Peritoneal dialysis impairs nitric oxide homeostasis and may predispose infants with low systolic blood pressure to cerebral ischemia

Carlström, Mattias; Cananau, Carmen; Checa, Antonio; Wide, Katarina; Sartz, Lisa; Svensson, Anders; Wheelock, Craig E.; Westphal, Susanne; Békássy, Zivile; Bárány, Peter; Lundberg, Jon O.; Hansson, Sverker; Weitzberg, Eddie; Krmar, Rafael T.

doi:10.1016/j.niox.2016.05.005

Cited by 8 publications

(10 citation statements)

References 34 publications

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“…The mechanisms contributing to increased morbidity and mortality are probably multifactorial. In both adults and paediatric patients, repeated dialysis lowers circulating levels of nitrate and nitrite, as well as marker of NO signalling (ie, cGMP), which is associated with increased blood pressure and increased incidence of ischaemic stroke . Based on these findings, the authors proposed that supplementation with inorganic nitrate may prevent dialysis‐mediated NO deficiency, thus reduce the risk of having adverse cardiovascular complications during chronic dialysis.…”

Section: Organ Systems Involved In the Blood Pressure Reduction By Inmentioning

confidence: 99%

Mechanisms underlying blood pressure reduction by dietary inorganic nitrate

2018

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Nitric oxide (NO) importantly contributes to cardiovascular homeostasis by regulating blood flow and maintaining endothelial integrity. Conversely, reduced NO bioavailability is a central feature during natural ageing and in many cardiovascular disorders, including hypertension. The inorganic anions nitrate and nitrite are endogenously formed after oxidation of NO synthase (NOS)-derived NO and are also present in our daily diet. Knowledge accumulated over the past two decades has demonstrated that these anions can be recycled back to NO and other bioactive nitrogen oxides via serial reductions that involve oral commensal bacteria and various enzymatic systems. Intake of inorganic nitrate, which is predominantly found in green leafy vegetables and beets, has a variety of favourable cardiovascular effects. As hypertension is a major risk factor of morbidity and mortality worldwide, much attention has been paid to the blood pressure reducing effect of inorganic nitrate. Here, we describe how dietary nitrate, via stimulation of the nitrate-nitrite-NO pathway, affects various organ systems and discuss underlying mechanisms that may contribute to the observed blood pressure-lowering effect.

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Section: Organ Systems Involved In the Blood Pressure Reduction By Inmentioning

confidence: 99%

Mechanisms underlying blood pressure reduction by dietary inorganic nitrate

2018

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“…One study reported that neurodevelopmental delay was frequent when ESRD started in infancy and this affected approximately 45% of children 35 . Its pathophysiology was multifactorial, including comorbidities, haemodynamic instability during extracorporeal sessions, arterial hypertension and cerebral hypoperfusion due to hypotension episodes and, or, to nitric oxide homeostasis impairment during the sessions 36 …”

Section: Clinical Outcomesmentioning

confidence: 99%

“…35 Its pathophysiology was multifactorial, including comorbidities, haemodynamic instability during extracorporeal sessions, arterial hypertension and cerebral hypoperfusion due to hypotension episodes and, or, to nitric oxide homeostasis impairment during the sessions. 36 Even though specific data on the topic are missing, we may eventually hypothesise that these children and their families have an impaired quality of life. Indeed, when severe CKD has started in infancy it has been associated with a lower quality of life in adulthood than in the general adult populations.…”

Section: Children With Esrd Who Started Dialysis As Neonatesmentioning

confidence: 99%

Review: Neonatal dialysis is technically feasible but ethical and global issues need to be addressed

et al. 2020

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Aim Our aim was to look at the technical, ethical and global issues related to neonatal dialysis. Methods We performed a PubMed research on manuscripts published from March 2010 to March 2020 and retrospectively reviewed all neonates who received dialysis in our French paediatric and neonatal intensive care units from April 2009 to March 2019. Results Dialysis is performed on neonates with pre‐existing renal diseases, acute kidney injuries or inborn errors of metabolism. It is required in 0.5%‐1% of neonates admitted to the neonatal intensive care units. Peritoneal dialysis and extracorporeal blood purification are both feasible, with more complications, but the results are close to those obtained in older infants, at least in children without multi‐organ dysfunction. Novel haemodialysis machines are being evaluated. Ethical issues are a major concern. Multidisciplinary teams should consider associated comorbidities, risks of permanent end‐stage renal disease and provide parents with full and neutral information. These should drive decisions about whether dialysis is in child's best interests. Conclusion Neonatal dialysis is technically feasible, but ethically challenging, and short‐term and long‐term data remain limited. Prospective studies and dialysis registries would improve global management and quality of life of these patients at risk of chronic kidney disease.

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“…Amongst patients with end‐stage renal disease and chronic dialysis, cardiovascular complications are the major cause of death. The underlying pathological mechanisms are likely multifactorial, but repeated dialysis has been associated with reduced plasma levels of nitrate and nitrite, as well as lowering of the NO signalling marker cGMP . Compromised NO bioavailability in this patient group has been linked with elevated blood pressure in adults and increased incidence of ischaemic stroke in paediatric patients .…”

Section: Therapeutic Value Of Stimulating the Nitrate–nitrite–no Pathwaymentioning

confidence: 99%

“…The underlying pathological mechanisms are likely multifactorial, but repeated dialysis has been associated with reduced plasma levels of nitrate and nitrite, as well as lowering of the NO signalling marker cGMP . Compromised NO bioavailability in this patient group has been linked with elevated blood pressure in adults and increased incidence of ischaemic stroke in paediatric patients . These findings have triggered the idea that supplementation of nitrate (in the diet) or nitrite (in the dialysis fluid) may reduce the risk of serious cardiovascular complications by preventing NO deficiency that may occur during repeated sessions of dialysis.…”

Section: Therapeutic Value Of Stimulating the Nitrate–nitrite–no Pathwaymentioning

confidence: 99%

Therapeutic value of stimulating the nitrate‐nitrite‐nitric oxide pathway to attenuate oxidative stress and restore nitric oxide bioavailability in cardiorenal disease

Carlström

Montenegro

2018

J Intern Med

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Cardiovascular disorders including hypertension and associated renal disease are major health problems affecting more than 1.5 billion people worldwide. Apart from nonmodifiable factors such as ageing, family history and gender, both sedentary lifestyle and unhealthy dietary habits are considered as major risk factors. The disorders are interrelated suggesting common pathological pathways. Mechanistically, oxidative stress and compromised function of the nitric oxide synthase (NOS) system leading to endothelial dysfunction and reduction in nitric oxide (NO) bioavailability have been widely implicated and associated with development and progression of disease. New strategies that correct this redox imbalance and increase NO bioactivity may have major clinical implications. The inorganic anions, nitrate and nitrite, are endogenously formed by oxidization of NOS-derived NO, but there are also high amounts of nitrate in our daily diet. In this regard, accumulated evidence over the past two decades demonstrates that these anions can be recycled back to NO and other bioactive nitrogen oxides, thus offering an attractive alternative strategy for therapeutic exploitation. In this review, we describe how dietary stimulation of the nitrate-nitrite-NO pathway affects cardiovascular and renal functions in health and disease via modulation of oxidative stress and NO bioavailability. Clinical studies addressing potential effects on the renal system are still limited, but blood pressure-lowering effects of nitrate supplementation have been demonstrated in healthy and hypertensive subjects as well as in patients with chronic kidney disease. However, larger clinical studies are warranted to reveal whether chronic nitrate treatment can slow-down the progression of cardiorenal disease and associated complications.

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Peritoneal dialysis impairs nitric oxide homeostasis and may predispose infants with low systolic blood pressure to cerebral ischemia

Cited by 8 publications

References 34 publications

Mechanisms underlying blood pressure reduction by dietary inorganic nitrate

Mechanisms underlying blood pressure reduction by dietary inorganic nitrate

Review: Neonatal dialysis is technically feasible but ethical and global issues need to be addressed

Therapeutic value of stimulating the nitrate‐nitrite‐nitric oxide pathway to attenuate oxidative stress and restore nitric oxide bioavailability in cardiorenal disease

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