Hemodynamic Correlates of Proteinuria in Chronic Kidney Disease

Weir, Matthew R.; Townsend, Raymond R.; Fink, Jeffrey C.; Anderson, Cheryl A.M.; Appel, Lawrence J.; Chen, Jing; He, Jiang; Litbarg, Natasha; Rahman, Mahboob; Rosen, Liana W.; Sozio, Stephen M.; Steigerwalt, Susan; Strauss, Louise; Joffe, Marshall M.

doi:10.2215/cjn.01670211

Cited by 41 publications

(27 citation statements)

References 44 publications

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“…Hence, central blood pressures may be of higher clinical importance than peripheral pressures [33]. In addition, there is mounting evidence suggesting that monitoring of cASBP and cADBP as well as their cardiovascular relevance gain importance in the CKD population [34]. In the present study, we preferred to use the Mobil-O-Graph blood pressure device, which has been validated to estimate central hemodynamic parameters via measuring brachial oscillometric blood pressure waves noninvasively [35].…”

Section: Discussionmentioning

confidence: 99%

The Relationship between Serum Oxalic Acid, Central Hemodynamic Parameters and Colonization by Oxalobacter formigenes in Hemodialysis Patients

et al. 2015

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Background/Objective: Elevated pulse wave velocity (PWV) and central aortic blood pressures are independent predictors of increased cardiovascular morbidity and mortality in hemodialysis (HD) patients. Oxalic acid is a uremic retention molecule that is extensively studied in the pathogenesis of calcium oxalate stones. Oxalobacter formigenes, a member of the colon microbiota, has important roles in oxalate homeostasis. Data regarding the colonization by and the exact role of O. formigenes in the pathogenesis of oxalic acid metabolism in HD patients are scant. Hence, we aimed to determine the relationship between fecal O. formigenes colonization, serum oxalic acid and hemodynamic parameters in HD patients with regard to the colo-reno-cardiac axis. Methods: Fifty HD patients were enrolled in this study. PWV and central aortic systolic (cASBP) and diastolic blood pressures (cADBP) were measured with a Mobil-O-Graph (I.E.M. GmbH, Stolberg, Germany). Serum oxalic acid levels were assessed by ELISA, and fecal O. formigenes DNA levels were isolated and measured by real-time PCR. Results: Isolation of fecal O. formigenes was found in only 2 HD patients. One of them had 113,609 copies/ml, the other one had 1,056 copies/ml. Serum oxalic acid levels were found to be positively correlated with PWV (r = 0.29, p = 0.03), cASBP (r = 0.33, p = 0.001) and cADBP (r = 0.42, p = 0.002) and negatively correlated with LDL (r = -0.30, p = 0.03). In multivariate linear regression analysis, PWV was independently predicted by oxalic acid, glucose and triglyceride. Conclusions: This is the first study that demonstrates the absence of O. formigenes as well as a relation between serum oxalic acid and cASBP, cADBP and PWV in HD patients. Replacement of O. formigenes with pre- and probiotics might decrease serum oxalic acid levels and improve cardiovascular outcomes in HD patients.

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Section: Discussionmentioning

confidence: 99%

The Relationship between Serum Oxalic Acid, Central Hemodynamic Parameters and Colonization by Oxalobacter formigenes in Hemodialysis Patients

et al. 2015

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“…Furthermore, in the Chronic Renal Insufficiency Cohort, adding pulse wave velocity measurement to systolic BP accounted for minimal additional variation in 24 hour proteinuria. 22 Therefore, it would seem unlikely that the substantial change in the systolic BP-FE alb relationship at low eGFR is mediated entirely by arterial stiffness.…”

Section: Discussionmentioning

confidence: 99%

Modification of the Relationship Between Blood Pressure and Renal Albumin Permeability by Impaired Excretory Function and Diabetes

et al. 2015

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H ypertension accelerates the progression of chronic kidney disease (CKD) and controlling blood pressure (BP) is the mainstay of general CKD management. 1,2 In animal models, a remnant nephron effect has been described, whereby a reduction in nephron mass results in increased transmission of systemic hydrostatic pressure to the glomerular microcirculation, accompanied by increased glomerular permeability, proteinuria, and progressive renal injury.3-5 Operation of a similar phenomenon in human CKD is implied by the fact that faster CKD progression is associated with BP increments that in isolation rarely initiate significant loss of excretory function.6 However, the relationship between nephron loss and vulnerability to hypertensive damage in humans is poorly defined; it is unknown whether there is a threshold level of excretory impairment at which BP increments are more likely to overcome renal autoregulation and induce further injury. Antihypertensive trials have not reported effects on hard renal end points stratified by baseline function and so guidelines do not differentiate CKD BP targets on the basis of estimated glomerular filtration rate (eGFR). 1Increased glomerular albumin leak is a feature of hypertensive renal end-organ damage, and there is some evidence that CKD patients with heavier proteinuria benefit from lower BP targets. 7,8 It is postulated that these observations reflect an increase in glomerular permeability caused by elevated glomerular capillary hydrostatic pressure. 9,10We sought evidence of a human remnant nephron effect increasing the transmission of BP to the glomerular microcirculation and modulating the relationship between increasing BP and albumin permeability. Specifically, we hypothesized that at lower levels of excretory function, a given BP increment would be associated with a greater relative increase in renal albumin permeability. This hypothesis was tested in a representative sample of the US population: the National Health and Nutrition Examination Survey (NHANES) 1999 to 2010. Fractional excretion of albumin (FE alb , relative to creatinine) was used as the primary measure of albumin permeability; because a given albumin leak occurring across a reduced nephron mass must indicate a greater degree of albumin permeability, 11 FE alb is a more logical measure of renal albumin permeability than the total urine albumin:creatinine ratio (ACR).Diabetes mellitus, like reduced nephron mass, is considered to increase the transmission of systemic pressure to the Abstract-In animal models, reduced nephron mass impairs renal arteriolar autoregulation, increasing vulnerability of the remaining nephrons to elevated systemic blood pressure (BP). A feature of the resulting glomerular capillary hypertension is an increase in glomerular permeability. We sought evidence of a similar remnant nephron effect in human chronic kidney disease. In participants from the United States National Health and Nutrition Examination Surveys 1999 to 2010 (N=23 710), we examined the effect of reduced estimated ...

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“…Systemic hypertension and glomerular hypertension has also been associated with more marked proteinuria both in experimental rodent studies and also in human studies. 159,160 The evidence for systemic hypertension contributing to the development or progression of feline CKD is unclear. In feline experimental renal mass reduction models, systemic hypertension has been associated with histopathological changes.…”

Section: Systemic Hypertensionmentioning

confidence: 99%

Current Understanding of the Pathogenesis of Progressive Chronic Kidney Disease in Cats

Jepson

2016

Veterinary Clinics of North America: Small Animal Practice

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Abstract:In cats with chronic kidney disease (CKD), the most common histopathological finding is tubulointerstitial inflammation and fibrosis. However, these changes reflect a non-specific response of the kidney to any inciting injury. The risk of development of CKD in a patient is likely to reflect genetic predispositions, ageing, environmental and individual factors that influence decline in renal function over the course of a cat's life. However, there is still relatively little information about exactly which risk factors predispose a cat to develop CKD and these will be explored. Whilst many cats diagnosed with CKD have stable disease for many years, some cats show overtly progressive disease.

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Hemodynamic Correlates of Proteinuria in Chronic Kidney Disease

Cited by 41 publications

References 44 publications

The Relationship between Serum Oxalic Acid, Central Hemodynamic Parameters and Colonization by <b><i>Oxalobacter formigenes </i></b>in Hemodialysis Patients

The Relationship between Serum Oxalic Acid, Central Hemodynamic Parameters and Colonization by <b><i>Oxalobacter formigenes </i></b>in Hemodialysis Patients

Modification of the Relationship Between Blood Pressure and Renal Albumin Permeability by Impaired Excretory Function and Diabetes

Current Understanding of the Pathogenesis of Progressive Chronic Kidney Disease in Cats

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