1
|
Zhou H, Dong L, Liu X, Li F, Tang Y, Qin W. The heart rate non-dipping pattern was associated with target organ damage in patients with chronic kidney disease. Int Urol Nephrol 2024; 56:3381-3388. [PMID: 38829465 DOI: 10.1007/s11255-024-04095-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2024] [Accepted: 05/24/2024] [Indexed: 06/05/2024]
Abstract
PURPOSE We performed the study to investigate the association between heart rate (HR) non-dipping pattern and target organ damage in patients with chronic kidney disease (CKD) and hypertension. METHODS In this cross-sectional study, 447 patients with CKD and hypertension were enrolled. 24 h ambulatory blood pressure monitoring was conducted. Linear regression and logistic regression analysis were conducted to investigate the association between HR non-dipping pattern and target organ damage, including estimated glomerular filtration rate (eGFR), left ventricular mass index (LVMI), and left ventricular hypertrophy (LVH). RESULTS Overall, 261 patients (58.4%) followed non-dipping patterns of HR. HR non-dipping pattern remained to be significantly associated with reduced eGFR (β: -0.384; 95% CI: -0.719 to -0.050; p = 0.025) and the higher prevalence of CKD stages 4-5 (OR: 2.141; 95% CI: 1.153 to 3.977; p = 0.016). Meanwhile, HR non-dipping pattern was independently associated with LVMI (β: 0.021; 95% CI: 0.000 to 0.041; p = 0.049) and LVH (OR: 1.78; 95% CI: 1.07 to 2.96; p = 0.027) after adjusting for confounding factors. CONCLUSIONS HR non-dipping pattern was independently associated with impaired renal function and cardiac damage. Non-dipping HR deserves further attention and needs to be detected and treated during the management of CKD patients.
Collapse
Affiliation(s)
- Huan Zhou
- Division of Nephrology, Department of Medicine, West China Hospital, Sichuan University, Guoxue Alley 37, Chengdu, 610041, Sichuan, China
| | - Lingqiu Dong
- Division of Nephrology, Department of Medicine, West China Hospital, Sichuan University, Guoxue Alley 37, Chengdu, 610041, Sichuan, China
| | - Xiang Liu
- Department of Hematology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Fangming Li
- Division of Nephrology, Department of Medicine, West China Hospital, Sichuan University, Guoxue Alley 37, Chengdu, 610041, Sichuan, China
- Department of Nephrology, Chengdu Seventh People's Hospital, Chengdu, Sichuan, China
| | - Yi Tang
- Division of Nephrology, Department of Medicine, West China Hospital, Sichuan University, Guoxue Alley 37, Chengdu, 610041, Sichuan, China
| | - Wei Qin
- Division of Nephrology, Department of Medicine, West China Hospital, Sichuan University, Guoxue Alley 37, Chengdu, 610041, Sichuan, China.
| |
Collapse
|
2
|
Marumoto H, Tsuboi N, Sasaki T, Okabayashi Y, Haruhara K, Kanzaki G, Koike K, Yokoo T. Sodium excretion per nephron and nighttime hypertension in patients with IgA nephropathy. Hypertens Res 2024; 47:2616-2618. [PMID: 39014116 DOI: 10.1038/s41440-024-01800-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2024] [Revised: 06/13/2024] [Accepted: 06/24/2024] [Indexed: 07/18/2024]
Affiliation(s)
- Hirokazu Marumoto
- Division of Nephrology and Hypertension, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan
| | - Nobuo Tsuboi
- Division of Nephrology and Hypertension, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan.
| | - Takaya Sasaki
- Division of Nephrology and Hypertension, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan
| | - Yusuke Okabayashi
- Division of Nephrology and Hypertension, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan
| | - Kotaro Haruhara
- Division of Nephrology and Hypertension, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan
| | - Go Kanzaki
- Division of Nephrology and Hypertension, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan
| | - Kentaro Koike
- Division of Nephrology and Hypertension, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan
| | - Takashi Yokoo
- Division of Nephrology and Hypertension, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan
| |
Collapse
|
3
|
Kurzhagen JT, Titze S, Büschges-Seraphin B, Schiffer M, Schneider MP, Eckardt KU, Hilgers KF. Spot urinary sodium in CKD patients: correlation with 24h-excretion and evaluation of commonly used prediction equations. BMC Nephrol 2024; 25:210. [PMID: 38937680 PMCID: PMC11212440 DOI: 10.1186/s12882-024-03639-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 06/12/2024] [Indexed: 06/29/2024] Open
Abstract
BACKGROUND Salt intake in CKD patients can affect cardiovascular risk and kidney disease progression. Twenty-four hour (24h) urine collections are often used to investigate salt metabolism but are cumbersome to perform. We assessed urinary sodium (U-Na) concentration in spot urine samples and investigated the correlation with 24h U-Na excretion and concentration in CKD patients under nephrological care. Further, we studied the role of CKD stage and diuretics and evaluated the performance of commonly used formulas for the prediction of 24h U-Na excretion from spot urine samples. METHODS One hundred eight patients of the German Chronic Kidney Disease (GCKD) study were included. Each participant collected a 24h urine and two spot urine samples within the same period. The first spot urine sample (AM) was part of the second morning urine. The second urine sample was collected before dinner (PM). Patients were advised to take their medication as usual without changing dietary habits. U-Na concentrations in the two spot urine samples and their average ((AM + PM)/2) were correlated with U-Na concentration and total Na excretion in the 24h urine collections. Correlations were subsequently studied after stratification by CKD stage and diuretic intake. The usefulness of three commonly applied equations to estimate 24h U-Na excretion from spot urine samples (Kawasaki, Tanaka and Intersalt) was determined using Bland-Altman plots, analyses of sensitivity, specificity, as well as positive (PPV) and negative predictive values (NPV). RESULTS Participants (42 women, 66 men) were on average (± SD) 62.2 (± 11.9) years old, with a mean serum creatinine of 1.6 (± 0.5) mg/dl. 95% had arterial hypertension, 37% diabetes mellitus and 55% were on diuretics. The best correlation with 24h U-Na total excretion was found for the PM spot U-Na sample. We also found strong correlations when comparing spot and 24h urine U-Na concentration. Correction of spot U-Na for U-creatinine did not improve strength of correlations. Neither CKD stage, nor intake of diuretics had significant impact on these correlations. All examined formulas revealed a significant mean bias. The lowest mean bias and the strongest correlation between estimated and measured U-Na excretion in 24h were obtained using the Tanaka-formula. Also, application of the Tanaka-formula with PM U-Na provided best sensitivity, specificity, PPV and NPV to estimate U-Na excretion > 4g/d corresponding to a salt consumption > 10g/d. CONCLUSION U-Na concentration of spot urine samples correlated with 24h U-Na excretion especially when PM spot U-Na was used. However, correlation coefficients were relatively low. Neither CKD stage nor intake of diuretics appeared to have an influence on these correlations. There was a significant bias for all tested formulas with the Tanaka-formula providing the strongest correlation with measured 24h U-Na excretion. In summary, using spot urine samples together with the Tanaka-formula in epidemiological studies appears feasible to determine associations between approximate salt intake and outcomes in CKD patients. However, the usefulness of spot-urine samples to guide and monitor salt consumption in individual patients remains limited.
Collapse
Affiliation(s)
- Johanna T Kurzhagen
- Department of Nephrology and Hypertension, University of Erlangen-Nuremberg, Medizinische Klinik 4, Universitätsklinikum Erlangen, Erlangen, Germany.
| | - Stephanie Titze
- Department of Nephrology and Hypertension, University of Erlangen-Nuremberg, Medizinische Klinik 4, Universitätsklinikum Erlangen, Erlangen, Germany
- Kassenärztliche Bundesvereinigung, Berlin, Germany
| | | | - Mario Schiffer
- Department of Nephrology and Hypertension, University of Erlangen-Nuremberg, Medizinische Klinik 4, Universitätsklinikum Erlangen, Erlangen, Germany
| | - Markus P Schneider
- Department of Nephrology and Hypertension, University of Erlangen-Nuremberg, Medizinische Klinik 4, Universitätsklinikum Erlangen, Erlangen, Germany
| | - Kai-Uwe Eckardt
- Department of Nephrology and Hypertension, University of Erlangen-Nuremberg, Medizinische Klinik 4, Universitätsklinikum Erlangen, Erlangen, Germany
- Department of Nephrology and Medical Intensive Care, Charité - University Medicine Berlin, Berlin, Germany
| | - Karl F Hilgers
- Department of Nephrology and Hypertension, University of Erlangen-Nuremberg, Medizinische Klinik 4, Universitätsklinikum Erlangen, Erlangen, Germany
| |
Collapse
|
4
|
Chen Z, Jiang X, Wu J, Lin L, Zhou Z, Li M, Wang C. Association between short-term blood pressure variability and target organ damage in non-dialysis patients with chronic kidney disease. BMC Nephrol 2024; 25:111. [PMID: 38515022 PMCID: PMC10958852 DOI: 10.1186/s12882-024-03541-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 03/11/2024] [Indexed: 03/23/2024] Open
Abstract
BACKGROUND It is unclear whether short-term blood pressure variability (BPV) is associated with target organ damage in patients with non-dialysis chronic kidney disease (CKD). METHODS A cross-sectional, single-center study was conducted among 3442 non-dialysis CKD patients hospitalized in the department of Nephrology of the Fifth Affiliated Hospital of Sun Yat-sen University from November 2017 to July 2022 and collected the demographic, laboratory, clinic blood pressure, ambulatory blood pressure data, and short-term BPV assessed by the weighted standard deviation (wSD) derived from ambulatory blood pressure monitoring (ABPM). Multivariate logistic analyses were used to evaluate the independent effects between short-term BPV and subclinical target organ damage, including left ventricular hypertrophy (LVH), abnormal carotid intima-media thickness (CIMT), low estimated glomerular filtration rate (eGFR), and albuminuria. RESULTS The average age of the participants was 47.53 ± 14.06 years and 56% of participants were male. The baseline eGFR was 69 mL/min/1.73 m2. Based on the tertile distribution of wSD according to equal numbers, patients were divided into three categories with T1(< 9.66 mmHg), T2(9.66-12.23 mmHg), and T3(> 12.23 mmHg) of SBPV; T1(< 8.17 mmHg), T2(8.17-9.93 mmHg), and T3(> 9.93 mmHg) of DBPV. The participants with the higher wSD group had a higher prevalence of target organ damage than their counterparts (P-trend < 0.05). An increasing trend in short-term variability was present with advancing CKD stages (P-trend < 0.001). Multivariate logistic analyses results showed that the odds ratio (OR) of SBP wSD was (1.07 [1.03,1.11], P < 0.001) for LVH, (1.04 [1.01,1.07, P = 0.029) for abnormal CIMT, (1.05 [1.02,1.08], P = 0.002) for low eGFR, and (1.06 [1.02,1.09], P = 0.002) for albuminuria; The OR of DBP wSD was (1.07 [1.02,1.12], P = 0.005) for LVH, (1.05 [1.01,1.09], P = 0.028) for abnormal CIMT, (1.05 [1.01,1.09], P = 0.022) for low eGFR, and (1.05 [1.01,1.10], P = 0.025) for albuminuria when adjusted for confounding factors and mean BP. CONCLUSIONS In conclusion, short-term BPV is associated with target organ damage, and irresponsible of average blood pressure levels, in Chinese non-dialysis CKD participants.
Collapse
Affiliation(s)
- Zhaoting Chen
- Division of Nephrology, Department of Medicine, The Fifth Affiliated Hospital Sun Yat-Sen University, 52 Meihua East Road, Zhuhai, Guangdong, 519000, China
- Guangdong Provincial Key Laboratory of Biomedical Imaging, The Fifth Affiliated Hospital Sun Yat-Sen University, 52 Meihua East Road, Zhuhai, Guangdong, 519000, China
- Department of Nephrology, Institute of Nephrology, The Second Affiliated Hospital of Hainan Medical University, 368 Yehai Avenue, Haikou, Hainan, 570311, China
| | - Xinying Jiang
- Division of Nephrology, Department of Medicine, The Fifth Affiliated Hospital Sun Yat-Sen University, 52 Meihua East Road, Zhuhai, Guangdong, 519000, China
- Guangdong Provincial Key Laboratory of Biomedical Imaging, The Fifth Affiliated Hospital Sun Yat-Sen University, 52 Meihua East Road, Zhuhai, Guangdong, 519000, China
| | - Jingcan Wu
- Division of Nephrology, Department of Medicine, The Fifth Affiliated Hospital Sun Yat-Sen University, 52 Meihua East Road, Zhuhai, Guangdong, 519000, China
- Guangdong Provincial Key Laboratory of Biomedical Imaging, The Fifth Affiliated Hospital Sun Yat-Sen University, 52 Meihua East Road, Zhuhai, Guangdong, 519000, China
| | - Lin Lin
- Division of Nephrology, Department of Medicine, The Fifth Affiliated Hospital Sun Yat-Sen University, 52 Meihua East Road, Zhuhai, Guangdong, 519000, China
| | - Zhengping Zhou
- Division of Nephrology, Department of Medicine, The Fifth Affiliated Hospital Sun Yat-Sen University, 52 Meihua East Road, Zhuhai, Guangdong, 519000, China
| | - Man Li
- Guangdong Provincial Key Laboratory of Biomedical Imaging, The Fifth Affiliated Hospital Sun Yat-Sen University, 52 Meihua East Road, Zhuhai, Guangdong, 519000, China
| | - Cheng Wang
- Division of Nephrology, Department of Medicine, The Fifth Affiliated Hospital Sun Yat-Sen University, 52 Meihua East Road, Zhuhai, Guangdong, 519000, China.
- Guangdong Provincial Key Laboratory of Biomedical Imaging, The Fifth Affiliated Hospital Sun Yat-Sen University, 52 Meihua East Road, Zhuhai, Guangdong, 519000, China.
| |
Collapse
|
5
|
Ko YE, Jhee JH. Short-term blood pressure variability as a potential therapeutic target for kidney disease. Clin Hypertens 2023; 29:23. [PMID: 37580839 PMCID: PMC10426225 DOI: 10.1186/s40885-023-00248-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Accepted: 07/11/2023] [Indexed: 08/16/2023] Open
Abstract
Short-term blood pressure variability (BPV) measured with ambulatory blood pressure (BP) monitoring has been demonstrated to be significant in predicting various clinical outcomes. Short-term BPV is distinguished from long-term BPV based on the time interval in which BP fluctuations are measured. Increased short-term BPV has been linked to detrimental effects on the microvascular structure and contributes to subclinical organ damage in the heart, blood vessels, and kidneys, regardless of the average 24-h BP levels. Short-term BPV can be defined by various measures, including calculated metrics (standard deviation, coefficient of variation, average real variability, weighted standard deviation, variability independent of the mean) or dipping patterns. Nevertheless, the additional role of short-term BPV beyond the predictive value of average 24-h BPs or established risk factors for cardiovascular disease and kidney disease remains unclear. In particular, longitudinal studies that evaluate the association between short-term BPV and kidney function impairment are limited and no conclusive data exist regarding which short-term BPV indicators most accurately reflect the prognosis of kidney disease. The issue of how to treat BPV in clinical practice is another concern that is frequently raised. This paper presents a review of the evidence for the prognostic role of short-term BPV in kidney outcomes. Additionally, this review discusses the remaining concerns about short-term BPV that need to be further investigated as an independent risk modifier.
Collapse
Affiliation(s)
- Ye Eun Ko
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jong Hyun Jhee
- Division of Nephrology, Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea.
| |
Collapse
|
6
|
Sarejloo S, Dehesh M, Fathi M, Khanzadeh M, Lucke-Wold B, Ghaedi A, Khanzadeh S. Meta-analysis of differences in neutrophil to lymphocyte ratio between hypertensive and non-hypertensive individuals. BMC Cardiovasc Disord 2023; 23:283. [PMID: 37270484 PMCID: PMC10239597 DOI: 10.1186/s12872-023-03304-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Accepted: 05/14/2023] [Indexed: 06/05/2023] Open
Abstract
This study systematically reviewed the evidence regarding differences in the neutrophil to lymphocyte ratio (NLR) level between hypertensive and normotensive individuals as well as between patients with dipper and non-dipper hypertension (HTN). PubMed, Scopus, and Web of Science databases were systematically searched up to 20 December 2021. This was done without any limitation with regard to date, publication, or language. Pooled weighted mean differences (WMD) with 95% confidence intervals (95% CI) were reported. We assessed the quality of studies based on the Newcastle-Ottawa Scale (NOS). In total, 21 studies were included in our study. There was a significant increase in NLR levels for the hypertensive group in comparison to the control group (WMD = 0.40, 95%CI = 0.22-0.57, P < 0.0001). In addition, the NLR levels were higher in the non-dipper than in the dipper group (WMD = 0.58, 95%CI = 0.19-0.97, P = 0.003). Our findings showed that hypertensive patients had higher level of NLR than normotensive individuals.
Collapse
Affiliation(s)
- Shirin Sarejloo
- Cardiovascular Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | - Mobina Fathi
- Shahid Beheshti University of Medical Sciences, Tehran, Islamic Republic of Iran
| | - Monireh Khanzadeh
- Geriatric & Gerontology Department, Medical School, Tehran University of Medical and Health Sciences, Tehran, Iran
| | | | - Arshin Ghaedi
- Student Research Committee, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | | |
Collapse
|
7
|
Borrelli S, Garofalo C, Gabbai FB, Chiodini P, Signoriello S, Paoletti E, Ravera M, Bussalino E, Bellizzi V, Liberti ME, De Nicola L, Minutolo R. Dipping Status, Ambulatory Blood Pressure Control, Cardiovascular Disease, and Kidney Disease Progression: A Multicenter Cohort Study of CKD. Am J Kidney Dis 2023; 81:15-24.e1. [PMID: 35709922 DOI: 10.1053/j.ajkd.2022.04.010] [Citation(s) in RCA: 18] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 04/19/2022] [Indexed: 12/24/2022]
Abstract
RATIONALE & OBJECTIVE Ambulatory blood pressure (BP) monitoring allows concurrent evaluation of BP control and nocturnal BP dipping status, both related to adverse outcomes. However, few studies have assessed the prognostic role of combining information on dipping status and achieved ambulatory BP in patients with chronic kidney disease (CKD). STUDY DESIGN Prospective observational cohort study. SETTING & PARTICIPANTS 906 patients with hypertension and CKD attending 1 of 3 Italian nephrology clinics. EXPOSURE Four groups were defined by simultaneously classifying systolic ambulatory BP levels as being at goal (daytime SBP <135 and nighttime SBP <120 mm Hg) or above goal, and the presence or absence of nocturnal dipping (nighttime to daytime SBP ratio of <0.9 versus ≥0.9). OUTCOME The composite of time to initiation of maintenance dialysis or estimated glomerular filtration rate (eGFR) decline ≥50%, and the composite of fatal and nonfatal cardiovascular events. ANALYTICAL APPROACH Multivariable Cox proportional hazards models were used to estimate risks of kidney disease progression and cardiovascular disease in the 4 exposure groups where nocturnal dipping with systolic ambulatory BP at goal was the reference group. RESULTS The mean patient age was 63.8 years, 61% were male, and 26.4% had diabetes; eGFR was 41.1 ± 20.8 mL/min/1.73 m2. The dipping prevalence in each of the 4 groups was as follows: nocturnal dipping with ambulatory BP at goal, 18.6%; no nocturnal dipping with ambulatory BP at goal, 20.5%; nocturnal dipping with ambulatory BP above goal, 11.8%; and no nocturnal dipping with ambulatory BP above goal, 49.1%. Among patients with ambulatory BP above goal, the risk of cardiovascular events was greater in the absence (HR, 2.79 [95% CI, 1.64-4.75]) and presence (HR, 2.05 [95% CI, 1.10-3.84]) of nocturnal dipping. The same held true for risk of kidney disease progression (HRs of 2.40 [95% CI, 1.58-3.65] and 2.11 [95% CI, 1.28-3.48] in the absence and presence of nocturnal dipping, respectively). Patients at the ambulatory BP goal but who did not experience nocturnal dipping had an increased risk of the cardiovascular end point (HR, 2.06 [95% CI, 1.15-3.68]) and the kidney disease progression outcome (HR, 1.82 [95% CI, 1.17-2.82]). LIMITATIONS Lack of a diverse cohort (all those enrolled were White). Residual uncontrolled confounding. CONCLUSIONS Systolic ambulatory BP above goal or the absence of nocturnal dipping, regardless of ambulatory BP, is associated with higher risks of cardiovascular disease and kidney disease progression among patients with CKD. PLAIN-LANGUAGE SUMMARY Among patients with chronic kidney disease (CKD), ambulatory blood pressure (BP) monitoring improves the identification of individuals at high risk of clinical disease outcomes. Those with uncontrolled ambulatory BP are known to have a higher risk of developing cardiovascular disease and kidney disease progression, particularly when their ambulatory BP does not decline by at least 10% at night. Whether this is also true for patients with presence of optimal ambulatory BP levels but a BP pattern of no nighttime decline is largely unknown. We measured ambulatory BP in 900 Italian patients with CKD and followed them for several years. We found that, independent of ambulatory BP level, the absence of nighttime reductions in BP was associated with worsening of CKD and more frequent cardiovascular events. The absence of nighttime declines in BP is an independent risk factor for adverse events among patients with CKD. Future studies are needed to examine whether treating the absence of nighttime declines in BP improves clinical outcomes.
Collapse
Affiliation(s)
- Silvio Borrelli
- Division of Nephrology, University of Campania, Luigi Vanvitelli, Naples, Italy
| | - Carlo Garofalo
- Division of Nephrology, University of Campania, Luigi Vanvitelli, Naples, Italy
| | - Francis B Gabbai
- Department of Medicine, VA San Diego Healthcare System and University of California at San Diego Medical School, San Diego, California
| | - Paolo Chiodini
- Division of Nephrology and Medical Statistics Unit, University of Campania, Luigi Vanvitelli, Naples, Italy
| | - Simona Signoriello
- Division of Nephrology and Medical Statistics Unit, University of Campania, Luigi Vanvitelli, Naples, Italy
| | - Ernesto Paoletti
- Nephrology, Dialysis and Transplantation Unit, Policlinico San Martino, Genoa, Italy
| | - Maura Ravera
- Nephrology, Dialysis and Transplantation Unit, Policlinico San Martino, Genoa, Italy
| | - Elisabetta Bussalino
- Nephrology, Dialysis and Transplantation Unit, Policlinico San Martino, Genoa, Italy
| | - Vincenzo Bellizzi
- Nephrology Unit, University Hospital "San Giovanni di Dio e Ruggi d'Aragona," Salerno, Italy
| | - Maria Elena Liberti
- Division of Nephrology, University of Campania, Luigi Vanvitelli, Naples, Italy
| | - Luca De Nicola
- Division of Nephrology, University of Campania, Luigi Vanvitelli, Naples, Italy
| | - Roberto Minutolo
- Division of Nephrology, University of Campania, Luigi Vanvitelli, Naples, Italy.
| |
Collapse
|
8
|
Haruhara K, Kanzaki G, Tsuboi N. Nephrons, podocytes and chronic kidney disease: Strategic antihypertensive therapy for renoprotection. Hypertens Res 2023; 46:299-310. [PMID: 36224286 PMCID: PMC9899692 DOI: 10.1038/s41440-022-01061-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2022] [Revised: 08/06/2022] [Accepted: 09/05/2022] [Indexed: 02/07/2023]
Abstract
Chronic kidney disease (CKD) is one of the strongest risk factors for hypertension, and hypertension can exacerbate the progression of CKD. Thus, the management of CKD and antihypertensive therapy are inextricably linked. Research over the past decades has shown that the human kidney is more diverse than initially thought. Subjects with low nephron endowment are at increased risk of developing CKD and hypertension, which is consistent with the theory of the developmental origins of health and disease. Combined with other lifetime risks of CKD, hypertension may lead to a vicious cycle consisting of podocyte injury, glomerulosclerosis and further loss of nephrons. Of note, recent studies have shown that the number of nephrons correlates well with the number of podocytes, suggesting that these two components are intrinsically linked and may influence each other. Both nephrons and podocytes have no or very limited regenerative capacity and are destined to decrease throughout life. Therefore, one of the best strategies to slow the progression of CKD is to maintain the "numbers" of these essential components necessary to preserve renal function. To this end, both the achievement of an optimal blood pressure and a maximum reduction in urinary protein excretion are essential. Lifestyle modifications and antihypertensive drug therapy must be carefully individualized to address the potential diversity of the kidneys.
Collapse
Affiliation(s)
- Kotaro Haruhara
- grid.411898.d0000 0001 0661 2073Division of Nephrology and Hypertension, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan
| | - Go Kanzaki
- grid.411898.d0000 0001 0661 2073Division of Nephrology and Hypertension, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan
| | - Nobuo Tsuboi
- grid.411898.d0000 0001 0661 2073Division of Nephrology and Hypertension, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan
| |
Collapse
|
9
|
Costello HM, Johnston JG, Juffre A, Crislip GR, Gumz ML. Circadian clocks of the kidney: function, mechanism, and regulation. Physiol Rev 2022; 102:1669-1701. [PMID: 35575250 PMCID: PMC9273266 DOI: 10.1152/physrev.00045.2021] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 05/03/2022] [Accepted: 05/07/2022] [Indexed: 11/22/2022] Open
Abstract
An intrinsic cellular circadian clock is located in nearly every cell of the body. The peripheral circadian clocks within the cells of the kidney contribute to the regulation of a variety of renal processes. In this review, we summarize what is currently known regarding the function, mechanism, and regulation of kidney clocks. Additionally, the effect of extrarenal physiological processes, such as endocrine and neuronal signals, on kidney function is also reviewed. Circadian rhythms in renal function are an integral part of kidney physiology, underscoring the importance of considering time of day as a key biological variable. The field of circadian renal physiology is of tremendous relevance, but with limited physiological and mechanistic information on the kidney clocks this is an area in need of extensive investigation.
Collapse
Affiliation(s)
- Hannah M Costello
- Department of Physiology and Functional Genomics, University of Florida, Gainesville, Florida
- Division of Nephrology, Hypertension, and Renal Transplantation, Department of Medicine, University of Florida, Gainesville, Florida
| | - Jermaine G Johnston
- Division of Nephrology, Hypertension, and Renal Transplantation, Department of Medicine, University of Florida, Gainesville, Florida
- North Florida/South Georgia Malcom Randall Department of Veterans Affairs Medical Center, Gainesville, Florida
| | - Alexandria Juffre
- Department of Physiology and Functional Genomics, University of Florida, Gainesville, Florida
- Division of Nephrology, Hypertension, and Renal Transplantation, Department of Medicine, University of Florida, Gainesville, Florida
- Department of Biochemistry and Molecular Biology, University of Florida, Gainesville, Florida
| | - G Ryan Crislip
- Department of Physiology and Functional Genomics, University of Florida, Gainesville, Florida
- Division of Nephrology, Hypertension, and Renal Transplantation, Department of Medicine, University of Florida, Gainesville, Florida
| | - Michelle L Gumz
- Department of Physiology and Functional Genomics, University of Florida, Gainesville, Florida
- Division of Nephrology, Hypertension, and Renal Transplantation, Department of Medicine, University of Florida, Gainesville, Florida
- North Florida/South Georgia Malcom Randall Department of Veterans Affairs Medical Center, Gainesville, Florida
- Department of Biochemistry and Molecular Biology, University of Florida, Gainesville, Florida
- Center for Integrative Cardiovascular and Metabolic Diseases, University of Florida, Gainesville, Florida
| |
Collapse
|
10
|
Akyüz A, Işık F. Systemic Immune-Inflammation Index: A Novel Predictor for Non-dipper Hypertension. Cureus 2022; 14:e28176. [PMID: 36148183 PMCID: PMC9482807 DOI: 10.7759/cureus.28176] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/19/2022] [Indexed: 12/03/2022] Open
Abstract
Introduction The non-dipper hypertension (HT) pattern is associated with more end-organ damage and cardiovascular events than is dipper HT. Inflammation is widely established to play a role in the pathophysiology of HT. Recently, a new inflammatory and prognostic marker called the systemic immune-inflammation index (SII) has emerged. Our goal is to determine whether there is a relationship between non-dipper HT and SII. Methods Our study is a single-center retrospective and ninety-one patients with HT were included. All patients were analyzed with simultaneous 24-hour ambulatory blood pressure monitoring and laboratory parameters. Thirty-five patients had dipper HT while 56 patients had non-dipper HT. SII was calculated according to neutrophil, platelet, and lymphocyte counts. Results The median age was 48 (45-61 interquartile range (IQR)) in the non-dipper HT group, whereas it was 54 (44-64 IQR) in the dipper HT group. Although the neutrophil level, neutrophil-lymphocyte ratio, platelet lymphocyte ratio, SII, sleeping systolic blood pressure (BP), and sleeping diastolic BP were higher (p=0.020, p=0.041, p=0.046, p=0.019, p<0.001, and p=0.001, respectively) in the non-dipper HT group, the lymphocyte level was lower (p=0.040). A multivariate logistic regression model shows that SII (odds ratio (OR)=1.023, 95% confidence interval (CI)=1.002-1.112, p=0.012) may be an independent predictor of non-dipper HT. Conclusion Our study showed that the SII level was higher in the non-dipper HT patient group than in the dipper HT group. Furthermore, SII was an independent predictor of non-dipper HT. The high SII value in hypertension patients can be used as an early warning parameter to identify non-dipper HT patients.
Collapse
|
11
|
KARAMANLIOĞLU M, ŞAHAN E. The relationship between white coat hypertension and the index of cardiac electrophysiological balance (ICEB). JOURNAL OF HEALTH SCIENCES AND MEDICINE 2022. [DOI: 10.32322/jhsm.1029715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Aim: The index of cardiac electrophysiological balance (ICEB) is a new marker that can show the potential for ventricular arrhythmia and indicate the balancebetween ventricular depolarization and repolarization. A tendency toward ventricular arrhythmia has been shown innon-dipper hypertension and prehypertensive patients in various studies. White coat hypertension (WCH) has been shown to be associated with target organ damage and the actual development of hypertension. In this study, we aimed to evaluate the effect of dipper and non-dipper patterns on the ICEB in patients diagnosed with WCH.
Material and Method: A total of 108 patients were included in this study. Patients were divided into two groups as dipper and non-dipper patterns according to ABPM. QT/QRS (ICEB) and cQT/QRS (ICEBc) were recorded with computerized interpretation of the electrocardiogram.
Results: While electrocardiographic parameters including heart rate, PR interval, QT interval, cQT interval, and ICEB were similar in both groups (p>.05), in the non-dipper group, QRS duration was lower (p=.017) and ICEBc was higher (p=.001).
Conclusion: ICEBc may predict asusceptibility to ventricular arrhythmias in WCH patients. Therefore, non-dipper WCH patients with a high ICEBc should be followed for arrhythmia outcomes in addition to hypertensive outcomes.
Collapse
|
12
|
Seeman T, Pfaff M, Sethna CB. Isolated nocturnal hypertension in pediatric kidney transplant recipients. Pediatr Transplant 2022; 26:e14192. [PMID: 34845793 DOI: 10.1111/petr.14192] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 10/29/2021] [Accepted: 10/31/2021] [Indexed: 12/30/2022]
Abstract
BACKGROUND Isolated nocturnal hypertension (INH) is defined as nighttime hypertension in the setting of normal daytime blood pressure (BP), diagnosed by ambulatory BP monitoring (ABPM). METHODS AND RESULTS Hypertension affects 60%-80% of pediatric kidney transplant recipients, and INH is the most common type of ambulatory hypertension. INH is associated with an increased prevalence of hypertension-mediated target organ damage such as left ventricular hypertrophy in adults and in pediatric kidney transplant recipients. CONCLUSION Ambulatory BP monitoring should be performed annually in all pediatric kidney transplant recipients to diagnose hypertension phenotypes that are not detectable by office BP such as masked hypertension, white-coat hypertension, or INH. Isolated nocturnal hypertension in pediatric transplant patients requires study as a treatment target.
Collapse
Affiliation(s)
- Tomáš Seeman
- Department of Pediatrics, Dr. von Hauner Children's Hospital, University Hospital, Munich, Germany.,Department of Pediatrics, 2nd Faculty of Medicine, Charles University Prague, Prague, Czech Republic
| | - Mairead Pfaff
- Department of Pediatrics, Division of Pediatric Nephrology, Cohen Children's Medical Center, Northwell Health, New Hyde Park, New York, USA
| | - Christine B Sethna
- Department of Pediatrics, Division of Pediatric Nephrology, Cohen Children's Medical Center, Northwell Health, New Hyde Park, New York, USA.,Zucker School of Medicine at Hofstra/Northwell, Uniondale, New York, USA
| |
Collapse
|
13
|
Evaluation of cardiovascular risk in children with solitary functioning kidney. Clin Exp Nephrol 2022; 26:415-423. [PMID: 35037126 DOI: 10.1007/s10157-021-02169-7] [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: 06/02/2021] [Accepted: 12/05/2021] [Indexed: 11/03/2022]
Abstract
BACKGROUND The present study investigates cardiovascular risk and kidney damage in patients with solitary kidneys. METHODS Included in the study were 40 children with a unilateral functioning kidney and 60 healthy controls, all of whom were evaluated for carotid intima-media thickness, ischemia-modified albumin and oxidative stress parameters, and 24-h ambulatory blood pressure monitoring. RESULTS Serum creatinine and urine microalbumin levels were higher and creatinine clearance was lower in the patient group than in the control group, and serum ischemia-modified albumin, carotid intima-media thickness, aldosterone, plasma renin activity and blood pressure were all higher in the patient group than in the control group. In addition, the patient group was showed a non-dipper pattern. CONCLUSION Children with a normal functioning solitary kidney are likely at higher risk of developing cardiovascular disease and such patients should be followed closely before marked kidney impairment occurs.
Collapse
|
14
|
Ridgway A, Cotterill N, Dawson S, Drake MJ, Henderson EJ, Huntley AL, Rees J, Strong E, Dudley C, Udayaraj U. Nocturia and Chronic Kidney Disease: Systematic Review and Nominal Group Technique Consensus on Primary Care Assessment and Treatment. Eur Urol Focus 2022; 8:18-25. [PMID: 35031353 DOI: 10.1016/j.euf.2021.12.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 12/28/2021] [Indexed: 12/24/2022]
Abstract
CONTEXT Reduced renal function impairs salt and water homeostasis, which can drive nocturnal or 24-h polyuria. Nocturia can arise early in chronic kidney disease (CKD). Evidence-based recommendations can facilitate management outside nephrology clinics. OBJECTIVE To conduct a systematic review (SR) of nocturia in CKD and achieve expert consensus for management in primary care and in specialist clinics outside nephrology. EVIDENCE ACQUISITION Four databases were searched from January 2000 to April 2020. A total of 4011 titles and abstracts were screened, and 108 studies underwent full-text screening. Seven studies met the inclusion criteria and two were identified through other sources. Consensus was achieved among an expert panel with public involvement using the nominal group technique (NGT). EVIDENCE SYNTHESIS Several plausible mechanisms contribute to nocturnal or 24-h polyuria in CKD, but there is little evidence on interventions to improve nocturia. NGT assessment recommendations for nocturia (at least two voids per night) in patients with CKD or at risk of CKD being assessed in a non-nephrology setting are: history (thirst, fluid intake), medication review (diuretics, lithium, calcium channel antagonists, nonsteroidal anti-inflammatory medications), examination (oedematous state, blood pressure), urinalysis (haematuria and albumin/creatinine ratio), blood tests (blood urea, serum creatinine and electrolytes, estimated glomerular filtration rate), and a bladder diary. Renal ultrasound should follow local CKD guidelines. Treatment options include optimising blood pressure control, dietary adjustment to reduce salt intake, fluid advice, and a medication review. Referral to specialist nephrology services should follow local guidelines. CONCLUSIONS CKD should be considered when evaluating patients with nocturia. The aim of assessment is to identify mechanisms and instigate therapy, but the latter may be more applicable to reducing wider morbidity associated with CKD than nocturia itself. PATIENT SUMMARY People with kidney disease can suffer severe sleep disturbance because of a need to pass urine overnight. We looked at published research and found some useful information about the underlying mechanisms. A group of experts was able to develop practical approaches for assessing and treating this condition.
Collapse
Affiliation(s)
- Alex Ridgway
- Bristol Urological Institute, North Bristol NHS Trust, Bristol, UK
| | - Nikki Cotterill
- Bristol Urological Institute, North Bristol NHS Trust, Bristol, UK; School of Health and Social Wellbeing, University of the West of England, Bristol, UK
| | - Shoba Dawson
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Marcus J Drake
- Bristol Urological Institute, North Bristol NHS Trust, Bristol, UK; Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.
| | - Emily J Henderson
- Bristol Urological Institute, North Bristol NHS Trust, Bristol, UK; Older Person's Unit, Royal United Hospital NHS Foundation Trust Bath, Combe Park, Bath, UK
| | - Alyson L Huntley
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | | | - Edward Strong
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Christopher Dudley
- Nephrology Department, Southmead Hospital, North Bristol NHS Trust, Bristol, UK
| | - Udaya Udayaraj
- Nuffield Department of Medicine, University of Oxford, Oxford, UK; Oxford Kidney Unit, Churchill Hospital, Oxford, UK
| |
Collapse
|
15
|
Indhumathi E, Angraje S, Mishra B, Macha J. Is ambulatory blood pressure monitoring required for elderly hemodialysis patients during the interdialytic period? - Experience of a tertiary care center in South India. Indian J Nephrol 2022; 32:60-66. [PMID: 35283562 PMCID: PMC8916151 DOI: 10.4103/ijn.ijn_160_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 09/04/2020] [Accepted: 10/06/2020] [Indexed: 11/04/2022] Open
|
16
|
Damianaki A, Polychronopoulou E, Wuerzner G, Burnier M. New Aspects in the Management of Hypertension in Patients with Chronic Kidney Disease not on Renal Replacement Therapy. High Blood Press Cardiovasc Prev 2021; 29:125-135. [PMID: 34910287 PMCID: PMC8942929 DOI: 10.1007/s40292-021-00495-1] [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: 11/03/2021] [Accepted: 11/30/2021] [Indexed: 11/07/2022] Open
Abstract
With chronic kidney disease (CKD) being a global arising health problem, strategies for delaying kidney disease progression and reducing the high cardiovascular risk inherent to CKD, are the main objectives of the actual management of patients with kidney diseases. In these patients, the control of arterial hypertension is essential, as high blood pressure (BP) is a strong determinant of worst cardiovascular and renal outcomes. Achieving target blood pressures recommended by international guidelines is mandatory and often demands a multiple levels management, including several pharmacological and lifestyle measures. Even in the presence of adequate BP control, the residual cardiovascular risk remains high. In this respect, the recent demonstration that novel agents such as sodium glucose transporter 2 (SGLT2) inhibitors or the new non-steroidal mineralocorticoid antagonist finerenone can retard the progression of kidney diseases and reduce cardiovascular mortality on top of standard of care treatment with renin-angiotensin system inhibitors represent enormous progresses. These studies also demonstrate that cardiovascular and renal protection can be obtained beyond blood pressure control. Other promising novelties are still to come such as renal denervation and endothelin receptor antagonists in the setting of diabetic and non-diabetic kidney diseases. In the present review, we shall discuss the classic and the new aspects for the management of hypertension in CKD, integrating the new data from recent clinical studies.
Collapse
Affiliation(s)
- Aikaterini Damianaki
- Service of Nephrology and Hypertension, University Hospital, Rue du Bugnon 17, 1011, Lausanne, Switzerland
| | - Erietta Polychronopoulou
- Service of Nephrology and Hypertension, University Hospital, Rue du Bugnon 17, 1011, Lausanne, Switzerland
| | - Gregoire Wuerzner
- Service of Nephrology and Hypertension, University Hospital, Rue du Bugnon 17, 1011, Lausanne, Switzerland.,Hypertension Research Foundation, Saint-Légier, Switzerland
| | - Michel Burnier
- Service of Nephrology and Hypertension, University Hospital, Rue du Bugnon 17, 1011, Lausanne, Switzerland. .,Hypertension Research Foundation, Saint-Légier, Switzerland.
| |
Collapse
|
17
|
Masked morning hypertension correlated with target organ damage in non-dialysis patients with chronic kidney disease. J Hypertens 2021; 38:1794-1801. [PMID: 32694329 DOI: 10.1097/hjh.0000000000002461] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To determine the prevalence of masked morning hypertension and investigate its role in target organ damage in nondialysis patients with chronic kidney disease. METHODS A total of 1841 patients with chronic kidney disease admitted to our hospital were recruited. According to measurements of clinic blood pressure and ambulatory blood pressure, they were divided into four groups: normotension, white-coat hypertension, masked morning hypertension, and sustained hypertension. Multivariate logistic regression analyses were used to evaluate the association between masked morning hypertension and cardiovascular and renal parameters. RESULTS Overall, 288 (15.6%) patients were diagnosed with masked morning hypertension. Patients with masked morning hypertension had a higher prevalence of left ventricular hypertrophy, abnormal carotid intima-media thickness, and impaired renal function when compared with normotensive patients, although lower than those with sustained hypertension. After adjustment for demographics and clinical characteristics, masked morning hypertension was related to cardiovascular damage and renal dysfunction compared with normotension. The odds ratio for left ventricular hypertrophy, abnormal carotid intima-media thickness and impaired renal function was 1.955 [95% confidence interval (CI), 1.247-3.065], 1.469 (95% CI: 1.011-2.133), and 1.819 (95% CI: 1.112-2.976), respectively. Masked morning hypertension correlated with target organ damage even when patients with a history of cardiovascular disease were excluded. CONCLUSION The prevalence of masked morning hypertension in nondialysis chronic kidney disease patients was high, and masked morning hypertension was associated with target organ damage in chronic kidney disease patients.
Collapse
|
18
|
Zhang J, Sun R, Jiang T, Yang G, Chen L. Circadian Blood Pressure Rhythm in Cardiovascular and Renal Health and Disease. Biomolecules 2021; 11:biom11060868. [PMID: 34207942 PMCID: PMC8230716 DOI: 10.3390/biom11060868] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 06/05/2021] [Accepted: 06/08/2021] [Indexed: 12/21/2022] Open
Abstract
Blood pressure (BP) follows a circadian rhythm, it increases on waking in the morning and decreases during sleeping at night. Disruption of the circadian BP rhythm has been reported to be associated with worsened cardiovascular and renal outcomes, however the underlying molecular mechanisms are still not clear. In this review, we briefly summarized the current understanding of the circadian BP regulation and provided therapeutic overview of the relationship between circadian BP rhythm and cardiovascular and renal health and disease.
Collapse
Affiliation(s)
- Jiayang Zhang
- Advanced Institute for Medical Sciences, Dalian Medical University, Dalian 116044, China; (J.Z.); (R.S.); (T.J.)
| | - Ruoyu Sun
- Advanced Institute for Medical Sciences, Dalian Medical University, Dalian 116044, China; (J.Z.); (R.S.); (T.J.)
| | - Tingting Jiang
- Advanced Institute for Medical Sciences, Dalian Medical University, Dalian 116044, China; (J.Z.); (R.S.); (T.J.)
| | - Guangrui Yang
- School of Bioengineering, Dalian University of Technology, Dalian 116024, China;
| | - Lihong Chen
- Advanced Institute for Medical Sciences, Dalian Medical University, Dalian 116044, China; (J.Z.); (R.S.); (T.J.)
- Correspondence: ; Tel.: +86-411-86118984
| |
Collapse
|
19
|
Wang Q, Wang Y, Wang J, Zhang L, Zhao MH. Nocturnal Systolic Hypertension and Adverse Prognosis in Patients with CKD. Clin J Am Soc Nephrol 2021; 16:356-364. [PMID: 33568382 PMCID: PMC8011017 DOI: 10.2215/cjn.14420920] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2020] [Accepted: 01/05/2021] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND OBJECTIVES Nocturnal hypertension is associated with adverse outcomes in patients with CKD. However, the individual association of entities of nocturnal hypertension according to achievement of systolic and/or diastolic BP goals with kidney failure and cardiovascular outcomes of CKD is not clear. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS Our study analyzed data from participants in the Chinese Cohort Study of Chronic Kidney Disease. Nocturnal hypertension was categorized into three entities: isolated nocturnal diastolic hypertension with diastolic BP ≥70 mm Hg and systolic BP <120 mm Hg, isolated nocturnal systolic hypertension with systolic BP ≥120 mm Hg and diastolic BP <70 mm Hg, and nocturnal systolic-diastolic hypertension with both systolic BP ≥120 mm Hg and diastolic BP ≥70 mm Hg. Associations of nocturnal hypertension entities with kidney failure and cardiovascular outcomes were evaluated by Cox regression. RESULTS In total, 2024 patients with CKD stages 1-4 were included in our analysis (mean age, 49±14 years; 57% men; eGFR=51±29 ml/min per 1.73 m2; proteinuria: 0.9 [0.4-2.1] g/d). Among them, 1484 (73%) patients had nocturnal hypertension, with the proportions of 26%, 8%, and 66% for isolated nocturnal diastolic hypertension, isolated nocturnal systolic hypertension, and nocturnal systolic-diastolic hypertension, respectively. Three hundred twenty kidney events and 148 cardiovascular events were recorded during median follow-up intervals of 4.8 and 5.0 years for kidney and cardiovascular events, respectively. After adjustment, isolated nocturnal systolic hypertension was associated with a higher risk for cardiovascular events (hazard ratio, 3.17; 95% confidence interval, 1.61 to 6.23). Nocturnal systolic-diastolic hypertension showed a higher risk for both kidney failure (hazard ratio, 1.71; 95% confidence interval, 1.17 to 2.49) and cardiovascular outcomes (hazard ratio, 2.19; 95% confidence interval, 1.24 to 3.86). No association was observed between isolated nocturnal diastolic hypertension with either kidney failure or cardiovascular events. CONCLUSIONS Nocturnal systolic hypertension, either alone or in combination with diastolic hypertension, is associated with higher risks for adverse outcomes in patients with CKD.
Collapse
Affiliation(s)
- Qin Wang
- Renal Division, Department of Medicine, Peking University First Hospital, Institute of Nephrology, Peking University, Key Laboratory of Renal Disease, National Health and Family Planning Commission of the People’s Republic of China, Key Laboratory of Chronic Kidney Disease Prevention and Treatment, Ministry of Education, Beijing, China
| | - Yu Wang
- Renal Division, Department of Medicine, Peking University First Hospital, Institute of Nephrology, Peking University, Key Laboratory of Renal Disease, National Health and Family Planning Commission of the People’s Republic of China, Key Laboratory of Chronic Kidney Disease Prevention and Treatment, Ministry of Education, Beijing, China
| | - Jinwei Wang
- Renal Division, Department of Medicine, Peking University First Hospital, Institute of Nephrology, Peking University, Key Laboratory of Renal Disease, National Health and Family Planning Commission of the People’s Republic of China, Key Laboratory of Chronic Kidney Disease Prevention and Treatment, Ministry of Education, Beijing, China
| | - Luxia Zhang
- Renal Division, Department of Medicine, Peking University First Hospital, Institute of Nephrology, Peking University, Key Laboratory of Renal Disease, National Health and Family Planning Commission of the People’s Republic of China, Key Laboratory of Chronic Kidney Disease Prevention and Treatment, Ministry of Education, Beijing, China,Center for Data Science in Health and Medicine, Peking University, Beijing, China
| | - Ming-Hui Zhao
- Renal Division, Department of Medicine, Peking University First Hospital, Institute of Nephrology, Peking University, Key Laboratory of Renal Disease, National Health and Family Planning Commission of the People’s Republic of China, Key Laboratory of Chronic Kidney Disease Prevention and Treatment, Ministry of Education, Beijing, China,Peking-Tsinghua Center for Life Sciences, Beijing, China
| | | | | |
Collapse
|
20
|
Polychronopoulou E, Wuerzner G, Burnier M. How Do I Manage Hypertension in Patients with Advanced Chronic Kidney Disease Not on Dialysis? Perspectives from Clinical Practice. Vasc Health Risk Manag 2021; 17:1-11. [PMID: 33442257 PMCID: PMC7797323 DOI: 10.2147/vhrm.s292522] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Accepted: 12/18/2020] [Indexed: 12/24/2022] Open
Abstract
In the general population, the prevalence of moderate and severe chronic kidney disease (CKD) is usually below 5% but this figure is often higher in specific groups of patients such as those with type 2 diabetes. Patients with advanced CKD (CKD stage 3b and 4) are at high or very high cardiovascular risk, and their risk of progressing towards end-stage kidney disease (CKD stage 5) and the need of renal replacement therapy are elevated. Hypertension is a major cause of poor cardiovascular and renal outcomes in severe CKD. Therefore, an adequate control of blood pressure (BP) is mandatory. However, normalizing BP is often challenging in these patients because the clinical management of hypertension in advanced CKD is not well defined and rarely supported by large randomized controlled trials. In the present review, we discuss the characteristics of hypertension in advanced CKD, excluding dialysis, and its management integrating data from recent clinical studies and a pragmatic approach enriched by a long-standing clinical experience.
Collapse
Affiliation(s)
| | - Gregoire Wuerzner
- Service of Nephrology and Hypertension, University Hospital, Lausanne, Switzerland.,Hypertension Research Foundation, Saint-Légier, Switzerland
| | - Michel Burnier
- Service of Nephrology and Hypertension, University Hospital, Lausanne, Switzerland.,Hypertension Research Foundation, Saint-Légier, Switzerland
| |
Collapse
|
21
|
Chuwa G, Chillo P. Ambulatory Blood Pressure Profiles and Correlation with Cardiovascular Risk Factors in a Sample of 390 University Employees in Tanzania. Integr Blood Press Control 2021; 13:197-208. [PMID: 33380824 PMCID: PMC7767712 DOI: 10.2147/ibpc.s280763] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2020] [Accepted: 11/04/2020] [Indexed: 11/25/2022] Open
Abstract
Background Hypertension is a major risk factor for cardiovascular morbidity and mortality. Increasingly, evidence suggests that 24-hour ambulatory blood pressure (BP) monitoring (ABPM) is more accurate than clinic BP in predicting cardiovascular risk. However, this association has not been widely studied in subSaharan Africa, especially in Tanzania. Aim To explore the relationship between 24-hour ABPM profiles and cardiovascular risk factors in comparison with clinic BP among Muhimbili University of Health and Allied Sciences (MUHAS) employees. Methods A descriptive cross-sectional study was conducted from October 2018 to February 2019. Socio-demographic and cardiovascular risk information was gathered. We used an automated ABPM device to record 24-hour ambulatory BP. Correlation between BP profiles and cardiovascular risk factors was done using Pearson’s correlation coefficient, and independent factors for hypertension were determined using logistic regression analysis. P-value of <0.05 was considered statistically significant. Results In total, 390 employees participated. Their mean age was 40.5 ± 8.9 years, and 53.6% were men. The mean office systolic and diastolic BP were 126±12 mmHg and 78±13 mmHg, respectively, while the corresponding values for mean 24-hour ABPM were 122±14 and 75±10 mmHg. The prevalence of hypertension was 23.1%. The prevalence of white coat hypertension was 16.2%, while masked hypertension and nocturnal non-dipping were present in 11.5 and 66.7%, respectively. Overall, the mean 24-hour systolic BP showed the strongest correlations with cardiovascular risk factors while mean office systolic BP showed least. Independent associated factors of hypertension were male gender, age ≥40 years, family history of hypertension, central obesity, raised cholesterol and uric acid levels, all p<0.01. Conclusion Compared to office BP, ABPM measurements had stronger correlations with cardiovascular risk factors in this population, and therefore likely to reflect true BP. ABPM has revealed high proportion of masked, white coat and nocturnal non-dipping, supporting use of ABPM to detect these clinically important BP profiles.
Collapse
Affiliation(s)
- Godfrey Chuwa
- Department of Internal Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Pilly Chillo
- Department of Internal Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| |
Collapse
|
22
|
Jeong JH, Fonkoue IT, Quyyumi AA, DaCosta D, Park J. Nocturnal blood pressure is associated with sympathetic nerve activity in patients with chronic kidney disease. Physiol Rep 2020; 8:e14602. [PMID: 33112490 PMCID: PMC7592496 DOI: 10.14814/phy2.14602] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 09/11/2020] [Indexed: 01/04/2023] Open
Abstract
Elevated nocturnal blood pressure (BP) and nocturnal non-dipping are frequently observed in patients with chronic kidney disease (CKD) and are stronger predictors of cardiovascular complications and CKD progression than standard office BP. The sympathetic nervous system (SNS) is thought to modulate diurnal hemodynamic changes and the vascular endothelium plays a fundamental role in BP regulation. We hypothesized that SNS overactivity and endothelial dysfunction in CKD are linked to elevated nocturnal BP and non-dipping. In 32 CKD patients with hypertension (56 ± 7 years), office BP, 24-hr ambulatory BP, muscle sympathetic nerve activity (MSNA) and endothelial function via flow-mediated dilation (FMD) were measured. Participants were subsequently divided into dippers (nighttime average BP > 10% lower than the daytime average BP, n = 8) and non-dippers (n = 24). Non-dippers had higher nighttime BP (p < .05), but not office and daytime BP, compared to dippers. MSNA burst incidence (81 ± 13 versus 67 ± 13 bursts/100 HR, p = .019) was higher and brachial artery FMD (1.7 ± 1.5 versus 4.7 ± 1.9%, p < .001) was lower in non-dippers compared to dippers. MSNA and FMD each predicted nighttime systolic (β = 0.48,-0.46, p = .02, 0.07, respectively) and diastolic BP (β = 0.38,-0.47, p = .04, 0.03, respectively) in multivariate-adjusted analyses. Our novel findings demonstrate that unfavorable nocturnal BP profiles are associated with elevated SNS activity and endothelial dysfunction in CKD. Specifically, CKD patients with higher nighttime BP and the non-dipping pattern have higher MSNA and lower FMD. These support our hypothesis that SNS overactivation and endothelial dysfunction are linked to the dysregulation of nighttime BP as well as the magnitude of BP lowering at nighttime in CKD.
Collapse
Affiliation(s)
- Jin H. Jeong
- Division of Renal MedicineDepartment of MedicineEmory University School of MedicineAtlantaGAUSA
- Department of Veterans Affairs Health Care SystemResearch Service LineDecaturGAUSA
| | - Ida T. Fonkoue
- Division of Renal MedicineDepartment of MedicineEmory University School of MedicineAtlantaGAUSA
- Department of Veterans Affairs Health Care SystemResearch Service LineDecaturGAUSA
| | - Arshed A. Quyyumi
- Division of CardiologyDepartment of MedicineEmory University School of medicineAtlantaGAUSA
| | - Dana DaCosta
- Division of Renal MedicineDepartment of MedicineEmory University School of MedicineAtlantaGAUSA
- Department of Veterans Affairs Health Care SystemResearch Service LineDecaturGAUSA
| | - Jeanie Park
- Division of Renal MedicineDepartment of MedicineEmory University School of MedicineAtlantaGAUSA
- Department of Veterans Affairs Health Care SystemResearch Service LineDecaturGAUSA
| |
Collapse
|
23
|
Correlations between indices of dynamic components of ambulatory blood pressure and renal damage in elderly Chinese male with essential hypertension. Blood Press Monit 2020; 25:303-309. [PMID: 32769403 PMCID: PMC7643796 DOI: 10.1097/mbp.0000000000000470] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Twenty-four-hour ambulatory blood pressure monitoring (ABPM) is an accurate method to document changes in blood pressure (BP) and is more predictive than office and home BP monitoring for cardiovascular outcomes in elderly people. We aimed to determine the relationship between ABPM indices and renal damage in elderly Chinese male patients with essential hypertension. METHODS We investigated 998 Chinese men (mean age of 78.44 ± 12.02 years) with essential hypertension. Renal function, laboratory testing, and ABPM, including ABP, BP variability, and BP circadian rhythms were investigated. Data were shown according to BP controlling status. The relationships between ABPM indices and renal damage [expressed by urine protein, urine albumin/creatinine ratio (uACR), estimated glomerular filtration rate (eGFR), blood urea nitrogen (BUN)] were assessed using multiple regression analysis. RESULTS After adjustments for age, common cardiovascular risk factors, and medications, uACR level was positively associated with 24-h mean systolic blood pressure (SBP), 24-h mean pulse pressure (PP), and 24-h SBP percent time of elevation. eGFR level was negatively associated with the 24-h mean SBP and 24-h mean PP. BUN level was positively correlated with the 24-h mean SBP, 24-h mean PP, and 24-h SBP percent time of elevation, whereas the BUN level was negatively associated with the 24-h DBP SD. CONCLUSION The ABPM indices associated with renal damage may be regarded as an early predictive marker for renal function impairment in Chinese elderly male patients with hypertension.
Collapse
|
24
|
Ambulatory blood pressure variability and risk of cardiovascular events, all-cause mortality, and progression of kidney disease. J Hypertens 2020; 38:1712-1721. [DOI: 10.1097/hjh.0000000000002477] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
|
25
|
Wang Q, Wang Y, Wang J, Zhang L, Zhao MH. Short-Term Systolic Blood Pressure Variability and Kidney Disease Progression in Patients With Chronic Kidney Disease: Results From C-STRIDE. J Am Heart Assoc 2020; 9:e015359. [PMID: 32508195 PMCID: PMC7429039 DOI: 10.1161/jaha.120.015359] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Background It is unclear whether short‐term blood pressure variability is associated with renal outcomes in patients with chronic kidney disease. Methods and Results This study analyzed data from participants in the C‐STRIDE (Chinese Cohort Study of Chronic Kidney Disease) who had chronic kidney disease stages 1 to 4. Short‐term blood pressure variability was measured by calculating the weighted SD (w‐SD) of systolic blood pressure (SBP). Renal outcomes were defined as dialysis initiation and/or transplantation. Risk factors associated with w‐SD of SBP were evaluated by linear regression. Associations of short‐term SBP variability with renal outcomes were evaluated by Cox regression. In total, 1421 patients with chronic kidney disease were included in this study (mean age, 49.4±13.6 years; 56.2% men; estimated glomerular filtration rate, 50.5±29.3 mL/min per 1.73 m2; proteinuria, 0.9 [0.3–2.0] g/d). Mean w‐SD of SBP was 12.6±4.4 mm Hg. w‐SD of SBP was independently associated with older age, 24‐hour SBP, blood pressure circadian pattern, and angiotensin II receptor blocker treatment. During a median follow‐up of 4.9 years, 237 patients developed renal outcomes (37.01 per 1000 patient‐years). The incidence rate increased across the quartiles of w‐SD (log‐rank P=0.005). w‐SD of SBP was associated with an increased risk of renal outcomes, both as a continuous variable (hazard ratio [HR], 1.47; 95% CI, 1.09–1.99) and as a categorical variable (quartile 4 versus quartile 1: HR, 1.60; 95% CI, 1.08–2.36), independent of 24‐hour SBP, daytime SBP, and nighttime SBP. Conclusions Short‐term SBP was independently associated with the risk of dialysis initiation and/or transplantation in patients with chronic kidney disease.
Collapse
Affiliation(s)
- Qin Wang
- Renal Division Department of Medicine Peking University First Hospital Institute of Nephrology Peking University Beijing China.,Key Laboratory of Renal Disease National Health and Family Planning Commission of the People's Republic of China Key Laboratory of Chronic Kidney Disease Prevention and Treatment Ministry of Education Beijing China
| | - Yu Wang
- Renal Division Department of Medicine Peking University First Hospital Institute of Nephrology Peking University Beijing China.,Key Laboratory of Renal Disease National Health and Family Planning Commission of the People's Republic of China Key Laboratory of Chronic Kidney Disease Prevention and Treatment Ministry of Education Beijing China
| | - Jinwei Wang
- Renal Division Department of Medicine Peking University First Hospital Institute of Nephrology Peking University Beijing China.,Key Laboratory of Renal Disease National Health and Family Planning Commission of the People's Republic of China Key Laboratory of Chronic Kidney Disease Prevention and Treatment Ministry of Education Beijing China
| | - Luxia Zhang
- Renal Division Department of Medicine Peking University First Hospital Institute of Nephrology Peking University Beijing China.,Key Laboratory of Renal Disease National Health and Family Planning Commission of the People's Republic of China Key Laboratory of Chronic Kidney Disease Prevention and Treatment Ministry of Education Beijing China.,Center for Data Science in Health and Medicine Peking University Beijing China
| | - Ming-Hui Zhao
- Renal Division Department of Medicine Peking University First Hospital Institute of Nephrology Peking University Beijing China.,Key Laboratory of Renal Disease National Health and Family Planning Commission of the People's Republic of China Key Laboratory of Chronic Kidney Disease Prevention and Treatment Ministry of Education Beijing China.,Peking-Tsinghua Center for Life Sciences Beijing China
| | | |
Collapse
|
26
|
Association of a Disrupted Dipping Pattern of Blood Pressure with Progression of Renal Injury during the Development of Salt-Dependent Hypertension in Rats. Int J Mol Sci 2020; 21:ijms21062248. [PMID: 32213948 PMCID: PMC7139748 DOI: 10.3390/ijms21062248] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2020] [Revised: 03/19/2020] [Accepted: 03/21/2020] [Indexed: 12/28/2022] Open
Abstract
The aim of the present study is to investigate whether a disruption of the dipping pattern of blood pressure (BP) is associated with the progression of renal injury in Dahl salt-sensitive (DSS) hypertensive rats. Seven-week-old DSS rats were fed a high salt diet (HSD; 8% NaCl) for 10 weeks, followed by a transition to a normal salt diet (NSD; 0.3% NaCl) for 4 weeks. At baseline, NSD-fed DSS rats showed a dipper-type circadian rhythm of BP. By contrast, HSD for 5 days caused a significant increase in the difference between the active and inactive periods of BP with an extreme dipper type of BP, while proteinuria and renal tissue injury were not observed. Interestingly, HSD feeding for 10 weeks developed hypertension with a non-dipper pattern of BP, which was associated with obvious proteinuria and renal tissue injury. Four weeks after switching to an NSD, BP and proteinuria were significantly decreased, and the BP circadian rhythm returned to the normal dipper pattern. These data suggest that the non-dipper pattern of BP is associated with the progression of renal injury during the development of salt-dependent hypertension.
Collapse
|
27
|
Maruhashi T, Kihara Y, Higashi Y. Perspectives on the management of hypertension in Japan. Expert Opin Pharmacother 2020; 21:1179-1187. [DOI: 10.1080/14656566.2020.1724958] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Tatsuya Maruhashi
- Department of Cardiovascular Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Yasuki Kihara
- Department of Cardiovascular Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Yukihito Higashi
- Department of Cardiovascular Regeneration and Medicine, Research Institute for Radiation Biology and Medicine, Hiroshima University, Hiroshima, Japan
- Division of Regeneration and Medicine, Hiroshima University Hospital, Hiroshima, Japan
| |
Collapse
|
28
|
Zhang J, Rao J, Liu M, Zhou W, Li Y, Wu J, Peng H, Lou T. Abnormal circadian rhythm of urinary sodium excretion correlates closely with hypertension and target organ damage in Chinese patients with CKD. Int J Med Sci 2020; 17:702-711. [PMID: 32218691 PMCID: PMC7085274 DOI: 10.7150/ijms.42875] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Accepted: 02/03/2020] [Indexed: 12/18/2022] Open
Abstract
Whether the abnormal circadian rhythm of urinary sodium excretion is associated with hypertension in chronic kidney disease (CKD) is poorly understood. In this study, we assessed the relationship between the circadian rhythm of urinary sodium excretion and hypertension. Urinary samples were collected during both the day (07:00 to 22:00) and night (22:00 to 07:00) to estimate night/day urinary sodium excretion ratios. Blood pressure (BP) and clinical data were also measured. A total of 1,099 Chinese CKD patients were recruited, 308 patients were excluded, and 791 patients were final enrolled in this study. Among them, 291 patients were normotensive and 500 were hypertensive CKD patients. A 1:1 propensity score matching (PSM) analysis was performed with age and estimated glomerular filtration rate (eGFR) matched between 190 normotensive and hypertensive patients. In the full cohort and PSM cohort, multivariate regression analysis showed that the night/day urinary sodium excretion ratio was an independent risk factor for clinical hypertension, whereas 24 h urinary sodium excretion, diurnal and nocturnal urinary sodium excretion were not. When the night/day urinary sodium excretion ratios were further divided into tertiles (tertile 1 < 0.47, tertile 2, 0.47-0.84 and tertile 3 > 0.84), multivariate analysis showed that tertile 3 was independently associated with hypertension in the full and PSM cohorts. In addition, tertile 3 was also independently associated with eGFR ≤ 60 mL/min/1.73 m2 and left ventricular hypertrophy. These data suggested that an abnormal circadian rhythm of urinary sodium excretion was independently associated with hypertension and target-organ damage. Individualized salt intake and therapeutic strategies should be used to normalize the natriuretic dipping profile in CKD patients.
Collapse
Affiliation(s)
- Jun Zhang
- Division of Nephrology, Department of medicine, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong 510630, China
| | - Jialing Rao
- Division of Nephrology, Department of medicine, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong 510630, China
| | - Man Liu
- Division of Gastroenterology and Hepatology, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Wenying Zhou
- Department of Laboratory medicine, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong 510630, China
| | - Yuanqing Li
- Division of Nephrology, Department of medicine, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong 510630, China
| | - Jianhao Wu
- Division of Nephrology, Department of medicine, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong 510630, China
| | - Hui Peng
- Division of Nephrology, Department of medicine, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong 510630, China
| | - Tanqi Lou
- Division of Nephrology, Department of medicine, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong 510630, China
| |
Collapse
|
29
|
Borrelli S, De Nicola L, Minutolo R, Perna A, Provenzano M, Argentino G, Cabiddu G, Russo R, La Milia V, De Stefano T, Conte G, Garofalo C. Sodium toxicity in peritoneal dialysis: mechanisms and "solutions". J Nephrol 2019; 33:59-68. [PMID: 31734929 DOI: 10.1007/s40620-019-00673-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Accepted: 11/11/2019] [Indexed: 01/19/2023]
Abstract
The major trials in peritoneal dialysis (PD) have demonstrated that increasing peritoneal clearance of small solutes is not associated with any advantage on survival, whereas sodium and fluid overload heralds higher risk of death and technique failure. On the other hand, higher sodium and fluid overload due to loss of residual kidney function (RKF) and higher transport membrane is associated with poor patient and technique survival. Recent experimental studies also show that, independently from fluid overload, sodium accumulation in the peritoneal interstitium exerts direct inflammatory and angiogenetic stimuli, with consequent structural and functional changes of peritoneum, while in patients with Chronic Kidney Disease sodium stored in interstitial skin acts as independent determinant of left ventricular hypertrophy. Noteworthy, this tissue pool of sodium is modifiable being removed by dialysis. Therefore, novel PD strategies to optimize sodium removal, including the use of bimodal and/or low-sodium solutions, are actively tested. Nonetheless, a holistic approach aimed at preserving peritoneal function and the kidney may represent the key of therapy success in the hard task of preserving adequate sodium balance in PD patients. In this review, we describe the available evidence on sodium toxicity in PD, either related or unrelated to fluid overload, and we also discuss about possible "solutions" to preserve or restore sodium balance in PD patients.
Collapse
Affiliation(s)
- Silvio Borrelli
- Nephrology Units at University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Luca De Nicola
- Nephrology Units at University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Roberto Minutolo
- Nephrology Units at University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Alessandra Perna
- Nephrology Units at University of Campania "Luigi Vanvitelli", Naples, Italy
| | | | | | | | | | | | - Toni De Stefano
- Nephrology Units at University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Giuseppe Conte
- Nephrology Units at University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Carlo Garofalo
- Nephrology Units at University of Campania "Luigi Vanvitelli", Naples, Italy.
| | | |
Collapse
|
30
|
Kim CS, Choi HS, Bae EH, Kim SW, Ma SK. Optimal blood pressure target and measurement in patients with chronic kidney disease. Korean J Intern Med 2019; 34:1181-1187. [PMID: 31189302 PMCID: PMC6823567 DOI: 10.3904/kjim.2019.164] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Accepted: 05/19/2019] [Indexed: 01/13/2023] Open
Abstract
The prevalence rates of hypertension and chronic kidney disease (CKD) are increasing with the aging of the population. Hypertension and CKD are closely related, and hypertension with accompanying CKD is difficult to control. This difficulty controlling blood pressure (BP) can be explained by changes in diurnal variation in BP, such as non-dipping and reverse dipping patterns, increased pulse pressure, and BP variability in CKD patients resulting in a high frequency of nocturnal hypertension or masked hypertension. CKD patients with uncontrolled or nocturnal hypertension are at increased risk for cardiovascular disease, progression of CKD, and all-cause death. Recent studies have shown that intensive reduction of systolic BP below 120 mmHg is seems to favor in CKD patients regardless of the presence or absence of diabetes. As BP control is difficult in patients with CKD, appropriate measurement of BP is important. Automated BP monitoring could reduce the so-called "white coat effect" (spike in BP) that may be triggered by measurement in a clinical setting. Moreover, out-of-office BP monitoring at home or ambulatory BP monitoring for 24 hours may provide critical information regarding diurnal BP variability and nocturnal BP in patients with CKD.
Collapse
Affiliation(s)
- Chang Seong Kim
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Hong Sang Choi
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Eun Hui Bae
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Soo Wan Kim
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Seong Kwon Ma
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
- Correspondence to Seong Kwon Ma, M.D. Department of Internal Medicine, Chonnam National University Medical School, 42 Jebong-ro, Dong-gu, Gwangju 61469, Korea Tel: +82-62-220-6579 Fax: +82-62-225-8578 E-mail:
| |
Collapse
|
31
|
Zhang D, Pollock DM. Diurnal Regulation of Renal Electrolyte Excretion: The Role of Paracrine Factors. Annu Rev Physiol 2019; 82:343-363. [PMID: 31635525 DOI: 10.1146/annurev-physiol-021119-034446] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Many physiological processes, including most kidney-related functions, follow specific rhythms tied to a 24-h cycle. This is largely because circadian genes operate in virtually every cell type in the body. In addition, many noncanonical genes have intrinsic circadian rhythms, especially within the liver and kidney. This new level of complexity applies to the control of renal electrolyte excretion. Furthermore, there is growing evidence that paracrine and autocrine factors, especially the endothelin system, are regulated by clock genes. We have known for decades that excretion of electrolytes is dependent on time of day, which could play an important role in fluid volume balance and blood pressure control. Here, we review what is known about the interplay between paracrine and circadian control of electrolyte excretion. The hope is that recognition of paracrine and circadian factors can be considered more deeply in the future when integrating with well-established neuroendocrine control of excretion.
Collapse
Affiliation(s)
- Dingguo Zhang
- Division of Nephrology, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama 35233, USA; ,
| | - David M Pollock
- Division of Nephrology, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama 35233, USA; ,
| |
Collapse
|
32
|
Murakami S, Otsuka K, Kono T. Repeated ambulatory monitoring reveals an evening rise in blood pressure in a Japanese population. J Clin Hypertens (Greenwich) 2019; 21:1675-1681. [PMID: 31566893 DOI: 10.1111/jch.13709] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2019] [Revised: 06/20/2019] [Accepted: 06/28/2019] [Indexed: 01/18/2023]
Abstract
Recent studies have revealed 2 peaks in the onset of cardiovascular events, 1 in the morning and another in the evening. We evaluated whether blood pressure (BP) also rises in the morning/evening and identified the determinants of evening BP rise using 24-hour ambulatory BP monitoring for 7 consecutive days. We identified 2 BP peaks, 1 in the morning (0-3 hours after waking) and 1 in the evening (9-12 hours after waking). Subjects were subclassified according to the extent of evening BP rise: those in the top quartile (≥6.45 mm Hg, n = 34; ER group) vs all others. After adjustment for age, sex, and 24-hour systolic BP, evening BP rise was associated with the use of antihypertensive medications [odds ratio (OR), 3.57; 95% confidence interval (CI), 1.46-8.74; P = .01] and estimated glomerular filtration rate (OR, 0.96; 95% CI, 0.93-0.99; P = .04), confirming its association with antihypertensive medication use and renal dysfunction.
Collapse
Affiliation(s)
- Shougo Murakami
- Department of Cardiovascular Medicine, Soseikai General Hospital, Kyoto, Japan
| | - Kuniaki Otsuka
- Executive Medical Center, Totsuka Royal Clinic, Tokyo Women Medical University, Tokyo, Japan
| | - Tatsuji Kono
- Department of Cardiovascular Medicine, Soseikai General Hospital, Kyoto, Japan
| |
Collapse
|
33
|
Short-term blood pressure variability in nondialysis chronic kidney disease patients: correlates and prognostic role on the progression of renal disease. J Hypertens 2019; 36:2398-2405. [PMID: 29995698 DOI: 10.1097/hjh.0000000000001825] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE In chronic kidney disease (CKD), few cross-sectional studies evidenced an association between short-term BP variability (BPV) derived from ambulatory blood pressure (ABP) monitoring and renal damage. However, no study has evaluated the association of short-term BPV with the risk of CKD progression. METHODS We performed a cohort study to assess the correlates and the predictive value for incident renal outcomes of short-term BPV in hypertensive patients with CKD stage G1-5. As measures of short-term BPV, we considered the weighted SD (W-SD), and the coefficient of variation of SBP (CV-24-h SBP). Primary outcome was a composite endpoint of ESRD (chronic dialysis or transplantation) or GFR decline of at least 50%. RESULTS We included 465 patients (63.5 ± 14.2 years; 54.7% men; eGFR: 44 ± 22 ml/min per 1.73 m; proteinuria: 0.2 [0.1-0.9] g/day); W-SD, CV-24-h SBP and 24 h SBP were 12.5 ± 3.3 mmHg, 11.1 ± 2.8% and 127 ± 16 mmHg, respectively. W-SD was independently associated with older age, history of cardiovascular disease, diagnosis of diabetic, hypertensive and polycystic nephropathy, and higher 24 h SBP whereas no association with eGFR and proteinuria was found. During follow-up (median, 6.4 years), 130 patients reached the renal outcome (107 ESRD and 23 GFR decline of ≥50%). Higher 24 h, daytime and night-time SBP robustly predicted the composite renal endpoint [1.18 (1.10-1.25) for 5 mmHg], whereas BPV as measured by the W-SD did not either when expressed as a continuous variable [hazard ratio 0.97 (95% CI 0.91-1.04)] or when categorized into tertiles [1.16 (0.70-1.92) and 0.95 (0.54-1.68) in II and III tertiles, respectively]. Similar findings were found with CV-24-h SBP. CONCLUSION In CKD patients, short-term BPV is strongly associated with 24 h, night-time and daytime BP but is independent from the eGFR and proteinuria and does not predict CKD progression.
Collapse
|
34
|
Cirillo M, Bilancio G, Lombardi C, Cavallo P, Terradura Vagnarelli O, Zanchetti A, Laurenzi M. Osmotic indices and kidney concentrating activity: population-based data on correlates and prognostic power. Nephrol Dial Transplant 2019; 33:274-283. [PMID: 28339633 DOI: 10.1093/ndt/gfw426] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Accepted: 11/05/2016] [Indexed: 01/10/2023] Open
Abstract
Background Research data are limited on indices of osmotic equilibrium and of kidney concentrating activity (KCA). This study investigated correlates and prognostic power of these indices in a sample of the general population. Methods Urine osmolality (U-osm), plasma osmolality (P-osm), plasma creatinine and other variables were measured by the Gubbio Study for the 1988-92 exam (baseline). Plasma creatinine and other variables were re-measured in the 2001-07 exam (follow-up). KCA was assessed as the U-osm/P-osm ratio and kidney function as estimated glomerular filtration rate (eGFR). Results Baseline data were complete in 4220 adults, of whom 852 died before follow-up and 2795 participated in the follow-up. At baseline, the following independent cross-sectional associations were identified: female sex and higher urine flow with lower values of U-osm, P-osm and U-osm/P-osm ratio (P < 0.01); obesity with higher values of U-osm, P-osm and U-osm/P-osm ratio (P < 0.01); older age and lower eGFR with lower U-osm, lower U-osm/P-osm ratio and higher P-osm (P < 0.05); hypertension and smoking with lower U-osm and lower U-osm/P-osm ratio (P < 0.05) but not with P-osm. From baseline to follow-up, the annualized rate was 1.26% for mortality and -0.74 ± 0.76 mL/min × 1.73 m2 for eGFR change. Mortality was independently predicted by baseline U-osm and baseline U-osm/P-osm ratio (hazard ratio for one higher standard deviation was ≤0.91, 95% confidence interval was ≤0.97, P < 0.01), but not by baseline P-osm. The eGFR change was not independently predicted by baseline values of U-osm, P-osm and U-osm/P-osm ratio (P ≥ 0.4). Conclusions Sex, age, obesity, eGFR, urine flow, hypertension and smoking independently associated with U-osm and KCA. U-osm and KCA independently predicted mortality, but not kidney function change over time.
Collapse
Affiliation(s)
- Massimo Cirillo
- Department 'Scuola Medica Salernitana', University of Salerno, Baronissi, Italy.,Unit of Nephrology and Hypertension, University Hospital, Salerno, Italy
| | - Giancarlo Bilancio
- Department 'Scuola Medica Salernitana', University of Salerno, Baronissi, Italy.,Unit of Nephrology and Hypertension, University Hospital, Salerno, Italy
| | | | | | | | | | | |
Collapse
|
35
|
Kukida M, Mogi M, Kan-no H, Tsukuda K, Bai HY, Shan BS, Yamauchi T, Higaki A, Min LJ, Iwanami J, Okura T, Higaki J, Horiuchi M. AT2 receptor stimulation inhibits phosphate-induced vascular calcification. Kidney Int 2019; 95:138-148. [DOI: 10.1016/j.kint.2018.07.028] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2017] [Revised: 07/09/2018] [Accepted: 07/26/2018] [Indexed: 02/06/2023]
|
36
|
Isobe-Sasaki Y, Fukuda M, Ogiyama Y, Sato R, Miura T, Fuwa D, Mizuno M, Matsuoka T, Shibata H, Ito H, Ono M, Abe-Dohmae S, Kiyono K, Yamamoto Y, Kobori H, Michikawa M, Hayano J, Ohte N. Sodium balance, circadian BP rhythm, heart rate variability, and intrarenal renin-angiotensin-aldosterone and dopaminergic systems in acute phase of ARB therapy. Physiol Rep 2018; 5:5/11/e13309. [PMID: 28576855 PMCID: PMC5471446 DOI: 10.14814/phy2.13309] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Revised: 04/29/2017] [Accepted: 05/10/2017] [Indexed: 01/11/2023] Open
Abstract
We have revealed that even in humans, activated intrarenal renin–angiotensin–aldosterone system (RAAS) enhances tubular sodium reabsorption to facilitate salt sensitivity and nondipper rhythm of blood pressure (BP), and that angiotensin receptor blocker (ARB) could increase daytime urinary sodium excretion rate (UNaV) to produce lower sodium balance and restore nondipper rhythm. However, the sympathetic nervous system and intrarenal dopaminergic system can also contribute to renal sodium handling. A total of 20 patients with chronic kidney disease (61 ± 15 years) underwent 24‐h ambulatory BP monitoring before and during two‐day treatment with ARB, azilsartan. Urinary angiotensinogen excretion rate (UAGTV, μg/gCre) was measured as intrarenal RAAS; urinary dopamine excretion rate (UDAV, pg/gCre) as intrarenal dopaminergic system; heart rate variabilities (HRV, calculated from 24‐h Holter‐ECG) of non‐Gaussianity index λ25s as sympathetic nerve activity; and power of high‐frequency (HF) component or deceleration capacity (DC) as parasympathetic nerve activity. At baseline, glomerular filtration rate correlated inversely with UAGTV (r = −0.47, P = 0.04) and positively with UDAV (r = 0.58, P = 0.009). HF was a determinant of night/day BP ratio (β = −0.50, F = 5.8), rather than DC or λ25s. During the acute phase of ARB treatment, a lower steady sodium balance was not achieved. Increase in daytime UNaV preceded restoration of BP rhythm, accompanied by decreased UAGTV (r = −0.88, P = 0.05) and increased UDAV (r = 0.87, P = 0.05), but with no changes in HRVs. Diminished sodium excretion can cause nondipper BP rhythm. This was attributable to intrarenal RAAS and dopaminergic system and impaired parasympathetic nerve activity. During the acute phase of ARB treatment, cooperative effects of ARB and intrarenal dopaminergic system exert natriuresis to restore circadian BP rhythm.
Collapse
Affiliation(s)
- Yukako Isobe-Sasaki
- Department of Cardio-Renal Medicine and Hypertension, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Michio Fukuda
- Department of Cardio-Renal Medicine and Hypertension, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Yoshiaki Ogiyama
- Department of Cardio-Renal Medicine and Hypertension, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Ryo Sato
- Department of Cardio-Renal Medicine and Hypertension, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Toshiyuki Miura
- Department of Cardio-Renal Medicine and Hypertension, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Daisuke Fuwa
- Department of Cardio-Renal Medicine and Hypertension, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Masashi Mizuno
- Department of Cardio-Renal Medicine and Hypertension, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Tetsuhei Matsuoka
- Department of Cardio-Renal Medicine and Hypertension, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Hiroko Shibata
- Department of Cardio-Renal Medicine and Hypertension, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Hiroyuki Ito
- Department of Cardio-Renal Medicine and Hypertension, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Minamo Ono
- Department of Cardio-Renal Medicine and Hypertension, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Sumiko Abe-Dohmae
- Department of Biochemistry, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Ken Kiyono
- Department of Mechanical Science and Bioengineering, Osaka University, Osaka, Japan
| | - Yoshiharu Yamamoto
- Department of Physical and Health Education, University of Tokyo Graduate School of Education, Tokyo, Japan
| | - Hiroyuki Kobori
- International University of Health and Welfare, Tokyo, Japan
| | - Makoto Michikawa
- Department of Biochemistry, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Junichiro Hayano
- Department of Medical Education, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Nobuyuki Ohte
- Department of Cardio-Renal Medicine and Hypertension, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| |
Collapse
|
37
|
Tanriverdi Z, Unal B, Eyuboglu M, Bingol Tanriverdi T, Nurdag A, Demirbag R. The importance of frontal QRS-T angle for predicting non-dipper status in hypertensive patients without left ventricular hypertrophy. Clin Exp Hypertens 2017; 40:318-323. [DOI: 10.1080/10641963.2017.1377214] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Affiliation(s)
| | - Baris Unal
- Clinic of Cardiology, Cumra State Hospital, Konya, Turkey
| | - Mehmet Eyuboglu
- Department of Cardiology, Ilke Medicine Center, Izmir, Turkey
| | - Tugba Bingol Tanriverdi
- Department of Anesthesiology, Mehmet Akif Inan Training and Research Hospital, Sanliurfa, Turkey
| | - Abdullah Nurdag
- Clinic of Cardiology, Balikligol State Hospital, Sanliurfa, Turkey
| | - Recep Demirbag
- Department of Cardiology, Faculty of Medicine, Harran University, Sanliurfa, Turkey
| |
Collapse
|
38
|
Tanriverdi Z, Eyuboglu M, Bingol Tanriverdi T, Nurdag A, Demirbag R. The relationship between fragmented QRS and non-dipper status in hypertensive patients without left ventricular hypertrophy. Clin Exp Hypertens 2017; 39:680-684. [PMID: 28657410 DOI: 10.1080/10641963.2017.1313855] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND Fragmented QRS (fQRS) has been shown to be associated with poor outcome in various cardiovascular diseases. Non-dipper hypertension is also associated with increased cardiovascular mortality. The aim of our study is to investigate the relationship between fQRS and non-dipper status in hypertensive patients without left ventricular hypertrophy (LVH). METHODS This study included 106 hypertensive patients without LVH. Patients were divided into two groups: dipper hypertension and non-dipper hypertension. The presence of fQRS was analyzed from surface electrocardiography. RESULTS Frequency of fQRS (56% vs. 19.6%, p < 0.001) and mean number of leads with fQRS (1.9 ± 1.7 vs. 0.6 ± 1.0, p < 0.001) were significantly higher in patients with non-dipper hypertension compared to dipper hypertension. In addition, the number of leads with fQRS was positively correlated with systolic (r = 0.334, p < 0.001) and diastolic (r = 0.280, p = 0.004) blood pressures (BP). By a multivariate regression analysis, fQRS (OR: 5.207, 95% CI: 2.195-12.353, p < 0.001) was found to be independent predictor of non-dipper status. CONCLUSION fQRS is independent predictor of non-dipper status in hypertensive patients without LVH. Also, the higher number of leads with fQRS is associated with higher sleep systolic and diastolic BPs.
Collapse
Affiliation(s)
- Zulkif Tanriverdi
- a Clinic of Cardiology , Balikligol State Hospital , Sanliurfa , Turkey
| | - Mehmet Eyuboglu
- b Department of Cardiology , Avrupa Medicine Center , Karabaglar , Izmir , Turkey
| | - Tugba Bingol Tanriverdi
- c Department of Anesthesiology , Mehmet Akif Inan Training and Research Hospital , Sanliurfa , Turkey
| | - Abdullah Nurdag
- a Clinic of Cardiology , Balikligol State Hospital , Sanliurfa , Turkey
| | - Recep Demirbag
- d Department of Cardiology, Faculty of Medicine , Harran University , Sanliurfa , Turkey
| |
Collapse
|
39
|
Demir M, Aktaş İ, Yıldırım A. Left atrial mechanical function and stiffness in patients with nondipper hypertension: A speckle tracking study. Clin Exp Hypertens 2017; 39:319-324. [DOI: 10.1080/10641963.2016.1246566] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Mehmet Demir
- Bursa Yüksek İhtisas Education and Research Hospital Cardiology Department, Bursa, Turkey
| | - İbrahim Aktaş
- Bursa Yüksek İhtisas Education and Research Hospital Cardiology Department, Bursa, Turkey
| | - Ahmet Yıldırım
- Bursa Yüksek İhtisas Education and Research Hospital Cardiology Department, Bursa, Turkey
| |
Collapse
|
40
|
Katafuchi E, Nakayama M, Tanaka S, Sakoh T, Yoshitomi R, Fukui A, Seki M, Nakamata Y, Tominaga M, Tsuruya K, Kitazono T. Comparison of Prognostic Values of Daytime and Night-Time Systolic Blood Pressures on Renal Outcomes in Patients With Chronic Kidney Disease. Circ J 2017; 81:1454-1462. [PMID: 28450669 DOI: 10.1253/circj.cj-17-0063] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Differences in the predictive value of daytime systolic blood pressure (SBP) and night-time SBP by ambulatory blood pressure monitoring on renal outcomes have not been fully investigated in chronic kidney disease (CKD) patients. This study compared the prognostic value between daytime and night-time SBP on renal outcomes in CKD.Methods and Results:This prospective observational study included 421 patients. The composite renal endpoint was endstage renal disease (ESRD) or death. Cox models were used to determine associations of daytime and night-time SBP with renal outcomes. There were 150 renal events (ESRD, 130; death, 20). Multivariable Cox analyses demonstrated that hazard ratios (HRs) [95% confidence interval (CI)] for composite renal outcomes of every 10-mmHg increase in daytime and night-time SBP levels were 1.13 (1.02-1.26) (P=0.02) and 1.15 (1.05-1.27) (P<0.01), respectively. In addition, compared with the 1st daytime or night-time SBP quartile, HRs (95% CI) for outcomes in the 2nd, 3rd, and 4th quartiles were: daytime SBP, 1.25 (0.70-2.25), 1.09 (0.61-1.94), and 1.58 (0.88-2.85; P=0.13) (P for trend=0.16); night-time SBP, 1.09 (0.61-1.96), 1.31 (0.76-2.28), and 1.82 (1.00-3.30; P=0.049) (P for trend=0.03), respectively. CONCLUSIONS Night-time SBP appeared superior to daytime SBP for predicting renal outcomes in this population of patients.
Collapse
Affiliation(s)
- Eisuke Katafuchi
- Division of Nephrology and Clinical Research Institute, Department of Internal Medicine, National Hospital Organization Kyushu Medical Center
| | - Masaru Nakayama
- Division of Nephrology and Clinical Research Institute, Department of Internal Medicine, National Hospital Organization Kyushu Medical Center
| | - Shigeru Tanaka
- Department of Internal Medicine, Fukuoka Dental College.,Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University
| | - Teppei Sakoh
- Division of Nephrology and Clinical Research Institute, Department of Internal Medicine, National Hospital Organization Kyushu Medical Center
| | - Ryota Yoshitomi
- Division of Nephrology and Clinical Research Institute, Department of Internal Medicine, National Hospital Organization Kyushu Medical Center
| | - Akiko Fukui
- Division of Nephrology and Clinical Research Institute, Department of Internal Medicine, National Hospital Organization Kyushu Medical Center
| | - Makiko Seki
- Division of Nephrology and Clinical Research Institute, Department of Internal Medicine, National Hospital Organization Kyushu Medical Center
| | - Yusuke Nakamata
- Division of Nephrology and Clinical Research Institute, Department of Internal Medicine, National Hospital Organization Kyushu Medical Center
| | - Mitsuhiro Tominaga
- Division of Hypertension and Clinical Research Institute, Department of Internal Medicine, National Hospital Organization Kyushu Medical Center
| | - Kazuhiko Tsuruya
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University.,Department of Integrated Therapy for Chronic Kidney Disease, Graduate School of Medical Sciences, Kyushu University
| | - Takanari Kitazono
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University
| |
Collapse
|
41
|
Relationship between diurnal blood pressure and renal histopathological changes in white coat hypertension. J Nephrol 2017; 30:551-556. [PMID: 28286934 DOI: 10.1007/s40620-017-0382-1] [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: 11/18/2016] [Accepted: 02/10/2017] [Indexed: 10/20/2022]
Abstract
BACKGROUND Multiple epidemiological studies have clearly demonstrated the macrovascular risks associated with white coat hypertension (WCH) or sustained hypertension (SH). In patients with WCH, there is no literature available on renal histopathological changes and that on blood pressure pattern and native kidney outcome is scant. We aimed to clarify the relationship between blood pressure variables and pathological features of kidney biopsies in living kidney donors with WCH. METHODS This cross-sectional study included living kidney donors with WCH (n = 10) and SH (n = 10), and 20 healthy kidney donors with similar demographic features (control group). Kidney allograft biopsy samples were obtained during transplantation and chronic glomerular, vascular and tubulointertitial changes were semiquantitatively scored according to the Banff classification. RESULTS The mean age of the 20 hypertensive subjects (Group 1) and controls (Group 2) was 59.3 ± 8.5 versus 59.6 ± 7.6 years and almost half were female. There was no difference in renal function parameters between the groups; however, kidney histopathology in Group 1 was worse than Group 2 with a chronicity index of 2.80 ± 1.67 versus 1.75 ± 1.16 (p = 0.02). There was no difference between histopathological scores of patients with WCH or SH (chronicity index: 2.60 ± 1.43 vs. 2.70 ± 1.70, p = 0.88). Night-to-day mean arterial pressure (MAP) ratio was significantly associated with chronicity index in patients with WCH. Moreover, WCH patients with non-dipper hypertensive pattern had a worse chronicity index. CONCLUSIONS Significant histopathological alterations in the kidney were observed in patients with WCH and SH, and were accentuated in WCH patients with non-dipper blood pressure pattern.
Collapse
|
42
|
Changes of blood pressure patterns and target organ damage in patients with chronic kidney disease. J Hypertens 2017; 35:593-601. [DOI: 10.1097/hjh.0000000000001185] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
43
|
Dietary sodium and nocturnal blood pressure dipping in normotensive men and women. J Hum Hypertens 2016; 31:145-150. [PMID: 27511475 PMCID: PMC5214254 DOI: 10.1038/jhh.2016.53] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2016] [Revised: 06/17/2016] [Accepted: 07/05/2016] [Indexed: 12/20/2022]
Abstract
Impaired nocturnal blood pressure (BP) dipping (i.e., <10% decline in nocturnal BP) is associated with an increased risk of cerebrovascular and cardiovascular diseases. Excess sodium has been shown to impair BP regulation and increase cardiovascular disease risk, yet few studies have assessed the influence of dietary sodium on nocturnal dipping in normotensive adults. The purpose of this study was to determine the effects of dietary sodium on BP dipping in normotensive men and women. Eighty healthy normotensive adults participated in a controlled feeding study (men: n=39, 34±2 yrs; women: n=41, 41±2 yrs). Participants consumed a standardized run-in 100 mmol sodium·day−1 diet for 7 days, followed by 7 days of low sodium (LS; 20 mmol·day−1) and high sodium (HS; 300 mmol·day−1) diets in random order. On the final day of each diet, subjects wore a 24h ambulatory BP monitor, collected a 24h urine sample, and provided a blood sample. During the run-in diet, 24h urinary sodium excretion was 79.4±5.1 mmol·24h−1 in men and 85.3±5.5 mmol·24h−1 in women (p>0.05). Systolic BP dipping was not different between men (11.4±1.0%) and women (11.2±0.9%) (p>0.05). During the HS diet, 24h urinary sodium excretion increased compared to the LS diet in men (LS=31.7±4.6 mmol·24h−1 vs. HS=235.0±13.9 mmol·24h−1, p<0.01) and women (LS=25.8±2.2 mmol·24h−1 vs. HS=234.7±13.8 mmol·24h−1, p<0.01). Despite this large increase in sodium intake and excretion, systolic BP dipping was not blunted in men (LS=8.9±1.0% vs. HS=9.4±1.2%, p>0.05) or women (LS=10.3±0.8% vs. HS=10.5±0.8%, p>0.05). Among normotensive men and women, HS does not blunt nocturnal BP dipping.
Collapse
|
44
|
Nakai K, Fujii H, Watanabe K, Watanabe S, Awata R, Kono K, Yonekura Y, Goto S, Nishi S. Riser pattern is a predictor of kidney mortality among patients with chronic kidney disease. Clin Exp Hypertens 2016; 38:476-81. [DOI: 10.3109/10641963.2016.1163368] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Kentaro Nakai
- Division of Nephrology and Kidney Center, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Hideki Fujii
- Division of Nephrology and Kidney Center, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Kentaro Watanabe
- Division of Nephrology and Kidney Center, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Shuhei Watanabe
- Division of Nephrology and Kidney Center, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Rie Awata
- Division of Nephrology and Kidney Center, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Keiji Kono
- Division of Nephrology and Kidney Center, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Yuriko Yonekura
- Division of Nephrology and Kidney Center, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Shunsuke Goto
- Division of Nephrology and Kidney Center, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Shinichi Nishi
- Division of Nephrology and Kidney Center, Kobe University Graduate School of Medicine, Kobe, Japan
| |
Collapse
|
45
|
Velasquez MT, Beddhu S, Nobakht E, Rahman M, Raj DS. Ambulatory Blood Pressure in Chronic Kidney Disease: Ready for Prime Time? Kidney Int Rep 2016; 1:94-104. [PMID: 28164170 PMCID: PMC5283800 DOI: 10.1016/j.ekir.2016.05.001] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2016] [Revised: 05/15/2016] [Accepted: 05/18/2016] [Indexed: 12/15/2022] Open
Abstract
Hypertension is common in patients with chronic kidney disease (CKD) and is the most important modifiable risk factor for CKD progression and adverse cardiovascular events in these patients. Diagnosis and successful management of hypertension are critically dependent on accurate blood pressure (BP) measurement. This is most relevant to CKD patients, in whom BP control is difficult to achieve and in whom early antihypertensive treatment is imperative to prevent kidney and cardiovascular complications. Accumulated data indicate that ambulatory blood pressure monitoring (ABPM) is better in detecting hypertension than office BP measurement. ABPM is also a superior prognostic marker compared with office BP and has successfully identified hypertensive CKD patients at increased risk. Additionally, ABPM provides information on circadian BP variation and short-term BP variability, which is associated with cardiovascular and renal outcomes. This paper reviews the evidence for the usefulness of ABPM in detection and management of hypertension in CKD patients and discusses our current understanding of the pathophysiology of altered circadian BP rhythm and variability in CKD and the role of abnormal BP patterns detected by ABPM in relation to outcomes in CKD. In addition, this Review examines the emerging role of antihypertensive chronotherapy to tailor BP management to the circadian BP pattern abnormality detected by 24-hour ABPM.
Collapse
Affiliation(s)
- Manuel T. Velasquez
- Division of Renal Diseases and Hypertension, The George Washington University, Washington, DC, USA
| | - Srinivasan Beddhu
- University of Utah School of Medicine, Kidney and Liver Clinic, Salt Lake City, Utah, USA
| | - Ehsan Nobakht
- Division of Renal Diseases and Hypertension, The George Washington University, Washington, DC, USA
| | - Mahboob Rahman
- University Hospitals Case Medical Center, Department of Medicine–Hypertension, Cleveland, Ohio, USA
| | - Dominic S. Raj
- Division of Renal Diseases and Hypertension, The George Washington University, Washington, DC, USA
| |
Collapse
|
46
|
Fuwa D, Fukuda M, Ogiyama Y, Sato R, Mizuno M, Miura T, Abe-Dohmae S, Michikawa M, Kobori H, Ohte N. Addition of hydrochlorothiazide to angiotensin receptor blocker therapy can achieve a lower sodium balance with no acceleration of intrarenal renin angiotensin system in patients with chronic kidney disease. J Renin Angiotensin Aldosterone Syst 2016; 17:1470320316652032. [PMID: 27283968 PMCID: PMC4940185 DOI: 10.1177/1470320316652032] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2016] [Accepted: 04/14/2016] [Indexed: 01/09/2023] Open
Abstract
Objective: Angiotensin receptor blockers (ARBs) produce a lower sodium (Na) balance, and the natriuretic effect is enhanced under Na deprivation, despite falls in blood pressure (BP) and glomerular filtration rate (GFR). Methods: The effect of additional hydrochlorothiazide (HCTZ; 12.5 mg/day) to ARB treatment (valsartan; 80 mg/day) on glomerulotubular Na balance was evaluated in 23 patients with chronic kidney disease. Results: Add-on HCTZ decreased GFR, tubular Na load, and tubular Na reabsorption (tNa), although 24-hour urinary Na excretion (UNaV) remained constant. Daily urinary angiotensinogen excretion (UAGTV, 152±10→82±17 μg/g Cre) reduced (p=0.02). Changes in tubular Na load (r2=0.26) and tNa (r2=0.25) correlated with baseline 24-hour UAGTV. Changes in filtered Na load correlated with changes in nighttime systolic BP (r2=0.17), but not with changes in daytime systolic BP. The change in the tNa to filtered Na load ratio was influenced by the change in daytime UNaV (β=−0.67, F=16.8), rather than the change in nighttime UNaV. Conclusions: Lower Na balance was produced by add-on HCTZ to ARB treatment without an increase of intra-renal renin-angiotensin system activity, leading to restoration of nocturnal hypertension. A further study is needed to demonstrate that the reduction of UAGTV by additional diuretics to ARBs prevents the progression of nephropathy or cardiovascular events.
Collapse
Affiliation(s)
- Daisuke Fuwa
- Department of Cardio-Renal Medicine and Hypertension, Nagoya City University Graduate School of Medical Sciences, Japan
| | - Michio Fukuda
- Department of Cardio-Renal Medicine and Hypertension, Nagoya City University Graduate School of Medical Sciences, Japan
| | - Yoshiaki Ogiyama
- Department of Cardio-Renal Medicine and Hypertension, Nagoya City University Graduate School of Medical Sciences, Japan
| | - Ryo Sato
- Department of Cardio-Renal Medicine and Hypertension, Nagoya City University Graduate School of Medical Sciences, Japan
| | - Masashi Mizuno
- Department of Cardio-Renal Medicine and Hypertension, Nagoya City University Graduate School of Medical Sciences, Japan
| | - Toshiyuki Miura
- Department of Cardio-Renal Medicine and Hypertension, Nagoya City University Graduate School of Medical Sciences, Japan
| | - Sumiko Abe-Dohmae
- Department of Biochemistry, Nagoya City University Graduate School of Medical Sciences, Japan
| | - Makoto Michikawa
- Department of Biochemistry, Nagoya City University Graduate School of Medical Sciences, Japan
| | | | - Nobuyuki Ohte
- Department of Cardio-Renal Medicine and Hypertension, Nagoya City University Graduate School of Medical Sciences, Japan
| |
Collapse
|
47
|
Parati G, Ochoa JE, Bilo G, Agarwal R, Covic A, Dekker FW, Fliser D, Heine GH, Jager KJ, Gargani L, Kanbay M, Mallamaci F, Massy Z, Ortiz A, Picano E, Rossignol P, Sarafidis P, Sicari R, Vanholder R, Wiecek A, London G, Zoccali C. Hypertension in Chronic Kidney Disease Part 2. Hypertension 2016; 67:1102-10. [DOI: 10.1161/hypertensionaha.115.06896] [Citation(s) in RCA: 67] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Gianfranco Parati
- From the Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy (G.P., J.E.O.); Department of Cardiovascular, Neural and Metabolic Sciences, San Luca Hospital, IRCCS Istituto Auxologico Italiano, Milan, Italy (G.P., J.E.O., G.B.); Indiana University and VAMC, Indianapolis (R.A.); Clinic of Nephrology, C. I. Parhon University Hospital, Gr. T. Popa University of Medicine and Pharmacy, Iasi, Romania (A.C.); Department of Clinical Epidemiology, Leiden University Medical Center,
| | - Juan Eugenio Ochoa
- From the Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy (G.P., J.E.O.); Department of Cardiovascular, Neural and Metabolic Sciences, San Luca Hospital, IRCCS Istituto Auxologico Italiano, Milan, Italy (G.P., J.E.O., G.B.); Indiana University and VAMC, Indianapolis (R.A.); Clinic of Nephrology, C. I. Parhon University Hospital, Gr. T. Popa University of Medicine and Pharmacy, Iasi, Romania (A.C.); Department of Clinical Epidemiology, Leiden University Medical Center,
| | - Grzegorz Bilo
- From the Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy (G.P., J.E.O.); Department of Cardiovascular, Neural and Metabolic Sciences, San Luca Hospital, IRCCS Istituto Auxologico Italiano, Milan, Italy (G.P., J.E.O., G.B.); Indiana University and VAMC, Indianapolis (R.A.); Clinic of Nephrology, C. I. Parhon University Hospital, Gr. T. Popa University of Medicine and Pharmacy, Iasi, Romania (A.C.); Department of Clinical Epidemiology, Leiden University Medical Center,
| | - Rajiv Agarwal
- From the Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy (G.P., J.E.O.); Department of Cardiovascular, Neural and Metabolic Sciences, San Luca Hospital, IRCCS Istituto Auxologico Italiano, Milan, Italy (G.P., J.E.O., G.B.); Indiana University and VAMC, Indianapolis (R.A.); Clinic of Nephrology, C. I. Parhon University Hospital, Gr. T. Popa University of Medicine and Pharmacy, Iasi, Romania (A.C.); Department of Clinical Epidemiology, Leiden University Medical Center,
| | - Adrian Covic
- From the Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy (G.P., J.E.O.); Department of Cardiovascular, Neural and Metabolic Sciences, San Luca Hospital, IRCCS Istituto Auxologico Italiano, Milan, Italy (G.P., J.E.O., G.B.); Indiana University and VAMC, Indianapolis (R.A.); Clinic of Nephrology, C. I. Parhon University Hospital, Gr. T. Popa University of Medicine and Pharmacy, Iasi, Romania (A.C.); Department of Clinical Epidemiology, Leiden University Medical Center,
| | - Friedo W. Dekker
- From the Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy (G.P., J.E.O.); Department of Cardiovascular, Neural and Metabolic Sciences, San Luca Hospital, IRCCS Istituto Auxologico Italiano, Milan, Italy (G.P., J.E.O., G.B.); Indiana University and VAMC, Indianapolis (R.A.); Clinic of Nephrology, C. I. Parhon University Hospital, Gr. T. Popa University of Medicine and Pharmacy, Iasi, Romania (A.C.); Department of Clinical Epidemiology, Leiden University Medical Center,
| | - Danilo Fliser
- From the Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy (G.P., J.E.O.); Department of Cardiovascular, Neural and Metabolic Sciences, San Luca Hospital, IRCCS Istituto Auxologico Italiano, Milan, Italy (G.P., J.E.O., G.B.); Indiana University and VAMC, Indianapolis (R.A.); Clinic of Nephrology, C. I. Parhon University Hospital, Gr. T. Popa University of Medicine and Pharmacy, Iasi, Romania (A.C.); Department of Clinical Epidemiology, Leiden University Medical Center,
| | - Gunnar H. Heine
- From the Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy (G.P., J.E.O.); Department of Cardiovascular, Neural and Metabolic Sciences, San Luca Hospital, IRCCS Istituto Auxologico Italiano, Milan, Italy (G.P., J.E.O., G.B.); Indiana University and VAMC, Indianapolis (R.A.); Clinic of Nephrology, C. I. Parhon University Hospital, Gr. T. Popa University of Medicine and Pharmacy, Iasi, Romania (A.C.); Department of Clinical Epidemiology, Leiden University Medical Center,
| | - Kitty J. Jager
- From the Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy (G.P., J.E.O.); Department of Cardiovascular, Neural and Metabolic Sciences, San Luca Hospital, IRCCS Istituto Auxologico Italiano, Milan, Italy (G.P., J.E.O., G.B.); Indiana University and VAMC, Indianapolis (R.A.); Clinic of Nephrology, C. I. Parhon University Hospital, Gr. T. Popa University of Medicine and Pharmacy, Iasi, Romania (A.C.); Department of Clinical Epidemiology, Leiden University Medical Center,
| | - Luna Gargani
- From the Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy (G.P., J.E.O.); Department of Cardiovascular, Neural and Metabolic Sciences, San Luca Hospital, IRCCS Istituto Auxologico Italiano, Milan, Italy (G.P., J.E.O., G.B.); Indiana University and VAMC, Indianapolis (R.A.); Clinic of Nephrology, C. I. Parhon University Hospital, Gr. T. Popa University of Medicine and Pharmacy, Iasi, Romania (A.C.); Department of Clinical Epidemiology, Leiden University Medical Center,
| | - Mehmet Kanbay
- From the Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy (G.P., J.E.O.); Department of Cardiovascular, Neural and Metabolic Sciences, San Luca Hospital, IRCCS Istituto Auxologico Italiano, Milan, Italy (G.P., J.E.O., G.B.); Indiana University and VAMC, Indianapolis (R.A.); Clinic of Nephrology, C. I. Parhon University Hospital, Gr. T. Popa University of Medicine and Pharmacy, Iasi, Romania (A.C.); Department of Clinical Epidemiology, Leiden University Medical Center,
| | - Francesca Mallamaci
- From the Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy (G.P., J.E.O.); Department of Cardiovascular, Neural and Metabolic Sciences, San Luca Hospital, IRCCS Istituto Auxologico Italiano, Milan, Italy (G.P., J.E.O., G.B.); Indiana University and VAMC, Indianapolis (R.A.); Clinic of Nephrology, C. I. Parhon University Hospital, Gr. T. Popa University of Medicine and Pharmacy, Iasi, Romania (A.C.); Department of Clinical Epidemiology, Leiden University Medical Center,
| | - Ziad Massy
- From the Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy (G.P., J.E.O.); Department of Cardiovascular, Neural and Metabolic Sciences, San Luca Hospital, IRCCS Istituto Auxologico Italiano, Milan, Italy (G.P., J.E.O., G.B.); Indiana University and VAMC, Indianapolis (R.A.); Clinic of Nephrology, C. I. Parhon University Hospital, Gr. T. Popa University of Medicine and Pharmacy, Iasi, Romania (A.C.); Department of Clinical Epidemiology, Leiden University Medical Center,
| | - Alberto Ortiz
- From the Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy (G.P., J.E.O.); Department of Cardiovascular, Neural and Metabolic Sciences, San Luca Hospital, IRCCS Istituto Auxologico Italiano, Milan, Italy (G.P., J.E.O., G.B.); Indiana University and VAMC, Indianapolis (R.A.); Clinic of Nephrology, C. I. Parhon University Hospital, Gr. T. Popa University of Medicine and Pharmacy, Iasi, Romania (A.C.); Department of Clinical Epidemiology, Leiden University Medical Center,
| | - Eugenio Picano
- From the Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy (G.P., J.E.O.); Department of Cardiovascular, Neural and Metabolic Sciences, San Luca Hospital, IRCCS Istituto Auxologico Italiano, Milan, Italy (G.P., J.E.O., G.B.); Indiana University and VAMC, Indianapolis (R.A.); Clinic of Nephrology, C. I. Parhon University Hospital, Gr. T. Popa University of Medicine and Pharmacy, Iasi, Romania (A.C.); Department of Clinical Epidemiology, Leiden University Medical Center,
| | - Patrick Rossignol
- From the Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy (G.P., J.E.O.); Department of Cardiovascular, Neural and Metabolic Sciences, San Luca Hospital, IRCCS Istituto Auxologico Italiano, Milan, Italy (G.P., J.E.O., G.B.); Indiana University and VAMC, Indianapolis (R.A.); Clinic of Nephrology, C. I. Parhon University Hospital, Gr. T. Popa University of Medicine and Pharmacy, Iasi, Romania (A.C.); Department of Clinical Epidemiology, Leiden University Medical Center,
| | - Pantelis Sarafidis
- From the Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy (G.P., J.E.O.); Department of Cardiovascular, Neural and Metabolic Sciences, San Luca Hospital, IRCCS Istituto Auxologico Italiano, Milan, Italy (G.P., J.E.O., G.B.); Indiana University and VAMC, Indianapolis (R.A.); Clinic of Nephrology, C. I. Parhon University Hospital, Gr. T. Popa University of Medicine and Pharmacy, Iasi, Romania (A.C.); Department of Clinical Epidemiology, Leiden University Medical Center,
| | - Rosa Sicari
- From the Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy (G.P., J.E.O.); Department of Cardiovascular, Neural and Metabolic Sciences, San Luca Hospital, IRCCS Istituto Auxologico Italiano, Milan, Italy (G.P., J.E.O., G.B.); Indiana University and VAMC, Indianapolis (R.A.); Clinic of Nephrology, C. I. Parhon University Hospital, Gr. T. Popa University of Medicine and Pharmacy, Iasi, Romania (A.C.); Department of Clinical Epidemiology, Leiden University Medical Center,
| | - Raymond Vanholder
- From the Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy (G.P., J.E.O.); Department of Cardiovascular, Neural and Metabolic Sciences, San Luca Hospital, IRCCS Istituto Auxologico Italiano, Milan, Italy (G.P., J.E.O., G.B.); Indiana University and VAMC, Indianapolis (R.A.); Clinic of Nephrology, C. I. Parhon University Hospital, Gr. T. Popa University of Medicine and Pharmacy, Iasi, Romania (A.C.); Department of Clinical Epidemiology, Leiden University Medical Center,
| | - Andrzej Wiecek
- From the Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy (G.P., J.E.O.); Department of Cardiovascular, Neural and Metabolic Sciences, San Luca Hospital, IRCCS Istituto Auxologico Italiano, Milan, Italy (G.P., J.E.O., G.B.); Indiana University and VAMC, Indianapolis (R.A.); Clinic of Nephrology, C. I. Parhon University Hospital, Gr. T. Popa University of Medicine and Pharmacy, Iasi, Romania (A.C.); Department of Clinical Epidemiology, Leiden University Medical Center,
| | - Gerard London
- From the Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy (G.P., J.E.O.); Department of Cardiovascular, Neural and Metabolic Sciences, San Luca Hospital, IRCCS Istituto Auxologico Italiano, Milan, Italy (G.P., J.E.O., G.B.); Indiana University and VAMC, Indianapolis (R.A.); Clinic of Nephrology, C. I. Parhon University Hospital, Gr. T. Popa University of Medicine and Pharmacy, Iasi, Romania (A.C.); Department of Clinical Epidemiology, Leiden University Medical Center,
| | - Carmine Zoccali
- From the Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy (G.P., J.E.O.); Department of Cardiovascular, Neural and Metabolic Sciences, San Luca Hospital, IRCCS Istituto Auxologico Italiano, Milan, Italy (G.P., J.E.O., G.B.); Indiana University and VAMC, Indianapolis (R.A.); Clinic of Nephrology, C. I. Parhon University Hospital, Gr. T. Popa University of Medicine and Pharmacy, Iasi, Romania (A.C.); Department of Clinical Epidemiology, Leiden University Medical Center,
| |
Collapse
|
48
|
Ahbap E, Sakaci T, Kara E, Sahutoglu T, Koc Y, Basturk T, Sevinc M, Akgol C, Kayalar AO, Ucar ZA, Bayraktar F, Unsal A. The relationship between serum albumin levels and 24-h ambulatory blood pressure monitoring recordings in non-diabetic essential hypertensive patients. Clinics (Sao Paulo) 2016; 71:257-63. [PMID: 27276394 PMCID: PMC4874261 DOI: 10.6061/clinics/2016(05)03] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2015] [Accepted: 02/11/2016] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES The goal of this study was to evaluate the relationship between serum albumin levels and 24-hour ambulatory blood pressure monitoring (24-h ABPM) recordings in non-diabetic essential hypertensive patients. METHODS A total of 354 patients (mean [SD] age: 55.5 [14.3] years, 50% females) with essential hypertension and 24-h ABPM recordings were included. Patient 24-h nighttime and daytime ABPM values, systolic and diastolic dipping status and average nocturnal dipping were recorded. The correlations between serum albumin levels and nocturnal systolic and diastolic dipping were evaluated, and correlates of average nocturnal systolic dipping were determined via a linear regression model. RESULTS Overall, 73.2% of patients were determined to be non-dippers. The mean (SD) levels of serum albumin (4.2 [0.3] g/dL vs. 4.4 [0.4] g/dL, p<0.001) and the average nocturnal systolic (15.2 [4.8] mmHg vs. 0.3 [6.6] mmHg, p<0.001) and diastolic dipping (4.2 [8.6] mmHg vs. 18.9 [7.0] mmHg, p<0.001) were significantly lower in non-dippers than in dippers. A significant positive correlation was noted between serum albumin levels and both systolic (r=0.297, p<0.001) and diastolic dipping (r=0.265, p<0.001). The linear regression analysis revealed that for each one-unit increase in serum albumin, the average nocturnal dip in systolic BP increased by 0.17 mmHg (p=0.033). CONCLUSION Our findings indicate an association between serum albumin levels and the deterioration of circadian BP rhythm among essential hypertensive patients along with the identification of a non-dipper pattern in more than two-thirds of patients. Our findings emphasize the importance of serum albumin levels, rather than urinary albumin excretion, as an independent predictor of nocturnal systolic dipping, at least in non-diabetic essential hypertensive patients with moderate proteinuria.
Collapse
Affiliation(s)
- Elbis Ahbap
- Sisli Etfal Training and Research Hospital, Department of Nephrology, Istanbul, Turkey
| | - Tamer Sakaci
- Sisli Etfal Training and Research Hospital, Department of Nephrology, Istanbul, Turkey
| | - Ekrem Kara
- Recep Tayyip Erdogan University, School of Medicine, Rize Educational and Research Hospital, Internal Medicine, Nephrology, Rize, Turkey
- E-mail:
| | - Tuncay Sahutoglu
- Sisli Etfal Training and Research Hospital, Department of Nephrology, Istanbul, Turkey
| | - Yener Koc
- Sisli Etfal Training and Research Hospital, Department of Nephrology, Istanbul, Turkey
| | - Taner Basturk
- Sisli Etfal Training and Research Hospital, Department of Nephrology, Istanbul, Turkey
| | - Mustafa Sevinc
- Sisli Etfal Training and Research Hospital, Department of Nephrology, Istanbul, Turkey
| | - Cuneyt Akgol
- Sisli Etfal Training and Research Hospital, Department of Nephrology, Istanbul, Turkey
| | - Arzu O. Kayalar
- Sisli Etfal Training and Research Hospital, Department of Nephrology, Istanbul, Turkey
| | - Zuhal A. Ucar
- Sisli Etfal Training and Research Hospital, Department of Nephrology, Istanbul, Turkey
| | - Feyza Bayraktar
- Sisli Etfal Training and Research Hospital, Department of Nephrology, Istanbul, Turkey
| | - Abdulkadir Unsal
- Sisli Etfal Training and Research Hospital, Department of Nephrology, Istanbul, Turkey
| |
Collapse
|
49
|
Ohashi N, Ishigaki S, Isobe S, Tsuji N, Iwakura T, Ono M, Tsuji T, Sakao Y, Kato A, Yasuda H. Hyperuricaemia is associated with renal damage independently of hypertension and intrarenal renin-angiotensin system activation, as well as their circadian rhythms. Nephrology (Carlton) 2016; 20:814-9. [PMID: 25968901 DOI: 10.1111/nep.12504] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/06/2015] [Indexed: 01/13/2023]
Abstract
AIM Both hyperuricaemia and activation of the intrarenal renin-angiotensin system (RAS) play an important role in the development of hypertension and renal damage. However, it has not been clear whether hyperuricaemia is associated with renal damage due to hypertension or intrarenal RAS activation, as well as their circadian rhythms. METHODS We recruited 43 chronic kidney disease (CKD) patients who did not receive RAS blockers and antihyperuricaemic drugs, and investigated the relationship among serum uric acid (sUA) levels, the circadian rhythm of urinary angiotensinogen (U-AGT) excretion levels, and the levels of albuminuria (U-ACR) and proteinuria (U-P/Cr). RESULTS sUA levels were significantly associated with estimated glomerular filtration rate (eGFR) (P = 0.002), systolic blood pressure (SBP) (daytime, P = 0.031), and U-ACR (daytime, P = 0.006 and nighttime, P = 0.008) and U-P/Cr (daytime, P = 0.017 and nighttime, P = 0.013). However, there were no significant differences between sUA levels and SBP in nighttime and U-AGT excretion levels in both time periods. Multiple regression analyses for sUA levels were performed using age, sex, eGFR and each parameter (SBP, U-AGT/Cr, U-ACR or U-P/Cr). sUA levels were not associated with SBP or U-AGT/Cr in both time periods. sUA levels tended to correlate with U-P/Cr levels in nighttime, and were significantly associated with U-P/Cr in daytime (P = 0.026) and U-ACR in daytime (P = 0.017) and nighttime (P = 0.046). Moreover, no significant differences were found between sUA levels and night-to-day ratios of some parameters. CONCLUSION These data suggest that hyperuricaemia is associated with renal damage, independently of hypertension and intrarenal RAS activation, as well as their circadian rhythms.
Collapse
Affiliation(s)
- Naro Ohashi
- Internal Medicine 1, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Sayaka Ishigaki
- Internal Medicine 1, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Shinsuke Isobe
- Internal Medicine 1, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Naoko Tsuji
- Internal Medicine 1, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Takamasa Iwakura
- Internal Medicine 1, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Masafumi Ono
- Internal Medicine 1, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Takayuki Tsuji
- Internal Medicine 1, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Yukitoshi Sakao
- Blood Purification Unit, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Akihiko Kato
- Blood Purification Unit, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Hideo Yasuda
- Internal Medicine 1, Hamamatsu University School of Medicine, Hamamatsu, Japan
| |
Collapse
|
50
|
Drawz PE, Alper AB, Anderson AH, Brecklin CS, Charleston J, Chen J, Deo R, Fischer MJ, He J, Hsu CY, Huan Y, Keane MG, Kusek JW, Makos GK, Miller ER, Soliman EZ, Steigerwalt SP, Taliercio JJ, Townsend RR, Weir MR, Wright JT, Xie D, Rahman M. Masked Hypertension and Elevated Nighttime Blood Pressure in CKD: Prevalence and Association with Target Organ Damage. Clin J Am Soc Nephrol 2016; 11:642-52. [PMID: 26912547 DOI: 10.2215/cjn.08530815] [Citation(s) in RCA: 134] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2015] [Accepted: 01/04/2016] [Indexed: 12/19/2022]
Abstract
BACKGROUND AND OBJECTIVES Masked hypertension and elevated nighttime BP are associated with increased risk of hypertensive target organ damage and adverse cardiovascular and renal outcomes in patients with normal kidney function. The significance of masked hypertension for these risks in patients with CKD is less well defined. The objective of this study was to evaluate the association between masked hypertension and kidney function and markers of cardiovascular target organ damage, and to determine whether this relationship was consistent among those with and without elevated nighttime BP. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS This was a cross-sectional study. We performed 24-hour ambulatory BP in 1492 men and women with CKD enrolled in the Chronic Renal Insufficiency Cohort Study. We categorized participants into controlled BP, white-coat, masked, and sustained hypertension on the basis of clinic and 24-hour ambulatory BP. We obtained echocardiograms and measured pulse wave velocity in 1278 and 1394 participants, respectively. RESULTS The percentages of participants with controlled BP, white-coat, masked, and sustained hypertension were 49.3%, 4.1%, 27.8%, and 18.8%, respectively. Compared with controlled BP, masked hypertension independently associated with low eGFR (-3.2 ml/min per 1.73 m(2); 95% confidence interval, -5.5 to -0.9), higher proteinuria (+0.9 unit higher in log2 urine protein; 95% confidence interval, 0.7 to 1.1), and higher left ventricular mass index (+2.52 g/m(2.7); 95% confidence interval, 0.9 to 4.1), and pulse wave velocity (+0.92 m/s; 95% confidence interval, 0.5 to 1.3). Participants with masked hypertension had lower eGFR only in the presence of elevated nighttime BP (-3.6 ml/min per 1.73 m(2); 95% confidence interval, -6.1 to -1.1; versus -1.4 ml/min per 1.73 m(2); 95% confidence interval, -6.9 to 4.0, among those with nighttime BP <120/70 mmHg; P value for interaction with nighttime systolic BP 0.002). CONCLUSIONS Masked hypertension is common in patients with CKD and associated with lower eGFR, proteinuria, and cardiovascular target organ damage. In patients with CKD, ambulatory BP characterizes the relationship between BP and target organ damage better than BP measured in the clinic alone.
Collapse
|