scholarly journals High-Salt Diet Accelerated the Decline of Residual Renal Function in Patients With Peritoneal Dialysis

2021 ◽  
Vol 8 ◽  
Author(s):  
Nirong Gong ◽  
Chun Zhou ◽  
Jianxia Hu ◽  
Xiaohong Zhong ◽  
Zhixiu Yi ◽  
...  

Objective: This study aims to investigate the relationship between dietary salt intake and residual renal function in peritoneal dialysis (PD) patients.Methods: The daily salt intake of the patients was calculated based on a 3 day dietary record. Sixty-two patients were divided into three groups: 33 patients in the low salt intake group (salt intake <6.0 g/day), 17 in the medium salt intake group (salt intake 6.0 to <8.0 g/day), and 12 in the high salt intake group (salt intake ≥8.0 g/day). Regular follow-up was conducted every 3 months. Urine volume, peritoneal ultrafiltration volume, and other clinical indicators were recorded. Biochemical indexes were detected to evaluate the changes in residual renal function and peritoneal function during follow-up.Results: A positive correlation between dietary sodium intake and sodium excretion was found. During 12-month follow-up, a decrease of residual renal function showed a significant difference among the three groups (p = 0.041) (15.3 ± 27.5 vs. 12.5 ± 11.5 vs. 32.9 ± 18.4 L/W/1.73 m2 in the low-, medium-, and high salt intake groups, respectively). Consistently, a higher decline of residual renal function (adjusted β, 20.37; 95% CI, 2.83, 37.91) was found in participants with high salt intake (salt intake ≥8 g/day) compared with those in non-high salt intake.Conclusion: Our study showed that the sodium excretion by peritoneal dialysis was positively correlated with dietary sodium intake in PD patients. The high salt intake diet (salt intake ≥8 g/day) may lead to a faster decline of residual renal function in PD patients.

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Naftali Stern ◽  
Assaf Buch ◽  
Rebecca Goldsmith ◽  
Lesley Nitsan ◽  
Miri Margaliot ◽  
...  

AbstractSince current recommendations call for a substantial reduction in overall sodium consumption, we tested whether or not these recommendations are implemented in common large subpopulations such as those with abnormal weight or hypertension in the current high sodium, high-calorie nutritional environment. In a national representative cross-sectional survey of the community-dwelling subjects aged 25–65 years conducted in Israel between 2015 and 2017, 582 randomly selected subjects completed health and dietary questionnaires, underwent blood pressure and anthropometric measurements and collected 24-h urine specimens, to assess dietary sodium intake. Overall mean 24-h sodium excretion was 3834 mg, more than double the recommended upper intake for adults < 1500 mg/day. Sodium excretion was directly related to caloric intake and blood pressure and linked to the presence of hypertension and overweight/obesity. The highest sodium excretion was seen in overweight/obese hypertensive subjects. This recent national survey shows a high consumption of sodium in the Israeli population and a dose–response association between caloric intake and urinary sodium excretion, independent of BMI and hypertension. Nevertheless, overweight/obese subjects with hypertension consume (excrete) more sodium than other BMI/ blood pressure-related phenotypes and may thus comprise a target subpopulation for future efforts to reduce sodium intake.


2006 ◽  
Vol 134 (11-12) ◽  
pp. 503-508
Author(s):  
Natasa Jovanovic ◽  
Mirjana Lausevic ◽  
Biljana Stojimirovic

Introduction:Most of patients with chronic renal failure are affected by normochromic, normocytic anemia caused by different etiological factors. Anemia causes a series of symptoms in chronic renal failure, which can hardly be recognized from the uremic signs. Anemia adds to morbidity and mortality rates in patients affected by advanced chronic renal failure. Blood count partially improves during the first months after starting the chronic renal replacement therapy, in correlation with the quality of depuration program, with extension of erythrocyte lifetime and with hemoconcentration due to reduction of plasma volume. Recent trials found that higher residual renal function (RRF) significantly reduced co-morbidity, the rate and duration of hospitalization and risk of treatment failure. Objective: The aim of the study was to follow blood count parameters in 32 patients on chronic continuous ambulatory peritoneal dialysis (CAPD) during the first six months of treatment, to evaluate the influence of demographic and clinical factors on blood count and RRF, and to examine the correlation between RRF and blood count parameters. Method: A total of 32 patients affected by end-stage renal disease of different major cause during the first six months of CADP treatment were studied. RRF and blood count were evaluated as well as their relationship during the follow-up. Results: Blood count significantly improved in our patients during the first six months of CAPD treatment even if Hb and HTC failed to reach normal values. Iron serum level slightly decreased because of more abundant erythropoiesis and iron utilization during the first six months of treatment. RRF slightly decreased. After six months of CAPD treatment, the patients with higher RRF had significantly higher Hb, HTC and erythrocyte number and a lot of positive correlations between RRF and anemia markers were observed. Conclusion: After 6-month follow-up period, the patients with higher RRF had significantly higher blood count parameters, and several positive correlations between RRF and blood count markers were confirmed.


2017 ◽  
Vol 37 (3) ◽  
pp. 283-289 ◽  
Author(s):  
Htay Htay ◽  
Yeoungjee Cho ◽  
Elaine M. Pascoe ◽  
Darsy Darssan ◽  
Carmel Hawley ◽  
...  

ObjectivePreservation of residual renal function (RRF) is associated with improved survival. The aim of the present study was to identify independent predictors of RRF and urine volume (UV) in incident peritoneal dialysis (PD) patients.MethodsThe study included incident PD patients who were balANZ trial participants. The primary and secondary outcomes were RRF and UV, respectively. Both outcomes were analyzed using mixed effects linear regression with demographic data in the first model and PD-related parameters included in a second model.ResultsThe study included 161 patients (mean age 57.9 ± 14.1 years, 44% female, 33% diabetic, mean follow-up 19.5 ± 6.6 months). Residual renal function declined from 7.5 ± 2.9 mL/min/1.73 m2at baseline to 3.3 ± 2.8 mL/min/1.73 m2at 24 months. Better preservation of RRF was independently predicted by male gender, higher baseline RRF, higher time-varying systolic blood pressure (SBP), biocompatible (neutral pH, low glucose degradation product) PD solution, lower peritoneal ultrafiltration (UF) and lower dialysate glucose exposure. In particular, biocompatible solution resulted in 27% better RRF preservation. Each 1 L/day increase in UF was associated with 8% worse RRF preservation ( p = 0.007) and each 10 g/day increase in dialysate glucose exposure was associated with 4% worse RRF preservation ( p < 0.001). Residual renal function was not independently predicted by body mass index, diabetes mellitus, renin angiotensin system inhibitors, peritoneal solute transport rate, or PD modality. Similar results were observed for UV.ConclusionsCommon modifiable risk factors which were consistently associated with preserved RRF and residual UV were use of biocompatible PD solutions and achievement of higher SBP, lower peritoneal UF, and lower dialysate glucose exposure over time.


1996 ◽  
Vol 270 (2) ◽  
pp. F301-F310 ◽  
Author(s):  
C. Drummer ◽  
W. Franck ◽  
M. Heer ◽  
W. G. Forssmann ◽  
R. Gerzer ◽  
...  

We examined the effects of a high-salt (100 mmol NaCl) and a low-salt (5 mmol NaCl) meal on the renal excretion of sodium and chloride in 12 healthy male upright subjects. We also measured the urinary excretion of urodilatin [ANP-(95-126)], and the plasma or serum concentrations of atrial natriuretic peptide [ANP-(99-126)], aldosterone, and renin. The high-salt meal produced a postprandial natriuresis (urinary sodium excretion from 59.0 to a peak rate of 204.6 mumol/min in 3rd h after ingestion of meal) and chloride excretion. In parallel, the urinary excretion of urodilatin increased from 35.7 to a peak rate of 105 fmol/min. The effect of high-salt intake on urinary sodium, chloride, and urodilatin excretion was significant (analysis of variance, P < 0.01), and close significant correlations were observed between urodilatin and sodium excretion (mean R = 0.702) as well as between urodilatin and chloride excretion (mean R = 0.776). In contrast, plasma ANP, which was acutely elevated 15 min after high-salt intake, was already back to low-salt values 1 h later. It did not parallel the postprandial natriuretic profile, and no positive correlation between plasma ANP and sodium excretion was observed. These results provide further evidence that urodilatin, not ANP, is the member of this peptide family primarily involved in the regulation of the excretion of sodium and chloride.


2015 ◽  
Vol 9 (4) ◽  
pp. e72
Author(s):  
Katarzyna Stolarz-Skrzypek ◽  
Adam Bednarski ◽  
Grzegorz Kiełbasa ◽  
Malgorzata Kloch-Badelek ◽  
Danuta Czarnecka

2002 ◽  
Vol 13 (suppl 1) ◽  
pp. S48-S52
Author(s):  
Prakash Keshaviah ◽  
Allan J. Collins ◽  
Jennie Z. Ma ◽  
David N. Churchill ◽  
Kevin E. Thorpe

ABSTRACT. Several studies have recently confirmed that hemodialysis (HD) and continuous ambulatory peritoneal dialysis (CAPD) survival is highly associated with delivered therapy Kt/Vurea. A direct comparison of equivalently dosed CAPD and HD has not previously been performed. A total of 968 incident HD patients at the Regional Kidney Disease Program from 1987 to June 1995 were studied, and these results were compared with those of the Canadian-United States prospective trial (CANUSA) consisting of 680 incident CAPD patients from September 1990 to December 31, 1992, with follow-up through December 31, 1993. All patients had quantitation of urea nitrogen for a total delivered dialysis session. On HD, in vivo, 2-pool, pre- and post-blood urea nitrogen kinetic modeling was performed with residual renal function determined every 6 mo. Patients were characterized by age, gender, race, renal diagnosis, and comorbid conditions. A Cox proportional hazards model was used to evaluate the effect of the individual comorbid conditions and the effect of dialysis therapy in the time-dependent method. The mean total Kt/V, both residual renal function and dialytic therapy in the HD patients, was 1.59. The CANUSA-delivered weekly Kt/V was 2.38 at the beginning of the baseline period and 1.99 after 24 mo of follow-up. When the peak concentration hypothesis was used, a Kt/V of 1.59 on HD was equivalent to a weekly CAPD dose of 2.1 to 2.2. A 1-unit increase in Kt/V was associated with 7% lower risk of death on HD and with a similar 8% lower risk of death while on CAPD. Patients with diabetes aged 46 to 60 yr had virtually identical 2-yr survival estimates on HD (83 to 90%), compared with CAPD (83 to 89%), with Kt/V ranges from 0.84 to 1.70 in HD and from 1.6 to 2.2 weekly Kt/V on peritoneal dialysis. Comparisons between HD and CAPD in older patients with diabetes yielded comparable results. Patient survival is highly influenced by delivered dialysis in both HD and peritoneal dialysis. Carefully matching of the therapies with delivered Kt/V demonstrates little differences in the survival outcome of HD and peritoneal dialysis patients, in contrast to some previous reports.


1997 ◽  
Vol 8 (8) ◽  
pp. 1311-1314
Author(s):  
A Fine ◽  
B Fontaine ◽  
M Ma

Salt restriction in continuous ambulatory peritoneal dialysis (CAPD) patients is widely prescribed and thereby may reduce quality of life. It is presumed that this has a beneficial effect on BP and reduces the need for hypertonic dialysate. However, this has never been formally evaluated. A double-blind crossover study of placebo versus sodium chloride pills (60 mEq of sodium per day) is presented in 20 stable CAPD patients, 10 of whom were hypertensive. Dietary sodium was quantified throughout the study by 3-d dietary histories and remained unaltered throughout. There was a clinically unimportant but statistically significant rise in BP with added salt: 135/77 to 144/82 (P < 0.05). No rise in BP occurred in the hypertensive patients. Weights, use of hypertonic dialysate, and BP medications remained unaltered throughout the study. In conclusion, 200 mEq of sodium per day, i.e., a normal sodium intake, is easily tolerated in stable CAPD patients, and the recommended sodium intake commonly prescribed is too restrictive.


2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Wenjing Zhang ◽  
Jia LV ◽  
Lan Li ◽  
Zhigang Wang ◽  
Dapeng Hao ◽  
...  

Abstract Background and Aims Incremental Peritoneal Dialysis (IPD) is the practice of initiating PD exchange less than four times a day in consideration of residual renal function (RRF). More clinical studies have confirmed the feasibility and effectiveness of IPD, especially in the protection of residual renal function, which is obviously superior to full-dose PD. Urgent-start peritoneal dialysis (USPD) is a popular PD method. Due to lack of pre-dialysis education, most of patients who were newly diagnosed with ESRD in China chose USPD. Well, can incremental peritoneal dialysis be used for USPD patients when starting dialysis? Compared to full-dose PD, whether incremental PD affects the residual renal function in USPD patients? Here we report the first study of incremental peritoneal dialysis’s effect on residual renal function. Method A retrospective analysis of medical records was performed on 169 patients who received USPD from August 2008 to March 2017. Patients were divided into 2 groups according to dialysis dose: incremental PD(i-PD) group (dialysis dose were less than or equal to 6000ml or 3 exchanges per day) and full-dose PD(f-PD) group (dialysis dose were great than or equal to 8000ml or 4 exchanges per day). The demographics, clinical biochemical indexes, dialysis dose, urine volume, dialysis ultrafiltration volume, RRF, dialysis adequacy, peritoneal dialysis infection complications, mechanical complications and survival rates were compared between two groups in 1 year follow-up. Results: (1).A total of 169 patients were enrolled, including 111 patients (average age 45.01±12.84 years) in i-PD group and 58 patients (average age 43.5±15.62 years) in f-PD group. The demographics and clinical biochemical indexes in the two groups before peritoneal dialysis were similar (P&gt;0.05). (2).During the follow-up period, the dialysis dose in f-PD group(8034.48±262.61ml/d, 8080.00±395.80ml/d, 8155.17±523.21ml/d, 8051.72±906.55ml/d) were more than those in i-PD group(5891.89±528.31ml/d, 6159.57±1185.06ml/d, 6468.47±1588.71ml/d, 6900.90±1543.05ml/d), P&lt;0.05. And the dialysis adequacy in both groups were up to standard: the total Kt/V (i-PD group: 1.96±0.56, 2.01±0.70, 2.02±0.55, 1.90±0.52; f-PD group: 2.18±0.47, 2.22±0.55, 2.05±0.44, 2.03±0.42) were greater than 1.7 and the total Ccr (i-PD group: 79.39±29.75, 79.02±25.11, 78.26±30.00, 73.09±29.14; f-PD group: 89.78±29.89, 91.54±35.56, 82.38±29.27, 72.96±23.75) were greater than 60L. (3).During the whole follow-up period, the residual renal function between two groups had no statistically significant(i-PD group: 3.96±2.52ml/min, 3.46±1.95ml/min, 3.58±2.85ml/min, 2.91±2.33ml/min; f-PD group: 4.31±4.83ml/min, 3.45±2.36ml/min, 3.16±2.15ml/min, 2.36±1.65ml/min), P&gt;0.05. (4).During the whole follow-up period, the blood pressure control, correction of anemia, and correction of calcium and phosphorus abnormalities were also similar in both groups, P&gt;0.05. (5).At 1-month and 6-month, the urine volume were higher in i-PD group(1024.33±492.91ml/d, 1017.03±571.66ml/d) than those in f-PD group(782.93±415.89ml/d, 788.27±491.02ml/d), P&lt;0.05. The dialysis ultrafiltration volume in f-PD group (481.67±723.69ml/d, 632.77±687.89ml/d, 338.87±963.14ml/d, 750.43±849.69ml/d) were higher than those in i-PD group(343.30±520.00ml/d, 495.70±916.76ml/d, 341.78±925.57ml/d, 439.65±1297.13ml/d) during the whole follow-up period, but the differences were not statistically significant (P&gt;0.05). (6).The exit-site infection, peritonitis, mechanical complications and technical survival were similar between the two groups (P&gt;0.05). Conclusion Incremental peritoneal dialysis will not cause rapid decline of residual renal function in USPD patients, and the dialysis effect and complications are similar to full-dose peritoneal dialysis. Therefore, we recommend that USPD patients can be treated by incremental peritoneal dialysis.


Hypertension ◽  
2016 ◽  
Vol 68 (suppl_1) ◽  
Author(s):  
Joshua S Speed ◽  
Kelly A Hyndman ◽  
Kaehler A Roth ◽  
Malgorzata Kasztan ◽  
Jermaine G Johnston ◽  
...  

Circadian rhythms in physiologic functions are driven, at the molecular level, by a group of transcription factors that oscillate over a 24 hour period, collectively termed the molecular clock. Within the kidney, it has been shown that the molecular clock directly influences transcription of Na + transporters and channels, including ENaC. ENaC is regulated by endothelin-1 (ET-1), via ET B receptor activation, in response to high salt intake. Thus, we hypothesized that increases in dietary sodium regulate the renal molecular clock (which in turn would facilitate Na+ homeostasis) through an ET B dependent mechanism. To address this question, we examined the effect of high salt (HS) intake on renal clock gene ( Bmal1, Cry1, Per1, Per2 ) expression. Control and ET B receptor deficient (ET B def) rats (a model of elevated renal ENaC) were placed on either HS or normal salt (NS) for two weeks and euthanized every 4 hours beginning at Zeitgeber Time 0 (Lights on). In the inner medulla, HS causes a phase delay in Bmal1 (Fig 1A) expression in control but not ET B def rats (Fig 1B). In addition, HS suppressed the expression of Cry1 , and Per2 during the respective acrophase in both control and ET B def rats (Fig 1C-1F) with no significant effect on Per1 . In contrast, no significant difference in the expression of Bmal1, Cry1, Per2, or Per1 (Fig 1I-1P) was found in response to HS in the renal cortex of either control or ET B def. These data indicate that HS feeding desynchronizes the molecular clock within the kidney and provides evidence that peripheral clocks are regulated in a cell type specific manner, even within the same organ.


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