Diuretic and renal effects of angiotensin receptor-neprilysin inhibitor in patients hospitalized for acute heart failure

In patients hospitalized for acute decompensation of heart failure (HF), the impact of angiotensin receptor-neprilysin inhibitor (ARNI) on diuresis and renal function has not been fully investigated. Patients with HF and reduced ejection fraction who were hospitalized for acute decompensation and newly initiated ARNI after hemodynamic stabilization were enrolled. Changes in urine volume (UV), body weight, estimated glomerular filtration rate (eGFR), and urine N-acetyl-beta-d-glucosaminidase (uNAG) levels before and after ARNI initiation were investigated. Changes in the diuretic response [DR, calculated as urine volume/(intravenous furosemide volume/40 mg)], N-terminal pro-brain natriuretic peptide (NT-proBNP), hematocrit, and plasma volume (PV) were also evaluated. A total of 60 patients were enrolled. ARNI was initiated at a median of 6 [5, 7] days after hospitalization. After initiation of ARNI, body weight, NT-proBNP, and PV decreased. UV and DR increased only on the day of ARNI initiation (delta UV 400 ± 957 ml and delta DR 1100 ± 3107 ml/40 mg furosemide) and then decreased to baseline levels. In the multivariable linear regression analysis, younger age, higher BMI, and higher NT-proBNP levels were significantly associated with greater UV after ARNI initiation. eGFR and uNAG did not significantly change after the initiation of ARNI [delta eGFR -1.7 ± 12.0 mL/min/1.73 m² and delta uNAG 2.0 (-5.6, 6.9) IU/L]. In patients hospitalized for HF, the initiation of ARNI was associated with a small and transient increase in UV and DR, and was not associated with worsening of renal function or tubular injury.

Biomarkers of cadmium exposure and renal function in estuarine adult villagers

OBJECTIVE

Assess cadmium (Cd) exposure of adults living in two estuarine communities in Aratu bay, Bahia, Brazil and its association with effects on renal function.

METHODS

This cross-sectional study included 88 volunteers aged 17-55 years, living in the following two communities: Santa Luzia (SL) located more intimately in the bay and Cotegipe (CT), a bit further and closer to a ferro-manganese alloy plant. Cd in blood (CdB) and urine (CdU), along with blood lead (PbB) levels were determined by graphite furnace atomic absorption spectrometry. Renal function was evaluated by the estimated glomerular filtration rate (eGFR) and tubular cell biomarkers: retinol binding protein (RBP), β2-microglobulin (β2M), and N-acetyl-β-D-glucosaminidase (NAG).

RESULTS

The median CdU levels in villagers of the two communities were 0.20 and 0.44 µg/g creat. and SL vs CT, respectively. Age range (> 35 years), cigarette smoking and lower family income were significantly associated with more elevated CdU levels. Multiple linear regression analysis demonstrated a significant association between LnCdU and LnRBP levels (β = 0.200, 95%CI 0.074-0.365) after adjusted for sex, urinary creatinine and blood lead levels.

CONCLUSION

These data show consistent evidences of association between Cd exposure and elevated tubular cell biomarker excretion in estuarine villagers living close to an industrial site.

Human biomonitoring initiative (HBM4EU): Human biomonitoring guidance values (HBM-GVs) derived for cadmium and its compounds

AIMS

The methodology agreed within the framework of the HBM4EU project is used in this work to derive HBM-GVs for the general population (HBM-GV_GenPop) and for workers (HBM-GV_Worker) exposed to cadmium (Cd) and its compounds.

METHODS

For Cd, a significant number of epidemiological studies with dose-response relationships are available, in particular for kidney effects. These effects are described in terms of a relation between urinary Cd (U-Cd) or blood Cd (B-Cd) levels and low molecular weight proteinuria (LMWP) markers like beta-2-microglobulin (β2M) and retinol-binding protein (RBP). In order to derive HBM-GVs for the general population and workers, an assessment of data from evaluations conducted by national or international organisations was undertaken. In this work, it appeared relevant to select renal effects as the critical effect for the both groups, however, differences between general population (including sensitive people) and workers (considered as an homogenous population of adults who should not be exposed to Cd if they suffer from renal diseases) required the selection of different key studies (i.e. conducted in general population for HBM-GV_GenPop and at workplace for HBM-GV_Worker).

RESULTS AND CONCLUSIONS

For U-Cd, a HBM-GV_GenPop of 1 µg/g creatinine (creat) is recommended for adults older than 50 years, based on a robust meta-analysis performed by EFSA (EFSA, 2009a). To take into account the accumulation of Cd in the human body throughout life, threshold or 'alert' values according to age were estimated for U-Cd. At workplace, a HBM-GV_Worker of 2 μg/g creat is derived from the study of Chaumont et al., (2011) for U-Cd, and in addition to this recommendation a HBM-GV_worker for B-Cd of 5 µg/L is also proposed. The HBM-GV_Worker for U-Cd is similar to the biological limit value (BLV) set by the new amendment of the European Carcinogens and Mutagens Directive in June 2019 (2 µg/g creat for U-Cd).

Human inorganic mercury exposure, renal effects and possible pathways in Wanshan mercury mining area, China

Rice can accumulate methylmercury (MeHg) and rice consumption is the main route of MeHg exposure for the local population in Guizhou, China. However, inorganic Hg (IHg) load in human body is not comprehensively studied in highly Hg polluted areas such as Hg mining areas. This study is designed to evaluate human IHg exposure, related renal effects and possible pathways in Wanshan Hg mining area, Guizhou, Southwest China. Residents lived within 3 km to the mine waste heaps showed high Urine Hg (UHg) concentrations and the geometrical means (Geomean) of UHg were 8.29, 5.13, and 10.3 μg/g Creatinine (Cr) at site A, D, and E, respectively. It demonstrated a gradient of UHg concentrations with the distance from the pollution sources. A significantly positive correlation between paired results for UHg concentrations and serum creatinine (SCr) was observed in this study, but not for UHg and blood urea nitrogen (BUN). There are significant increases of SCr in two quartiles with high UHg concentrations. The results indicated that human IHg exposure may cause impairment of renal function. By calculation of Probable Daily Intake from different routes, we found that dietary intake is the main pathway of IHg exposure for the local population, rather than inhalation of Hg vapor.

Renal and blood pressure effects from environmental cadmium exposure in Thai children

Very few studies have shown renal and blood pressure effects from environmental cadmium exposure in children. This population study examined associations between urinary cadmium excretion, a good biomarker of long-term cadmium exposure, and renal dysfunctions and blood pressure in environmentally exposed Thai children. Renal functions including urinary excretion of β2-microglobulin, calcium (early renal effects), and total protein (late renal effect), and blood pressure were measured in 594 primary school children. Of the children studied, 19.0% had urinary cadmium ≥ 1 μg/g creatinine. The prevalence of urinary cadmium ≥ 1 μg/g creatinine was significantly higher in girls and in those consuming rice grown in cadmium-contaminated areas. The geometric mean levels of urinary β2-microglobulin, calcium, and total protein significantly increased with increasing tertiles of urinary cadmium. The analysis did not show increased blood pressure with increasing tertiles of urinary cadmium. After adjusting for age, sex, and blood lead levels, the analysis showed significant positive associations between urinary cadmium and urinary β2-microglobulin and urinary calcium, but not urinary total protein nor blood pressure. Our findings provide evidence that environmental cadmium exposure can affect renal functions in children. A follow-up study is essential to assess the clinical significance and progress of renal effects in these children.