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Carty JS, Watts JA, Arroyo JP. Vasopressin, protein metabolism, and water conservation. Curr Opin Nephrol Hypertens 2024:00041552-990000000-00173. [PMID: 38934092 DOI: 10.1097/mnh.0000000000001012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/28/2024]
Abstract
PURPOSE OF REVIEW Highlight the mechanisms through which vasopressin and hypertonic stress regulate protein metabolism. RECENT FINDINGS Mammals have an 'aestivation-like' response in which hypertonic stress increases muscle catabolism and urea productionVasopressin can directly regulate ureagenesis in the liver and the kidneyIn humans chronic hypertonic stress is associated with premature aging, diabetes, cardiovascular disease, and premature mortality. SUMMARY There is an evolutionarily conserved 'aestivation-like' response in humans in which hypertonic stress results in activation of the vasopressin system, muscle catabolism, and ureagenesis in order to promote water conservation.
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Affiliation(s)
- Joshua S Carty
- Division of Nephrology and Hypertension, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Jason A Watts
- Epigenetics and Stem Cell Laboratory, National Institute of Environmental Health Sciences, National Institutes of Health, Research Triangle Park, North Carolina
| | - Juan Pablo Arroyo
- Division of Nephrology and Hypertension, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
- Vanderbilt Center for Kidney Disease, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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Robayo-Amortegui H, Quintero-Altare A, Florez-Navas C, Serna-Palacios I, Súarez-Saavedra A, Buitrago-Bernal R, Casallas-Barrera JO. Fluid dynamics of life: exploring the physiology and importance of water in the critical illness. Front Med (Lausanne) 2024; 11:1368502. [PMID: 38745736 PMCID: PMC11092983 DOI: 10.3389/fmed.2024.1368502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Accepted: 04/12/2024] [Indexed: 05/16/2024] Open
Abstract
Water acknowledged as a vital component for life and the universal solvent, is crucial for diverse physiological processes in the human body. While essential for survival, the human body lacks the capacity to produce water, emphasizing the need for regular ingestion to maintain a homeostatic environment. The human body, predominantly composed of water, exhibits remarkable biochemical properties, playing a pivotal role in processes such as protein transport, thermoregulation, the cell cycle, and acid–base balance. This review delves into comprehending the molecular characteristics of water and its interactions within the human body. The article offers valuable insights into the intricate relationship between water and critical illness. Through a comprehensive exploration, it seeks to enhance our understanding of water’s pivotal role in sustaining overall human health.
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Affiliation(s)
- Henry Robayo-Amortegui
- Department of Critical Care Medicine, Fundación Clínica Shaio, Bogotá, DC, Colombia
- Department of Medicine, Critical Care Resident, Universidad de La Sabana, Chía Cundinamarca, Colombia
| | - Alejandro Quintero-Altare
- Department of Critical Care Medicine, Fundación Clínica Shaio, Bogotá, DC, Colombia
- Department of Medicine, Critical Care Resident, Universidad de La Sabana, Chía Cundinamarca, Colombia
| | - Catalina Florez-Navas
- Department of Critical Care Medicine, Fundación Clínica Shaio, Bogotá, DC, Colombia
- Department of Medicine, Critical Care Resident, Universidad de La Sabana, Chía Cundinamarca, Colombia
| | - Isacio Serna-Palacios
- Department of Medicine, Critical Care Resident, Universidad de La Sabana, Chía Cundinamarca, Colombia
| | | | - Ricardo Buitrago-Bernal
- Department of Critical Care Medicine, Fundación Clínica Shaio, Bogotá, DC, Colombia
- Exploratorium group, Fundación Clínica Shaio, Bogotá, DC, Colombia
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3
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Marton A, Saffari SE, Rauh M, Sun RN, Nagel AM, Linz P, Lim TT, Takase-Minegishi K, Pajarillaga A, Saw S, Morisawa N, Yam WK, Minegishi S, Totman JJ, Teo S, Teo LLY, Ng CT, Kitada K, Wild J, Kovalik JP, Luft FC, Greasley PJ, Chin CWL, Sim DKL, Titze J. Water Conservation Overrides Osmotic Diuresis During SGLT2 Inhibition in Patients With Heart Failure. J Am Coll Cardiol 2024; 83:1386-1398. [PMID: 38599715 DOI: 10.1016/j.jacc.2024.02.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Revised: 02/08/2024] [Accepted: 02/08/2024] [Indexed: 04/12/2024]
Abstract
BACKGROUND Sodium-glucose cotransporter 2 inhibitors are believed to improve cardiac outcomes due to their osmotic diuretic potential. OBJECTIVES The goal of this study was to test the hypothesis that vasopressin-driven urine concentration overrides the osmotic diuretic effect of glucosuria induced by dapagliflozin treatment. METHODS DAPA-Shuttle1 (Hepato-renal Regulation of Water Conservation in Heart Failure Patients With SGLT-2 Inhibitor Treatment) was a single-center, double-blind, randomized, placebo-controlled trial, in which patients with chronic heart failure NYHA functional classes I/II and reduced ejection fraction were randomly assigned to receive dapagliflozin 10 mg daily or placebo (1:1) for 4 weeks. The primary endpoint was change from baseline in urine osmolyte concentration. Secondary endpoints included changes in copeptin levels and solute free water clearance. RESULTS Thirty-three randomized, sodium-glucose cotransporter 2 inhibitor-naïve participants completed the study, 29 of whom (placebo: n = 14; dapagliflozin: n = 15) provided accurate 24-hour urine collections (mean age 59 ± 14 years; left ventricular ejection fraction 31% ± 9%). Dapagliflozin treatment led to an isolated increase in urine glucose excretion by 3.3 mmol/kg/d (95% CI: 2.51-4.04; P < 0.0001) within 48 hours (early) which persisted after 4 weeks (late; 2.7 mmol/kg/d [95% CI: 1.98-3.51]; P < 0.0001). Dapagliflozin treatment increased serum copeptin early (5.5 pmol/L [95% CI: 0.45-10.5]; P < 0.05) and late (7.8 pmol/L [95% CI: 2.77-12.81]; P < 0.01), leading to proportional reductions in free water clearance (early: -9.1 mL/kg/d [95% CI: -14 to -4.12; P < 0.001]; late: -11.0 mL/kg/d [95% CI: -15.94 to -6.07; P < 0.0001]) and elevated urine concentrations (late: 134 mmol/L [95% CI: 39.28-229.12]; P < 0.01). Therefore, urine volume did not significantly increase with dapagliflozin (mean difference early: 2.8 mL/kg/d [95% CI: -1.97 to 7.48; P = 0.25]; mean difference late: 0.9 mL/kg/d [95% CI: -3.83 to 5.62]; P = 0.70). CONCLUSIONS Physiological-adaptive water conservation eliminated the expected osmotic diuretic potential of dapagliflozin and thereby prevented a glucose-driven increase in urine volume of approximately 10 mL/kg/d · 75 kg = 750 mL/kg/d. (Hepato-renal Regulation of Water Conservation in Heart Failure Patients With SGLT-2 Inhibitor Treatment [DAPA-Shuttle1]; NCT04080518).
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Affiliation(s)
- Adriana Marton
- Programme in Cardiovascular and Metabolic Disorders, Duke-NUS Medical School, Singapore; Department of Internal Medicine 4-Nephrology and Hypertension, Paracelsus Private Medical School Nuremberg, Nuremberg, Germany.
| | | | - Manfred Rauh
- Research Laboratory, Division of Paediatrics, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Ruo-Ning Sun
- Clinical Imaging Research Centre, Centre for Translational Medicine, Singapore
| | - Armin M Nagel
- Institute of Radiology, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg (FAU), Erlangen, Germany; German Cancer Research Center (DKFZ), Division of Medical Physics in Radiology, Heidelberg, Germany
| | - Peter Linz
- Institute of Radiology, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg (FAU), Erlangen, Germany
| | - Tzy Tiing Lim
- Programme in Cardiovascular and Metabolic Disorders, Duke-NUS Medical School, Singapore
| | | | | | - Sharon Saw
- Department of Laboratory Medicine, National University Hospital, Singapore
| | - Norihiko Morisawa
- Programme in Cardiovascular and Metabolic Disorders, Duke-NUS Medical School, Singapore
| | - Wan Keat Yam
- Programme in Cardiovascular and Metabolic Disorders, Duke-NUS Medical School, Singapore
| | - Shintaro Minegishi
- Programme in Cardiovascular and Metabolic Disorders, Duke-NUS Medical School, Singapore
| | - John J Totman
- Clinical Imaging Research Centre, Centre for Translational Medicine, Singapore; Radiography and Medical Imaging Department, Fatima College of Health Sciences, Abu Dhabi, United Arab Emirates
| | - Serena Teo
- Clinical Imaging Research Centre, Centre for Translational Medicine, Singapore
| | - Louis L Y Teo
- Department of Cardiology, National Heart Centre Singapore, Singapore
| | - Choon Ta Ng
- Department of Cardiology, National Heart Centre Singapore, Singapore
| | - Kento Kitada
- Department of Pharmacology, Faculty of Medicine, Kagawa University, Kagawa, Japan
| | - Johannes Wild
- Center for Cardiology, Cardiology I, Johannes Gutenberg-University, Mainz, Germany
| | - Jean-Paul Kovalik
- Programme in Cardiovascular and Metabolic Disorders, Duke-NUS Medical School, Singapore
| | - Friedrich C Luft
- Experimental and Clinical Research Center, Max-Delbrück Center for Molecular Medicine, Medical Faculty of the Charité, Berlin, Germany
| | - Peter J Greasley
- Early Discovery and Development, Cardiovascular, Renal and Metabolism, BioPharmaceuticals R&D, AstraZeneca, Gothenburg, Sweden
| | - Calvin W L Chin
- Department of Cardiology, National Heart Centre Singapore, Singapore
| | - David K L Sim
- Department of Cardiology, National Heart Centre Singapore, Singapore
| | - Jens Titze
- Programme in Cardiovascular and Metabolic Disorders, Duke-NUS Medical School, Singapore; III. Department of Medicine and Hamburg Center for Kidney Health (HCKH), University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Division of Nephrology, Duke University Medical Center, Durham, North Carolina, USA.
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Bagordo D, Rossi GP, Delles C, Wiig H, Rossitto G. Tangram of Sodium and Fluid Balance. Hypertension 2024; 81:490-500. [PMID: 38084591 PMCID: PMC10863667 DOI: 10.1161/hypertensionaha.123.19569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2024]
Abstract
Homeostasis of fluid and electrolytes is a tightly controlled physiological process. Failure of this process is a hallmark of hypertension, chronic kidney disease, heart failure, and other acute and chronic diseases. While the kidney remains the major player in the control of whole-body fluid and electrolyte homeostasis, recent discoveries point toward more peripheral mechanisms leading to sodium storage in tissues, such as skin and muscle, and a link between this sodium and a range of diseases, including the conditions above. In this review, we describe multiple facets of sodium and fluid balance from traditional concepts to novel discoveries. We examine the differences between acute disruption of sodium balance and the longer term adaptation in chronic disease, highlighting areas that cannot be explained by a kidney-centric model alone. The theoretical and methodological challenges of more recently proposed models are discussed. We acknowledge the different roles of extracellular and intracellular spaces and propose an integrated model that maintains fluid and electrolyte homeostasis and can be distilled into a few elemental players: the microvasculature, the interstitium, and tissue cells. Understanding their interplay will guide a more precise treatment of conditions characterized by sodium excess, for which primary aldosteronism is presented as a prototype.
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Affiliation(s)
- Domenico Bagordo
- Emergency and Hypertension Unit, Dipartimento di Medicina (DIMED), Università degli Studi di Padova, Italy (D.B., G.P.R., G.R.)
| | - Gian Paolo Rossi
- Emergency and Hypertension Unit, Dipartimento di Medicina (DIMED), Università degli Studi di Padova, Italy (D.B., G.P.R., G.R.)
| | - Christian Delles
- School of Cardiovascular & Metabolic Health, University of Glasgow, United Kingdom (G.R., C.D.)
| | - Helge Wiig
- Department of Biomedicine, University of Bergen, Norway (H.W.)
| | - Giacomo Rossitto
- Emergency and Hypertension Unit, Dipartimento di Medicina (DIMED), Università degli Studi di Padova, Italy (D.B., G.P.R., G.R.)
- School of Cardiovascular & Metabolic Health, University of Glasgow, United Kingdom (G.R., C.D.)
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5
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Davydov DM, de la Coba P, Contreras-Merino AM, Reyes Del Paso GA. Impact of homeostatic body hydration status, evaluated by hemodynamic measures, on different pain sensitization paths to a chronic pain syndrome. Sci Rep 2024; 14:1908. [PMID: 38253727 PMCID: PMC10803325 DOI: 10.1038/s41598-024-52419-3] [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: 05/11/2023] [Accepted: 01/18/2024] [Indexed: 01/24/2024] Open
Abstract
Contrasting findings on the mechanisms of chronic pain and hypertension development render the current conventional evidence of a negative relationship between blood pressure (BP) and pain severity insufficient for developing personalized treatments. In this interdisciplinary study, patients with fibromyalgia (FM) exhibiting clinically normal or elevated BP, alongside healthy participants were assessed. Different pain sensitization responses were evaluated using a dynamic 'slowly repeated evoked pain' (SREP) measure, as well as static pain pressure threshold and tolerance measures. Cardiovascular responses to clino-orthostatic (lying-standing) challenges were also examined as acute re- and de-hydration events, challenging cardiovascular and cerebrovascular homeostasis. These challenges involve compensating effects from various cardiac preload or afterload mechanisms associated with different homeostatic body hydration statuses. Additionally, hair cortisol concentration was considered as a factor with an impact on chronic hydration statuses. Pain windup (SREP) and lower pain threshold in FM patients were found to be related to BP rise during clinostatic (lying) rehydration or orthostatic (standing) dehydration events, respectively. These events were determined by acute systemic vasoconstriction (i.e., cardiac afterload response) overcompensating for clinostatic or orthostatic cardiac preload under-responses (low cardiac output or stroke volume). Lower pain tolerance was associated with tonic blood pressure reduction, determined by permanent hypovolemia (low stroke volume) decompensated by permanent systemic vasodilation. In conclusion, the body hydration status profiles assessed by (re)activity of systemic vascular resistance and effective blood volume-related measures can help predict the risk and intensity of different pain sensitization components in chronic pain syndrome, facilitating a more personalized management approach.
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Affiliation(s)
- Dmitry M Davydov
- María Zambrano Senior Scholar, University of Jaén, Campus Las Lagunillas s/n, 23071, Jaén, Spain.
- Laboratory of Neuroimmunopathology, Institute of General Pathology and Pathophysiology, Russian Academy of Sciences, Moscow, Russia.
| | - Pablo de la Coba
- Department of Psychology, University of Extremadura, Badajoz, Spain
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Arteaga S, Dolenz BJ, Znosko BM. Competitive Influence of Alkali Metals in the Ion Atmosphere on Nucleic Acid Duplex Stability. ACS OMEGA 2024; 9:1287-1297. [PMID: 38222622 PMCID: PMC10785066 DOI: 10.1021/acsomega.3c07563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 12/04/2023] [Accepted: 12/11/2023] [Indexed: 01/16/2024]
Abstract
The nonspecific atmosphere around nucleic acids, often termed the ion atmosphere, encompasses a collection of weak ion-nucleic acid interactions. Although nonspecific, the ion atmosphere has been shown to influence nucleic acid folding and structural stability. Studies investigating the composition of the ion atmosphere have shown competitive occupancy of the atmosphere between metal ions in the same solution. Many studies have investigated single ion effects on nucleic acid secondary structure stability; however, no comprehensive studies have investigated how the competitive occupancy of mixed ions in the ion atmosphere influences nucleic acid secondary structure stability. Here, six oligonucleotides were optically melted in buffers containing molar quantities, or mixtures, of either XCl (X = Li, K, Rb, or Cs) or NaCl. A correction factor was developed to better predict RNA duplex stability in solutions containing mixed XCl/NaCl. For solutions containing a 1:1 mixture of XCl/NaCl, one alkali metal chloride contributed more to duplex stability than the other. Overall, there was a 54% improvement in predictive capabilities with the correction factor compared with the standard 1.0 M NaCl nearest-neighbor models. This correction factor can be used in models to better predict RNA secondary structure in solutions containing mixed XCl/NaCl.
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Affiliation(s)
- Sebastian
J. Arteaga
- Department of Chemistry, Saint Louis University, Saint
Louis, Missouri 63103, United States
| | - Bruce J. Dolenz
- Department of Chemistry, Saint Louis University, Saint
Louis, Missouri 63103, United States
| | - Brent M. Znosko
- Department of Chemistry, Saint Louis University, Saint
Louis, Missouri 63103, United States
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7
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Ziegler AA, Lawton SBR, Grobe CC, Reho JJ, Freudinger BP, Burnett CML, Nakagawa P, Grobe JL, Segar JL. Early-life sodium deprivation programs long-term changes in ingestive behaviors and energy expenditure in C57BL/6J mice. Am J Physiol Regul Integr Comp Physiol 2023; 325:R576-R592. [PMID: 37720996 PMCID: PMC10866575 DOI: 10.1152/ajpregu.00137.2023] [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: 06/12/2023] [Revised: 09/07/2023] [Accepted: 09/07/2023] [Indexed: 09/19/2023]
Abstract
Postnatal growth failure remains a significant problem for infants born prematurely, despite aggressive efforts to improve perinatal nutrition. Though often dysregulated in early life when children are born preterm, sodium (Na) homeostasis is vital to achieve optimal growth. We hypothesize that insufficient Na supply in this critical period contributes to growth restriction and programmed risks for cardiometabolic disease in later adulthood. Thus, we sought to ascertain the effects of prolonged versus early-life Na depletion on weight gain, body composition, food and water intake behaviors, and energy expenditure in C57BL/6J mice. In one study, mice were provided a low (0.04%)- or normal/high (0.30%)-Na diet between 3 and 18 wk of age. Na-restricted mice demonstrated delayed growth and elevated basal metabolic rate. In a second study, mice were provided 0.04% or 0.30% Na diet between 3 and 6 wk of age and then returned to standard (0.15%)-Na diet through the end of the study. Na-restricted mice exhibited growth delays that quickly caught up on return to standard diet. Between 6 and 18 wk of age, previously restricted mice exhibited sustained, programmed changes in feeding behaviors, reductions in total food intake, and increases in water intake and aerobic energy expenditure while maintaining normal body composition. Although having no effect in control mice, administration of the ganglionic blocker hexamethonium abolished the programmed increase in basal metabolic rate in previously restricted mice. Together these data indicate that early-life Na restriction can cause programmed changes in ingestive behaviors, autonomic function, and energy expenditure that persist well into adulthood.
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Affiliation(s)
- Alisha A Ziegler
- Department of Physiology, Medical College of Wisconsin, Milwaukee, Wisconsin, United States
- Division of Neonatology, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin, United States
| | - Samuel B R Lawton
- Department of Physiology, Medical College of Wisconsin, Milwaukee, Wisconsin, United States
| | - Connie C Grobe
- Division of Neonatology, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin, United States
| | - John J Reho
- Department of Physiology, Medical College of Wisconsin, Milwaukee, Wisconsin, United States
- Comprehensive Rodent Metabolic Phenotyping Core, Medical College of Wisconsin, Milwaukee, Wisconsin, United States
| | - Bonnie P Freudinger
- Engineering Core, Medical College of Wisconsin, Milwaukee, Wisconsin, United States
| | - Colin M L Burnett
- Division of Cardiovascular Medicine, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, United States
| | - Pablo Nakagawa
- Department of Physiology, Medical College of Wisconsin, Milwaukee, Wisconsin, United States
- Cardiovascular Center, Medical College of Wisconsin, Milwaukee, Wisconsin, United States
- Neuroscience Research Center, Medical College of Wisconsin, Milwaukee, Wisconsin, United States
| | - Justin L Grobe
- Department of Physiology, Medical College of Wisconsin, Milwaukee, Wisconsin, United States
- Comprehensive Rodent Metabolic Phenotyping Core, Medical College of Wisconsin, Milwaukee, Wisconsin, United States
- Cardiovascular Center, Medical College of Wisconsin, Milwaukee, Wisconsin, United States
- Neuroscience Research Center, Medical College of Wisconsin, Milwaukee, Wisconsin, United States
- Department of Biomedical Engineering, Medical College of Wisconsin, Wisconsin, United States
| | - Jeffrey L Segar
- Department of Physiology, Medical College of Wisconsin, Milwaukee, Wisconsin, United States
- Division of Neonatology, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin, United States
- Cardiovascular Center, Medical College of Wisconsin, Milwaukee, Wisconsin, United States
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8
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Ramos Gonzalez M, Axler MR, Kaseman KE, Lobene AJ, Farquhar WB, Witman MA, Kirkman DL, Lennon SL. Melatonin supplementation reduces nighttime blood pressure but does not affect blood pressure reactivity in normotensive adults on a high-sodium diet. Am J Physiol Regul Integr Comp Physiol 2023; 325:R465-R473. [PMID: 37642281 PMCID: PMC11178293 DOI: 10.1152/ajpregu.00101.2023] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 08/11/2023] [Accepted: 08/23/2023] [Indexed: 08/31/2023]
Abstract
High-sodium diets (HSDs) can cause exaggerated increases in blood pressure (BP) during physiological perturbations that cause sympathetic activation, which is related to cardiovascular risk. Melatonin supplementation has been shown to play a role in BP regulation. Our aim was to examine the effects of melatonin taken during an HSD on 24-h BP and BP reactivity during isometric handgrip (IHG) exercise, postexercise ischemia (PEI), and the cold pressor test (CPT). Twenty-two participants (11 men/11 women, 26.5 ± 3.1 yr, BMI: 24.1 ± 1.8 kg/m2, BP: 111 ± 9/67 ± 7 mmHg) were randomized to a 10-day HSD (6,900 mg sodium/day) that was supplemented with either 10 mg/day of melatonin (HSD + MEL) or placebo (HSD + PL). Twenty-four-hour ambulatory BP monitoring was assessed starting on day 9. Mean arterial pressure (MAP) was quantified during the last 30 s of IHG at 40% of maximal voluntary contraction and CPT, and during 3 min of PEI. Melatonin did not change 24-h MAP (HSD + PL: 83 ± 6 mmHg; HSD + MEL: 82 ± 5 mmHg; P = 0.23) but decreased nighttime peripheral (HSD + PL: 105 ± 10 mmHg; HSD + MEL: 100 ± 10 mmHg; P = 0.01) and central systolic BP (HSD + PL: 97 ± 9 mmHg; HSD + MEL: 93 ± 8 mmHg; P = 0.04) on the HSD compared with the HSD + PL. The absolute and percent change in MAP during IHG was not different between conditions (all P > 0.05). In conclusion, melatonin supplementation did not alter BP reactivity to the perturbations tested on an HSD but may be beneficial in lowering BP in young healthy normotensive adults.NEW & NOTEWORTHY BP reactivity was assessed during isometric handgrip (IHG) exercise, postexercise ischemia (PEI), and the cold pressor test (CPT) after 10 days of a high-sodium diet with and without melatonin supplementation. Melatonin did not alter BP reactivity in healthy normotensive men and women. However, melatonin did decrease nighttime peripheral and central systolic BP, suggesting it may be beneficial in lowering BP even in those with a normal BP.
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Affiliation(s)
- Macarena Ramos Gonzalez
- Department of Kinesiology and Applied Physiology, University of Delaware, Newark, Delaware, United States
| | - Michael R Axler
- Department of Kinesiology and Applied Physiology, University of Delaware, Newark, Delaware, United States
| | - Kathryn E Kaseman
- Department of Kinesiology and Applied Physiology, University of Delaware, Newark, Delaware, United States
| | - Andrea J Lobene
- Department of Kinesiology and Applied Physiology, University of Delaware, Newark, Delaware, United States
| | - William B Farquhar
- Department of Kinesiology and Applied Physiology, University of Delaware, Newark, Delaware, United States
| | - Melissa A Witman
- Department of Kinesiology and Applied Physiology, University of Delaware, Newark, Delaware, United States
| | - Danielle L Kirkman
- Department of Kinesiology and Health Sciences, Virginia Commonwealth University, Richmond, Virginia, United States
| | - Shannon L Lennon
- Department of Kinesiology and Applied Physiology, University of Delaware, Newark, Delaware, United States
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9
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Mohd Nor NAN, Kari A, Haron MN, Komilus CF. Effect of Bee Bread on Corticosterone Level in Rat Dams Exposed to Gestational Heat Stress. Trop Life Sci Res 2023; 34:151-163. [PMID: 37860096 PMCID: PMC10583849 DOI: 10.21315/tlsr2023.34.3.8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 03/24/2023] [Indexed: 10/21/2023] Open
Abstract
Environmental temperature rises are powerful stimuli that can alter both the sympathetic nervous system and the hypothalamic-pituitary-adrenocortical axis (HPA). Heat stress has been shown to harm pregnancy outcomes such as causing spontaneous abortion, low birth weight, growth retardation and stillbirth. Supplementation of bee bread in pregnant rats under heat stress exposure has been shown to improve the pregnancy outcomes. However, whether supplementation of bee bread during heat stress exposure may also reduce the level of the stress hormone, corticosterone has yet been reported. Therefore, this study aims to determine the effect of bee bread on corticosterone level, progesterone level, oestradiol level and zonation of the adrenal cortex of pregnant rats under heat stress exposure. Pregnant rats were randomly categorised into four groups (n = 6): Control (C: standard feeding), Treatment 1 (T1: 0.5 g bee bread/kg body weight/day), Treatment 2 (T2: standard feeding with heat exposure), and Treatment 3 (T3: 0.5 g bee bread/kg body weight/day with heat exposure). Bee bread (0.5 g/kg body weight/day) was force-fed to pregnant rats through oral gavage beginning on day 0 of pregnancy and continuing until delivery. Heat stress was generated experimentally by putting both T2 and T3 rats in an egg incubator for 45 min daily at a temperature of 43°C till delivery. On a postnatal Day 21, dams were euthanised to assess serum corticosterone, progesterone, oestradiol levels and adrenal gland histology. Rats in the T2 group had a significantly (P < 0.05) increase in the zona fasciculata thickness (94.95 ± 1.55 μm) and higher corticosterone levels (49.57 ± 1.57 ng/mL) compared with control. However, supplementation of bee bread during heat stress was able to show an improvement in adrenal zona fasciculata thickness by decreasing to 79.89 ± 3.08 μm and corticosterone level reduced to 35.31 ± 1.73 ng/mL significantly (P < 0.05). Therefore, these findings may imply that bee bread is effective as a neutralizer in lowering the production of stress hormone.
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Affiliation(s)
- Nur Akmar Nadhirah Mohd Nor
- School of Animal Science, Aquatic Science and Environment, Faculty of Bioresources and Food Industry, Universiti Sultan Zainal Abidin 22200 Besut, Terengganu, Malaysia
| | - Asmad Kari
- School of Animal Science, Aquatic Science and Environment, Faculty of Bioresources and Food Industry, Universiti Sultan Zainal Abidin 22200 Besut, Terengganu, Malaysia
| | - Mohd Nizam Haron
- School of Animal Science, Aquatic Science and Environment, Faculty of Bioresources and Food Industry, Universiti Sultan Zainal Abidin 22200 Besut, Terengganu, Malaysia
| | - Connie Fay Komilus
- School of Animal Science, Aquatic Science and Environment, Faculty of Bioresources and Food Industry, Universiti Sultan Zainal Abidin 22200 Besut, Terengganu, Malaysia
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10
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McArdle Z, Singh R, Moritz K, Schreuder M, Denton K. Brief early life angiotensin-converting enzyme inhibition attenuates the diuretic response to saline loading in sheep with solitary functioning kidney. Clin Sci (Lond) 2023; 137:1285-1296. [PMID: 37565514 PMCID: PMC10447225 DOI: 10.1042/cs20230663] [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: 06/15/2023] [Revised: 07/28/2023] [Accepted: 08/11/2023] [Indexed: 08/12/2023]
Abstract
A solitary functioning kidney (SFK) from birth predisposes to hypertension and kidney dysfunction, and this may be associated with impaired fluid and sodium homeostasis. Brief and early angiotensin-converting enzyme inhibition (ACEi) in a sheep model of SFK delays onset of kidney dysfunction. We hypothesized that modulation of the renin-angiotensin system via brief postnatal ACEi in SFK would reprogram renal sodium and water handling. Here, blood pressure (BP), kidney haemodynamics and kidney excretory function were examined in response to an isotonic saline load (0.13 ml/kg/min, 180 min) at 20 months of age in SFK (fetal unilateral nephrectomy at 100 days gestation; term 150 days), sham and SFK+ACEi sheep (ACEi in SFK 4-8 weeks of age). Basal BP was higher in SFK than sham (∼13 mmHg), and similar between SFK and SFK+ACEi groups. Saline loading caused a small increase in BP (∼3-4 mmHg) the first 2 h in SFK and sham sheep but not SFK+ACEi sheep. Glomerular filtration rate did not change in response to saline loading. Total sodium excretion was similar between groups. Total urine excretion was similar between SFK and sham animals but was ∼40% less in SFK+ACEi animals compared with SFK animals. In conclusion, the present study indicates that water homeostasis in response to a physiological challenge is attenuated at 20 months of age by brief early life ACEi in SFK. Further studies are required to determine if ACEi in early life in children with SFK could compromise fluid homeostasis later in life.
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Affiliation(s)
- Zoe McArdle
- Cardiovascular Program, Monash Biomedicine Discovery Institute and Department of Physiology, Monash University, Melbourne, Australia
| | - Reetu R. Singh
- Cardiovascular Program, Monash Biomedicine Discovery Institute and Department of Physiology, Monash University, Melbourne, Australia
| | - Karen M. Moritz
- Child Health Research Centre and School of Biomedical Sciences, The University of Queensland, Brisbane, Queensland, Australia
| | - Michiel F. Schreuder
- Department of Pediatric Nephrology, Amalia Children’s Hospital, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Kate M. Denton
- Cardiovascular Program, Monash Biomedicine Discovery Institute and Department of Physiology, Monash University, Melbourne, Australia
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11
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Sánchez-Lozada LG, Madero M, Mazzali M, Feig DI, Nakagawa T, Lanaspa MA, Kanbay M, Kuwabara M, Rodriguez-Iturbe B, Johnson RJ. Sugar, salt, immunity and the cause of primary hypertension. Clin Kidney J 2023; 16:1239-1248. [PMID: 37529651 PMCID: PMC10387395 DOI: 10.1093/ckj/sfad058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Indexed: 08/03/2023] Open
Abstract
Despite its discovery more than 150 years ago, the cause of primary hypertension remains unknown. Most studies suggest that hypertension involves genetic, congenital or acquired risk factors that result in a relative inability of the kidney to excrete salt (sodium chloride) in the kidneys. Here we review recent studies that suggest there may be two phases, with an initial phase driven by renal vasoconstriction that causes low-grade ischemia to the kidney, followed by the infiltration of immune cells that leads to a local autoimmune reaction that maintains the renal vasoconstriction. Evidence suggests that multiple mechanisms could trigger the initial renal vasoconstriction, but one way may involve fructose that is provided in the diet (such as from table sugar or high fructose corn syrup) or produced endogenously. The fructose metabolism increases intracellular uric acid, which recruits NADPH oxidase to the mitochondria while inhibiting AMP-activated protein kinase. A drop in intracellular ATP level occurs, triggering a survival response. Leptin levels rise, triggering activation of the sympathetic central nervous system, while vasopressin levels rise, causing vasoconstriction in its own right and stimulating aldosterone production via the vasopressin 1b receptor. Low-grade renal injury and autoimmune-mediated inflammation occur. High-salt diets can amplify this process by raising osmolality and triggering more fructose production. Thus, primary hypertension may result from the overactivation of a survival response triggered by fructose metabolism. Restricting salt and sugar and hydrating with ample water may be helpful in the prevention of primary hypertension.
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Affiliation(s)
- Laura G Sánchez-Lozada
- Department of Cardio-Renal Physiopathology, Instituto Nacional de Cardiología “Ignacio Chavez”, Mexico City, Mexico
| | - Magdalena Madero
- Division of Nephrology, Department of Medicine, Instituto Nacional de Cardiología “Ignacio Chavez”, Mexico City, Mexico
| | - Marilda Mazzali
- Division of Nephrology, University of Campinas, São Paulo, Brazil
| | - Daniel I Feig
- Division of Pediatric Nephrology, University of Alabama, Birmingham, AL, USA
| | | | - Miguel A Lanaspa
- Department of Medicine, University of Colorado Anschutz Medical Center, Aurora, CO, USA
| | - Mehmet Kanbay
- Department of Medicine, Koc University School of Medicine, Istanbul, Turkey
| | | | - Bernardo Rodriguez-Iturbe
- Department of Nephrology and Mineral Metabolism, Instituto Nacional de Ciencias Médicas y Nutrición “Salvador Zubirán”, Mexico City
| | - Richard J Johnson
- Department of Medicine, University of Colorado Anschutz Medical Center, Aurora, CO, USA
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12
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Watso JC, Fancher IS, Gomez DH, Hutchison ZJ, Gutiérrez OM, Robinson AT. The damaging duo: Obesity and excess dietary salt contribute to hypertension and cardiovascular disease. Obes Rev 2023; 24:e13589. [PMID: 37336641 PMCID: PMC10406397 DOI: 10.1111/obr.13589] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 05/08/2023] [Accepted: 05/24/2023] [Indexed: 06/21/2023]
Abstract
Hypertension is a primary risk factor for cardiovascular disease. Cardiovascular disease is the leading cause of death among adults worldwide. In this review, we focus on two of the most critical public health challenges that contribute to hypertension-obesity and excess dietary sodium from salt (i.e., sodium chloride). While the independent effects of these factors have been studied extensively, the interplay of obesity and excess salt overconsumption is not well understood. Here, we discuss both the independent and combined effects of excess obesity and dietary salt given their contributions to vascular dysfunction, autonomic cardiovascular dysregulation, kidney dysfunction, and insulin resistance. We discuss the role of ultra-processed foods-accounting for nearly 60% of energy intake in America-as a major contributor to both obesity and salt overconsumption. We highlight the influence of obesity on elevated blood pressure in the presence of a high-salt diet (i.e., salt sensitivity). Throughout the review, we highlight critical gaps in knowledge that should be filled to inform us of the prevention, management, treatment, and mitigation strategies for addressing these public health challenges.
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Affiliation(s)
- Joseph C. Watso
- Department of Nutrition and Integrative Physiology, Florida State University, Tallahassee, Florida, USA
| | - Ibra S. Fancher
- Department of Kinesiology and Applied Physiology, University of Delaware, Newark, Delaware, USA
| | - Dulce H. Gomez
- School of Kinesiology, Auburn University, Auburn, Alabama, USA
- Division of Endocrinology, Diabetes, and Hypertension, Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | | | - Orlando M. Gutiérrez
- Division of Nephrology, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
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13
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Costello HM, Krilis G, Grenier C, Severs D, Czopek A, Ivy JR, Nixon M, Holmes MC, Livingstone DEW, Hoorn EJ, Dhaun N, Bailey MA. High salt intake activates the hypothalamic-pituitary-adrenal axis, amplifies the stress response, and alters tissue glucocorticoid exposure in mice. Cardiovasc Res 2023; 119:1740-1750. [PMID: 36368681 PMCID: PMC10325699 DOI: 10.1093/cvr/cvac160] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 09/09/2022] [Accepted: 09/24/2022] [Indexed: 11/13/2022] Open
Abstract
AIMS High salt intake is common and contributes to poor cardiovascular health. Urinary sodium excretion correlates directly with glucocorticoid excretion in humans and experimental animals. We hypothesized that high salt intake activates the hypothalamic-pituitary-adrenal axis activation and leads to sustained glucocorticoid excess. METHODS AND RESULTS In male C57BL/6 mice, high salt intake for 2-8 weeks caused an increase in diurnal peak levels of plasma corticosterone. After 2 weeks, high salt increased Crh and Pomc mRNA abundance in the hypothalamus and anterior pituitary, consistent with basal hypothalamic-pituitary-adrenal axis activation. Additionally, high salt intake amplified glucocorticoid response to restraint stress, indicative of enhanced axis sensitivity. The binding capacity of Corticosteroid-Binding Globulin was reduced and its encoding mRNA downregulated in the liver. In the hippocampus and anterior pituitary, Fkbp5 mRNA levels were increased, indicating increased glucocorticoid exposure. The mRNA expression of the glucocorticoid-regenerating enzyme, 11β-hydroxysteroid dehydrogenase Type 1, was increased in these brain areas and in the liver. Sustained high salt intake activated a water conservation response by the kidney, increasing plasma levels of the vasopressin surrogate, copeptin. Increased mRNA abundance of Tonebp and Avpr1b in the anterior pituitary suggested that vasopressin signalling contributes to hypothalamic-pituitary-adrenal axis activation by high salt diet. CONCLUSION Chronic high salt intake amplifies basal and stress-induced glucocorticoid levels and resets glucocorticoid biology centrally, peripherally and within cells.
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Affiliation(s)
- Hannah M Costello
- Edinburgh Kidney, British Heart Foundation Centre for Cardiovascular Science, The Universtiy of Edinburgh, Edinburgh, EH16 4TJ, United Kingdom
| | - Georgios Krilis
- Edinburgh Kidney, British Heart Foundation Centre for Cardiovascular Science, The Universtiy of Edinburgh, Edinburgh, EH16 4TJ, United Kingdom
| | - Celine Grenier
- Edinburgh Kidney, British Heart Foundation Centre for Cardiovascular Science, The Universtiy of Edinburgh, Edinburgh, EH16 4TJ, United Kingdom
| | - David Severs
- Department of Internal Medicine, Division of Nephrology and Transplantation, Erasmus Medical Center, University Medical Center Rotterdam, 3000 CA Rotterdam, The Netherlands
| | - Alicja Czopek
- Edinburgh Kidney, British Heart Foundation Centre for Cardiovascular Science, The Universtiy of Edinburgh, Edinburgh, EH16 4TJ, United Kingdom
| | - Jessica R Ivy
- Edinburgh Kidney, British Heart Foundation Centre for Cardiovascular Science, The Universtiy of Edinburgh, Edinburgh, EH16 4TJ, United Kingdom
| | - Mark Nixon
- Edinburgh Kidney, British Heart Foundation Centre for Cardiovascular Science, The Universtiy of Edinburgh, Edinburgh, EH16 4TJ, United Kingdom
| | - Megan C Holmes
- Edinburgh Kidney, British Heart Foundation Centre for Cardiovascular Science, The Universtiy of Edinburgh, Edinburgh, EH16 4TJ, United Kingdom
| | - Dawn E W Livingstone
- Edinburgh Kidney, British Heart Foundation Centre for Cardiovascular Science, The Universtiy of Edinburgh, Edinburgh, EH16 4TJ, United Kingdom
| | - Ewout J Hoorn
- Department of Internal Medicine, Division of Nephrology and Transplantation, Erasmus Medical Center, University Medical Center Rotterdam, 3000 CA Rotterdam, The Netherlands
| | - Neeraj Dhaun
- Edinburgh Kidney, British Heart Foundation Centre for Cardiovascular Science, The Universtiy of Edinburgh, Edinburgh, EH16 4TJ, United Kingdom
| | - Matthew A Bailey
- Edinburgh Kidney, British Heart Foundation Centre for Cardiovascular Science, The Universtiy of Edinburgh, Edinburgh, EH16 4TJ, United Kingdom
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14
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Olde Engberink RHG, van Oosten PJ, Weber T, Tabury K, Baatout S, Siew K, Walsh SB, Valenti G, Chouker A, Boutouyrie P, Heer M, Jordan J, Goswami N. The kidney, volume homeostasis and osmoregulation in space: current perspective and knowledge gaps. NPJ Microgravity 2023; 9:29. [PMID: 37005397 PMCID: PMC10067832 DOI: 10.1038/s41526-023-00268-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Accepted: 03/13/2023] [Indexed: 04/04/2023] Open
Abstract
Although we have sent humans into space for more than 50 years crucial questions regarding kidney physiology, volume regulation and osmoregulation remain unanswered. The complex interactions between the renin-angiotensin-aldosterone system, the sympathetic nervous system, osmoregulatory responses, glomerular function, tubular function, and environmental factors such as sodium and water intake, motion sickness and ambient temperature make it difficult to establish the exact effect of microgravity and the subsequent fluid shifts and muscle mass loss on these parameters. Unfortunately, not all responses to actual microgravity can be reproduced with head-down tilt bed rest studies, which complicates research on Earth. Better understanding of the effects of microgravity on kidney function, volume regulation and osmoregulation are needed with the advent of long-term deep space missions and planetary surface explorations during which orthostatic intolerance complaints or kidney stone formation can be life-threatening for astronauts. Galactic cosmic radiation may be a new threat to kidney function. In this review, we summarise and highlight the current understandings of the effects of microgravity on kidney function, volume regulation and osmoregulation and discuss knowledge gaps that future studies should address.
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Affiliation(s)
- Rik H G Olde Engberink
- Amsterdam UMC location University of Amsterdam, Department of Internal Medicine, Section of Nephrology, Meibergdreef 9, Amsterdam, The Netherlands.
- Amsterdam Cardiovascular Sciences, Microcirculation, Amsterdam, The Netherlands.
| | - Paula J van Oosten
- Amsterdam UMC location University of Amsterdam, Department of Internal Medicine, Section of Nephrology, Meibergdreef 9, Amsterdam, The Netherlands
- Amsterdam Cardiovascular Sciences, Microcirculation, Amsterdam, The Netherlands
| | - Tobias Weber
- Space Medicine Team, European Astronaut Centre (EAC), Cologne, Germany
- KBR GmbH, Cologne, Germany
| | - Kevin Tabury
- Radiobiology Unit, Belgian Nuclear Research Centre, SCK CEN, Mol, Belgium
| | - Sarah Baatout
- Radiobiology Unit, Belgian Nuclear Research Centre, SCK CEN, Mol, Belgium
| | - Keith Siew
- London Tubular Centre, UCL Department of Renal Medicine, University College London, London, UK
| | - Stephen B Walsh
- London Tubular Centre, UCL Department of Renal Medicine, University College London, London, UK
| | - Giovanna Valenti
- Department of Biosciences, Biotechnologies and Biopharmaceutics, University of Bari Aldo Moro, Bari, Italy
| | - Alexander Chouker
- Laboratory of Translational Research Stress and Immunity, Department of Anesthesiology, Hospital of the Ludwig-Maximilians-University (LUM), Munich, Germany
| | - Pierre Boutouyrie
- Université Paris Cité, Inserm, PARCC, F-75015, Paris, France
- Service de Pharmacologie, DMU CARTE, AP-HP, Hôpital Européen Georges Pompidou, FR-75015, Paris, France
| | - Martina Heer
- German Aerospace Center (DLR), Institute of Aerospace Medicine, Cologne, Germany
- Institute of Nutritional and Food Sciences, University of Bonn, Bonn, Germany
| | - Jens Jordan
- Institute of Aerospace Medicine, German Aerospace Center (DLR) and University of Cologne, Cologne, Germany
| | - Nandu Goswami
- Gravitational Physiology and Medicine Research Unit, Division of Physiology, Otto Löwi Research Center of Vascular Biology, Inflammation, and Immunity, Medical University of Graz, Graz, Austria
- College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates
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15
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Chang DC, Stinson EJ, Piaggi P, Krakoff J, Gluck ME. Disinhibition augments thirst perception from two dehydrating stimuli in men. Appetite 2023; 182:106429. [PMID: 36539161 PMCID: PMC9870948 DOI: 10.1016/j.appet.2022.106429] [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: 10/25/2022] [Revised: 12/15/2022] [Accepted: 12/16/2022] [Indexed: 12/23/2022]
Abstract
Physiological systems controlling water and energy ingestion are coordinated. Whether maladaptive eating behavior and appetite for water are linked is unknown. Thus, we sought to investigate the association between maladaptive eating and both thirst and water drinking behavior with two dehydrating conditions. Twenty-two lean men and 20 men with obesity (mean age 32.3 ± 8.4 years and 30.0 ± 11.1 years, respectively) completed the Three-Factor Eating Questionnaire (TFEQ) and Gormally Binge Eating Scale. On separate days, volunteers were dehydrated by a 2-h hypertonic saline infusion and a 24-h water deprivation, and thirst was measured on a 100-mm visual analogue scale (VAS) during each procedure. After each dehydrating condition, ad libitum water intake was measured. In the saline infusion, higher Disinhibition on the TFEQ was associated with thirst in the lean group (β = 4.2 mm VAS, p = 0.03) but not in the group with obesity (p = 0.51). In the water-deprivation condition, higher Disinhibition was also associated with thirst in the lean group (β = 5.6 mm VAS, p = 0.01) with the strength of relationship being 3.5-fold stronger than that observed in the group with obesity (β = 1.6 mm VAS, p = 0.0003). Hunger, Restraint, and binge-eating scores were not associated with thirst in either dehydrating condition (all p > 0.05). Maladaptive eating behaviors were not associated with ad libitum water intake (all p > 0.05). Disinhibition is associated with higher thirst perception in healthy weight individuals and may be attenuated in obesity. The characteristics of disinhibition which typically includes a heightened readiness to eat, may reflect a more general phenotype that also reflects a readiness to drink.
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Affiliation(s)
- Douglas C Chang
- Phoenix Epidemiology and Clinical Research Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Phoenix, AZ, USA.
| | - Emma J Stinson
- Phoenix Epidemiology and Clinical Research Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Phoenix, AZ, USA
| | - Paolo Piaggi
- Phoenix Epidemiology and Clinical Research Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Phoenix, AZ, USA; Department of Information Engineering, University of Pisa, Pisa, Italy
| | - Jonathan Krakoff
- Phoenix Epidemiology and Clinical Research Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Phoenix, AZ, USA
| | - Marci E Gluck
- Phoenix Epidemiology and Clinical Research Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Phoenix, AZ, USA
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16
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Jaques DA, Ponte B, Olivier V, de Seigneux S, Feraille E, Burnier M, Pechère-Bertschi A. Variability of 24-Hour Sodium Urinary Excretion in Young Healthy Males Based on Consecutive Urine Collections: Impact on Categorization of Salt Intake. J Ren Nutr 2023; 33:450-455. [PMID: 36738948 DOI: 10.1053/j.jrn.2022.12.010] [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: 07/18/2022] [Revised: 11/17/2022] [Accepted: 12/19/2022] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVE Several nonconsecutive 24-h urinary collections are considered the gold standard for estimating dietary salt intake. As those samples are logistically demanding, we aimed to describe the variability of 24-h sodium urinary excretion over consecutive days and report its adequacy with sodium intake. METHODS We enrolled 16 healthy male volunteers in a prospective controlled study. All participants randomly received a low salt diet (LSD) (3 g/day of NaCl), a normal salt diet (NSD) (6 g/day of NaCl), and a high salt diet (HSD) (15 g/day of NaCl) for 7 days in a crossover design without wash-out period. RESULTS On day 6, median sodium urinary excretion was 258 (216-338), 10 (8-18), and 87 (69-121) mmol/day for HSD, LSD, and NSD, respectively (P < .001). When considering days 4-6, sodium urinary excretion was in steady state as models with and without interaction term "diet type X sample day" were not significantly different (P = .163). On day 6, area under the curve (AUC) of receiver operating characteristic for urinary sodium excretion to detect HSD was 1.0 (1.0-1.0) and a cut-point of 175 mmol/day was 100% sensitive and specific to detect HSD. On day 6, receiver operating characteristic AUC to detect LSD was 0.993 (0.978-1.0) and a cut-point of 53 mmol/day was 96.4% sensitive and 100% specific to detect LSD. CONCLUSION A steady state of sodium balance, where sodium intake is proportional to its excretion, is reached within a few days under a constant diet in the real-life setting. Categorization of salt consumption into low (3 g/day), normal (6 g/day), or high (15 g/day) based on a single 24-h urine collection is nearly perfect. Based on these results, repeated nonconsecutive urine collection might prove unnecessary to estimate sodium intake in daily clinical practice provided that diet is rather constant over time.
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Affiliation(s)
- David A Jaques
- Division of Nephrology and Hypertension, Geneva University Hospitals, Geneva, Switzerland.
| | - Belén Ponte
- Division of Nephrology and Hypertension, Geneva University Hospitals, Geneva, Switzerland
| | - Valérie Olivier
- Division of Nephrology and Hypertension, Geneva University Hospitals, Geneva, Switzerland; Department of Cell Physiology and Metabolism, University of Geneva, Geneva, Switzerland
| | - Sophie de Seigneux
- Division of Nephrology and Hypertension, Geneva University Hospitals, Geneva, Switzerland; Department of Cell Physiology and Metabolism, University of Geneva, Geneva, Switzerland
| | - Eric Feraille
- Division of Nephrology and Hypertension, Geneva University Hospitals, Geneva, Switzerland; Department of Cell Physiology and Metabolism, University of Geneva, Geneva, Switzerland
| | - Michel Burnier
- Division of Nephrology and Hypertension, Lausanne University Hospitals, Lausanne, Switzerland
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17
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Kitada K. [Water turnover in humans]. Nihon Yakurigaku Zasshi 2023; 158:421. [PMID: 37673620 DOI: 10.1254/fpj.23020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/08/2023]
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18
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Rossitto G, Delles C. Mechanisms of sodium-mediated injury in cardiovascular disease: old play, new scripts. FEBS J 2022; 289:7260-7273. [PMID: 34355504 DOI: 10.1111/febs.16155] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Revised: 06/08/2021] [Accepted: 08/04/2021] [Indexed: 01/13/2023]
Abstract
There is a strong association between salt intake and cardiovascular diseases, particularly hypertension, on the population level. The mechanisms that explain this association remain incompletely understood and appear to extend beyond blood pressure. In this review, we describe some of the 'novel' roles of Na+ in cardiovascular health and disease: energetic implications of sodium handling in the kidneys; local accumulation in tissue; fluid dynamics; and the role of the microvasculature, with particular focus on the lymphatic system. We describe the interplay between these factors that involves body composition, metabolic signatures, inflammation and composition of the extracellular and intracellular milieus.
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Affiliation(s)
- Giacomo Rossitto
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, UK.,Department of Medicine (DIMED), University of Padua, Italy
| | - Christian Delles
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, UK
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19
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Durst und Trinken – Physiologie und Bedeutung für die Störungen des Wasserhaushalts. JOURNAL FÜR KLINISCHE ENDOKRINOLOGIE UND STOFFWECHSEL 2022. [DOI: 10.1007/s41969-022-00179-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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20
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Araújo CDA, de Araújo GGL, Magalhães ALR, Gois GC, de Matos MHT, Lima DO, Rodrigues RTDS, de Quadros CP, Wagner R, Vendruscolo RG, Campos FS. Meat quality in ewes submitted to reduction in water supply. Small Rumin Res 2022. [DOI: 10.1016/j.smallrumres.2022.106801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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21
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Masenga SK, Pilic L, Hamooya BM, Nzala S, Heimburger DC, Mutale W, Koethe JR, Kirabo A, Munsaka SM, Elijovich F. Immediate pressor response to oral salt and its assessment in the clinic: a time series clinical trial. Clin Hypertens 2022; 28:25. [PMID: 36104796 PMCID: PMC9476589 DOI: 10.1186/s40885-022-00209-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 05/06/2022] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND High blood pressure (BP) is associated with high-salt consumption especially in sub-Saharan Africa. Although the pressor effect of salt is viewed as a chronic effect, some studies suggest that a salty meal may increase BP immediately in some individuals, and that this effect may cause endothelial dysfunction. Therefore, the aim of our research was to study the immediate pressor response to oral salt (IPROS) and its determinants, with the expectation that a simple methodology may be devised to diagnose it in the clinic or in low-resource environments. METHODS We conducted a time series trial at Livingstone Central Hospital. We present data in 127 normotensive participants who ingested 2 g of sodium chloride; their BP was monitored for 120 minutes in intervals of 10 minutes. Sociodemographic and clinical data were collected. Descriptive and inferential statistics were used for analyses of data. RESULTS Median age was 30 years (interquartile range, 22-46 years) and 52% were female patients. An increase of ≥10 mmHg in mean arterial pressure (MAP), considered a clinically significant IPROS, was present in 62% of participants. Systolic BP 30 minutes after the salt load was a significant predictor of IPROS, avoiding the need to calculate MAP in the clinic setting. CONCLUSIONS We confirm the presence of an IPROS in a high proportion (62%) of otherwise normotensive participants. The average time course for this response was 30 minutes and its duration was sustained for the 120-minutes period of study in most of the participants. Prediction of IPROS by ∆SBP (change in systolic blood pressure) at 30 minutes allows for easy assessment of possible responder status in the clinic. Our data indicate that the IPROS to oral salt-loads in the range currently consumed by the Western world and African populations in single meals may increase the 24-hour BP load, which is a risk factor for hypertension and target organ damage. The relevance of our findings indicates the need to include dietary sodium assessment in the diagnosis, prevention, and management of high BP.
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Affiliation(s)
- Sepiso K. Masenga
- grid.442660.20000 0004 0449 0406HAND Research Group, School of Medicine and Health Sciences, Mulungushi University, Akapelwa street, LUTH Premises, Livingstone, Zambia ,grid.12984.360000 0000 8914 5257Department of Biomedical Sciences, School of Health Sciences, University of Zambia, Lusaka, Zambia
| | - Leta Pilic
- grid.417907.c0000 0004 5903 394XFaculty of Sport, Health and Applied Science, St. Mary’s University, Twickenham, London, UK
| | - Benson M. Hamooya
- grid.442660.20000 0004 0449 0406HAND Research Group, School of Medicine and Health Sciences, Mulungushi University, Akapelwa street, LUTH Premises, Livingstone, Zambia ,grid.12984.360000 0000 8914 5257School of Public Health and School of Medicine, University of Zambia, Lusaka, Zambia
| | - Selestine Nzala
- grid.12984.360000 0000 8914 5257School of Public Health and School of Medicine, University of Zambia, Lusaka, Zambia
| | - Douglas C. Heimburger
- grid.12984.360000 0000 8914 5257School of Public Health and School of Medicine, University of Zambia, Lusaka, Zambia ,grid.412807.80000 0004 1936 9916Department of Medicine, Vanderbilt Institute for Global Health and Vanderbilt University Medical Center, Nashville, TN USA
| | - Wilbroad Mutale
- grid.12984.360000 0000 8914 5257School of Public Health and School of Medicine, University of Zambia, Lusaka, Zambia
| | - John R. Koethe
- grid.412807.80000 0004 1936 9916Department of Medicine, Vanderbilt Institute for Global Health and Vanderbilt University Medical Center, Nashville, TN USA
| | - Annet Kirabo
- grid.412807.80000 0004 1936 9916Department of Medicine, Vanderbilt Institute for Global Health and Vanderbilt University Medical Center, Nashville, TN USA
| | - Sody M. Munsaka
- grid.12984.360000 0000 8914 5257Department of Biomedical Sciences, School of Health Sciences, University of Zambia, Lusaka, Zambia
| | - Fernando Elijovich
- grid.412807.80000 0004 1936 9916Department of Medicine, Vanderbilt Institute for Global Health and Vanderbilt University Medical Center, Nashville, TN USA
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Canaud B, Kooman J, Maierhofer A, Raimann J, Titze J, Kotanko P. Sodium First Approach, to Reset Our Mind for Improving Management of Sodium, Water, Volume and Pressure in Hemodialysis Patients, and to Reduce Cardiovascular Burden and Improve Outcomes. FRONTIERS IN NEPHROLOGY 2022; 2:935388. [PMID: 37675006 PMCID: PMC10479686 DOI: 10.3389/fneph.2022.935388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Accepted: 06/07/2022] [Indexed: 09/08/2023]
Abstract
New physiologic findings related to sodium homeostasis and pathophysiologic associations require a new vision for sodium, fluid and blood pressure management in dialysis-dependent chronic kidney disease patients. The traditional dry weight probing approach that has prevailed for many years must be reviewed in light of these findings and enriched by availability of new tools for monitoring and handling sodium and water imbalances. A comprehensive and integrated approach is needed to improve further cardiac health in hemodialysis (HD) patients. Adequate management of sodium, water, volume and hemodynamic control of HD patients relies on a stepwise approach: the first entails assessment and monitoring of fluid status and relies on clinical judgement supported by specific tools that are online embedded in the HD machine or devices used offline; the second consists of acting on correcting fluid imbalance mainly through dialysis prescription (treatment time, active tools embedded on HD machine) but also on guidance related to diet and thirst management; the third consist of fine tuning treatment prescription to patient responses and tolerance with the support of innovative tools such as artificial intelligence and remote pervasive health trackers. It is time to come back to sodium and water imbalance as the root cause of the problem and not to act primarily on their consequences (fluid overload, hypertension) or organ damage (heart; atherosclerosis, brain). We know the problem and have the tools to assess and manage in a more precise way sodium and fluid in HD patients. We strongly call for a sodium first approach to reduce disease burden and improve cardiac health in dialysis-dependent chronic kidney disease patients.
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Affiliation(s)
- Bernard Canaud
- School of Medicine, Montpellier University, Montpellier, France
- Global Medical Office, Freseenius Medical Care (FMC)-France, Fresnes, France
| | - Jeroen Kooman
- Maastricht University Maastricht Medical Center (UMC), Maastricht University, Maastricht, Netherlands
| | - Andreas Maierhofer
- Global Research Development, Fresenius Medical Care (FMC) Deutschland GmbH, Bad Homburg, Germany
| | - Jochen Raimann
- Research Division, Renal Research Institute, New York, NY, United States
| | - Jens Titze
- Cardiovascular and Metabolic Disease Programme, Duke-National University Singapore (NUS) Medical School, Singapore, Singapore
| | - Peter Kotanko
- Research Division, Renal Research Institute, New York, NY, United States
- Nephrology, Icahn School of Medicine at Mount Sinai, New York, NY, United States
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Ackland GL, Abbott TEF. Hypotension as a marker or mediator of perioperative organ injury: a narrative review. Br J Anaesth 2022; 128:915-930. [PMID: 35151462 PMCID: PMC9204667 DOI: 10.1016/j.bja.2022.01.012] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 12/16/2021] [Accepted: 01/08/2022] [Indexed: 12/21/2022] Open
Abstract
Perioperative hypotension has been repeatedly associated with organ injury and worse outcome, yet many interventions to reduce morbidity by attempting to avoid or reverse hypotension have floundered. In part, this reflects uncertainty as to what threshold of hypotension is relevant in the perioperative setting. Shifting population-based definitions for hypertension, plus uncertainty regarding individualised norms before surgery, both present major challenges in constructing useful clinical guidelines that may help improve clinical outcomes. Aside from these major pragmatic challenges, a wealth of biological mechanisms that underpin the development of higher blood pressure, particularly with increasing age, suggest that hypotension (however defined) or lower blood pressure per se does not account solely for developing organ injury after major surgery. The mosaic theory of hypertension, first proposed more than 60 yr ago, incorporates multiple, complementary mechanistic pathways through which clinical (macrovascular) attempts to minimise perioperative organ injury may unintentionally subvert protective or adaptive pathways that are fundamental in shaping the integrative host response to injury and inflammation. Consideration of the mosaic framework is critical for a more complete understanding of the perioperative response to acute sterile and infectious inflammation. The largely arbitrary treatment of perioperative blood pressure remains rudimentary in the context of multiple complex adaptive hypertensive endotypes, defined by distinct functional or pathobiological mechanisms, including the regulation of reactive oxygen species, autonomic dysfunction, and inflammation. Developing coherent strategies for the management of perioperative hypotension requires smarter, mechanistically solid interventions delivered by RCTs where observer bias is minimised.
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Affiliation(s)
- Gareth L Ackland
- Translational Medicine and Therapeutics, William Harvey Research Institute, Queen Mary University of London, London, UK.
| | - Tom E F Abbott
- Translational Medicine and Therapeutics, William Harvey Research Institute, Queen Mary University of London, London, UK
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Serum Aldosterone and Urine Electrolytes Dynamics in Response to DASH Diet Intervention – an Inpatient Mechanistic Study. J Clin Transl Sci 2022; 6:e84. [PMID: 35949658 PMCID: PMC9305085 DOI: 10.1017/cts.2022.394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 04/17/2022] [Accepted: 04/18/2022] [Indexed: 11/07/2022] Open
Abstract
Background: Methods: Results: Conclusion:
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25
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Tolvaptan induces body fluid loss and subsequent water conservation in normal rats. J Pharmacol Sci 2022; 149:115-123. [DOI: 10.1016/j.jphs.2022.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Revised: 04/13/2022] [Accepted: 04/19/2022] [Indexed: 01/12/2023] Open
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26
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Sodium content of foods sold in the Czech market. Int J Gastron Food Sci 2022. [DOI: 10.1016/j.ijgfs.2022.100526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Barnett AM, Babcock MC, Watso JC, Migdal KU, Gutiérrez OM, Farquhar WB, Robinson AT. High dietary salt intake increases urinary NGAL excretion and creatinine clearance in healthy young adults. Am J Physiol Renal Physiol 2022; 322:F392-F402. [PMID: 35157527 PMCID: PMC8934673 DOI: 10.1152/ajprenal.00240.2021] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 02/02/2022] [Accepted: 02/11/2022] [Indexed: 11/22/2022] Open
Abstract
In rodents and older patients with elevated blood pressure (BP), high dietary sodium increases excretion of biomarkers of kidney injury, but it is unclear whether this effect occurs in healthy young adults. The purpose of this study was to determine whether short-term high dietary salt increases urinary excretion of the kidney injury biomarkers neutrophil gelatinase-associated lipocalin (NGAL) and kidney injury molecule-1 (KIM-1) in healthy young adults. Twenty participants participated in a double-blind, placebo-controlled, randomized crossover study. For 10 days each, participants were asked to consume salt (3,900 mg sodium) or placebo capsules. We measured BP during each visit, obtained 24-h urine samples for measurements of electrolytes, NGAL, and KIM-1, and assessed creatinine clearance. Compared with placebo, salt loading increased daily urinary sodium excretion (placebo: 130.3 ± 62.4 mmol/24 h vs. salt: 287.2 ± 72.0 mmol/24 h, P < 0.01). There was no difference in mean arterial BP (placebo: 77 ± 7 mmHg vs. salt: 77 ± 6 mmHg, P = 0.83) between conditions. However, salt loading increased the urinary NGAL excretion rate (placebo: 59.8 ± 44.4 ng/min vs. salt: 80.8 ± 49.5 ng/min, P < 0.01) and increased creatinine clearance (placebo: 110.5 ± 32.9 mL/min vs. salt: 145.0 ± 24.9 mL/min, P < 0.01). Urinary KIM-1 excretion was not different between conditions. In conclusion, in healthy young adults 10 days of dietary salt loading increased creatinine clearance and increased urinary excretion of the kidney injury biomarker marker NGAL but not KIM-1.NEW & NOTEWORTHY In healthy young adults, 10 days of dietary salt loading increased creatinine clearance and increased urinary excretion of the kidney injury biomarker marker neutrophil gelatinase-associated lipocalin despite no change in resting blood pressure.
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Affiliation(s)
- Alex M Barnett
- Neurovascular Physiology Laboratory, School of Kinesiology, Auburn University, Auburn, Alabama
| | - Matthew C Babcock
- Department of Kinesiology and Applied Physiology, University of Delaware, Newark, Delaware
- Division of Geriatric Medicine, University of Colorado-Anschutz Medical Campus, Aurora, Colorado
| | - Joseph C Watso
- Department of Kinesiology and Applied Physiology, University of Delaware, Newark, Delaware
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, and Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Kamila U Migdal
- Department of Kinesiology and Applied Physiology, University of Delaware, Newark, Delaware
- War Related Illness and Injury Study Center, Washington DC Department of Veteran Affairs Medical Center, Washington, District of Columbia
| | - Orlando M Gutiérrez
- Division of Nephrology, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - William B Farquhar
- Department of Kinesiology and Applied Physiology, University of Delaware, Newark, Delaware
| | - Austin T Robinson
- Neurovascular Physiology Laboratory, School of Kinesiology, Auburn University, Auburn, Alabama
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Scholtes RA, Muskiet MH, van Baar MJ, Hesp AC, Greasley PJ, Hammarstedt A, Karlsson C, Hallow KM, Danser AJ, Heerspink HJ, van Raalte DH. The adaptive renal response for volume homeostasis during two weeks of dapagliflozin treatment in people with type 2 diabetes and preserved renal function on a sodium-controlled diet. Kidney Int Rep 2022; 7:1084-1092. [PMID: 35570989 PMCID: PMC9091605 DOI: 10.1016/j.ekir.2022.02.023] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 02/11/2022] [Accepted: 02/15/2022] [Indexed: 12/20/2022] Open
Abstract
Introduction Proximal tubule sodium uptake is diminished following sodium glucose cotransporter 2 (SGLT2) inhibition. We previously showed that during SGLT2 inhibition, the kidneys adapt by increasing sodium uptake at distal tubular segments, thereby maintaining body sodium balance. Despite continuous glycosuria, we detected no increased urine volumes. We therefore assessed the adaptive renal responses to prevent excessive fluid loss. Methods We conducted a mechanistic open-label study in people with type 2 diabetes mellitus with preserved kidney function, who received a standardized sodium intake (150 mmol/d) to evaluate the effects of dapagliflozin on renin-angiotensin-aldosterone system (RAAS) hormones, volume-related biomarkers, urinary albumin-to-creatinine ratio (UACR), and estimated glomerular filtration rate (eGFR), at start of treatment (day 4), end of treatment (day 14), and follow-up (day 18). Results A total of 14 people were enrolled. Plasma renin and angiotensin II and urinary aldosterone and angiotensinogen were acutely and persistently increased during treatment with dapagliflozin. Plasma copeptin level was numerically increased after 4 days (21%). Similarly, fractional urea excretion was significantly decreased at start of treatment (−17%). Free water clearance was significantly decreased after 4 days (−74%) and 14 days (−41%). All changes reversed after dapagliflozin discontinuation. Conclusion Dapagliflozin-induced osmotic diuresis triggers kidney adaptive mechanisms to maintain volume and sodium balance in people with type 2 diabetes and preserved kidney function. ClinicalTrials.gov (identification: NCT03152084).
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Dietary salt with nitric oxide deficiency induces nocturnal polyuria in mice via hyperactivation of intrarenal angiotensin II-SPAK-NCC pathway. Commun Biol 2022; 5:175. [PMID: 35228649 PMCID: PMC8885931 DOI: 10.1038/s42003-022-03104-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Accepted: 02/01/2022] [Indexed: 11/12/2022] Open
Abstract
Nocturnal polyuria is the most frequent cause of nocturia, a common disease associated with a compromised quality of life and increased mortality. Its pathogenesis is complex, and the detailed underlying mechanism remains unknown. Herein, we report that concomitant intake of a high-salt diet and reduced nitric oxide (NO) production achieved through Nω-Nitro-L-arginine methyl ester hydrochloride (L-NAME) administration in mice resulted in nocturnal polyuria recapitulating the clinical features in humans. High salt intake under reduced NO production overactivated the angiotensin II-SPAK (STE20/SPS1-related proline–alanine-rich protein kinase)-NCC (sodium chloride co-transporter) pathway in the kidney, resulting in the insufficient excretion of sodium during the day and its excessive excretion at night. Excessive Na excretion at night in turn leads to nocturnal polyuria due to osmotic diuresis. Our study identified a central role for the intrarenal angiotensin II-SPAK-NCC pathway in the pathophysiology of nocturnal polyuria, highlighting its potential as a promising therapeutic target. This study reports a mouse model of nocturnal polyuria - increased urine production at night that causes compromised quality of life and may impact mortality in older people. The authors identify a molecular pathway in the kidney that could prove to be a promising drug target for nocturnal polyuria.
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Abstract
Purpose of Review The regulation of blood pressure is conventionally conceptualised into the product of “circulating blood volume” and “vasoconstriction components”. Over the last few years, however, demonstration of tissue sodium storage challenged this dichotomous view. Recent Findings We review the available evidence pertaining to this phenomenon and the early association made with blood pressure; we discuss open questions regarding its originally proposed hypertonic nature, recently challenged by the suggestion of a systemic, isotonic, water paralleled accumulation that mirrors absolute or relative extracellular volume expansion; we present the established and speculate on the putative implications of this extravascular sodium excess, in either volume-associated or -independent form, on blood pressure regulation; finally, we highlight the prevalence of high tissue sodium in cardiovascular, metabolic and inflammatory conditions other than hypertension. Summary We conclude on approaches to reduce sodium excess and on the potential of emerging imaging technologies in hypertension and other conditions.
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Rohrscheib M, Sam R, Raj DS, Argyropoulos CP, Unruh ML, Lew SQ, Ing TS, Levin NW, Tzamaloukas AH. Edelman Revisited: Concepts, Achievements, and Challenges. Front Med (Lausanne) 2022; 8:808765. [PMID: 35083255 PMCID: PMC8784663 DOI: 10.3389/fmed.2021.808765] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Accepted: 12/13/2021] [Indexed: 11/13/2022] Open
Abstract
The key message from the 1958 Edelman study states that combinations of external gains or losses of sodium, potassium and water leading to an increase of the fraction (total body sodium plus total body potassium) over total body water will raise the serum sodium concentration ([Na]S), while external gains or losses leading to a decrease in this fraction will lower [Na]S. A variety of studies have supported this concept and current quantitative methods for correcting dysnatremias, including formulas calculating the volume of saline needed for a change in [Na]S are based on it. Not accounting for external losses of sodium, potassium and water during treatment and faulty values for body water inserted in the formulas predicting the change in [Na]S affect the accuracy of these formulas. Newly described factors potentially affecting the change in [Na]S during treatment of dysnatremias include the following: (a) exchanges during development or correction of dysnatremias between osmotically inactive sodium stored in tissues and osmotically active sodium in solution in body fluids; (b) chemical binding of part of body water to macromolecules which would decrease the amount of body water available for osmotic exchanges; and (c) genetic influences on the determination of sodium concentration in body fluids. The effects of these newer developments on the methods of treatment of dysnatremias are not well-established and will need extensive studying. Currently, monitoring of serum sodium concentration remains a critical step during treatment of dysnatremias.
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Affiliation(s)
- Mark Rohrscheib
- Department of Medicine, University of New Mexico School of Medicine, Albuquerque, NM, United States
| | - Ramin Sam
- Department of Medicine, Zuckerberg San Francisco General Hospital and Trauma Center, University of California San Francisco School of Medicine, San Francisco, CA, United States
| | - Dominic S Raj
- Department of Medicine, George Washington University, Washington, DC, United States
| | - Christos P Argyropoulos
- Department of Medicine, University of New Mexico School of Medicine, Albuquerque, NM, United States
| | - Mark L Unruh
- Department of Medicine, University of New Mexico School of Medicine, Albuquerque, NM, United States
| | - Susie Q Lew
- Department of Medicine, George Washington University, Washington, DC, United States
| | - Todd S Ing
- Department of Medicine, Stritch School of Medicine, Loyola University Chicago, Maywood, IL, United States
| | - Nathan W Levin
- Mount Sinai Icahn School of Medicine, New York, NY, United States
| | - Antonios H Tzamaloukas
- Research Service, Department of Medicine, Raymond G. Murphy Veterans Affairs Medical Center and University of New Mexico School of Medicine, Albuquerque, NM, United States
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Kidoguchi S, Kitada K, Nakajima K, Nakano D, Ohsaki H, Kittikulsuth W, Kobara H, Masaki T, Yokoo T, Takahashi K, Titze J, Nishiyama A. Hepatocellular carcinoma induces body mass loss in parallel with osmolyte and water retention in rats. Life Sci 2022; 289:120192. [PMID: 34871664 DOI: 10.1016/j.lfs.2021.120192] [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: 10/05/2021] [Revised: 11/22/2021] [Accepted: 11/26/2021] [Indexed: 02/07/2023]
Abstract
AIMS The number of cancer survivors with cardiovascular disease is increasing. However, the effect of cancer on body fluid regulation remains to be clarified. In this study, we evaluated body osmolyte and water imbalance in rats with hepatocellular carcinoma. MAIN METHODS Wistar rats were administered diethylnitrosamine, a carcinogenic drug, to establish liver cancer. We analyzed tissue osmolyte and water content, and their associations with aldosterone secretion. KEY FINDINGS Hepatocellular carcinoma rats had significantly reduced body mass and the amount of total body sodium, potassium, and water. However, these rats had significantly increased relative tissue sodium, potassium, and water content per tissue dry weight. Furthermore, these changes in sodium and water balance in hepatocellular carcinoma rats were significantly associated with increased 24-h urinary aldosterone excretion. Supplementation with 0.25% salt in drinking water improved body weight reduction associated with sodium and water retention in hepatocellular carcinoma rats, which was suppressed by treatment with spironolactone, a mineralocorticoid receptor antagonist. Additionally, the urea-driven water conservation system was activated in hepatocellular carcinoma rats. SIGNIFICANCE These findings suggest that hepatocellular carcinoma induces body mass loss in parallel with activation of the water conservation system including aldosterone secretion and urea accumulation to retain osmolyte and water. The osmolyte and water retention at the tissue level may be a causative factor for ascites and edema formation in liver failure rats.
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Affiliation(s)
- Satoshi Kidoguchi
- Department of Pharmacology, Faculty of Medicine, Kagawa University, Kagawa, Japan; Division of Nephrology and Hypertension, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan
| | - Kento Kitada
- Department of Pharmacology, Faculty of Medicine, Kagawa University, Kagawa, Japan.
| | - Kazuki Nakajima
- Center for Joint Research Facilities Support, Research Promotion and Support Headquarters, Fujita Health University School of Medicine, Toyoake, Aichi, Japan
| | - Daisuke Nakano
- Department of Pharmacology, Faculty of Medicine, Kagawa University, Kagawa, Japan
| | - Hiroyuki Ohsaki
- Department of Medical Biophysics, Kobe University Graduate School of Health Science, Kobe, Japan
| | - Wararat Kittikulsuth
- Department of Pharmacology, Faculty of Medicine, Kagawa University, Kagawa, Japan
| | - Hideki Kobara
- Department of Gastroenterology and Neurology, Faculty of Medicine, Kagawa University, Kagawa, Japan
| | - Tsutomu Masaki
- Department of Gastroenterology and Neurology, Faculty of Medicine, Kagawa University, Kagawa, Japan
| | - Takashi Yokoo
- Division of Nephrology and Hypertension, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan
| | - Kazuo Takahashi
- Department of Biomedical Molecular Sciences, Fujita Health University School of Medicine, Toyoake, Aichi, Japan
| | - Jens Titze
- Cardiovascular and Metabolic Disorders, Duke-NUS Medical School, Singapore, Singapore; Division of Nephrology and Hypertension, Friedrich-Alexander University Erlangen-Nuremberg, Germany; Division of Nephrology, Duke University Medical Center, Durham, NC, USA
| | - Akira Nishiyama
- Department of Pharmacology, Faculty of Medicine, Kagawa University, Kagawa, Japan
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Zhang J, Zhang N, Liu S, Du S, Ma G. Young Adults with Higher Salt Intake Have Inferior Hydration Status: A Cross-Sectional Study. Nutrients 2022; 14:nu14020287. [PMID: 35057468 PMCID: PMC8778661 DOI: 10.3390/nu14020287] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 01/06/2022] [Accepted: 01/07/2022] [Indexed: 11/28/2022] Open
Abstract
The body’s water and sodium balances are tightly regulated and monitored by the brain. Few studies have explored the relationship between water and salt intake, and whether sodium intake with different levels of fluid intake leads to changes in hydration status remains unknown. The aim of the present study was to determine the patterns of water intake and hydration status among young adults with different levels of daily salt intakes. Participants’ total drinking fluids and water from food were determined by a 7-day 24-h fluid intake questionnaire for 7 days (from Day 1 to Day 7) and duplicate portion method (Day 5, Day 6 and Day 7). Urine of 24 h for 3 days (Day 5, Day 6 and Day 7) was collected and tested for the osmolality, the urine-specific gravity (USG), the concentrations of electrolytes, pH, creatinine, uric acid and the urea. The fasting blood samples for 1 day (Day 6) were collected and measured for the osmolality and the concentrations of electrolytes. The salt intakes of the participants were evaluated from the concentrations of Na of 24 h urine of 3 days (Day 5, Day 6 and Day 7). Participants were divided into four groups according to the quartile of salt intake, including the low salt intake (LS1), LS2, high salt intake (HS1) and HS2 groups. In total, 156 participants (including 80 male and 76 female young adults) completed the study. The salt intakes were 7.6, 10.9, 14.7 and 22.4 g among participants in the four groups (LS1, LS2, HS1 and HS2 groups, respectively), which differed significantly in all groups (F = 252.020; all p < 0.05). Compared to the LS1 and LS2 groups, the HS2 group had 310–381, 250–358 and 382–655 mL more amounts of water from the total water intake (TWI), total drinking fluids and water from food (all p < 0.05), respectively. Participants in the HS2 group had 384–403, 129–228 and 81–114 mL more in the water, water from dishes and staple foods, respectively, than those in the groups of LS1 and LS2 (p < 0.05). The HS2 group excreted 386–793 mL more urine than those in the groups of LS1 and LS2 (p < 0.05). However, regarding urine osmolality, the percentage of participants with optimal hydration status decreased from 41.0% in LS1 and LS2 to 25.6% in the HS2 group (p < 0.05). Participants with higher salt intake had higher TWI, total drinking fluids and water from food. Nevertheless, they had inferior hydration status. A reduction in salt intake should be encouraged among young adults to maintain optimal hydration status.
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Affiliation(s)
- Jianfen Zhang
- Department of Nutrition and Food Hygiene, School of Public Health, Peking University, 38 Xue Yuan Road, Haidian District, Beijing 100191, China; (J.Z.); (G.M.)
- Laboratory of Toxicological Research and Risk Assessment for Food Safety, Peking University, 38 Xue Yuan Road, Haidian District, Beijing 100191, China
| | - Na Zhang
- Department of Nutrition and Food Hygiene, School of Public Health, Peking University, 38 Xue Yuan Road, Haidian District, Beijing 100191, China; (J.Z.); (G.M.)
- Laboratory of Toxicological Research and Risk Assessment for Food Safety, Peking University, 38 Xue Yuan Road, Haidian District, Beijing 100191, China
- Correspondence: ; Tel./Fax: +86-10-8280-5266
| | - Shufang Liu
- School of Public Health, Hebei University Health Science Center, 342 Yuhua Road, Lianchi District, Baoding 071000, China;
| | - Songming Du
- Chinese Nutrition Society, Room 1405, Beijing Broadcasting Building, No. 14 Jianguomenwai Street, Chaoyang District, Beijing 100053, China;
| | - Guansheng Ma
- Department of Nutrition and Food Hygiene, School of Public Health, Peking University, 38 Xue Yuan Road, Haidian District, Beijing 100191, China; (J.Z.); (G.M.)
- Laboratory of Toxicological Research and Risk Assessment for Food Safety, Peking University, 38 Xue Yuan Road, Haidian District, Beijing 100191, China
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Increased Salt Intake Decreases Diet-Induced Thermogenesis in Healthy Volunteers: A Randomized Placebo-Controlled Study. Nutrients 2022; 14:nu14020253. [PMID: 35057434 PMCID: PMC8779306 DOI: 10.3390/nu14020253] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 01/04/2022] [Accepted: 01/05/2022] [Indexed: 02/04/2023] Open
Abstract
High salt intake ranks among the most important risk factors for noncommunicable diseases. Western diets, which are typically high in salt, are associated with a high prevalence of obesity. High salt is thought to be a potential risk factor for obesity independent of energy intake, although the underlying mechanisms are insufficiently understood. A high salt diet could influence energy expenditure (EE), specifically diet-induced thermogenesis (DIT), which accounts for about 10% of total EE. We aimed to investigate the influence of high salt on DIT. In a randomized, double-blind, placebo-controlled, parallel-group study, 40 healthy subjects received either 6 g/d salt (NaCl) or placebo in capsules over 2 weeks. Before and after the intervention, resting EE, DIT, body composition, food intake, 24 h urine analysis, and blood pressure were obtained. EE was measured by indirect calorimetry after a 12 h overnight fast and a standardized 440 kcal meal. Thirty-eight subjects completed the study. Salt intake from foods was 6 g/d in both groups, resulting in a total salt intake of 12 g/d in the salt group and 6 g/d in the placebo group. Urine sodium increased by 2.29 g/d (p < 0.0001) in the salt group, indicating overall compliance. The change in DIT differed significantly between groups (placebo vs. salt, p = 0.023). DIT decreased by 1.3% in the salt group (p = 0.048), but increased by 0.6% in the placebo group (NS). Substrate oxidation indicated by respiratory exchange ratio, body composition, resting blood pressure, fluid intake, hydration, and urine volume did not change significantly in either group. A moderate short-term increase in salt intake decreased DIT after a standardized meal. This effect could at least partially contribute to the observed weight gain in populations consuming a Western diet high in salt.
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Alwis US, Verbakel I, Pauwaert K, Delanghe J, Dossche L, Van Camp J, Roggeman S, Everaert K. The Influence of Salt Sensitivity Phenotype on Sodium Excretion and Diuresis: A Chrononutrition Pilot Study. Int J Clin Pract 2022; 2022:9608962. [PMID: 35685516 PMCID: PMC9159230 DOI: 10.1155/2022/9608962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 12/06/2021] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Chrononutrition studies on interaction of diet/nutrients on endogenous circadian clocks and meal timing on metabolic homeostasis may be of importance in the management of nocturnal polyuria (NP), owing to loss of circadian rhythm in nighttime urination. Dietary salt restriction is an increasingly popular lifestyle recommendation for NP patients. AIM This study aims to evaluate the effect of an acute salt load on diuresis and to study the phenomenon of salt sensitivity. Methodology. Young, healthy men (n = 21, fasted and sober) ingested 500 ml of water on the control day and 8 g and 12 g of salt with water (500 ml) on two other days. Blood and urine samples were collected at 0 hrs, 2 hrs, and 4 hrs and voided volumes were recorded. Diuresis, serum and urine osmolality, sodium, potassium, urea, and creatinine were measured. Salt sensitivity was determined based on the rate of sodium excretion. RESULTS Compared to 8 g, ingestion of 12 g of salt significantly increased diuresis after 4 hrs. Pure water load induced fast diuresis, whereas salt and water load initially reduced diuresis and promoted late increase in diuresis. The total voided volume was significantly lower in the salt sensitive individuals. CONCLUSION Taken together, salt sensitivity profile and type and time of fluid intake are important considerations to build effective personalized lifestyle recommendations for NP patients, which needs further investigation.
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Affiliation(s)
| | - Irina Verbakel
- Department of Human Structure and Repair, Ghent University, 9000 Ghent, Belgium
| | - Kim Pauwaert
- Department of Human Structure and Repair, Ghent University, 9000 Ghent, Belgium
| | - Joris Delanghe
- Department of Diagnostic Sciences, Ghent University, 9000 Ghent, Belgium
| | - Lien Dossche
- Department of Internal Medicine and Pediatrics, Ghent University, 9000 Ghent, Belgium
- Department of Pediatric Nephrology, Ghent University, 9000 Ghent, Belgium
| | - John Van Camp
- Department of Food Technology, Safety and Health, Ghent University, 9000 Ghent, Belgium
| | - Saskia Roggeman
- Research and Policy Department, Psychiatric Center Sint-Jan-Baptist, 9060 Zelzate, Belgium
| | - Karel Everaert
- Department of Human Structure and Repair, Ghent University, 9000 Ghent, Belgium
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Sahinoz M, Elijovich F, Ertuglu LA, Ishimwe J, Pitzer A, Saleem M, Mwesigwa N, Kleyman TR, Laffer CL, Kirabo A. Salt Sensitivity of Blood Pressure in Blacks and Women: A Role of Inflammation, Oxidative Stress, and Epithelial Na + Channel. Antioxid Redox Signal 2021; 35:1477-1493. [PMID: 34569287 PMCID: PMC8713266 DOI: 10.1089/ars.2021.0212] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Significance: Salt sensitivity of blood pressure (SSBP) is an independent risk factor for mortality and morbidity due to cardiovascular disease, and disproportionately affects blacks and women. Several mechanisms have been proposed, including exaggerated activation of sodium transporters in the kidney leading to salt retention and water. Recent Advances: Recent studies have found that in addition to the renal epithelium, myeloid immune cells can sense sodium via the epithelial Na+ channel (ENaC), which leads to activation of the nicotinamide adenine dinucleotide phosphate oxidase enzyme complex, increased fatty acid oxidation, and production of isolevuglandins (IsoLGs). IsoLGs are immunogenic and contribute to salt-induced hypertension. In addition, aldosterone-mediated activation of ENaC has been attributed to the increased SSBP in women. The goal of this review is to highlight mechanisms contributing to SSBP in blacks and women, including, but not limited to increased activation of ENaC, fatty acid oxidation, and inflammation. Critical Issues: A critical barrier to progress in management of SSBP is that its diagnosis is not feasible in the clinic and is limited to expensive and laborious research protocols, which makes it difficult to investigate. Yet without understanding the underlying mechanisms, this important risk factor remains without treatment. Future Directions: Further studies are needed to understand the mechanisms that contribute to differential blood pressure responses to dietary salt and find feasible diagnostic tools. This is extremely important and may go a long way in mitigating the racial and sex disparities in cardiovascular outcomes. Antioxid. Redox Signal. 35, 1477-1493.
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Affiliation(s)
- Melis Sahinoz
- Division of Nephrology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Fernando Elijovich
- Division of Clinical Pharmacology, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Lale A Ertuglu
- Division of Nephrology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Jeanne Ishimwe
- Division of Clinical Pharmacology, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Ashley Pitzer
- Division of Clinical Pharmacology, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Mohammad Saleem
- Division of Clinical Pharmacology, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Naome Mwesigwa
- Department of Medicine and Dentistry, Kampala International University, Kampala, Uganda
| | - Thomas R Kleyman
- Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.,Department of Cell Biology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.,Department of Pharmacology and Chemical Biology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Cheryl L Laffer
- Division of Clinical Pharmacology, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Annet Kirabo
- Division of Clinical Pharmacology, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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Oppelaar JJ, Rorije NMG, Olde Engberink RHG, Chahid Y, van Vlies N, Verberne HJ, van den Born BJH, Vogt L. Perturbed body fluid distribution and osmoregulation in response to high salt intake in patients with hereditary multiple exostoses. Mol Genet Metab Rep 2021; 29:100797. [PMID: 34815940 PMCID: PMC8591465 DOI: 10.1016/j.ymgmr.2021.100797] [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: 08/24/2021] [Accepted: 08/24/2021] [Indexed: 11/26/2022] Open
Abstract
Background Hereditary Multiple Exostoses (HME) is a rare autosomal disorder characterized by the presence of multiple exostoses (osteochondromas) caused by a heterozygous loss of function mutation in EXT1 or EXT2; genes involved in heparan sulfate (HS) chain elongation. Considering that HS and other glycosaminoglycans play an important role in sodium and water homeostasis, we hypothesized that HME patients have perturbed whole body volume regulation and osmolality in response to high sodium conditions. Methods We performed a randomized cross-over study in 7 male HME patients and 12 healthy controls, matched for age, BMI, blood pressure and renal function. All subjects followed both an 8-day low sodium diet (LSD, <50 mmol/d) and high sodium diet (HSD, >200 mmol/d) in randomized order. After each diet, blood and urine samples were collected. Body fluid compartment measurements were performed by using the distribution curve of iohexol and 125I-albumin. Results In HME patients, HSD resulted in significant increase of intracellular fluid volume (ICFV) (1.2 L, p = 0.01). In this group, solute-mediated water clearance was significantly lower after HSD, and no changes in interstitial fluid volume (IFV), plasma sodium, and effective osmolality were observed. In healthy controls, HSD did not influence ICFV, but expanded IFV (1.8 L, p = 0.058) and increased plasma sodium and effective osmolality. Conclusion HME patients show altered body fluid distribution and osmoregulation after HSD compared to controls. Our results might indicate reduced interstitial sodium accumulation capacity in HME, leading to ICFV increase. Therefore, this study provides additional support that HS is crucial for maintaining constancy of the internal environment.
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Key Words
- BMI, Body mass index
- BP, Blood pressure
- ECFV, Extracellular fluid volume
- EXT1/EXT2, Extosin-1 / Extosin-2
- GAG, Glycosaminoglycan
- Glycosaminoglycans
- HME, Hereditary Multiple Exostoses
- HSD, High sodium diet
- Heparan sulfate
- Hereditary Multiple Exostoses
- ICFV, Intracellular fluid volume
- IFV, Interstital fluid volume
- LSD, Low sodium diet
- Osmoregulation
- PV, Plasma volume
- Sodium
- TBW, Total body water
- Water balance
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Affiliation(s)
- Jetta J Oppelaar
- Amsterdam UMC, University of Amsterdam, Department of Internal Medicine, Section of Nephrology, Amsterdam Cardiovascular Sciences, Meibergdreef 9, Amsterdam, the Netherlands
| | - Nienke M G Rorije
- Amsterdam UMC, University of Amsterdam, Department of Internal Medicine, Section of Nephrology, Amsterdam Cardiovascular Sciences, Meibergdreef 9, Amsterdam, the Netherlands
| | - Rik H G Olde Engberink
- Amsterdam UMC, University of Amsterdam, Department of Internal Medicine, Section of Nephrology, Amsterdam Cardiovascular Sciences, Meibergdreef 9, Amsterdam, the Netherlands
| | - Youssef Chahid
- Amsterdam UMC, University of Amsterdam, Department of Radiology and Nuclear Medicine, Meibergdreef 9, Amsterdam, the Netherlands
| | - Naomi van Vlies
- Amsterdam UMC, University of Amsterdam, Laboratory Genetic Metabolic Diseases, Meibergdreef 9, Amsterdam, the Netherlands
| | - Hein J Verberne
- Amsterdam UMC, University of Amsterdam, Department of Radiology and Nuclear Medicine, Meibergdreef 9, Amsterdam, the Netherlands
| | - Bert-Jan H van den Born
- Amsterdam UMC, University of Amsterdam, Department of Internal Medicine, Section of Vascular Medicine, Amsterdam Cardiovascular Sciences, Meibergdreef 9, Amsterdam, the Netherlands
| | - Liffert Vogt
- Amsterdam UMC, University of Amsterdam, Department of Internal Medicine, Section of Nephrology, Amsterdam Cardiovascular Sciences, Meibergdreef 9, Amsterdam, the Netherlands
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Effect of sodium administration on fluid balance and sodium balance in health and the perioperative setting. Extended summary with additional insights from the MIHMoSA and TOPMAST studies. J Crit Care 2021; 67:157-165. [PMID: 34798374 DOI: 10.1016/j.jcrc.2021.10.022] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2021] [Revised: 10/26/2021] [Accepted: 10/26/2021] [Indexed: 12/26/2022]
Abstract
PURPOSE We aimed to provide an extended analysis of the physiological handling of of the sodium burden induced by maintenance fluids. MATERIALS AND METHODS We revisited two studies that demonstrated, in healthy volunteers and in surgical patients, that maintenance fluids with 154 mmol/L of sodium lead to a more positive fluid balance than a regimen containing 54 mmol/L. We report different unpublished data on the renal handling of the imposed sodium burdens with specific attention to the resulting fluid and sodium balances. RESULTS The kidneys adapt to the sodium-rich fluids not only by altering sodium excretion, but also by retaining extra free water by concentrating urine. Realigning urinary sodium excretion with an increased administration takes around one day in health and much longer in the clinical setting. This difference may be explained by the presence of hypovolemia-induced aldosterone secretion in the latter group. Non-osmotic storage of sodium limits an unrestrained fluid retention even when very high amounts of sodium are administered but fluid accumulation will inevitably be further prolonged. CONCLUSIONS Sodium administration induced by sodium-rich maintenance fluids leads, especially in the clinical setting, to prolonged fluid retention when compared with a regimen that resembles a healthy dietary sodium intake, even when kidney function is normal.
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39
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Affiliation(s)
- David H Ellison
- From the Oregon Clinical and Translational Research Institute, Oregon Health and Science University (D.H.E) and the VA Portland Health Care System (D.H.E.) - both in Portland; and LeDucq Transatlantic Network of Excellence (D.H.E., P.W.) and the Departments of Medicine and Physiology, Johns Hopkins University (P.W.) - both in Baltimore
| | - Paul Welling
- From the Oregon Clinical and Translational Research Institute, Oregon Health and Science University (D.H.E) and the VA Portland Health Care System (D.H.E.) - both in Portland; and LeDucq Transatlantic Network of Excellence (D.H.E., P.W.) and the Departments of Medicine and Physiology, Johns Hopkins University (P.W.) - both in Baltimore
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40
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Nihlén S, Frithiof R, Titze J, Kawati R, Rasmusson J, Rylander C, Pikwer A, Castegren M, Belin A, Hultström M, Lipcsey M. The Contribution of Plasma Urea to Total Osmolality During Iatrogenic Fluid Reduction in Critically Ill Patients. FUNCTION (OXFORD, ENGLAND) 2021; 3:zqab055. [PMID: 35330925 PMCID: PMC8788870 DOI: 10.1093/function/zqab055] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 10/14/2021] [Accepted: 10/27/2021] [Indexed: 01/07/2023]
Abstract
Hyperosmolality is common in critically ill patients during body fluid volume reduction. It is unknown whether this is only a result of decreased total body water or an active osmole-producing mechanism similar to that found in aestivating animals, where muscle degradation increases urea levels to preserve water. We hypothesized that fluid volume reduction in critically ill patients contributes to a shift from ionic to organic osmolytes similar to mechanisms of aestivation. We performed a post-hoc analysis on data from a multicenter observational study in adult intensive care unit (ICU) patients in the postresuscitative phase. Fluid, electrolyte, energy and nitrogen intake, fluid loss, estimated glomerular filtration rate (eGFR), and estimated plasma osmolality (eOSM) were registered. Contributions of osmolytes Na+, K+, urea, and glucose to eOSM expressed as proportions of eOSM were calculated. A total of 241 patients were included. eOSM increased (median change 7.4 mOsm/kg [IQR-1.9-18]) during the study. Sodium's and potassium's proportions of eOSM decreased (P < .05 and P < .01, respectively), whereas urea's proportion increased (P < .001). The urea's proportion of eOSM was higher in patients with negative vs. positive fluid balance. Urea's proportion of eOSM increased with eOSM (r = 0.63; adjusted for eGFR r = 0.80), but not nitrogen intake. In patients without furosemide and/or renal replacement therapy (n = 17), urea's proportion of eOSM and eOSM correlated strongly (r = 0.92). Urea's proportion of eOSM was higher in patients not surviving up to 90 d. In stabilized ICU patients, the contribution of urea to plasma osmolality increased during body water volume reduction, statistically independently of nitrogen administration and eGFR. The shift from ionic osmolytes to urea during body fluid volume reduction is similar to that seen in aestivating animals. ClinicalTrials.org Identifier: NCT03972475.
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Affiliation(s)
| | - Robert Frithiof
- Department of Surgical Sciences, Anesthesiology and Intensive Care, Uppsala University, SE-751 05 Uppsala, Sweden
| | - Jens Titze
- Programme in Cardiovascular and Metabolic Disorders, Duke-NUS Medical School, Singapore 169856, Singapore,Division of Nephrology and Hypertension, Friedrich-Alexander University Erlangen-Nuremberg, 91012 Erlangen, Germany,Division of Nephrology, Duke University Medical Center, Durham, NC 27710, USA
| | - Rafael Kawati
- Department of Surgical Sciences, Anesthesiology and Intensive Care, Uppsala University, SE-751 05 Uppsala, Sweden
| | - Johan Rasmusson
- Department of Anesthesiology and Intensive Care, Gävle County Hospital, SE-801 87 Gävle, Sweden
| | - Christian Rylander
- Department of Anaesthesiology and Intensive Care Medicine, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, SE-413 45 Göteborg, Sweden
| | - Andreas Pikwer
- Centre for Clinical Research Sörmland, Uppsala University, SE-631 88 Eskilstuna, Sweden
| | - Markus Castegren
- Centre for Clinical Research Sörmland, Uppsala University, SE-631 88 Eskilstuna, Sweden,Perioperative Medicine and Intensive Care, Karolinska University Hospital, and FyFa, Karolinska Institutet, SE-171 77 Stockholm, Sweden
| | - Anton Belin
- Department of Surgical Sciences, Anesthesiology and Intensive Care, Uppsala University, SE-751 05 Uppsala, Sweden
| | - Michael Hultström
- Department of Surgical Sciences, Anesthesiology and Intensive Care, Uppsala University, SE-751 05 Uppsala, Sweden,Integrative Physiology, Department of Medical Cell Biology, Uppsala University, SE-751 23 Uppsala, Sweden
| | - Miklos Lipcsey
- Department of Surgical Sciences, Anesthesiology and Intensive Care, Uppsala University, SE-751 05 Uppsala, Sweden,Hedenstierna Laboratory, CIRRUS, Department of Surgical Sciences, Anesthesiology and Intensive Care, Uppsala University, SE-751 05 Uppsala, Sweden, and Akademiska sjukhuset, SE-751 85 Uppsala, Sweden
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Kitada K, Kidoguchi S, Nakano D, Nishiyama A. Sodium/glucose cotransporter 2 and renoprotection: From the perspective of energy regulation and water conservation. J Pharmacol Sci 2021; 147:245-250. [PMID: 34507633 DOI: 10.1016/j.jphs.2021.07.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 07/19/2021] [Accepted: 07/26/2021] [Indexed: 01/14/2023] Open
Abstract
Sodium/glucose cotransporter 2 (SGLT2) is a renal low-affinity high-capacity sodium/glucose cotransporter expressed in the apical membrane of the early segment of proximal tubules. SGLT2 reabsorbs filtered glucose in the kidney, and its inhibitors represent a new class of oral medications used for type 2 diabetes mellitus, which act by increasing glucose and sodium excretion in urine, thereby reducing blood glucose levels. However, clinical trials showed marked improvement of renal outcomes, even in nondiabetic kidney diseases, although the underlying mechanism of this renoprotective effect is unclear. We showed that long-term excretion of salt by the kidneys, which predisposes to osmotic diuresis and water loss, induces a systemic body response for water conservation. The energy-intensive nature of water conservation leads to a reprioritization of systemic body energy metabolism. According to current data, use of SGLT2 inhibitors may result in similar reprioritization of energy metabolism to prevent dehydration. In this review article, we discuss the beneficial effects of SGLT2 inhibition from the perspective of energy metabolism and water conservation.
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Affiliation(s)
- Kento Kitada
- Department of Pharmacology, Faculty of Medicine, Kagawa University, Kagawa, Japan.
| | - Satoshi Kidoguchi
- Department of Pharmacology, Faculty of Medicine, Kagawa University, Kagawa, Japan; Division of Nephrology and Hypertension, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan
| | - Daisuke Nakano
- Department of Pharmacology, Faculty of Medicine, Kagawa University, Kagawa, Japan
| | - Akira Nishiyama
- Department of Pharmacology, Faculty of Medicine, Kagawa University, Kagawa, Japan
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42
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High-salt diet suppresses autoimmune demyelination by regulating the blood-brain barrier permeability. Proc Natl Acad Sci U S A 2021; 118:2025944118. [PMID: 33723078 PMCID: PMC7999868 DOI: 10.1073/pnas.2025944118] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Dietary salt intake has been considered an important risk factor for autoimmune diseases like multiple sclerosis (MS). Here we studied the effects of a high-salt diet (HSD) using a spontaneous autoimmune disease mouse model resembling MS. We found that high-salt consumption protects mice from developing the neurological disease by promoting the tightening of the blood–brain barrier and preventing the migration of autoreactive T cells into the CNS. Our results emphasize the multifarious effects of high-salt consumption in autoimmune disease susceptibility. Sodium chloride, “salt,” is an essential component of daily food and vitally contributes to the body’s homeostasis. However, excessive salt intake has often been held responsible for numerous health risks associated with the cardiovascular system and kidney. Recent reports linked a high-salt diet (HSD) to the exacerbation of artificially induced central nervous system (CNS) autoimmune pathology through changes in microbiota and enhanced TH17 cell differentiation [M. Kleinewietfeld et al., Nature 496, 518–522 (2013); C. Wu et al., Nature 496, 513–517 (2013); N. Wilck et al., Nature 551, 585–589 (2017)]. However, there is no evidence that dietary salt promotes or worsens a spontaneous autoimmune disease. Here we show that HSD suppresses autoimmune disease development in a mouse model of spontaneous CNS autoimmunity. We found that HSD consumption increased the circulating serum levels of the glucocorticoid hormone corticosterone. Corticosterone enhanced the expression of tight junction molecules on the brain endothelial cells and promoted the tightening of the blood–brain barrier (BBB) thereby controlling the entry of inflammatory T cells into the CNS. Our results demonstrate the multifaceted and potentially beneficial effects of moderately increased salt consumption in CNS autoimmunity.
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43
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Sánchez I, de la Rubia Ortí JE, Platero JL, Mariscal G, Barrios C. Modification of Diurnal Cortisol Secretion in Women's Professional Basketball. A Pilot Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:8961. [PMID: 34501551 PMCID: PMC8430658 DOI: 10.3390/ijerph18178961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 08/11/2021] [Accepted: 08/22/2021] [Indexed: 12/02/2022]
Abstract
Elite basketball training causes high levels of physiological stress, which can lead to negative physiological disorders in female athletes. The aim of this study was to establish the impact of physical activity on the rhythm of salivary cortisol secretion in elite female basketball players over one week. The population sample included 9 women professional basketball players. The control group was made up of 9 women who did not do any exercise. Saliva samples were collected from all participants at 9:00 a.m. and 11:00 p.m. on training days. Samples from the basketball group showed a significantly higher cortisol secretion. Moreover, from the second night, the pattern of cortisol secretion of these players was reversed, showing higher levels of cortisol in saliva at night than in the morning. The results suggest that the secretion rhythm changed over the course of the week and according to competitive demands.
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Affiliation(s)
- Irene Sánchez
- Institute for Research on Musculoskeletal Disorders, Catholic University of Valencia San Vicente Mártir, 46001 Valencia, Spain; (I.S.); (C.B.)
| | - Jose Enrique de la Rubia Ortí
- Department of Nursing, Catholic University of Valencia San Vicente Mártir, 46001 Valencia, Spain; (J.E.d.l.R.O.); (J.L.P.)
| | - Jose Luis Platero
- Department of Nursing, Catholic University of Valencia San Vicente Mártir, 46001 Valencia, Spain; (J.E.d.l.R.O.); (J.L.P.)
| | - Gonzalo Mariscal
- Institute for Research on Musculoskeletal Disorders, Catholic University of Valencia San Vicente Mártir, 46001 Valencia, Spain; (I.S.); (C.B.)
| | - Carlos Barrios
- Institute for Research on Musculoskeletal Disorders, Catholic University of Valencia San Vicente Mártir, 46001 Valencia, Spain; (I.S.); (C.B.)
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44
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Gafane-Matemane LF, Kruger R, Smith W, Mels CMC, Van Rooyen JM, Mokwatsi GG, Uys AS, Brits SJ, Schutte AE. Characterization of the Renin-Angiotensin-Aldosterone System in Young Healthy Black Adults: The African Prospective Study on the Early Detection and Identification of Hypertension and Cardiovascular Disease (African-PREDICT Study). Hypertension 2021; 78:400-410. [PMID: 34176281 DOI: 10.1161/hypertensionaha.120.16879] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
[Figure: see text].
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Affiliation(s)
- Lebo F Gafane-Matemane
- Hypertension in Africa Research Team (HART), North-West University, Potchefstroom, South Africa (L.F.G.-M., R.K., W.S., C.M.C.M., J.M.V.R., G.G.M., A.S.U., S.J.B., A.E.S.).,South African Medical Research Council: Unit for Hypertension and Cardiovascular Disease, North-West University, Potchefstroom, South Africa (L.F.G.-M., R.K., W.S., C.M.C.M., J.M.V.R., G.G.M., A.S.U., S.J.B., A.E.S.)
| | - Ruan Kruger
- Hypertension in Africa Research Team (HART), North-West University, Potchefstroom, South Africa (L.F.G.-M., R.K., W.S., C.M.C.M., J.M.V.R., G.G.M., A.S.U., S.J.B., A.E.S.).,South African Medical Research Council: Unit for Hypertension and Cardiovascular Disease, North-West University, Potchefstroom, South Africa (L.F.G.-M., R.K., W.S., C.M.C.M., J.M.V.R., G.G.M., A.S.U., S.J.B., A.E.S.)
| | - Wayne Smith
- Hypertension in Africa Research Team (HART), North-West University, Potchefstroom, South Africa (L.F.G.-M., R.K., W.S., C.M.C.M., J.M.V.R., G.G.M., A.S.U., S.J.B., A.E.S.).,South African Medical Research Council: Unit for Hypertension and Cardiovascular Disease, North-West University, Potchefstroom, South Africa (L.F.G.-M., R.K., W.S., C.M.C.M., J.M.V.R., G.G.M., A.S.U., S.J.B., A.E.S.)
| | - Catharina M C Mels
- Hypertension in Africa Research Team (HART), North-West University, Potchefstroom, South Africa (L.F.G.-M., R.K., W.S., C.M.C.M., J.M.V.R., G.G.M., A.S.U., S.J.B., A.E.S.).,South African Medical Research Council: Unit for Hypertension and Cardiovascular Disease, North-West University, Potchefstroom, South Africa (L.F.G.-M., R.K., W.S., C.M.C.M., J.M.V.R., G.G.M., A.S.U., S.J.B., A.E.S.)
| | - Johannes M Van Rooyen
- Hypertension in Africa Research Team (HART), North-West University, Potchefstroom, South Africa (L.F.G.-M., R.K., W.S., C.M.C.M., J.M.V.R., G.G.M., A.S.U., S.J.B., A.E.S.).,South African Medical Research Council: Unit for Hypertension and Cardiovascular Disease, North-West University, Potchefstroom, South Africa (L.F.G.-M., R.K., W.S., C.M.C.M., J.M.V.R., G.G.M., A.S.U., S.J.B., A.E.S.)
| | - Gontse G Mokwatsi
- Hypertension in Africa Research Team (HART), North-West University, Potchefstroom, South Africa (L.F.G.-M., R.K., W.S., C.M.C.M., J.M.V.R., G.G.M., A.S.U., S.J.B., A.E.S.).,South African Medical Research Council: Unit for Hypertension and Cardiovascular Disease, North-West University, Potchefstroom, South Africa (L.F.G.-M., R.K., W.S., C.M.C.M., J.M.V.R., G.G.M., A.S.U., S.J.B., A.E.S.)
| | - Aletta S Uys
- Hypertension in Africa Research Team (HART), North-West University, Potchefstroom, South Africa (L.F.G.-M., R.K., W.S., C.M.C.M., J.M.V.R., G.G.M., A.S.U., S.J.B., A.E.S.).,South African Medical Research Council: Unit for Hypertension and Cardiovascular Disease, North-West University, Potchefstroom, South Africa (L.F.G.-M., R.K., W.S., C.M.C.M., J.M.V.R., G.G.M., A.S.U., S.J.B., A.E.S.)
| | - Sanette J Brits
- Hypertension in Africa Research Team (HART), North-West University, Potchefstroom, South Africa (L.F.G.-M., R.K., W.S., C.M.C.M., J.M.V.R., G.G.M., A.S.U., S.J.B., A.E.S.).,South African Medical Research Council: Unit for Hypertension and Cardiovascular Disease, North-West University, Potchefstroom, South Africa (L.F.G.-M., R.K., W.S., C.M.C.M., J.M.V.R., G.G.M., A.S.U., S.J.B., A.E.S.)
| | - Aletta E Schutte
- Hypertension in Africa Research Team (HART), North-West University, Potchefstroom, South Africa (L.F.G.-M., R.K., W.S., C.M.C.M., J.M.V.R., G.G.M., A.S.U., S.J.B., A.E.S.).,South African Medical Research Council: Unit for Hypertension and Cardiovascular Disease, North-West University, Potchefstroom, South Africa (L.F.G.-M., R.K., W.S., C.M.C.M., J.M.V.R., G.G.M., A.S.U., S.J.B., A.E.S.).,School of Population Health, University of New South Wales; Sydney, Australia (A.E.S.).,The George Institute for Global Health, Sydney, Australia (A.E.S.)
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Hanson P, Philp CJ, Randeva HS, James S, O’Hare JP, Meersmann T, Pavlovskaya GE, Barber TM. Sodium in the dermis colocates to glycosaminoglycan scaffold, with diminishment in type 2 diabetes mellitus. JCI Insight 2021; 6:145470. [PMID: 34003801 PMCID: PMC8262470 DOI: 10.1172/jci.insight.145470] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Accepted: 05/13/2021] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Dietary sodium intake mismatches urinary sodium excretion over prolonged periods. Our aims were to localize and quantify electrostatically bound sodium within human skin using triple-quantum-filtered (TQF) protocols for MRI and magnetic resonance spectroscopy (MRS) and to explore dermal sodium in type 2 diabetes mellitus (T2D). METHODS We recruited adult participants with T2D (n = 9) and euglycemic participants with no history of diabetes mellitus (n = 8). All had undergone lower limb amputations or abdominal skin reduction surgery for clinical purposes. We used 20 μm in-plane resolution 1H MRI to visualize anatomical skin regions ex vivo from skin biopsies taken intraoperatively, 23Na TQF MRI/MRS to explore distribution and quantification of freely dissolved and bound sodium, and inductively coupled plasma mass spectrometry to quantify sodium in selected skin samples. RESULTS Human dermis has a preponderance (>90%) of bound sodium that colocalizes with the glycosaminoglycan (GAG) scaffold. Bound and free sodium have similar anatomical locations. T2D associates with a severely reduced dermal bound sodium capacity. CONCLUSION We provide the first evidence to our knowledge for high levels of bound sodium within human dermis, colocating to the GAG scaffold, consistent with a dermal "third space repository" for sodium. T2D associates with diminished dermal electrostatic binding capacity for sodium.
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Affiliation(s)
- Petra Hanson
- Warwick Medical School, University of Warwick, Coventry, United Kingdom
- Warwickshire Institute for the Study of Diabetes Endocrinology and Metabolism, University Hospitals Coventry and Warwickshire (UHCW), Clifford Bridge Road, Coventry, United Kingdom
| | | | - Harpal S. Randeva
- Warwick Medical School, University of Warwick, Coventry, United Kingdom
- Warwickshire Institute for the Study of Diabetes Endocrinology and Metabolism, University Hospitals Coventry and Warwickshire (UHCW), Clifford Bridge Road, Coventry, United Kingdom
| | - Sean James
- Warwickshire Institute for the Study of Diabetes Endocrinology and Metabolism, University Hospitals Coventry and Warwickshire (UHCW), Clifford Bridge Road, Coventry, United Kingdom
| | - J. Paul O’Hare
- Warwick Medical School, University of Warwick, Coventry, United Kingdom
- Warwickshire Institute for the Study of Diabetes Endocrinology and Metabolism, University Hospitals Coventry and Warwickshire (UHCW), Clifford Bridge Road, Coventry, United Kingdom
| | - Thomas Meersmann
- Sir Peter Mansfield Imaging Centre (SPMIC), School of Medicine, and
- Nottingham NIHR Biomedical Research Centre, University of Nottingham, Nottingham, United Kingdom
| | - Galina E. Pavlovskaya
- Sir Peter Mansfield Imaging Centre (SPMIC), School of Medicine, and
- Nottingham NIHR Biomedical Research Centre, University of Nottingham, Nottingham, United Kingdom
| | - Thomas M. Barber
- Warwick Medical School, University of Warwick, Coventry, United Kingdom
- Warwickshire Institute for the Study of Diabetes Endocrinology and Metabolism, University Hospitals Coventry and Warwickshire (UHCW), Clifford Bridge Road, Coventry, United Kingdom
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46
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Decreased renal function increases the nighttime urine volume rate by carryover of salt excretion to the nighttime. Sci Rep 2021; 11:10587. [PMID: 34012017 PMCID: PMC8134424 DOI: 10.1038/s41598-021-90166-x] [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] [Received: 02/17/2021] [Accepted: 05/07/2021] [Indexed: 12/20/2022] Open
Abstract
To determine the pathophysiology of nocturnal polyuria associated with renal dysfunction, patients who underwent laparoscopic nephrectomy were prospectively studied. The diurnal variation in urine volume, osmolality, and salt excretion were measured on preoperative day 2 and postoperative day 7. The factors associated with an increase in the nighttime urine volume rate with decreased renal function were evaluated using multiple linear regression analysis. Forty-nine patients were included. The estimated glomerular filtration rate decreased from 73.3 ± 2.0 to 47.2 ± 1.6 mL/min/1.73 m2 (P < 0.01) and the nighttime urine volume rate increased from 40.6% ± 2.0% to 45.3% ± 1.5% (P = 0.04) with nephrectomy. The nighttime urine osmolality decreased from 273 ± 15 to 212 ± 10 mOsm/kg and the nighttime salt excretion rate increased from 38.7% ± 2.1% to 48.8% ± 1.7% (both P < 0.01) with nephrectomy. Multiple linear regression analysis showed that the increase in the nighttime urine volume rate was strongly affected by the increase in the nighttime salt excretion rate. A decrease in renal function causes an increase in the nighttime urine volume rate, mainly because of an increase in nighttime salt excretion. Trial registration number: UMIN000036760 (University Hospital Medical Information Network Clinical Trials Registry). Date of registration: From 1 June 2019 to 31 October 2020.
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47
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Van Regenmortel N, Moers L, Langer T, Roelant E, De Weerdt T, Caironi P, Malbrain MLNG, Elbers P, Van den Wyngaert T, Jorens PG. Fluid-induced harm in the hospital: look beyond volume and start considering sodium. From physiology towards recommendations for daily practice in hospitalized adults. Ann Intensive Care 2021; 11:79. [PMID: 33999276 PMCID: PMC8128950 DOI: 10.1186/s13613-021-00851-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 04/03/2021] [Indexed: 12/21/2022] Open
Abstract
PURPOSE Iatrogenic fluid overload is a potential side effect of intravenous fluid therapy in the hospital. Little attention has been paid to sodium administration as a separate cause of harm. With this narrative review, we aim to substantiate the hypothesis that a considerable amount of fluid-induced harm is caused not only by fluid volume, but also by the sodium that is administered to hospitalized patients. METHODS We show how a regular dietary sodium intake is easily surpassed by the substantial amounts of sodium that are administered during typical hospital stays. The most significant sodium burdens are caused by isotonic maintenance fluid therapy and by fluid creep, defined as the large volume unintentionally administered to patients in the form of dissolved medication. In a section on physiology, we elaborate on the limited renal handling of an acute sodium load. We demonstrate how the subsequent retention of water is an energy-demanding, catabolic process and how free water is needed to excrete large burdens of sodium. We quantify the effect size of sodium-induced fluid retention and discuss its potential clinical impact. Finally, we propose preventive measures, discuss the benefits and risks of low-sodium maintenance fluid therapy, and explore options for reducing the amount of sodium caused by fluid creep. CONCLUSION The sodium burdens caused by isotonic maintenance fluids and fluid creep are responsible for an additional and avoidable derailment of fluid balance, with presumed clinical consequences. Moreover, the handling of sodium overload is characterized by increased catabolism. Easy and effective measures for reducing sodium load and fluid retention include choosing a hypotonic rather than isotonic maintenance fluid strategy (or avoiding these fluids when enough free water is provided through other sources) and dissolving as many medications as possible in glucose 5%.
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Affiliation(s)
- Niels Van Regenmortel
- Department of Intensive Care Medicine, Antwerp University Hospital, Wilrijkstraat 10 Edegem, B-2650, Antwerp, Belgium. .,Department of Intensive Care Medicine, Ziekenhuis Netwerk Antwerpen Campus Stuivenberg, Lange Beeldekensstraat 267, B-2060, Antwerp, Belgium.
| | - Lynn Moers
- Department of Pharmacy, Ziekenhuis Netwerk Antwerpen Campus Stuivenberg, Lange Beeldekensstraat 267, B-2060, Antwerp, Belgium
| | - Thomas Langer
- Department of Medicine and Surgery, University of Milan-Bicocca, Monza, Italy.,Department of Anaesthesia and Intensive Care Medicine, Niguarda Ca' Granda, Milan, Italy
| | - Ella Roelant
- StatUa, Center for Statistics, University of Antwerp, Prinsstraat 13, B-2000, Antwerp, Belgium.,Clinical Trial Center (CTC), CRC Antwerp, Antwerp University Hospital, University of Antwerp, Wilrijkstraat 10, B-2650, Edegem, Belgium
| | - Tim De Weerdt
- Department of Nephrology, Kliniek Sint-Jan, Kruidtuinlaan 32, B-1000, Brussels, Belgium
| | - Pietro Caironi
- Department of Anesthesia and Critical Care, AOU S. Luigi Gonzaga, Department of Oncology, University of Turin, Turin, Italy
| | - Manu L N G Malbrain
- Faculty of Engineering, Vrije Universiteit Brussel (VUB), Laarbeeklaan 103, 1090, Jette, Belgium
| | - Paul Elbers
- Department of Intensive Care Medicine, Research VUmc Intensive Care (REVIVE), Amsterdam Medical Data Science (AMDS), Amsterdam Cardiovascular Sciences (ACS), Amsterdam Infection and Immunity Institute (AI&II), Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands
| | - Tim Van den Wyngaert
- Department of Nuclear Medicine, Antwerp University Hospital, Wilrijkstraat 10 Edegem, B-2650, Antwerp, Belgium.,Faculty of Medicine and Health Sciences, University of Antwerp, Universiteitsplein 1 Wilrijk, B-2610, Antwerp, Belgium
| | - Philippe G Jorens
- Department of Intensive Care Medicine, Antwerp University Hospital, Wilrijkstraat 10 Edegem, B-2650, Antwerp, Belgium.,Faculty of Medicine and Health Sciences, University of Antwerp, Universiteitsplein 1 Wilrijk, B-2610, Antwerp, Belgium
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48
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Jobin K, Müller DN, Jantsch J, Kurts C. Sodium and its manifold impact on our immune system. Trends Immunol 2021; 42:469-479. [PMID: 33962888 DOI: 10.1016/j.it.2021.04.002] [Citation(s) in RCA: 45] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 04/01/2021] [Accepted: 04/02/2021] [Indexed: 12/19/2022]
Abstract
The Western diet is rich in salt, and a high salt diet (HSD) is suspected to be a risk factor for cardiovascular diseases. It is now widely accepted that an experimental HSD can stimulate components of the immune system, potentially exacerbating certain autoimmune diseases, or alternatively, improving defenses against certain infections, such as cutaneous leishmaniasis. However, recent findings show that an experimental HSD may also aggravate other infections (e.g., pyelonephritis or systemic listeriosis). Here, we discuss the modulatory effects of a HSD on the microbiota, metabolic signaling, hormonal responses, local sodium concentrations, and their effects on various immune cell types in different tissues. We describe how these factors are integrated, resulting either in immune stimulation or suppression in various tissues and disease settings.
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Affiliation(s)
- Katarzyna Jobin
- Institute of Molecular Medicine and Experimental Immunology, University of Bonn, Bonn, Germany; Würzburg Institute of Systems Immunology, Max-Planck Research Group, University of Würzburg, Würzburg, Germany
| | - Dominik N Müller
- Experimental and Clinical Research Center (ECRC), a cooperation of Charité-Universitätsmedizin Berlin and Max Delbruck Center for Molecular Medicine, and Max Delbruck Center for Molecular Medicine in the Helmholtz Association (MDC), Berlin, Germany; Max Delbrück Center for Molecular Medicine in the Helmholtz Association, Berlin, Germany
| | - Jonathan Jantsch
- Institute of Clinical Microbiology and Hygiene, University Hospital of Regensburg and University of Regensburg, Regensburg, Germany.
| | - Christian Kurts
- Institute of Molecular Medicine and Experimental Immunology, University of Bonn, Bonn, Germany; Department of Microbiology and Immunology, Doherty Institute for Infection and Immunity, University of Melbourne, Victoria, Australia.
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49
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Kovarik JJ, Morisawa N, Wild J, Marton A, Takase‐Minegishi K, Minegishi S, Daub S, Sands JM, Klein JD, Bailey JL, Kovalik J, Rauh M, Karbach S, Hilgers KF, Luft F, Nishiyama A, Nakano D, Kitada K, Titze J. Adaptive physiological water conservation explains hypertension and muscle catabolism in experimental chronic renal failure. Acta Physiol (Oxf) 2021; 232:e13629. [PMID: 33590667 PMCID: PMC8244025 DOI: 10.1111/apha.13629] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Revised: 02/11/2021] [Accepted: 02/11/2021] [Indexed: 12/22/2022]
Abstract
Aim We have reported earlier that a high salt intake triggered an aestivation‐like natriuretic‐ureotelic body water conservation response that lowered muscle mass and increased blood pressure. Here, we tested the hypothesis that a similar adaptive water conservation response occurs in experimental chronic renal failure. Methods In four subsequent experiments in Sprague Dawley rats, we used surgical 5/6 renal mass reduction (5/6 Nx) to induce chronic renal failure. We studied solute and water excretion in 24‐hour metabolic cage experiments, chronic blood pressure by radiotelemetry, chronic metabolic adjustment in liver and skeletal muscle by metabolomics and selected enzyme activity measurements, body Na+, K+ and water by dry ashing, and acute transepidermal water loss in conjunction with skin blood flow and intra‐arterial blood pressure. Results 5/6 Nx rats were polyuric, because their kidneys could not sufficiently concentrate the urine. Physiological adaptation to this renal water loss included mobilization of nitrogen and energy from muscle for organic osmolyte production, elevated norepinephrine and copeptin levels with reduced skin blood flow, which by means of compensation reduced their transepidermal water loss. This complex physiologic‐metabolic adjustment across multiple organs allowed the rats to stabilize their body water content despite persisting renal water loss, albeit at the expense of hypertension and catabolic mobilization of muscle protein. Conclusion Physiological adaptation to body water loss, termed aestivation, is an evolutionary conserved survival strategy and an under‐studied research area in medical physiology, which besides hypertension and muscle mass loss in chronic renal failure may explain many otherwise unexplainable phenomena in medicine.
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Affiliation(s)
- Johannes J. Kovarik
- Programme in Cardiovascular and Metabolic DisordersDuke‐NUS Medical School Singapore Singapore
- Clinical Division of Nephrology and Dialysis Department of Internal Medicine III Medical University of Vienna Vienna Austria
| | - Norihiko Morisawa
- Department of Pharmacology Faculty of Medicine Kagawa University Kagawa Japan
| | - Johannes Wild
- Division for Cardiology 1 Centre for Cardiology Johannes Gutenberg‐University Mainz Mainz Germany
| | - Adriana Marton
- Programme in Cardiovascular and Metabolic DisordersDuke‐NUS Medical School Singapore Singapore
| | - Kaoru Takase‐Minegishi
- Programme in Cardiovascular and Metabolic DisordersDuke‐NUS Medical School Singapore Singapore
- Department of Stem Cell and Immune Regulation Yokohama City University Graduate School of Medicine Yokohama Japan
| | - Shintaro Minegishi
- Programme in Cardiovascular and Metabolic DisordersDuke‐NUS Medical School Singapore Singapore
- Department of Medical Science and Cardiorenal Medicine Yokohama City University Graduate School of Medicine Yokohama Japan
| | - Steffen Daub
- Division for Cardiology 1 Centre for Cardiology Johannes Gutenberg‐University Mainz Mainz Germany
| | - Jeff M. Sands
- Renal Division Department of Medicine Emory University Atlanta GA USA
| | - Janet D. Klein
- Renal Division Department of Medicine Emory University Atlanta GA USA
| | - James L. Bailey
- Renal Division Department of Medicine Emory University Atlanta GA USA
| | - Jean‐Paul Kovalik
- Programme in Cardiovascular and Metabolic DisordersDuke‐NUS Medical School Singapore Singapore
| | - Manfred Rauh
- Division of Paediatrics Research Laboratory Erlangen Germany
| | - Susanne Karbach
- Division for Cardiology 1 Centre for Cardiology Johannes Gutenberg‐University Mainz Mainz Germany
| | - Karl F. Hilgers
- Division of Nephrology and Hypertension University Clinic Erlangen Erlangen Germany
| | - Friedrich Luft
- Experimental and Clinical Research Center Max Delbrück Center for Molecular Medicine Berlin Germany
| | - Akira Nishiyama
- Department of Pharmacology Faculty of Medicine Kagawa University Kagawa Japan
| | - Daisuke Nakano
- Department of Pharmacology Faculty of Medicine Kagawa University Kagawa Japan
| | - Kento Kitada
- Programme in Cardiovascular and Metabolic DisordersDuke‐NUS Medical School Singapore Singapore
- JSPS Overseas Research Fellow Japan Society for the Promotion of Science Tokyo Japan
| | - Jens Titze
- Programme in Cardiovascular and Metabolic DisordersDuke‐NUS Medical School Singapore Singapore
- Division of Nephrology and Hypertension University Clinic Erlangen Erlangen Germany
- Division of Nephrology Duke University School of Medicine Durham NC USA
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50
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Rossitto G, Maiolino G, Lerco S, Ceolotto G, Blackburn G, Mary S, Antonelli G, Berton C, Bisogni V, Cesari M, Seccia TM, Lenzini L, Pinato A, Montezano A, Touyz RM, Petrie MC, Daly R, Welsh P, Plebani M, Rossi GP, Delles C. High sodium intake, glomerular hyperfiltration, and protein catabolism in patients with essential hypertension. Cardiovasc Res 2021; 117:1372-1381. [PMID: 33053160 PMCID: PMC8064429 DOI: 10.1093/cvr/cvaa205] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 05/28/2020] [Accepted: 07/10/2020] [Indexed: 01/01/2023] Open
Abstract
AIMS A blood pressure (BP)-independent metabolic shift towards a catabolic state upon high sodium (Na+) diet, ultimately favouring body fluid preservation, has recently been described in pre-clinical controlled settings. We sought to investigate the real-life impact of high Na+ intake on measures of renal Na+/water handling and metabolic signatures, as surrogates for cardiovascular risk, in hypertensive patients. METHODS AND RESULTS We analysed clinical and biochemical data from 766 consecutive patients with essential hypertension, collected at the time of screening for secondary causes. The systematic screening protocol included 24 h urine (24 h-u-) collection on usual diet and avoidance of renin-angiotensin-aldosterone system-confounding medications. Urinary 24 h-Na+ excretion, used to define classes of Na+ intake (low ≤2.3 g/day; medium 2.3-5 g/day; high >5 g/day), was an independent predictor of glomerular filtration rate after correction for age, sex, BP, BMI, aldosterone, and potassium excretion [P = 0.001; low: 94.1 (69.9-118.8) vs. high: 127.5 (108.3-147.8) mL/min/1.73 m2]. Renal Na+ and water handling diverged, with higher fractional excretion of Na+ and lower fractional excretion of water in those with evidence of high Na+ intake [FENa: low 0.39% (0.30-0.47) vs. high 0.81% (0.73-0.98), P < 0.001; FEwater: low 1.13% (0.73-1.72) vs. high 0.89% (0.69-1.12), P = 0.015]. Despite higher FENa, these patients showed higher absolute 24 h Na+ reabsorption and higher associated tubular energy expenditure, estimated by tubular Na+/ATP stoichiometry, accordingly [Δhigh-low = 18 (12-24) kcal/day, P < 0.001]. At non-targeted liquid chromatography/mass spectrometry plasma metabolomics in an unselected subcohort (n = 67), metabolites which were more abundant in high versus low Na+ intake (P < 0.05) mostly entailed intermediates or end products of protein catabolism/urea cycle. CONCLUSION When exposed to high Na+ intake, kidneys dissociate Na+ and water handling. In hypertensive patients, this comes at the cost of higher glomerular filtration rate, increased tubular energy expenditure, and protein catabolism from endogenous (muscle) or excess exogenous (dietary) sources. Glomerular hyperfiltration and the metabolic shift may have broad implications on global cardiovascular risk independent of BP.
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Affiliation(s)
- Giacomo Rossitto
- Institute of Cardiovascular and Medical Sciences, BHF Glasgow Cardiovascular Research Centre 126 University Place, University of Glasgow, Glasgow G12 8TA, UK
- Clinica dell’Ipertensione, DIMED, University of Padua, University Hospital, via Giustiniani 2, Padua 35126, Italy
| | - Giuseppe Maiolino
- Clinica dell’Ipertensione, DIMED, University of Padua, University Hospital, via Giustiniani 2, Padua 35126, Italy
| | - Silvia Lerco
- Clinica dell’Ipertensione, DIMED, University of Padua, University Hospital, via Giustiniani 2, Padua 35126, Italy
| | - Giulio Ceolotto
- Clinica dell’Ipertensione, DIMED, University of Padua, University Hospital, via Giustiniani 2, Padua 35126, Italy
| | - Gavin Blackburn
- Glasgow Polyomics, University of Glasgow, Wolfson Wohl Cancer Research Centre, Garscube Campus, Bearsden, Glasgow G61 1BD, UK
| | - Sheon Mary
- Institute of Cardiovascular and Medical Sciences, BHF Glasgow Cardiovascular Research Centre 126 University Place, University of Glasgow, Glasgow G12 8TA, UK
| | - Giorgia Antonelli
- Laboratory Medicine, DIMED, University of Padua, University Hospital, via Giustiniani 2, Padua 35126, Italy
| | - Chiara Berton
- Clinica dell’Ipertensione, DIMED, University of Padua, University Hospital, via Giustiniani 2, Padua 35126, Italy
| | - Valeria Bisogni
- Clinica dell’Ipertensione, DIMED, University of Padua, University Hospital, via Giustiniani 2, Padua 35126, Italy
| | - Maurizio Cesari
- Clinica dell’Ipertensione, DIMED, University of Padua, University Hospital, via Giustiniani 2, Padua 35126, Italy
| | - Teresa Maria Seccia
- Clinica dell’Ipertensione, DIMED, University of Padua, University Hospital, via Giustiniani 2, Padua 35126, Italy
| | - Livia Lenzini
- Clinica dell’Ipertensione, DIMED, University of Padua, University Hospital, via Giustiniani 2, Padua 35126, Italy
| | - Alessio Pinato
- Laboratory Medicine, DIMED, University of Padua, University Hospital, via Giustiniani 2, Padua 35126, Italy
| | - Augusto Montezano
- Institute of Cardiovascular and Medical Sciences, BHF Glasgow Cardiovascular Research Centre 126 University Place, University of Glasgow, Glasgow G12 8TA, UK
| | - Rhian M Touyz
- Institute of Cardiovascular and Medical Sciences, BHF Glasgow Cardiovascular Research Centre 126 University Place, University of Glasgow, Glasgow G12 8TA, UK
| | - Mark C Petrie
- Institute of Cardiovascular and Medical Sciences, BHF Glasgow Cardiovascular Research Centre 126 University Place, University of Glasgow, Glasgow G12 8TA, UK
| | - Ronan Daly
- Glasgow Polyomics, University of Glasgow, Wolfson Wohl Cancer Research Centre, Garscube Campus, Bearsden, Glasgow G61 1BD, UK
| | - Paul Welsh
- Institute of Cardiovascular and Medical Sciences, BHF Glasgow Cardiovascular Research Centre 126 University Place, University of Glasgow, Glasgow G12 8TA, UK
| | - Mario Plebani
- Laboratory Medicine, DIMED, University of Padua, University Hospital, via Giustiniani 2, Padua 35126, Italy
| | - Gian Paolo Rossi
- Clinica dell’Ipertensione, DIMED, University of Padua, University Hospital, via Giustiniani 2, Padua 35126, Italy
| | - Christian Delles
- Institute of Cardiovascular and Medical Sciences, BHF Glasgow Cardiovascular Research Centre 126 University Place, University of Glasgow, Glasgow G12 8TA, UK
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