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Bird JD, Leacy JK, Foster GE, Rickards CA, Wilson RJA, O'Halloran KD, Jendzjowsky NG, Pentz BA, Byman BRM, Thrall SF, Skalk AL, Hewitt SA, Steinback CD, Burns D, Ondrus P, Day TA. Time course and magnitude of ventilatory and renal acid-base acclimatization following rapid ascent to and residence at 3,800 m over nine days. J Appl Physiol (1985) 2021; 130:1705-1715. [PMID: 33703943 PMCID: PMC11025293 DOI: 10.1152/japplphysiol.00973.2020] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Accepted: 03/05/2021] [Indexed: 11/22/2022] Open
Abstract
Rapid ascent to high altitude imposes an acute hypoxic and acid-base challenge, with ventilatory and renal acclimatization countering these perturbations. Specifically, ventilatory acclimatization improves oxygenation, but with concomitant hypocapnia and respiratory alkalosis. A compensatory, renally mediated relative metabolic acidosis follows via bicarbonate elimination, normalizing arterial pH(a). The time course and magnitude of these integrated acclimatization processes are highly variable between individuals. Using a previously developed metric of renal reactivity (RR), indexing the change in arterial bicarbonate concentration (Δ[HCO3-]a; renal response) over the change in arterial pressure of CO2 (Δ[Formula: see text]; renal stimulus), we aimed to characterize changes in RR magnitude following rapid ascent and residence at altitude. Resident lowlanders (n = 16) were tested at 1,045 m (day [D]0) prior to ascent, on D2 within 24 h of arrival, and D9 during residence at 3,800 m. Radial artery blood draws were obtained to measure acid-base variables: [Formula: see text], [HCO3-]a, and pHa. Compared with D0, [Formula: see text] and [HCO3-]a were lower on D2 (P < 0.01) and D9 (P < 0.01), whereas significant changes in pHa (P = 0.072) and RR (P = 0.056) were not detected. As pHa appeared fully compensated on D2 and RR did not increase significantly from D2 to D9, these data demonstrate renal acid-base compensation within 24 h at moderate steady-state altitude. Moreover, RR was strongly and inversely correlated with ΔpHa on D2 and D9 (r≤ -0.95; P < 0.0001), suggesting that a high-gain renal response better protects pHa. Our study highlights the differential time course, magnitude, and variability of integrated ventilatory and renal acid-base acclimatization following rapid ascent and residence at high altitude.NEW & NOTEWORTHY We assessed the time course, magnitude, and variability of integrated ventilatory and renal acid-base acclimatization with rapid ascent and residence at 3,800 m. Despite reductions in [Formula: see text] upon ascent, pHa was normalized within 24 h of arrival at 3,800 m through renal compensation (i.e., bicarbonate elimination). Renal reactivity (RR) was unchanged between days 2 and 9, suggesting a lack of plasticity at moderate steady-state altitude. RR was strongly correlated with ΔpHa, suggesting that a high-gain renal response better protects pHa.
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Affiliation(s)
- Jordan D Bird
- Department of Biology, Faculty of Science and Technology, Mount Royal University, Calgary, Alberta, Canada
| | - Jack K Leacy
- Centre for Heart, Lung, and Vascular Health, School of Health and Exercise Sciences, University of British Columbia, Kelowna, British Columbia, Canada
| | - Glen E Foster
- Centre for Heart, Lung, and Vascular Health, School of Health and Exercise Sciences, University of British Columbia, Kelowna, British Columbia, Canada
| | - Caroline A Rickards
- Cerebral and Cardiovascular Physiology Laboratory, Department of Physiology and Anatomy, University of North Texas Health Sciences Centre, Fort Worth, Texas
| | - Richard J A Wilson
- Department of Physiology and Pharmacology, Hotchkiss Brain Institute and Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Ken D O'Halloran
- Department of Physiology, School of Medicine, College of Medicine and Health, University College Cork, Cork, Ireland
| | - Nicholas G Jendzjowsky
- Division of Respiratory and Critical Care Physiology and Medicine, The Lundquist Institute for Biomedical Innovation, Harbor-UCLA Medical Center, Torrance, California
| | - Brandon A Pentz
- Department of Biology, Faculty of Science and Technology, Mount Royal University, Calgary, Alberta, Canada
| | - Britta R M Byman
- Department of Biology, Faculty of Science and Technology, Mount Royal University, Calgary, Alberta, Canada
| | - Scott F Thrall
- Department of Biology, Faculty of Science and Technology, Mount Royal University, Calgary, Alberta, Canada
| | - Alexandra L Skalk
- Department of Biology, Faculty of Science and Technology, Mount Royal University, Calgary, Alberta, Canada
| | - Sarah A Hewitt
- Department of Biology, Faculty of Science and Technology, Mount Royal University, Calgary, Alberta, Canada
| | - Craig D Steinback
- Neurovascular Health Lab, Faculty of Kinesiology, Sport, & Recreation, University of Alberta, Edmonton, Alberta, Canada
| | - David Burns
- Department of Physiology, School of Medicine, College of Medicine and Health, University College Cork, Cork, Ireland
| | - Peter Ondrus
- Department of Family Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Trevor A Day
- Department of Biology, Faculty of Science and Technology, Mount Royal University, Calgary, Alberta, Canada
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Darmon M, Legrand M, Terzi N. Understanding the kidney during acute respiratory failure. Intensive Care Med 2016; 43:1144-1147. [PMID: 27620295 DOI: 10.1007/s00134-016-4532-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Accepted: 08/26/2016] [Indexed: 11/27/2022]
Affiliation(s)
- Michael Darmon
- Medical Intensive Care Unit, Saint-Etienne University Hospital, Medical ICU, Avenue Albert Raymond, 42270, Saint-Priest-En-Jarez, France.
- Faculté de médecine de Saint-Etienne, Saint-Etienne, France.
| | - Matthieu Legrand
- AP-HP, Anesthesiology, Critical Care and Burn Unit, AP-HP, HôpitalSaint-Louis, Paris, France
- Université Paris Diderot, Sorbonne Paris Cité, Paris, France
- UMR 942, INSERM, Paris, France
| | - Nicolas Terzi
- CHU Grenoble Alpes, Service de réanimation médicale, 38000, Grenoble, France
- Faculté de Médecine de Grenoble, Grenoble, France
- INSERM, U1042, Université Grenoble-Alpes, HP2, 38000, Grenoble, France
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Darmon M, Clec'h C, Adrie C, Argaud L, Allaouchiche B, Azoulay E, Bouadma L, Garrouste-Orgeas M, Haouache H, Schwebel C, Goldgran-Toledano D, Khallel H, Dumenil AS, Jamali S, Souweine B, Zeni F, Cohen Y, Timsit JF. Acute respiratory distress syndrome and risk of AKI among critically ill patients. Clin J Am Soc Nephrol 2014; 9:1347-53. [PMID: 24875195 DOI: 10.2215/cjn.08300813] [Citation(s) in RCA: 139] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND AND OBJECTIVES Increasing experimental evidence suggests that acute respiratory distress syndrome (ARDS) may promote AKI. The primary objective of this study was to assess ARDS as a risk factor for AKI in critically ill patients. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS This was an observational study on a prospective database fed by 18 intensive care units (ICUs). Patients with ICU stays >24 hours were enrolled over a 14-year period. ARDS was defined using the Berlin criteria and AKI was defined using the Risk, Injury, Failure, Loss of kidney function, and End-stage kidney disease criteria. Patients with AKI before ARDS onset were excluded. RESULTS This study enrolled 8029 patients, including 1879 patients with ARDS. AKI occurred in 31.3% of patients and was more common in patients with ARDS (44.3% versus 27.4% in patients without ARDS; P<0.001). After adjustment for confounders, both mechanical ventilation without ARDS (odds ratio [OR], 4.34; 95% confidence interval [95% CI], 3.71 to 5.10) and ARDS (OR, 11.01; 95% CI, 6.83 to 17.73) were independently associated with AKI. Hospital mortality was 14.2% (n=1140) and was higher in patients with ARDS (27.9% versus 10.0% in patients without ARDS; P<0.001) and in patients with AKI (27.6% versus 8.1% in those without AKI; P<0.001). AKI was associated with higher mortality in patients with ARDS (42.3% versus 20.2%; P<0.001). CONCLUSIONS ARDS was independently associated with AKI. This study suggests that ARDS should be considered as a risk factor for AKI in critically ill patients.
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Affiliation(s)
- Michael Darmon
- Due to the number of contributing authors, the affiliations are provided in the Supplemental Material.
| | - Christophe Clec'h
- Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
| | - Christophe Adrie
- Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
| | - Laurent Argaud
- Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
| | - Bernard Allaouchiche
- Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
| | - Elie Azoulay
- Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
| | - Lila Bouadma
- Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
| | - Maïté Garrouste-Orgeas
- Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
| | - Hakim Haouache
- Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
| | - Carole Schwebel
- Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
| | - Dany Goldgran-Toledano
- Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
| | - Hatem Khallel
- Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
| | - Anne-Sylvie Dumenil
- Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
| | - Samir Jamali
- Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
| | - Bertrand Souweine
- Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
| | - Fabrice Zeni
- Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
| | - Yves Cohen
- Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
| | - Jean-François Timsit
- Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
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Impact of mild hypoxemia on renal function and renal resistive index during mechanical ventilation. Intensive Care Med 2009; 35:1031-8. [PMID: 19242676 DOI: 10.1007/s00134-008-1372-5] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2008] [Accepted: 10/23/2008] [Indexed: 12/18/2022]
Abstract
RATIONALE Short-term hypoxemia affects diuresis and natriuresis in healthy individuals. No data are available on the impact of the mild hypoxemia levels usually tolerated in critically ill patients receiving mechanical ventilation. OBJECTIVES To assess the renal effects of mild hypoxemia during mechanical ventilation for acute lung injury (ALI). METHODS Prospective, physiological study in 12 mechanically ventilated patients with ALI. Patients were studied at baseline with an arterial saturation (SaO(2)) of 96% [94-98] then a comparison was performed between SaO(2) values of 88-90% (mild hypoxemia) and 98-99% (high oxygenation). MAIN RESULTS FiO(2) was set at 0.25 [0.23-0.32] and 0.7 [0.63-0.8], respectively, to obtain SaO(2) of 89 [89-90] and 99% [98-99]. Hemodynamic or respiratory parameters were not significantly affected by FiO(2) levels. Compared with high oxygenation level, mild hypoxemia using low FiO(2) was associated with increase in diuresis (median [interquartile range], 67 [55-105] vs. 55 [45-60] ml/h; P = 0.003) and in doppler-based renal resistive index (RI) (0.78 [0.66-0.85] vs. 0.72 [0.60-0.78]; P = 0.003). The 2-h calculated creatinine clearance also increased (63 [46-103] vs. 35 [30-85] ml/min; P = 0.005) without change in urinary creatinine (P = 0.13). No significant change in natriuresis was observed. Half of the patients were under norepinephrine infusion and the renal response did not differ according to the presence of vasopressors. CONCLUSION In patients with ALI, mild hypoxemia related to short-term low FiO(2) induce increases in diuresis and in renal RI. This latter point suggests intra-renal mechanisms that need to be further investigated.
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Abstract
With a prevalence of 10 to 11% in the general population, it is likely that many patients with chronic kidney disease will visit or reside in mountainous areas. Little is known, however, about whether short- or long-duration, high-altitude exposure poses a risk in this patient population. Given that many areas of the kidney are marginally oxygenated even at sea level and that kidney disease may result in further renal hypoxia and hypoxia-associated renal injury, there is concern that high altitude may accelerate the progression of chronic kidney disease. In this review, we address how chronic kidney disease and its management is affected at high altitude. We postulate that arterial hypoxemia at high altitude poses a risk of faster disease progression in those with preexisting kidney disease. In addition, we consider the risks of developing acute altitude illness in patients with chronic kidney disease and the appropriate use of medications for the prevention and treatment of these problems.
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Affiliation(s)
- Andrew M Luks
- Division of Pulmonary and Critical Care Medicine, University of Washington, Seattle, WA 98108, USA
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Cincunegui LM, Ituarte LMI, Viera TB, Ibañez JE, Carra GE, Saldeña TA, Saravi FD. Effects of chronic hypoxia on electrogenic transport and transport-related oxygen consumption in rat distal colon. Dig Dis Sci 2008; 53:1593-600. [PMID: 17939049 DOI: 10.1007/s10620-007-0042-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2007] [Accepted: 09/26/2007] [Indexed: 12/09/2022]
Abstract
The distal colon epithelium of rats submitted to chronic hypoxia shows higher short-circuit current (Isc) which, unlike non-hypoxic rat epithelium, has an amiloride-sensitive component despite low serum aldosterone levels. Isc and oxygen consumption (QO2) were simultaneously measured in mucosae from rats submitted to 0.5 atm for 10 days and from control rats in a modified Ussing chamber. Hypoxia increased Isc but not QO2. The slope of the regression line between Isc and QO2 reduction after ouabain addition was decreased in epithelia from hypoxic rats (P = 0.03). Chloride secretion blockade reduced Isc and QO2 in both groups, while sodium channel blockade did so only in the hypoxic group. Dual blockade in hypoxic rat epithelia caused correlated (P = 0.0025) additive decreases in Isc and QO2. Presented results suggest that chronic hypoxia induces an improved coupling between QO2 and electrogenic ion transport, and electrogenic sodium absorption despite low aldosterone levels.
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Affiliation(s)
- Liliana M Cincunegui
- Area de Física Biológica, Departamento de Morfología y Fisiología, Facultad de Ciencias Médicas, Universidad Nacional de Cuyo, Casilla de Correo 33, Mendoza 5500, Argentina
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Höhne C, Krebs MO, Seiferheld M, Boemke W, Kaczmarczyk G, Swenson ER. Acetazolamide prevents hypoxic pulmonary vasoconstriction in conscious dogs. J Appl Physiol (1985) 2005; 97:515-21. [PMID: 15247196 DOI: 10.1152/japplphysiol.01217.2003] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Acute hypoxia increases pulmonary arterial pressure and vascular resistance. Previous studies in isolated smooth muscle and perfused lungs have shown that carbonic anhydrase (CA) inhibition reduces the speed and magnitude of hypoxic pulmonary vasoconstriction (HPV). We studied whether CA inhibition by acetazolamide (Acz) is able to prevent HPV in the unanesthetized animal. Ten chronically tracheotomized, conscious dogs were investigated in three protocols. In all protocols, the dogs breathed 21% O(2) for the first hour and then 8 or 10% O(2) for the next 4 h spontaneously via a ventilator circuit. The protocols were as follows: protocol 1: controls given no Acz, inspired O(2) fraction (Fi(O(2))) = 0.10; protocol 2: Acz infused intravenously (250-mg bolus, followed by 167 microg.kg(-1).min(-1) continuously), Fi(O(2)) = 0.10; protocol 3: Acz given as above, but with Fi(O(2)) reduced to 0.08 to match the arterial Po(2) (Pa(O(2))) observed during hypoxia in controls. Pa(O(2)) was 37 Torr during hypoxia in controls, mean pulmonary arterial pressure increased from 17 +/- 1 to 23 +/- 1 mmHg, and pulmonary vascular resistance increased from 464 +/- 26 to 679 +/- 40 dyn.s(-1).cm(-5) (P < 0.05). In both Acz groups, mean pulmonary arterial pressure was 15 +/- 1 mmHg, and pulmonary vascular resistance ranged between 420 and 440 dyn.s(-1).cm(-5). These values did not change during hypoxia. In dogs given Acz at 10% O(2), the arterial Pa(O(2)) was 50 Torr owing to hyperventilation, whereas in those breathing 8% O(2) the Pa(O(2)) was 37 Torr, equivalent to controls. In conclusion, Acz prevents HPV in conscious spontaneously breathing dogs. The effect is not due to Acz-induced hyperventilation and higher alveolar Po(2), nor to changes in plasma endothelin-1, angiotensin-II, or potassium, and HPV suppression occurs despite the systemic acidosis with CA inhibition.
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Affiliation(s)
- Claudia Höhne
- Experimentelle Anaesthesie, Department of Anesthesiology and Intensive Care Medicine, Charité-Universitätsmedizin Berlin, Campus Virchow-Klinikum, Augustenburger Platz 1, D-13353 Berlin, Germany.
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