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Kohagura K. Effect of Combined DASH Diet with Sodium Restriction on Renal Function. KIDNEY360 2024; 5:487-488. [PMID: 38662535 PMCID: PMC11093539 DOI: 10.34067/kid.0000000000000427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2024]
Affiliation(s)
- Kentaro Kohagura
- Dialysis Unit, University of the Ryukyus Hospital, Nishihara-cho, Okinawa, Japan
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2
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Liao HW, Wang SM, Chan CK, Lin YH, Lin PC, Ho CH, Liu YC, Chueh JS, Wu VC. Transtubular potassium gradient predicts kidney function impairment after adrenalectomy in primary aldosteronism. Ther Adv Chronic Dis 2020; 11:2040622320944792. [PMID: 32922714 PMCID: PMC7457632 DOI: 10.1177/2040622320944792] [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: 02/15/2020] [Accepted: 06/26/2020] [Indexed: 11/17/2022] Open
Abstract
Background: In primary aldosteronism (PA), kidney function impairment could be concealed
by relative hyperfiltration and emerge after adrenalectomy. We hypothesized
transtubular gradient potassium gradient (TTKG), a kidney aldosterone
bioactivity indicator, could correlate to end organ damage and forecast
kidney function impairment after adrenalectomy. Methods: In the present prospective study, we enrolled lateralized PA patients who
underwent adrenalectomy and were followed up 12 months after operation in
the Taiwan Primary Aldosteronism Investigation (TAIPAI) registry from 2010
to 2018. The clinical outcome was kidney function impairment, defined as
estimated glomerular filtration rate (eGFR) <60 ml/min/1.73 m2
at 12 months after adrenalectomy. End organ damage is determined by
microalbuminuria and left ventricular mass. Results: In total, 323 patients [mean, 50.8 ± 10.9 years old; female 178 (55.1%)] were
enrolled. Comparing pre-operation and post-operation data, systolic blood
pressure, serum aldosterone, urinary albumin to creatinine ratio and eGFR
decreased. TTKG ⩾ 4.9 correlated with pre-operative urinary albumin to
creatinine ratio >50 mg/g [odds ratio (OR) = 2.42;
p = 0.034] and left ventricular mass (B = 20.10;
p = 0.018). Multivariate logistic regression analysis
demonstrated that TTKG ⩾ 4.9 could predict concealed chronic kidney disease
(OR = 5.42; p = 0.011) and clinical success (OR = 2.90,
p = 0.017) at 12 months after adrenalectomy. Conclusions: TTKG could predict concealed kidney function impairment and cure of
hypertension in PA patients after adrenalectomy. TTKG more than 4.9 as an
adverse surrogate of aldosterone and hypokalaemia correlated with
pre-operative end organ damage in terms of high proteinuria and cardiac
hypertrophy.
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Affiliation(s)
| | - Shuo-Meng Wang
- Department of Urology, National Taiwan University Hospital, Taipei
| | - Chieh-Kai Chan
- Department of Internal Medicine, National Taiwan University Hospital, Hsin-Chu branch, Hsin-Chu
| | - Yen-Hung Lin
- Department of Internal Medicine, National Taiwan University Hospital, Taipei
| | - Po-Chih Lin
- Department of Internal Medicine, National Taiwan University Hospital, Taipei
| | - Chen-Hsun Ho
- Division of Urology, Department of Surgery, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan
| | | | - Jeff S Chueh
- Glickman Urological and Kidney Institute, and Cleveland Clinic Lerner College of Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - Vin-Cent Wu
- Department of Internal Medicine, National Taiwan University Hospital, Room 1555, Clinical Research Building, 7 Chung-Shan South Road, Taipei 100
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3
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Kramer H. Diet and Chronic Kidney Disease. Adv Nutr 2019; 10:S367-S379. [PMID: 31728497 PMCID: PMC6855949 DOI: 10.1093/advances/nmz011] [Citation(s) in RCA: 60] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Revised: 12/04/2018] [Accepted: 01/07/2019] [Indexed: 02/07/2023] Open
Abstract
Kidney disease affects almost 15% of the US population, and prevalence is anticipated to grow as the population ages and the obesity epidemic continues due to Western dietary practices. The densely caloric Western diet, characterized by high animal protein and low fruit and vegetable content, has fueled the growth of chronic diseases, including chronic kidney disease. The glomerulus or filtering unit of the kidney is very susceptible to barotrauma, and diets high in animal protein impede the glomerulus' ability to protect itself from hemodynamic injury. High animal protein intake combined with low intake of fruits and vegetables also leads to a high net endogenous acid production requiring augmentation of ammonium excretion in order to prevent acidosis. This higher workload of the kidney to maintain a normal serum bicarbonate level may further exacerbate kidney disease progression. This article reviews the potential mechanisms whereby several key characteristics of the typical Western diet may impact kidney disease incidence and progression. Reducing animal protein intake and egg yolk and increasing intake of fruits and vegetables and fiber may prevent or delay end-stage renal disease, but few clinical trials have examined vegetarian diets for management of chronic kidney disease. More research is needed to determine optimal dietary patterns for the prevention of kidney disease and its progression.
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Affiliation(s)
- Holly Kramer
- Department of Public Health Sciences and Medicine
- Division of Nephrology and Hypertension, Loyola University, Chicago, IL
- Address correspondence to HK (e-mail: )
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Jardine MJ, Li N, Ninomiya T, Feng X, Zhang J, Shi J, Zhang Y, Zhang R, Zhang J, Hao J, Perkovic V, Heerspink HL, Wu Y, Yan LL, Neal B. Dietary Sodium Reduction Reduces Albuminuria: A Cluster Randomized Trial. J Ren Nutr 2019; 29:276-284. [DOI: 10.1053/j.jrn.2018.10.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Revised: 09/29/2018] [Accepted: 10/12/2018] [Indexed: 11/11/2022] Open
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Hong S, Choi YM, Ihm SH, Kim D, Choi MG, Yu JM, Hong EG. Association between metabolic parameters and glomerular hyperfiltration in a representative Korean population without chronic kidney disease. PLoS One 2018; 13:e0207843. [PMID: 30521539 PMCID: PMC6283579 DOI: 10.1371/journal.pone.0207843] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Accepted: 11/07/2018] [Indexed: 11/26/2022] Open
Abstract
Aims To investigate associations of glomerular hyperfiltration with other metabolic factors in a nationally representative dataset. Methods We analyzed cross-sectional data from 15,918 subjects with estimated glomerular filtration rate (eGFR) >60 ml/min/1.73 m2 and urine albumin creation ratio (ACR) <30 mg/g, who participated in the 5th and 6th Korea National Health and Nutrition Examination Surveys. Hyperfiltration was defined as eGFR (CKD-EPI equation) exceeding the age- and sex-specific 95th percentile for healthy control subjects. Results Prevalence of hyperfiltration was 5.2% and that among normal, prediabetic, and diabetic subjects was 4.9%, 5.6%, and 7.3%, respectively, after adjusting for age, sex, and body weight (p for trend = 0.008). In a multiple logistic regression analysis, hyperfiltration was associated with a body mass index ≥30 kg/m2 [odds ratio (OR) = 3.461, p<0.001], waist circumference 85 cm (men) or 80 cm (women) (OR = 1.425, p = 0.015), systolic blood pressure 120–129 mmHg (OR = 1.644, p = 0.022), fasting plasma glucose 140 mg/dL (OR = 1.695, p = 0.033) and t serum triglyceride level 500 mg/dL (OR = 2.988, p = 0.001), and was independently associated with the ACR (B = 0.053, p<0.001). Conclusions In a general Korean population, both hyperfiltration and ACR were associated with similar metabolic parameters, and hyperfiltration correlated independently with a high ACR. Longitudinal studies are needed to further explore risks of hyperfiltration and microalbuminuria.
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Affiliation(s)
- Sangmo Hong
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Hallym University Dongtan Sacred Heart Hospital, Hwaseong, Korea
| | - Yun Mi Choi
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Hallym University Dongtan Sacred Heart Hospital, Hwaseong, Korea
| | - Sung-Hee Ihm
- Division of Endocrinology and Metabolism, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Gyeonggi-do, Republic of Korea
| | - Dooman Kim
- Department of Endocrinology and Metabolism, Division of Internal Medicine, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Moon-Gi Choi
- Division of Endocrinology and Metabolism, Department of Internal Medicine, College of Medicine, Hallym University, Chuncheon, Republic of Korea
| | - Jae Myung Yu
- Division of Endocrinology Metabolism and Geriatric Medicine, Department of Internal Medicine, Hallym University Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Eun-Gyoung Hong
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Hallym University Dongtan Sacred Heart Hospital, Hwaseong, Korea
- * E-mail:
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Qi H, Liu Z, Cao H, Sun WP, Peng WJ, Liu B, Dong SJ, Xiang YT, Zhang L. Comparative Efficacy of Antihypertensive Agents in Salt-Sensitive Hypertensive Patients: A Network Meta-Analysis. Am J Hypertens 2018; 31:835-846. [PMID: 29438454 DOI: 10.1093/ajh/hpy027] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Accepted: 02/08/2018] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Salt-sensitive hypertension (SSH) is an intermediate inherited phenotype of essential hypertension as well as being an independent risk factor for cardiovascular disease. However, effective medications for the treatment of SSH have not been clarified. This study was to compare the efficacious of different classes of antihypertensive agents combined with salt intake on the reduction of blood pressure (BP) in patients with SSH. METHODS We used sources as PubMed, EMBASE, Cochrane Library, Cochrane Central Register of Controlled Trials (CENTRAL), ClinicalTrials.gov, International Clinical Trials Registry Platform (ICTRP), CNKI, and WANFANG database from inception to November 2016. Studies that compared the efficacy of 2 or more antihypertensive agents or placebos in adult salt-sensitive hypertensive patients were included. The outcomes included variations in mean arterial blood pressure, systolic and diastolic blood pressure. RESULTS Twenty-five studies were involved in this meta-analysis. A calcium channel blocker (CCB) with hydrochlorothiazide and moderate salt intake was significantly the most efficacious in comparison with placebo (standardized mean differences (SMD), 95% credibility intervals (CI): 26.66, 12.60 to 40.16), angiotensin receptor blockers (ARBs) (SMD, 95% CI: 22.94, 5.26 to 40.51), and the other interventions for patients with SSH and no concomitant diseases. For SSH patients who were obese, CCB with metformin and moderate salt intake would decrease blood pressure with 17.90 mm Hg. CONCLUSIONS For SSH patients with no concomitant diseases, CCB combined with hydrochlorothiazide and moderate salt intake was optimal in reducing BP, while CCB combined with metformin and moderate salt intake was the most efficacious at reducing BP in SSH patients with coexisting obesity.
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Affiliation(s)
- Han Qi
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing, China and Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing, China
| | - Zheng Liu
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing, China and Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing, China
| | - Han Cao
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing, China and Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing, China
| | - Wei-Ping Sun
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing, China and Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing, China
- Department of Cardiology, Beijing Luhe Hospital, Capital Medical University, Beijing, China
| | - Wen-Juan Peng
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing, China and Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing, China
| | - Bin Liu
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing, China and Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing, China
| | - Sheng-Jie Dong
- Department of Arthropathy, Yantai Yantaishan Hospital, Yantai, China
| | - Yu-Tao Xiang
- Unit of Psychiatry, Faculty of Health Sciences, University of Macau, Macao SAR, China
| | - Ling Zhang
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing, China and Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing, China
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Eirin A, Saad A, Woollard JR, Juncos LA, Calhoun DA, Tang H, Lerman A, Textor SC, Lerman LO. Glomerular Hyperfiltration in Obese African American Hypertensive Patients Is Associated With Elevated Urinary Mitochondrial-DNA Copy Number. Am J Hypertens 2017. [PMID: 28641368 DOI: 10.1093/ajh/hpx103] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Glomerular hyperfiltration may contribute to the high incidence of renal disease in Obese African Americans essential hypertensive (ObAAEH) patients, but the precise mechanisms responsible for renal injury have not been elucidated. Mitochondria are important determinants of renal injury in hypertension, and increased levels of mitochondrial DNA (mtDNA) in the urine may indicate renal mitochondrial injury. We hypothesized that urine mtDNA copy numbers would be higher in ObAAEH compared to Caucasian essential hypertensive (CEH) patients. METHODS We prospectively measured systemic, renal vein (RV), inferior vena cava (IVC), and urinary copy number of the mtDNA genes COX3 and ND1 by quantitative-PCR in CEH and ObAAEH patients during constant sodium intake and antihypertensive regimens, and compared them with healthy volunteers (HV) (n = 23 each). RESULTS Blood pressure was similarly elevated in CEH and ObAAEH, while glomerular filtration rate (GFR) was higher and age lower in ObAAEH. Urinary (but not plasma) COX3 and ND1 were higher in CEH compared to HV, and further elevated in ObAAEH patients. COX3 and ND1 renal gradients (RV-IVC) were higher in ObAAEH vs. CEH, and their urinary levels directly correlated with GFR. In multivariate analysis, GFR remained the only predictor of elevated urinary COX3 and ND1 levels. CONCLUSIONS Urinary fragments of the mitochondrial genome are elevated in ObAAEH patients and correlate with glomerular hyperfiltration. A positive gradient across the kidney in ObAAEH suggests selective renal release. These results are consistent with mitochondrial injury that may aggravate renal damage and accelerate hypertension-related morbidity/mortality rates in ObAAEH.
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Affiliation(s)
- Alfonso Eirin
- Department of Medicine, Divisions of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota, USA
| | - Ahmed Saad
- Department of Medicine, Divisions of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota, USA
| | - John R Woollard
- Department of Medicine, Divisions of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota, USA
| | - Luis A Juncos
- Department of Medicine, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - David A Calhoun
- Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Hui Tang
- Department of Medicine, Divisions of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota, USA
| | - Amir Lerman
- Department of Medicine, Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, USA
| | - Stephen C Textor
- Department of Medicine, Divisions of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota, USA
| | - Lilach O Lerman
- Department of Medicine, Divisions of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota, USA
- Department of Medicine, Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, USA
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Sadeghi M, Roohafza H, Pourmoghaddas M, Behnamfar O, Pourmoghaddas Z, Heidari E, Mahjoor Z, Mousavi M, Bahonar A, Sarrafzadegan N. How far cardio metabolic and psychological factors affect salt sensitivity in normotensive adult population? World J Cardiol 2017; 9:47-54. [PMID: 28163836 PMCID: PMC5253194 DOI: 10.4330/wjc.v9.i1.47] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2016] [Revised: 10/08/2016] [Accepted: 11/02/2016] [Indexed: 02/06/2023] Open
Abstract
AIM To evaluate the prevalence of salt sensitivity and the impact of cardiometabolic and psychological characteristics on salt sensitivity in normotensive population.
METHODS Of all participants, anthropometric measurements and fasting venous blood samples were collected, and study questionnaires were completed. Salt Sensitivity was defined based on the difference in mean arterial pressure with infusion of 2 L of normal saline followed by a low sodium diet and administration of three doses of oral furosemide the day after.
RESULTS Of 131 participants, 56 (42.7%) were diagnosed with salt sensitivity. Crude and age and sex adjusted regression analysis showed that low-density lipoprotein cholesterol and depression were positively associated with salt sensitivity (OR = 1.02, 95%CI: 1.01-1.04 and OR = 1.15, 95%CI: 1.00-1.34, respectively).
CONCLUSION The high prevalence of salt sensitivity and its significant relation with prevalent risk factors necessitates considering its reduction actions at the population level and the need for further research.
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Abstract
Human genetic variation is a determinant of nutrient efficacy and of tolerances and intolerances and has the potential to influence nutrient intake values (NIVs). Knowledge derived from the comprehensive identification of human genetic variation offers the potential to predict the physiological and pathological consequences of individual genetic differences and prevent and/or manage adverse outcomes through diet. Nutrients and genomes interact reciprocally; genomes confer differences in nutrient utilization, whereas nutrients effectively modify genome expression, stability, and viability. Understanding the interactions that occur among human genes, including all genetic variants thereof, and environmental exposures is enabling the development of genotype-specific nutritional regimens that prevent disease and promote wellness for individuals and populations throughout the life cycle. Genomic technologies may provide new criteria for establishing NIVs. The impact of a gene variant on NIVs will be dependent on its penetrance and prevalence within a population. Recent experiences indicate that few gene variants are anticipated to be sufficiently penetrant to affect average requirement (AR) values to a greater degree than environmental factors. If highly penetrant gene variants are identified that affect nutrient requirements, the prevalence of the variant in that country or region will determine the feasibility and necessity of deriving more than one AR or upper limit (UL) for affected genetic subgroups.
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Affiliation(s)
- Patrick J Stover
- Division of Nutritional Sciences, Cornell Uniersity, 315 Savage Hall, Ithaca, NY 14853, USA.
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Burke M, Pabbidi MR, Farley J, Roman RJ. Molecular mechanisms of renal blood flow autoregulation. Curr Vasc Pharmacol 2015; 12:845-58. [PMID: 24066938 PMCID: PMC4416696 DOI: 10.2174/15701611113116660149] [Citation(s) in RCA: 97] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2011] [Revised: 12/18/2011] [Accepted: 07/02/2013] [Indexed: 01/10/2023]
Abstract
Diabetes and hypertension are the leading causes of chronic kidney disease and their incidence is increasing at
an alarming rate. Both are associated with impairments in the autoregulation of renal blood flow (RBF) and greater transmission
of fluctuations in arterial pressure to the glomerular capillaries. The ability of the kidney to maintain relatively
constant blood flow, glomerular filtration rate (GFR) and glomerular capillary pressure is mediated by the myogenic response
of afferent arterioles working in concert with tubuloglomerular feedback that adjusts the tone of the afferent arteriole
in response to changes in the delivery of sodium chloride to the macula densa. Despite intensive investigation, the factors
initiating the myogenic response and the signaling pathways involved in the myogenic response and tubuloglomerular
feedback remain uncertain. This review focuses on current thought regarding the molecular mechanisms underlying myogenic
control of renal vascular tone, the interrelationships between the myogenic response and tubuloglomerular feedback,
the evidence that alterations in autoregulation of RBF contributes to hypertension and diabetes-induced nephropathy and
the identification of vascular therapeutic targets for improved renoprotection in hypertensive and diabetic patients.
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Affiliation(s)
| | | | | | - Richard J Roman
- Department of Pharmacology and Toxicology, University of Mississippi Medical Center, 2500 North State Street, Jackson, MS 39216, USA.
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Abstract
Elevation of blood pressure (BP) and the risk for progression to hypertension (HTN) is of increasing concern in children and adolescents. Indeed, it is increasingly recognized that target organ injury may begin with even low levels of BP elevation. Sodium intake has long been recognized as a modifiable risk factor for HTN. While it seems clear that sodium impacts BP in children, its effects may be enhanced by other factors including obesity and increasing age. Evidence from animal and human studies indicates that sodium may have adverse consequences on the cardiovascular system independent of HTN. Thus, moderation of sodium intake over a lifetime may reduce risk for cardiovascular morbidity in adulthood. An appetite for salt is acquired, and intake beyond our need is almost universal. Considering that eating habits in childhood have been shown to track into adulthood, modest sodium intake should be advocated as part of a healthy lifestyle.
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Affiliation(s)
- Coral D Hanevold
- Division of Nephrology, Seattle Children's Hospital, 4800 Sand Point Way NE, OC.9.820, Seattle, WA, 98105, USA,
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Okuhara Y, Hirotani S, Naito Y, Nakabo A, Iwasaku T, Eguchi A, Morisawa D, Ando T, Sawada H, Manabe E, Masuyama T. Intravenous salt supplementation with low-dose furosemide for treatment of acute decompensated heart failure. J Card Fail 2014; 20:295-301. [PMID: 24462960 DOI: 10.1016/j.cardfail.2014.01.012] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2013] [Revised: 12/27/2013] [Accepted: 01/15/2014] [Indexed: 12/26/2022]
Abstract
BACKGROUND Theoretically, salt supplementation should promote diuresis through increasing the glomerular filtration rate (GFR) during treatment of acute decompensated heart failure (ADHF) even with low-dose furosemide; however, there is little evidence to support this idea. METHODS AND RESULTS This was a prospective, randomized, open-label, controlled trial that compared the diuretic effectiveness of salt infusion with that of glucose infusion supplemented with low-dose furosemide in 44 consecutive patients with ADHF. Patients were randomly administered 1.7% hypertonic saline solution supplemented with 40 mg furosemide (salt infusion group) or glucose supplemented with 40 mg furosemide (glucose infusion group). Our major end points were 24-hour urinary volume and GFR. Urinary volume was greater in the salt infusion group than in the glucose infusion group (2,701 ± 920 vs 1,777 ± 797 mL; P < .001). There was no significant difference in the estimated GFR at baseline. Creatinine clearance for 24 h was greater in the salt infusion group than in the glucose infusion group (63.5 ± 52.6 vs 39.0 ± 26.3 mL min(-1) 1.73 m(-2); P = .048). CONCLUSIONS Salt supplementation rather than salt restriction evoked favorable diuresis through increasing GFR. The findings support an efficacious novel approach of the treatment of ADHF.
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Affiliation(s)
- Yoshitaka Okuhara
- Cardiovascular Division, Department of Internal Medicine, Hyogo College of Medicine, Hyogo, Japan
| | - Shinichi Hirotani
- Cardiovascular Division, Department of Internal Medicine, Hyogo College of Medicine, Hyogo, Japan.
| | - Yoshiro Naito
- Cardiovascular Division, Department of Internal Medicine, Hyogo College of Medicine, Hyogo, Japan
| | - Ayumi Nakabo
- Cardiovascular Division, Department of Internal Medicine, Hyogo College of Medicine, Hyogo, Japan
| | - Toshihiro Iwasaku
- Cardiovascular Division, Department of Internal Medicine, Hyogo College of Medicine, Hyogo, Japan
| | - Akiyo Eguchi
- Cardiovascular Division, Department of Internal Medicine, Hyogo College of Medicine, Hyogo, Japan
| | - Daisuke Morisawa
- Cardiovascular Division, Department of Internal Medicine, Hyogo College of Medicine, Hyogo, Japan
| | - Tomotaka Ando
- Cardiovascular Division, Department of Internal Medicine, Hyogo College of Medicine, Hyogo, Japan
| | - Hisashi Sawada
- Cardiovascular Division, Department of Internal Medicine, Hyogo College of Medicine, Hyogo, Japan
| | - Eri Manabe
- Cardiovascular Division, Department of Internal Medicine, Hyogo College of Medicine, Hyogo, Japan
| | - Tohru Masuyama
- Cardiovascular Division, Department of Internal Medicine, Hyogo College of Medicine, Hyogo, Japan
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Zhang J, Chandrashekar K, Lu Y, Duan Y, Qu P, Wei J, Juncos LA, Liu R. Enhanced expression and activity of Nox2 and Nox4 in the macula densa in ANG II-induced hypertensive mice. Am J Physiol Renal Physiol 2013; 306:F344-50. [PMID: 24285500 DOI: 10.1152/ajprenal.00515.2013] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
NAD(P)H oxidase (Nox)2 and Nox4 are the isoforms of Nox expressed in the macula densa (MD). MD-derived superoxide (O₂⁻), primarily generated by Nox2, is enhanced by acute ANG II stimulation. However, the effects of chronic elevations in ANG II during ANG II-induced hypertension on MD-derived O₂⁻ are unknown. We infused a slow pressor dose of ANG II (600 ng·min⁻¹·kg⁻¹) for 2 wk in C57BL/6 mice and found that mean arterial pressure was elevated by 22.3 ± 3.4 mmHg (P < 0.01). We measured O₂⁻ generation in isolated and perfused MDs and found that O₂⁻ generation by the MD was increased from 9.4 ± 0.9 U/min in control mice to 34.7 ± 1.8 U/min in ANG II-induced hypertensive mice (P < 0.01). We stimulated MMDD1 cells, a MD-like cell line, with ANG II and found that O₂⁻ generation increased from 921 ± 91 to 3,687 ± 183 U·min⁻¹·10⁵ cells⁻¹, which was inhibited with apocynin, oxypurinol, or NS-398 by 46%, 14%, and 12%, respectively. We isolated MD cells using laser capture microdissection and measured mRNA levels of Nox. Nox2 and Nox4 levels increased by 3.7 ± 0.17- and 2.6 ± 0.15-fold in ANG II-infused mice compared with control mice. In MMDD1 cells treated with Nox2 or Nox4 small interfering (si)RNAs, ANG II-stimulated O₂⁻ generation was blunted by 50% and 41%, respectively. In cells treated with p22(phox) siRNA, ANG II-stimulated O₂⁻ generation was completely blocked. In conclusion, we found that a subpressor dose of ANG II enhances O₂⁻ generation in the MD and that the sources of this O₂⁻ are primarily Nox2 and Nox4.
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Affiliation(s)
- Jie Zhang
- Dept. of Physiology and Biophysics, Univ. of Mississippi Medical Center, 2500 N. State St., Jackson, MS 39216.
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Han J, Chen Y, Liu Y, Liang Y, Wang X, Liu L, Wang F, Zhang L, Zhang H, Wang H. Common variants of the UMOD promoter associated with blood pressure in a community-based Chinese cohort. Hypertens Res 2012; 35:769-74. [DOI: 10.1038/hr.2012.51] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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16
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Textor SC, Gloviczki ML, Flessner MF, Calhoun DA, Glockner J, Grande JP, McKusick MA, Cha SS, Lerman LO. Association of filtered sodium load with medullary volumes and medullary hypoxia in hypertensive African Americans as compared with whites. Am J Kidney Dis 2011; 59:229-37. [PMID: 22130642 DOI: 10.1053/j.ajkd.2011.09.023] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2011] [Accepted: 09/28/2011] [Indexed: 11/11/2022]
Abstract
BACKGROUND African Americans develop hypertension earlier with more target manifestations than whites despite having a higher glomerular filtration rate (GFR) for any level of serum creatinine. STUDY DESIGN & PARTICIPANTS: This study tested the hypothesis that increased GFR and sodium reabsorption in African Americans is associated with increased metabolic work and medullary hypoxia in 49 nondiabetic patients with essential hypertension (29 whites and 20 African Americans) following a constant-sodium diet (150 mEq/d) and renin-angiotensin system blockade. PREDICTORS Ethnicity, age, measured GFR, sodium excretion, and body mass index. OUTCOMES We examined cortical and medullary volumes and blood flows using multidetector computed tomography and intrarenal deoxyhemoglobin (R2*) using blood oxygen level-dependent magnetic resonance. RESULTS Blood pressure and sodium excretion were similar, whereas African Americans were more obese and had higher iothalamate GFRs. Renal cortical volumes did not differ, but medullary volumes adjusted for body size and age were higher in African Americans (32.3 ± 11.2 vs 25.1 ± 7.4 cm(3)/m(2) body surface area; P < 0.001). Sodium reabsorption and blood flows were higher in African Americans. Basal cortical deoxyhemoglobin values were similar between ethnic groups, whereas medullary R2* was higher in African Americans (39.7 ± 5.1 vs 36.3 ± 6.5/s; P = 0.02), but decreased to levels similar to whites after furosemide treatment. Levels of the circulating isoprostane prostaglandin F(2α) were higher in African Americans and daily urinary prostaglandin F(2α) excretion in African Americans correlated directly with renal blood flow (R = 0.71; P < 0.01). LIMITATIONS Studies were limited to treated volunteers with normal kidney function without knowledge of prior nutrient intake. CONCLUSIONS These data show for the first time that increased sodium reabsorption in obese African American patients with hypertension was associated with enlarged medullary volumes, functional hypoxia related to solute reabsorption, and a direct relationship between blood flows and urinary isoprostane levels. Our results support a model of increased oxygen consumption and oxidative stress in African Americans that may accelerate hypertension and target-organ injury compared with white patients with essential hypertension.
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Jung J, Basile DP, Pratt JH. Sodium reabsorption in the thick ascending limb in relation to blood pressure: a clinical perspective. Hypertension 2011; 57:873-9. [PMID: 21403087 DOI: 10.1161/hypertensionaha.108.120246] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Jeesun Jung
- Department of Medical and Molecular Genetics, Indiana University School of Medicine, Indianapolis, IN, USA
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Kola LD, Sumaili EK, Krzesinski JM. How to treat hypertension in blacks: review of the evidence. Acta Clin Belg 2009; 64:466-76. [PMID: 20101869 DOI: 10.1179/acb.2009.082] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Presentation, response to therapy, and clinical outcome differ according to race for patients with hypertension. Black patients have a higher prevalence and earlier onset of hypertension than other ethnic groups, with poorer prognosis than white patients. Blacks are more likely to be salt-sensitive, and to have a low plasma renin activity than are whites. They are at much greater risk of developing cardiovascular and renal complications. Despite many advances in the understanding and treatment of cardiovascular diseases, black patients continue to have increased morbidity and mortality from the end-organ complications of hypertension. The explanations for these observations remain incompletely understood, but genetic differences, added to socio-economic and environmental factors, have been proposed to explain this disparity. The first therapeutic approach is to decrease salt and increase potassium intakes. Diuretics (thiazides and potassium-sparing agents) and calcium channel blockers constitute the first antihypertensive drug choices. The angiotensin-converting-enzyme inhibitors, the angiotensin II receptor blockers and beta-blockers appear to be less effective in blacks with regard to uncomplicated hypertension, especially in older people, but addition of a small dose of diuretic improves their efficacy. These combinations are preferred among patients with chronic kidney disease or heart failure. The goal for blood pressure target is the same in blacks as it is in whites, being a blood pressure of less than 140/90 mmHg in uncomplicated hypertension and less than 130/80 mmHg in patients with diabetes mellitus or chronic kidney disease.
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Affiliation(s)
- L D Kola
- Service de Néphrologie-Dialyse, Centre Hospitalier du Bois de l'Abbaye, rue Laplace 40, 4100 Seraing, Belgique
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Li R, Richey PA, DiSessa TG, Alpert BS, Jones DP. Blood aldosterone-to-renin ratio, ambulatory blood pressure, and left ventricular mass in children. J Pediatr 2009; 155:170-5. [PMID: 19464027 PMCID: PMC2726743 DOI: 10.1016/j.jpeds.2009.02.029] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2008] [Revised: 01/14/2009] [Accepted: 02/12/2009] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To assess the blood aldosterone-to-renin ratio (ARR) and its relationship to ambulatory blood pressure (ABP) and left ventricular mass (LVM) in children. STUDY DESIGN A cross-sectional clinical study was conducted in 102 children (71.6% African American; 62.7% male) ranging in age from 7 to 18 years (mean, 13.6 years; median, 14 years). ABP (24-hour monitoring) was expressed as blood pressure index (BPI; mean blood pressure/95th percentile by sex and height). LVM was measured by echocardiography and expressed as an index (LVMI = g/height [m](2.7)). Regression analyses were used to estimate associations. RESULTS African-American children had significantly lower serum aldosterone concentration and plasma renin activity compared with European-American children (aldosterone: 5.9 ng/dL vs 11.4 ng/dL, P < .0001; renin: 1.6 ng/mL/hour vs 2.8 ng/mL/hour, P = .01). However, ARR was not significantly different by race. ARR was not associated with 24-hour ABP but was significantly associated with LVMI (beta = 0.4 g/m(2.7); P = .02) after adjustment for the ratio of 24-hour urine Na to creatinine excretion, body mass index z- score, and ABP index. CONCLUSIONS The data indicated a significant association between ARR and LVMI, but not ABP, in children, suggesting early cardiac remodeling associated with a high ARR.
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Affiliation(s)
- Rongling Li
- Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, TN 38163, USA.
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Abstract
1. Initial attempts to inhibit renin in humans have faced numerous difficulties. Molecular modelling and X-ray crystallography of the active site of renin have led to the development of new orally active renin inhibitors, such as aliskiren. 2. Aliskiren has a low bioavailability (between 2.6 and 5.0%) compensated by its high potency to inhibit renin (IC50: 0.6 nmol/L) and a long plasma half-life (23-36 h), which makes it suitable for once-daily dosing. 3. The once-daily administration of aliskiren to hypertensive patients lowers BP as strongly as standard doses of established angiotensin II type 1 (AT1) receptor blockers (losartan, valsartan, irbesartan), hydrochlorothiazide, angiotensin converting enzyme inhibitors (ramipril and lisinopril) or long acting calcium channel blockers (amlodipine). In combination therapy, aliskiren further decreases blood pressure when combined with either hydrochlorothiazide, amlodipine, irbesartan or ramipril. 4. The biochemical consequences of renin inhibition differ from those of angiotensin I-converting enzyme (ACE) inhibition and Ang II antagonism, particularly in terms of angiotensin profiles and interactions with the bradykinin-nitric oxide-cyclic guanosine monophosphate pathway and possibly the (pro)renin receptor. 5. Blockade of the renin angiotensin system (RAS) with ACE inhibitors, AT1 receptor blockers or a combination of these drugs has become one of the most successful therapeutic approaches in medicine. However, it remains unclear how to optimize RAS blockade to maximize cardiovascular and renal benefits. In this context, renin inhibition to render the RAS fully quiescent is a new possibility requiring further study.
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21
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Direct renin inhibition: clinical pharmacology. J Mol Med (Berl) 2008; 86:647-54. [DOI: 10.1007/s00109-008-0329-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2008] [Accepted: 01/28/2008] [Indexed: 10/22/2022]
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Köttgen A, Selvin E, Stevens LA, Levey AS, Van Lente F, Coresh J. Serum cystatin C in the United States: the Third National Health and Nutrition Examination Survey (NHANES III). Am J Kidney Dis 2008; 51:385-94. [PMID: 18295054 DOI: 10.1053/j.ajkd.2007.11.019] [Citation(s) in RCA: 126] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2007] [Accepted: 11/17/2007] [Indexed: 01/08/2023]
Abstract
BACKGROUND Serum cystatin C increasingly is used as a marker of glomerular filtration rate and cardiovascular risk. However, information for serum cystatin C levels in the general population, specifically across a wide age range and different ethnicities, is lacking. OBJECTIVES To determine nationally representative serum cystatin C levels, estimate the prevalence of increased cystatin C levels in the general population, and identify factors associated with increased cystatin C levels. STUDY DESIGN Cross-sectional survey. SETTING AND PARTICIPANTS A nationally representative subsample of 7,596 participants aged 12 years or older in the Third National Health and Nutrition Examination Survey conducted in 1988-1994. PREDICTORS Age, sex, race/ethnicity, risk factors for chronic kidney disease. OUTCOMES Continuous serum cystatin C levels and serum cystatin C level greater than 1.12 mg/L. MEASUREMENTS Cystatin C was measured in 2006 from stored sera by using an automated particle-enhanced nephelometric assay. RESULTS Overall median serum cystatin C level was 0.85 mg/L. Median cystatin C levels increased steeply with age and were greater in males and non-Hispanic white persons, even in a healthy subgroup of 20- to 39-year-olds. Prevalences of increased serum cystatin C levels (>1.12 mg/L) were 1%, 41%, and greater than 50% in all persons aged younger than 20 years, 60 years or older, and 80 years or older. In persons aged 60 years and older, older age, non-Hispanic white ethnicity, hypertension, current smoking, lower levels of education and high-density lipoprotein cholesterol, and increased body mass index, C-reactive protein, and triglyceride values were associated significantly with increased serum cystatin C levels. LIMITATIONS No measured glomerular filtration rate, single measurement of cystatin C, cross-sectional study design. CONCLUSIONS Serum cystatin C level is related to sex and ethnicity, even in young healthy individuals. The prevalence of increased cystatin C levels increases dramatically with age, reaching greater than 50% after the age of 80 years in both sexes and all ethnic groups.
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Affiliation(s)
- Anna Köttgen
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health and the Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, MD 21287, USA
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Griffin KA, Kramer H, Bidani AK. Adverse renal consequences of obesity. Am J Physiol Renal Physiol 2008; 294:F685-96. [PMID: 18234955 DOI: 10.1152/ajprenal.00324.2007] [Citation(s) in RCA: 178] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Emerging evidence indicates that obesity, even in the absence of diabetes, contributes significantly to the development and progression of chronic kidney disease (CKD). Glomerular hyperfiltration/hypertrophy in response to the increased metabolic needs of obesity are postulated to lead to the development of glomerulosclerosis (GS) in a manner analogous to that in reduced renal mass states. Nevertheless, the individual risk for developing GS with obesity is very low. It is proposed that glomerular hyperfiltration/hypertrophy are per se not pathogenic in the absence of an enhanced glomerular blood pressure (BP) transmission, and the modest preglomerular vasodilation that is likely present in the large majority of obese individuals is not sufficient to result in such increased BP transmission. However, in the small subset of obese individuals who are also born with a substantially reduced nephron number, there is a greater risk of enhanced glomerular BP transmission due to the substantially greater preglomerular vasodilation. Of perhaps greater clinical importance, similar additive deleterious effects of obesity on BP transmission would be expected in individuals with reduced renal mass, either congenital or acquired, or with concurrent renal disease, leading to accelerated progression. Of note, a low birth weight may be a risk factor for not only reduced nephron numbers at birth, but also for obesity and hypertension, resulting in a clustering of risk factors for progressive GS. Therefore, even though the individual risk for developing obesity GS is low, the cumulative impact of obesity on the public health burden of CKD is likely to be large because of its huge prevalence.
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Affiliation(s)
- Karen A Griffin
- Loyola Univ. Medical Center, 2160 South First Ave., Maywood, IL 60153, USA.
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Agyemang C, van Valkengoed I, van den Born BJ, Stronks K. Prevalence of Microalbuminuria and Its Association with Pulse Pressure in a Multi-Ethnic Population in Amsterdam, The Netherlands. Kidney Blood Press Res 2008; 31:38-46. [DOI: 10.1159/000112923] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2007] [Accepted: 11/01/2007] [Indexed: 11/19/2022] Open
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Ménard J, Azizi M. The difficult conception, birth and delivery of a renin inhibitor: controversies around aliskiren. J Hypertens 2007; 25:1775-82. [PMID: 17762637 DOI: 10.1097/hjh.0b013e3282ef45e9] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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Abstract
Blockade of the renin-angiotensin system (RAS) with angiotensin I-converting enzyme (ACE) inhibitors and AT1-receptor (AT1R) blockers has become one of the most successful therapeutic approaches in medicine. The question is no longer whether RAS inhibition helps, but rather how we can optimize inhibition to achieve optimal cardiovascular and renal protection. Indeed, numerous data have shown that the RAS is not blocked fully over 24 hours with current doses of RAS blockers because they trigger a counter-regulatory renin release that can offset pharmacologic inhibition of the RAS. This absence of full blockade may have clinical implications. Combination therapy with ACE inhibitors and AT1R antagonists thus has been proposed to inhibit the biological effects of the reactive renin release triggered by single-site RAS inhibition. By using this approach, numerous experimental and clinical studies have suggested that this combination therapy has additive or synergistic effects on blood pressure and on the prevention of cardiovascular and renal lesions. Although similar intensity of RAS blockade can be achieved by either combination therapy or by using high doses of an AT1-receptor antagonist given alone, the ACE inhibitor present in the combination interferes with the bradykinin-nitric oxide pathway and the N-acetyl-Ser-Asp-Lys-Pro metabolism, which both may have additional biological effects.
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Affiliation(s)
- Michel Azizi
- Université Paris Descartes, Faculté de Médecine, and Assistance Publique Hôpitaux de Paris, Hôpital Européen Georges Pompidou, and INSERM, CIC 9201, Paris, France
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Azizi M, Ménard J, Bissery A, Guyene TT, Bura-Rivière A. Hormonal and hemodynamic effects of aliskiren and valsartan and their combination in sodium-replete normotensive individuals. Clin J Am Soc Nephrol 2007; 2:947-55. [PMID: 17702736 DOI: 10.2215/cjn.00360107] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND OBJECTIVES An AT1 receptor antagonist induces a counterregulatory renin release whose intensity and duration reflect the magnitude of the renin-angiotensin blockade. We investigated whether a renin inhibitor may neutralize this counterregulation and amplify the effects of AT1 receptor antagonists. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS In 12 normotensive male individuals who were on a high-sodium diet, a double-blind, placebo-controlled, randomized, crossover design was used to study the hormonal and BP effects of single oral administrations of 300 mg of the renin inhibitor aliskiren, 320 mg of valsartan, and a combination of these two drugs, each at half dosage (150 mg of aliskiren and 160 mg of valsartan). RESULTS Valsartan (320 mg) increased plasma renin activity and angiotensin I and angiotensin II levels, but 300 mg of aliskiren decreased them for 48 h. Aliskiren (300 mg) stimulated immunoreactive renin release more strongly than 320 mg of valsartan, decreased urinary aldosterone excretion for longer than 320 mg of valsartan, and had a similar BP-lowering effect as 320 mg of valsartan. In combination, 150 mg of aliskiren neutralized the valsartan (160 mg)-induced increase in plasma angiotensins for 48 h. The renin and aldosterone effects of the combination of 150 mg of aliskiren and 160 mg of valsartan were similar to those of 300 mg of aliskiren and greater than those of 320 mg of valsartan. When plasma drug concentrations were taken into account, the combination of 150 mg of aliskiren and 160 mg of valsartan had a synergistic effect on renin release. The BP-lowering effect of 150 mg of aliskiren and 160 mg of valsartan was similar to that of 300 mg of aliskiren and 320 mg of valsartan at peak but was more prolonged. CONCLUSION The stronger and longer lasting effects on plasma active renin and urinary aldosterone of aliskiren, alone or in combination, demonstrate a more effective blockade of the renin-angiotensin system than that obtained with 320 mg of valsartan alone.
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Affiliation(s)
- Michel Azizi
- Université Paris Descartes, Faculté de Médecine, Paris, France.
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Kwakernaak AJ, Tent H, Rook M, Krikken JA, Navis G. Renal hemodynamics in overweight and obesity: pathogenetic factors and targets for intervention. Expert Rev Endocrinol Metab 2007; 2:539-552. [PMID: 30290422 DOI: 10.1586/17446651.2.4.539] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Weight excess is a risk factor for progressive renal function loss, not only in subjects with renal disease or renal transplant recipients, but also in the general population. Considering the increasing prevalence of obesity worldwide, weight excess may become the main renal risk factor on a population basis, all the more so because the risk is not limited to morbid obesity, but is already apparent in the overweight range. The mechanism of the renal risk is multifactorial. In addition to the role of comorbid conditions such as hypertension and diabetes, current evidence supports a pathogenetic role for renal hemodynamics, specifically glomerular hyperfiltration, and also glomerular hypertension. Weight excess is associated with an elevated glomerular filtration rate and a less pronounced rise in renal plasma flow, resulting in an elevated filtration fraction. This suggests glomerular hypertension due to afferent-efferent dysbalance, which impairs glomerular protection from systemic hypertension. Data in renal transplant recipients support the pathogenetic role of elevated glomerular pressure for long-term renal prognosis. Blockade of the renin-angiotensin-aldosterone system can reverse the renal hemodynamic abnormalities. The obesity-associated renal risk is unfavourably affected by high sodium intake. This may be due to the effects of sodium on blood pressure, which is often sodium-sensitive in obesity, but direct renal effects are also present. Interestingly, sodium restriction ameliorates overweight-associated hyperfiltration in overweight subjects. More focus on weight excess as a renal risk factor is warranted. Preventive measures should focus on weight excess as well as on specific protection against renal damage, by renin-angiotensin-aldosterone system-blockade and moderate sodium restriction.
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Affiliation(s)
- Arjan J Kwakernaak
- a Department of Medicine, Division of Nephrology, University Medical Center Groningen, The Netherlands.
| | - Hilde Tent
- b Department of Medicine, Division of Nephrology, University Medical Center Groningen, The Netherlands.
| | - Mieneke Rook
- c Department of Medicine, Division of Nephrology, University Medical Center Groningen, The Netherlands.
| | - Jan A Krikken
- d Department of Medicine, Division of Nephrology, University Medical Center Groningen, The Netherlands.
| | - Gerjan Navis
- e Head of Experimental Nephrology Dept., Department of Medicine, Division of Nephrology, University Medical Center Groningen, Hanzeplein 1, 9700 RB The Netherlands.
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Liu R, Garvin JL, Ren Y, Pagano PJ, Carretero OA. Depolarization of the macula densa induces superoxide production via NAD(P)H oxidase. Am J Physiol Renal Physiol 2007; 292:F1867-72. [PMID: 17344185 DOI: 10.1152/ajprenal.00515.2006] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Superoxide (O2−) enhances tubuloglomerular feedback by scavenging nitric oxide at the macula densa. However, the singling pathway of O2−production in the macula densa is not known. We hypothesized that the increase in tubular NaCl concentration that initiates tubuloglomerular feedback induces O2−production by the macula densa via NAD(P)H oxidase, which is activated by macula densa depolarization. We isolated and microperfused the thick ascending limb of the loop of Henle and attached macula densa in rabbits. A fluorescent dye, dihydroethidium, was used to detect O2−production at the macula densa. When luminal NaCl was switched from 10 to 80 mM, a situation of initiating maximum tubuloglomerular feedback response, O2−production significantly increased. To make sure that the shifts in the oxyethidium/dihydroethidium ratio were due to changes in O2−, we used tempol (10−4M), a stable membrane-permeant superoxide dismutase mimetic. With tempol present, when we switched from 10 to 80 mM NaCl, the increase in oxyethidium/dihydroethidium ratio was blocked. To determine the source of O2−, we used the NAD(P)H oxidase inhibitor apocynin. When luminal NaCl was switched from 10 to 80 mM in the presence of apocynin, O2−production was inhibited by 80%. To see whether the effect of increasing luminal NaCl involves Na-K-2Cl cotransporters, we inhibited them with furosemide. When luminal NaCl was switched from 10 to 80 mM in the presence of furosemide, O2−production was blocked. To test whether depolarization of the macula densa induces O2−production, we artificially induced depolarization by adding valinomycin (10−6M) and 25 mM KCl to the luminal perfusate. Depolarization alone significantly increases O2−production. We conclude that increasing luminal NaCl induces O2−production during tubuloglomerular feedback. O2−generated by the macula densa is primarily derived from NAD(P)H oxidase and is induced by depolarization.
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Affiliation(s)
- Ruisheng Liu
- Hypertension and Vascular Research Division, Henry Ford Hospital, 2799 West Grand Blvd., Detroit, MI 48202, USA.
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Flack JM, Shafi T, Chandra S, Ramos J, Nasser SA, Crook ED. Hypertension in African Americans. Hypertension 2007. [DOI: 10.1016/b978-1-4160-3053-9.50045-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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O'Brien E. Aliskiren: a renin inhibitor offering a new approach for the treatment of hypertension. Expert Opin Investig Drugs 2006; 15:1269-77. [PMID: 16989601 DOI: 10.1517/13543784.15.10.1269] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
In recent years, the renin-angiotensin-aldosterone system has been shown to be crucial not only in blood pressure haemostasis but also in the evolution of atherosclerosis, which ultimately determines morbidity and mortality. The angiotensin-converting enzyme inhibitors and, recently, the angiotensin receptor blockers (with their low adverse-effect profile) have added a new dimension to the drug treatment of hypertension. Just a decade after the introduction of angiotensin receptor blockers, physicians treating hypertension are now offered another exciting approach to achieving blockade of the renin-angiotensin-aldosterone system through the inhibition of renin. This review outlines the background evidence for aliskiren, the first orally active renin inhibitor.
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Affiliation(s)
- Eoin O'Brien
- The Conway Institute of Biomolecular and Biomedical Research, University College Dublin, Belfield, Dublin 4, Ireland.
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Krikken JA, Lely AT, Bakker SJL, Navis G. The effect of a shift in sodium intake on renal hemodynamics is determined by body mass index in healthy young men. Kidney Int 2006; 71:260-5. [PMID: 17091123 DOI: 10.1038/sj.ki.5002011] [Citation(s) in RCA: 80] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
A body mass index (BMI)>or=25 kg/m2 increases the risk for long-term renal damage, possibly by renal hemodynamic factors. As epidemiological studies suggest interaction of BMI and sodium intake, we studied the combined effects of sodium intake and BMI on renal hemodynamics. Glomerular filtration rate (GFR) and effective renal plasma flow (ERPF) were measured in 95 healthy men (median age 23 years (95% confidence interval: 22-24), BMI: 23.0+/-2.5 kg/m2) on low (50 mmol Na+, LS) and high (200 mmol Na+, HS) sodium intake. Mean GFR and ERPF significantly increased by the change to HS (both P<0.001). During HS but not LS, GFR and filtration fraction (FF) positively correlated with BMI (R=0.32 and R=0.28, respectively, both P<0.01). Consequently, BMI correlated with the sodium-induced changes in GFR (R=0.30; P<0.01) and FF (R=0,23; P<0.05). The effects of HS on GFR and FF were significantly different for BMI>or=25 versus <25 kg/m2, namely 7.8+/-12.3 versus 16.1+/-13.1 ml/min (P<0.05) and -0.1+/-2.2 and 1.1+/-2.3% (P<0.05). FF was significantly higher in BMI>or=25 versus <25 kg/m2, (22.6+/-2.9 versus 24.6+/-2.4%, P<0.05) only during HS. ERPF was not related to BMI. Urinary albumin excretion was increased by HS from 6.0 (5.4-6.7) to 7.6 (6.9-8.9). Results were essentially similar after excluding the only two subjects with BMI>30 kg/m2. BMI is a determinant of the renal hemodynamic response to HS in healthy men, and of GFR and FF during HS, but not during LS. Consequently, HS elicited a hyperfiltration pattern in subjects with a BMI>or=25 kg/m2 that was absent during LS. Future studies should elucidate whether LS or diuretics can ameliorate the long-term renal risks of weight excess.
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Affiliation(s)
- J A Krikken
- Division of Nephrology, Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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Matavelli LC, Zhou X, Varagic J, Susic D, Frohlich ED. Salt loading produces severe renal hemodynamic dysfunction independent of arterial pressure in spontaneously hypertensive rats. Am J Physiol Heart Circ Physiol 2006; 292:H814-9. [PMID: 16997890 DOI: 10.1152/ajpheart.00671.2006] [Citation(s) in RCA: 77] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
We have previously shown that salt excess has adverse cardiac effects in spontaneously hypertensive rats (SHR), independent of its increased arterial pressure; however, the renal effects have not been reported. In the present study we evaluated the role of three levels of salt loading in SHR on renal function, systemic and renal hemodynamics, and glomerular dynamics. At 8 wk of age, rats were given a 4% (n = 11), 6% (n = 9), or 8% (n = 11) salt-load diet for the ensuing 8 wk; control rats (n = 11) received standard chow (0.6% NaCl). Rats had weekly 24-h proteinuria and albuminuria quantified. At the end of salt loading, all rats had systemic and renal hemodynamics measured; glomerular dynamics were specially studied by renal micropuncture in the control, 4% and 6% salt-loaded rats. Proteinuria and albuminuria progressively increased by the second week of salt loading in the 6% and 8% salt-loaded rats. Mean arterial pressure increased minimally, and glomerular filtration rate decreased in all salt-loaded rats. The 6% and 8% salt-loaded rats demonstrated decreased renal plasma flow and increased renal vascular resistance and serum creatinine concentration. Furthermore, 4% and 6% salt-loaded rats had diminished single-nephron plasma flow and increased afferent and efferent arteriolar resistances; glomerular hydrostatic pressure also increased in the 6% salt-loaded rats. In conclusion, dietary salt loading as low as 4% dramatically deteriorated renal function, renal hemodynamics, and glomerular dynamics in SHR independent of a minimal further increase in arterial pressure. These findings support the concept of a strong independent causal relationship between salt excess and cardiovascular and renal injury.
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Affiliation(s)
- Luis C Matavelli
- Hypertension Research Laboratory, Division of Research, Ochsner Clinic Foundation, New Orleans, Louisiana 70121, USA
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34
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Abstract
PURPOSE OF REVIEW Initial attempts to inhibit renin in humans have faced numerous difficulties. Molecular modeling and X-ray crystallography of the active site of renin have led to the development of new orally active renin inhibitors, such as aliskiren. Recent preclinical and clinical data suggest that this drug may be of value for treating patients with cardiovascular and renal disorders. RECENT FINDINGS The once-daily administration of aliskiren to hypertensive patients lowers blood pressure as strongly as, or more strongly than, standard doses of established angiotensin II type 1 receptor blockers. It further decreases blood pressure in combination with hydrochlorothiazide. The biochemical consequences of renin inhibition differ from those of angiotensin I-converting enzyme inhibition and angiotensin II antagonism, particularly in terms of angiotensin profiles and interactions with the bradykinin-nitric oxide-cGMP pathway and possibly the (pro)renin receptor. SUMMARY Blockade of the renin-angiotensin system with angiotensin I-converting enzyme inhibitors, angiotensin II type 1 receptor blockers or a combination of these drugs has become one of the most successful therapeutic approaches in medicine. It remains unclear, however, as to how to optimize the renin-angiotensin system blockade to maximize cardiovascular and renal benefits. In this context, renin inhibition to render the renin-angiotensin system fully quiescent is a new possibility requiring further study.
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Affiliation(s)
- Michel Azizi
- Université Paris Descartes, Faculté de Médecine, and Assistance Publique Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Paris, France.
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35
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Abstract
Hypertension is more frequent and more severe in blacks than in other racial groups. Salt-sensitive and low-renin hypertension are both more frequent in blacks. Cardiovascular morbidity appears to be similar in blacks and whites and depends on the classic cardiovascular risk factors. Kidney damage leading to end-stage renal disease is more frequent in blacks. Reduced salt intake improves drug efficacy. Diuretics and calcium channel blockers are more effective in lowering blood pressure, while angiotensin-converting-enzyme inhibitors may be more effective in preventing organ damage. Specific trials are needed to evaluate therapeutic benefits in blacks.
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Affiliation(s)
- Jean-Pierre Fauvel
- Service de Néphrologie et Hypertension Artérielle, Hôpital E. Herriot, Lyon.
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Azizi M, Webb R, Nussberger J, Hollenberg NK. Renin inhibition with aliskiren: where are we now, and where are we going? J Hypertens 2006; 24:243-56. [PMID: 16508564 DOI: 10.1097/01.hjh.0000202812.72341.99] [Citation(s) in RCA: 185] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
With the development of aliskiren, blockade of the renin-angiotensin-aldosterone system (RAAS) at the level of the interaction of renin with a substrate has become a clinical reality. This review covers the specific features of the first agent likely to achieve widespread clinical exposure, aliskiren. The potential of renin inhibition must be viewed in the context of the remarkable efficacy of both angiotensin-converting enzyme (ACE) inhibition and angiotensin receptor blockers (ARBs). The implications of blockade of the renin system at its rate-limiting step are reviewed, with the therapeutic implications for both the renin inhibitor employed alone or the renin inhibitor combined with an ACE inhibitor or ARB. The relevant and necessary studies are ongoing.
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Affiliation(s)
- Michel Azizi
- Clinical Investigation Center 9201, Hospital European Georges Pompidou, Paris, France
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37
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Abstract
Incidences of hypertension and hypertension-related renal failure are considerably higher in African-Americans than in white Americans. One explanation offered for this is that African-Americans have a higher incidence of low birth weight, the latter associated with lower numbers of glomeruli. However, although studies show a clear association between hypertension and glomerular number in whites, the situation in African-Americans appears more complex.
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Affiliation(s)
- M Haas
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland 21287, USA.
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Rostand SG, Cross SK, Kirk KA, Lee JY, Kuhlmann A, Amann K. Racial differences in renal arteriolar structure in children with minimal change nephropathy. Kidney Int 2006; 68:1154-60. [PMID: 16105046 DOI: 10.1111/j.1523-1755.2005.00507.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND African Americans are at increased risk for hypertension and chronic renal disease. Some data suggest this results from renal microvascular disease. The aim of this study was to determine if renal vascular changes were more pronounced in African Americans, were independent of blood pressure, and occurred in early childhood. METHODS We performed morphometric analysis on small cortical arteries and arterioles from 44 renal biopsies done in African American and white children (mean age 8.4 +/- SD 5.0 years) with minimal change nephropathy. Outer and inner vessel diameters were measured and wall:lumen and wall:outer diameter ratios (WT/OD) calculated. Clinical data on blood pressure, steroid use, serum creatinine, gender, age, and proteinuria were abstracted by chart review. A z score for systolic and diastolic blood pressure was calculated. Follow-up clinical data were available for 11 children. Data were compared using analysis of covariance (ANCOVA) and t test for paired data. RESULTS Lumen diameters of African Americans were 3.1 microm (23%) smaller that those of white children (P = 0.024). Similarly, their WT/OD was greater than in the whites, 0.31+/-0.03 vs. 0.28 +/- 0.02 (P= 0.048). These changes were independent of age, steroid use, systolic blood pressure and diastolic blood pressure z scores. Follow-up data showed a rise in serum creatinine (>50%) in five patients, +1.42 +/- 0.79 mg/dL (P = 0.016), of whom four were African American. There was no change in blood pressure. CONCLUSION The renal arterioles of African American children with minimal change nephropathy exhibit significantly smaller lumens and thicker walls than white children. The changes occur very early in life and are independent of age, blood pressure, and steroid use. Such changes may contribute to the African American predisposition to chronic renal disease and hypertension.
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Affiliation(s)
- Stephen G Rostand
- Nephrology Research and Training Center, Division of Nephrology, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama 35223, USA.
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39
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Abstract
In the United States, chronic kidney disease (CKD), and in particular end-stage renal disease (ESRD), represent a growing problem. Many other countries also have an increasing number of ESRD cases. Racial/ethnic disparities have been documented globally in the prevalence, incidence, and treatment of CKD, most extensively in the United States, but also in the United Kingdom, Australia, and New Zealand, among others. In many circumstances, these disparities are of a negative nature, that is, certain racial/ethnic groups fare worse than their white counterparts with respect to the treatment or outcome of CKD. However, in a few circumstances, they are of a positive nature, such as the survival advantage seen in minorities with ESRD compared with whites. The reasons for racial disparities in the prevalence, incidence, and treatment of CKD are not fully understood, although they are explained partly by coexisting medical conditions and modifiable risk factors, such as socioeconomic, lifestyle, and cultural. It is likely, however, that the complete picture incorporates a complex interaction between these sociocultural, genetic, and environmental factors. In a global society that prides itself on a high level of sensitivity and equality, there is an ethical and moral imperative to address the continuing racial/ethnic disparities in CKD and many of the factors underlying this epidemic. We review data highlighting the racial/ethnic disparities that exist in the incidence and treatment of CKD, with particular emphasis on ESRD. A better understanding of both the negative and positive racial/ethnic disparities may yield important insights, which can inform future research strategies and improve health outcomes for all patients afflicted with CKD.
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Affiliation(s)
- Keith C Norris
- Department of Medicine, Charles R. Drew University, Los Angeles, California 90059, USA.
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40
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Cordaillat M, Rugale C, Casellas D, Mimran A, Jover B. Cardiorenal abnormalities associated with high sodium intake: correction by spironolactone in rats. Am J Physiol Regul Integr Comp Physiol 2005; 289:R1137-43. [PMID: 15919735 DOI: 10.1152/ajpregu.00154.2005] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Reversal by the mineralocorticoid receptor antagonist spironolactone on cardiac and renal abnormalities, associated with long-term (since weaning) administration of a high (2 and 8% NaCl chow, HS2 and HS8) sodium diet, was assessed in Sprague-Dawley rats. At the age of 5 mo, spironolactone (20 or 100 mg/kg, gavage) or placebo were given for 14 days to HS2 and HS8 rats. A group fed a regular diet (0.8% NaCl, NS) remained untreated. High sodium intake had no detectable effect on blood pressure; however, cardiac mass index and cross-sectional area of the carotid artery, as well as albuminuria, were increased only in the HS8 group compared with the control group on NS diet. In addition, a marked reduction in glomerular filtration rate (by 40%), associated with a nonproportional fall in renal plasma flow (thus resulting in a decrease in filtration fraction), was observed only in the HS8 group. No change in cardiac and renal fibrosis was detected. Production of the reactive oxygen species (ROS) by aortic tissue was increased in HS8 rats, whereas ROS production by the heart was unaffected. Only the high dose of spironolactone was effective, as it markedly reversed the cardiac hypertrophy and renal hypofiltration associated with the HS8 feeding. The changes were observed in the absence of any effect on systemic blood pressure and production of ROS. These observations favor aldosterone’s role in the deleterious effects of marked and prolonged increases in sodium intake.
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Affiliation(s)
- Magali Cordaillat
- Groupe Rein et Hypertension, Université Montpellier I, Montpellier, France
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41
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Abstract
The kidneys are vital in the pathogenesis of hypertension and are also pathologically affected by the presence of hypertension. The prevalence of hypertension in chronic kidney disease (CKD) depends on age, the severity of renal failure, and proteinuria. The intricate and inextricable relationship between CKD and hypertension seems to cause cardiovascular disease that has assumed epidemic proportions. This article discusses the etiology and treatment of hypertension in CKD so that it can be better controlled.
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Affiliation(s)
- Martin J Andersen
- Division of Nephrology, Department of Medicine, Indiana University School of Medicine and Richard L. Roudebush Veterans Affairs Medical Center, 1481 West 10th Street, 111N, Indianapolis, IN 46202, USA
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42
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Delgado-Almeida A. Reinterpreting Sodium-Potassium Data in Salt-Sensitivity Hypertension: A Prospective Debate. Hypertension 2005; 45:e4; author reply e4. [PMID: 15630043 DOI: 10.1161/01.hyp.0000154194.49725.b7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Weissgarten J, Modai D, Berman S, Efrati S, Golik A, Cohen N, Cohn M, Galperin E, Averbukh Z. Hypertension but Not Sodium Intake Determines Progression of Renal Failure in Experimentally Uremic Rats. ACTA ACUST UNITED AC 2004; 98:p1-7. [PMID: 15388984 DOI: 10.1159/000079931] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2003] [Accepted: 06/03/2004] [Indexed: 11/19/2022]
Abstract
BACKGROUND/AIMS High sodium intake is implicated in contributing to progression of chronic renal failure. We studied the effect of high sodium consumption on progression of rat experimental renal failure while sodium-induced hypertension was pharmacologically controlled. METHODS 64 Sprague-Dawley rats underwent 5/6 nephrectomy. Subsequently, they were divided in three groups which were fed either low, normal, or high sodium diet. Only the high sodium-consuming group developed hypertension. This group was further divided in two subgroups in which hypertension was either untreated or titrated to normotension by hydralazine alone or with propranolol. RESULTS Sequential GFR values did not differ between the respective normotensive groups. Survival downslopes of all three normotensive groups (including the pharmacologically treated, high sodium-consuming subgroup) were also similar, extending over 10 weeks. By contrast, pharmacologically untreated animals exhibited severe hypertension and 100% mortality within 3 weeks. In all experimental groups, 24-hour urinary sodium excretion paralleled sodium intake. Proteinuria rose similarly and significantly in all animals on high sodium. A significant correlation between 24-hour sodium and proteinuria was evident throughout the experimental period. CONCLUSIONS (1) In 5/6 nephrectomized rats, renal function deterioration was not affected by dietary sodium, provided hypertension was pharmacologically controlled. (2) Enhanced proteinuria secondary to high sodium consumption had no adverse effect on progression of renal failure in this model.
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