyperus Rotundus, and Cassia Twig. Its effects include warming yang energy, activating blood circulation, and eliminating blood stasis. In our previous laboratory studies, we have proved that it can reduce MIRI and oxidative stress injury in rats suffering from ischemia myocardiopathy. It can also inhibit apoptosis and protect myocardium. In this paper, we review the research of Yixin formula and other related herbal medicines in MIRI therapy.
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Affiliation(s)
- Li Dong
- Institute of Cardiology of Integrated Traditional, Chinese and Western Medicine, P. R. China
| | - Zhijie Shen
- Department of Cardiology, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai 200135, P. R. China
| | - Hao Chi
- Department of Cardiology, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai 200135, P. R. China
| | - Yingjie Wang
- Department of Cardiology, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai 200135, P. R. China
| | - Zhaofeng Shi
- Department of Cardiology, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai 200135, P. R. China
| | - Hongjun Fang
- Department of Cardiology, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai 200135, P. R. China
| | - Yanling Yang
- Institute of Cardiology of Integrated Traditional, Chinese and Western Medicine, P. R. China
| | - Jingfeng Rong
- Department of Cardiology, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai 200135, P. R. China
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Fibbi B, Marroncini G, Anceschi C, Naldi L, Peri A. Hyponatremia and Oxidative Stress. Antioxidants (Basel) 2021; 10:1768. [PMID: 34829639 PMCID: PMC8614907 DOI: 10.3390/antiox10111768] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 10/26/2021] [Accepted: 11/03/2021] [Indexed: 12/15/2022] Open
Abstract
Hyponatremia, i.e., the presence of a serum sodium concentration ([Na+]) < 136 mEq/L, is the most frequent electrolyte imbalance in the elderly and in hospitalized patients. Symptoms of acute hyponatremia, whose main target is the central nervous system, are explained by the "osmotic theory" and the neuronal swelling secondary to decreased extracellular osmolality, which determines cerebral oedema. Following the description of neurological and systemic manifestations even in mild and chronic hyponatremia, in the last decade reduced extracellular [Na+] was associated with detrimental effects on cellular homeostasis independently of hypoosmolality. Most of these alterations appeared to be elicited by oxidative stress. In this review, we focus on the role of oxidative stress on both osmolality-dependent and -independent impairment of cell and tissue functions observed in hyponatremic conditions. Furthermore, basic and clinical research suggested that oxidative stress appears to be a common denominator of the degenerative processes related to aging, cancer progression, and hyponatremia. Of note, low [Na+] is able to exacerbate multiple manifestations of senescence and to decrease progression-free and overall survival in oncologic patients.
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Affiliation(s)
- Benedetta Fibbi
- Pituitary Diseases and Sodium Alterations Unit, AOU Careggi, 50139 Florence, Italy; (B.F.); (G.M.)
- Endocrinology, Department of Experimental and Clinical Biomedical Sciences “Mario Serio”, University of Florence, AOU Careggi, 50139 Florence, Italy; (C.A.); (L.N.)
| | - Giada Marroncini
- Pituitary Diseases and Sodium Alterations Unit, AOU Careggi, 50139 Florence, Italy; (B.F.); (G.M.)
- Endocrinology, Department of Experimental and Clinical Biomedical Sciences “Mario Serio”, University of Florence, AOU Careggi, 50139 Florence, Italy; (C.A.); (L.N.)
| | - Cecilia Anceschi
- Endocrinology, Department of Experimental and Clinical Biomedical Sciences “Mario Serio”, University of Florence, AOU Careggi, 50139 Florence, Italy; (C.A.); (L.N.)
| | - Laura Naldi
- Endocrinology, Department of Experimental and Clinical Biomedical Sciences “Mario Serio”, University of Florence, AOU Careggi, 50139 Florence, Italy; (C.A.); (L.N.)
| | - Alessandro Peri
- Pituitary Diseases and Sodium Alterations Unit, AOU Careggi, 50139 Florence, Italy; (B.F.); (G.M.)
- Endocrinology, Department of Experimental and Clinical Biomedical Sciences “Mario Serio”, University of Florence, AOU Careggi, 50139 Florence, Italy; (C.A.); (L.N.)
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Preoperative hyponatremia predicts complications in older patients undergoing digestive tract surgery: a propensity score matching analysis. Eur Geriatr Med 2021; 13:493-503. [PMID: 34558033 PMCID: PMC9018643 DOI: 10.1007/s41999-021-00559-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Accepted: 08/31/2021] [Indexed: 11/12/2022]
Abstract
Aim This study aimed to investigate the association between preoperative hyponatremia and life-threatening postoperative complications (including death) among older patients undergoing digestive tract surgery. Findings Preoperative hyponatremia was associated with an increased risk of life-threatening postoperative complications and mortality in older patients undergoing digestive tract surgery. Preoperative hyponatremia was also correlated with a higher risk of postoperative infectious complications. Message Preoperative hyponatremia can predict the development of life-threatening postoperative complications and mortality in older patients undergoing digestive tract surgery. Supplementary Information The online version contains supplementary material available at 10.1007/s41999-021-00559-4. Purpose Whether preoperative hyponatremia increases the risk of postoperative complications in older patients undergoing digestive tract surgery remains unclear. The purpose of the study was to investigate the association between preoperative hyponatremia and life-threatening postoperative complications (including death) among older patients undergoing digestive tract surgery. Methods This was a propensity score-matched, retrospective cohort study. We recruited older patients (≥ 65 years of age) who underwent digestive tract surgery in our institution. The propensity score matching (PSM; 1:2) was used to balance a range of covariates between patients with preoperative hyponatremia (serum sodium [Na+] levels < 135 mmol/L) and those with normal [Na+] levels (135–145 mmol/L). The primary outcome was the occurrence of life-threatening postoperative complications and mortality (i.e., Clavien–Dindo grade IV and V [CD IV and V] complications) during hospital stay. The relationship between preoperative hyponatremia and the development of CD IV and V complications was identified with logistic regression analysis. Results A total of 1076 patients were analyzed (mean age 73.9 years; 421 female [39.1%]). Preoperative hyponatremia was identified in 122 patients. After matching, 312 patients were included in the analyses (104 patients with preoperative hyponatremia and 208 patients with normal [Na+] levels; mean age, 76.3 years; 130 female [41.7%]). When compared with normal [Na+] levels, preoperative hyponatremia was associated with an increased risk of CD IV and V complications (odds ratio [OR] 2.082, 95% confidential interval [CI] 1.041–4.164, P = 0.038). Preoperative hyponatremia was also significantly associated with a higher risk of postoperative infectious complications (OR 2.158, 95% CI 1.138–4.091, P = 0.018). Conclusion Preoperative hyponatremia can predict an increased risk of life-threatening postoperative complications and mortality in older patients undergoing digestive tract surgery. Supplementary Information The online version contains supplementary material available at 10.1007/s41999-021-00559-4.
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Oniki T, Teshima Y, Nishio S, Ishii Y, Kira S, Abe I, Yufu K, Takahashi N. Hyponatraemia aggravates cardiac susceptibility to ischaemia/reperfusion injury. Int J Exp Pathol 2020; 100:350-358. [PMID: 31994291 DOI: 10.1111/iep.12338] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2018] [Revised: 01/16/2019] [Accepted: 11/07/2019] [Indexed: 01/04/2023] Open
Abstract
Hyponatraemia is defined as a serum sodium concentration of <135 mEql/L and is the most common electrolyte disturbance in patients with chronic heart failure. We hypothesize that hyponatraemia may induce Ca2+ overload and enhance reactive oxygen species (ROS) production, which will exacerbate myocardial injury more than normonatraemia. We investigated the effect of hyponatraemia on the ability of the heart to recover from ischaemia/reperfusion episodes. Cardiomyocytes were obtained from 1- to 3-day-old Sprague Dawley rats. After isolation, cardiomyocytes were placed in Dulbecco's modified Eagle's medium (DMEM) containing low sodium concentration (110, 120, or 130 mEq/L) or normal sodium concentration (140 mEq/L) for 72 hours. Exposure of cardiomyocytes to each of the low-sodium medium significantly increased both ROS and intracellular Ca2+ levels compared with the exposure to the normal-sodium medium. In vivo, 8-week-old male Sprague Dawley rats were divided into four groups: control group (Con), furosemide group (Fur), low-sodium diet group (Lsd) and both furosemide and low-sodium diet group (Fur + Lsd). The hearts subjected to global ischaemia exhibited considerable decrease in left ventricular developed pressure during reperfusion, and the size of infarcts induced by ischaemia/reperfusion significantly increased in the Fur, Lsd and Fur + Lsd compared with that in the Con. Hyponatraemia aggravates cardiac susceptibility to ischaemia/reperfusion injury by Ca2+ overload and increasing in ROS levels.
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Affiliation(s)
- Takahiro Oniki
- Department of Cardiology and Clinical Examination, Faculty of Medicine, Oita University, Yufu city, Japan
| | - Yasushi Teshima
- Department of Cardiology and Clinical Examination, Faculty of Medicine, Oita University, Yufu city, Japan
| | - Satoru Nishio
- Department of Cardiology and Clinical Examination, Faculty of Medicine, Oita University, Yufu city, Japan
| | - Yumi Ishii
- Department of Cardiology and Clinical Examination, Faculty of Medicine, Oita University, Yufu city, Japan
| | - Shintaro Kira
- Department of Cardiology and Clinical Examination, Faculty of Medicine, Oita University, Yufu city, Japan
| | - Ichitaro Abe
- Department of Cardiology and Clinical Examination, Faculty of Medicine, Oita University, Yufu city, Japan
| | - Kunio Yufu
- Department of Cardiology and Clinical Examination, Faculty of Medicine, Oita University, Yufu city, Japan
| | - Naohiko Takahashi
- Department of Cardiology and Clinical Examination, Faculty of Medicine, Oita University, Yufu city, Japan
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