Hyponatremia Research Articles

Dietary counselling to reduce moderate sodium intake: effects on cardiovascular and renal biomarkers: primary findings of the COSIP and STICK phase II feasibility randomised controlled trials.

While low sodium intake (<2.3g/day) is recommended, there is uncertainty about long-term feasibility and effects on cardiorenal biomarkers in populations with moderate intake. In two phase IIb, feasibility, randomised, parallel, open-label, controlled, single-centre trials, individuals aged >40 years with stable blood pressure (BP), without heart failure or postural hypotension were randomised to intensive dietary counselling (target sodium intake <2.3g/day) or usual care between March 2016 and July 2018. One trial included participants with chronic kidney disease (CKD); the other excluded those with CKD or cardiovascular disease. All participants received healthy eating advice. Primary outcomes were NT-pro B-type natriuretic peptide (NT-proBNP), high sensitivity troponin T (hsTnT), C-reactive protein (CRP), renin, aldosterone and, creatinine clearance (CrCl) at 2-years. These trials are registered with ClinicalTrials.gov, STICK trial (NCT02458248) and COSIP trial (NCT02738736). 373 participants, with mean 24-h urine sodium 3.16±1.47g/day, were randomised to intervention (n=187) or usual care (n=186). At 3-months, the intervention reduced 24-h urine sodium (intervention-0.11g/day, usual care+0.28g/day, p=0.003), BP (systolic-2.52mmHg, p=0.05; diastolic-1.92, p=0.02) and increased renin (+33.35 mIU/L [95%CI 3.78-62.91]). At 2-years, the intervention significantly reduced self-reported salt use (p<0.001), but not 24-h urine sodium (intervention-0.23g/day, usual care+0.05g/day, p=0.47). At 2-years, there were no significant between-group differences in BP (systolic p=0.66; diastolic p=0.09), NT-proBNP (p=0.68), hsTnT (p=0.20), CRP (p=0.56), renin (p=0.52), aldosterone (p=0.61), or CrCl (p=0.68). Among individuals with moderate sodium intake, intensive dietary counselling resulted in small short-term reductions in sodium intake and BP, but no significant effect on sodium intake, BP, or cardiorenal biomarkers at two years. Our trial suggests that it may not feasible to reduce sodium sustainably in those with a sodium intake around 3.0g/day, through an intensive dietary counselling intervention. The STICK trial was funded by the Health Research Board of Ireland and the COSIP trial was funded by the European Research Council.

The Predictors of Hepatorenal Syndrome Development in HCV Cirrhotic Ascitic Egyptian Patients with Spontaneous Bacterial Peritonitis.

Spontaneous bacterial peritonitis is considered a precipitating factor for renal impairment in patients with liver cirrhosis. No specific study addressing this problem has been reported. This study aimed to detect the incidence and predictive factors of hepatorenal syndrome in these patients. This study enrolled 121 hepatic cirrhotic patients with spontaneous bacterial peritonitis. History taking, clinical examination, and laboratory investigations including ascitic fluid analysis were carried out. Kidney function tests were repeated 3 days after the initiation of treatment. Patients were divided into 2 groups after one week of treatment during the follow-up period: Group I: patients without hepatorenal syndrome, and Group II: patients with hepatorenal syndrome. Multivariate analysis was performed to determine independent predictors of hepatorenal syndrome development. A total of 30 patients (24.8%) developed hepatorenal syndrome. Patients with hepatorenal syndrome had significantly lower sodium and albumin levels as well as higher creatinine, bilirubin, Child-Turcotte-Pugh score, portal vein diameter, Model for End-Stage Liver Disease score. Higher percentage of them had a history of recurrent spontaneous bacterial peritonitis and multiple therapeutic paracentesis of ascites. Multivariate analysis detected that serum bilirubin, Model for End-Stage Liver Disease-Sodium, and portal vein diameter were significant predictors of hepatorenal syndrome. Cutoff values were determined as 3.3 mg/dl for bilirubin, 15.9 mm for portal vein diameter, and 26 for Model for End-Stage Liver Disease-Sodium. Hepatorenal syndrome is a common complication of spontaneous bacterial peritonitis. In our study, high serum bilirubin, Model for End-Stage Liver Disease-Sodium, and portal vein diameter are predictors of the development of hepatorenal syndrome in patients with spontaneous bacterial peritonitis.

Abstract P387: Effects of Reduced Dietary Sodium and the Dash Diet on Glomerular Filtration Rate: Results From the Dash-Sodium Trial

Background: While prior studies demonstrated that a low-sodium, DASH diet reduced blood pressure, the effects of sodium reduction, alone or in combination with the DASH diet, on kidney function are still unknown. Objective: We measured cystatin C in stored specimens of the DASH-Na trial, to determine the effects of sodium reduction and the DASH diet, alone or combined, on kidney function assessed by eGFR. Methods: DASH-Sodium was a controlled, feeding study in adults with pre- or stage 1 hypertension, who were randomly assigned to the DASH diet or a control diet. On their assigned diet, participants consumed each of three sodium levels for 4-weeks following a 2-week run-in period where all consumed a high sodium-control diet. The three sodium levels were low (50 mmol/d), medium (100 mmol/d), and high (150 mmol/d). Outcomes included eGFR by cystatin C (CKD-EPI 2021 equation) at baseline and at the end of each feeding period. Results: Cystatin C was measured in 409 of the original 412 participants, 207 were assigned the DASH diet, and 202 were assigned the control diet. The mean age was 48 years; 56% were women, and 56% were Black. The mean baseline BP was 135/86 mm Hg and BMI was 29.2 kg/m 2 . Compared with control, the DASH diet did not affect eGFR (β=-0.96 mL/min per 1.73 m 2 ; 95% CI: -2.74, 0.83) ( Figure ). In contrast, low versus high sodium intake decreased eGFR (β=-2.36 mL/min per 1.73 m 2 ; 95% CI: -3.64, -1.07). Together, compared to the high sodium-control diet, the low sodium-DASH diet decreased eGFR by 3.10 mL/min per 1.73 m 2 (95% CI: -5.46, -0.73). Conclusions: A combined low sodium-DASH diet reduced eGFR over a 4-week feeding period. Whether these effects are reno-protective long-term represent an important clinical inquiry for subsequent research.

Abstract P100: Associations Between Urinary Biomarkers at Baseline and Salt and Potassium Sensitivity: The GenSalt Study

Introduction: Salt sensitivity of blood pressure is associated with an increased risk of hypertension and cardiovascular disease. Measurement methods of salt sensitivity of BP are inconvenient thus identifying biomarkers for salt sensitivity of BP has important clinical significance. Hypothesis: The urinary excretion of dopamine, kallikrein, norepinephrine and uromodulin at baseline are associated with salt sensitivity of BP. Methods: The Genetic Epidemiology Network of Salt Sensitivity (GenSalt) (n=1887) and GenSalt Replication (n=690) studies dietary interventions included a 3-day baseline exam, 7-day low sodium feeding, a 7-day high sodium feeding, and a 7-day high sodium feeding with potassium supplementation. Baseline urinary dopamine, kallikrein, norepinephrine, and uromodulin were measured by ELISA methods. Salt and potassium sensitivity were defined as change in SBP and DBP during dietary intervention. Urinary biomarkers below limit of detection (LOD) were replaced using LOD/√2 and censored likelihood multiple imputation (CLMI). Linear models between standardized log transformed urinary biomarkers and change in SBP and DBP were assessed after adjustment for age, baseline BP, sex, education, physical activity, smoking status, alcohol intake, 24-hour sodium excretion and GenSalt cohort. Results: Norepinephrine was positively associated with SBP in CLMI models (0.10 mmHg, CI: 0.00, 0.19) and DBP in LOD/√2 models (0.31 mmHg, CI: 0.05, 0.57) and CLMI models (0.10 mmHg, CI: 0.02, 0.18) during high sodium diet. Uromodulin was associated with decreased SBP in LOD/√2 models (-0.36 mmHg, CI: -0.57, -0.14) and CLMI models (-0.19 mmHg, CI: -0.31, -0.08) during potassium supplementation. Similarly, dopamine was positively associated with DBP during high sodium diet and negatively associated with DBP during potassium supplementation. Conclusion: These data indicate urinary biomarkers dopamine, norepinephrine and uromodulin are associated with BP salt sensitivity and may be used in risk stratification.

Abstract P635: Poverty, Sodium Intake and Abnormal Blood Pressure Among Youth 13 to 18 Years of Age

Hypertension (HTN) is a primary cause of cardiovascular disease (CVD) and begins in youth. Among adults, low socioeconomic status (SES) is a demonstrated risk factor for HTN. Low SES has been associated with increased sodium intake and obesity. In this study, we assess the impact of family income, obesity and sodium intake during adolescence on average systolic blood pressure (SBP) to determine if these factors are associated with HTN and elevated BP during adolescence. Methods: Using 2007-2018 National Health and Nutrition Examination Survey data, representative of the non-institutionalized civilian population 13 to 18 years of age, we employed multivariable logistic regression (proc survey logistic) to assess the relationship between abnormal BP diagnosis (HTN or elevated BP), family income, obesity, and sodium intake. Poverty was defined as a family income less than 5-times the poverty level. Sodium intake was estimated based upon a combined 1-day total dietary and 1-day diet supplement recall and was adjusted for total caloric intake per day. The upper quartile of adjusted sodium intake was used to distinguish high from low sodium intake. Abnormal BP was defined as an average systolic blood pressure (SBP) at or above 120mmHg. Multivariable logistic regression was carried out. Results: 2.4% and 13% of the adolescent population had average SBP at or above 130mmHg (HTN) or at or above 120mmHg (elevated BP), respectively. According to multivariable logistic regression, predictors of the HTN/Elevated BP were overweight status (OR: 2.4, 95%CI: 1.8, 3.2), obesity (OR: 3.6 95%CI: 2.8, 4.7), male sex (OR:3.6, 95%CI: 2.7, 4.9), non-Hispanic black race (OR: 1.8, 95%CI: 1.2, 1.4) and age (OR: 1.3, 95%CI: 1.2, 1.4). Poverty status (OR: 1.2, 95%CI: 0.74, 1.9), Hispanic ethnicity (OR 1.2, 95%CI: 0.87, 1.5), and sodium intake (OR: 1.1, 95%CI: 0.86, 1.4) were not associated with HTN/elevated BP. Conclusion: While SES factors contribute to abnormal BP, sodium intake and family income were not associated with HTN/elevated BP in adolescents using a single day dietary intake recall. According to our results, additional SES factors contribute to HTN/elevated BP in adolescents and should be further explored.

Abstract P428: Evaluating a Personalized Low Sodium Diet Intervention for Blood Pressure Control in Hypertensive Patients: A Pilot Study

Introduction: Although many clinical trials tested the effects of a low sodium diet (LSD) on high blood pressure (HBP) management, adherence to an LSD remains challenging. Considerable barriers to adherence to diet modification have been examined, and heterogenous responses to an LSD evolved. We tested the intra-individual response to an LSD to develop an individualized dietary intervention to optimize HBP management. The purpose of this pilot study was to determine the effectiveness of a personalized low-sodium diet (P-LSD), enhanced by mobile health technology for real-time dietary assessment and at-home BP monitoring in hypertensive adults. Methods: A total of 24 hypertensive patients (60.4±10.7 years) were randomly assigned to either PLSD (n=16) or usual care control groups (n=8). Participants in P-LSD went through individual sessions via video conferencing to discuss LSD regimens, patients’ food choices, and BP tracks on mobile apps. The Control group followed their usual care for HBP management. All participants in both groups monitored diet and BP using mobile apps for 8 weeks. A 24-hour urinary sodium excretion for the estimation of dietary sodium intake, SBP, and DBP were measured at the baseline and at 8 weeks. The preliminary effects of P-LSD were tested by paired t-test and analysis of covariance (ANCOVA). Results: Dietary sodium intake ( t = 3.82), SBP ( t = 3.95), and DBP ( t = 3.54) were significantly declined overtime in the P-LSD group (Ps&lt;0.01) but not in control group (Ps&gt;0.05). There were significant differences between the control and intervention groups in changes of dietary sodium intake (F=18.6, p&lt;0.001) and SBP over time (F=4.84, p&lt;0.05) before and after the intervention. No statistically significant difference was revealed in DBP between the two groups before the intervention (p=0.20). Conclusion: The PLSD appears to be effective on the adherence to an LSD and BP control in hypertensive patients. Future studies with larger sample sizes are warranted to examine the long-term effects of PLSD on outcomes.

Abstract 20: Effect of Dietary Sodium Reduction in Chronic Kidney Disease Patients With Albuminuria: Results of a Randomized Trial

Introduction: Albuminuria, an early marker of kidney damage, is a risk factor for chronic kidney disease (CKD) progression, cardiovascular disease (CVD), and death. Dietary sodium is a risk factor for elevated blood pressure, CVD, and all cause-mortality. It is particularly important in patients with CKD due to increased salt-sensitivity. It is unclear if dietary sodium reduction is associated with reduced albuminuria. Hypothesis: A low sodium diet will reduce albuminuria in patients with CKD. Methods: The Sodium Lowering and Urinary Protein Reduction (SUPER) Trial was a randomized, parallel trial testing the effect of a 24-week dietary sodium reduction intervention compared to usual diet on albuminuria in 151 CKD patients with albuminuria. Participants were eligible if they had an estimated glomerular filtration rate (eGFR) of 30-90 mL/min/1.73 m 2 and an albumin-to-creatinine ratio (ACR) of 30-1,500 mg/g. Intervention group participants received a dietician-led behavioral change intervention targeting sodium intake &lt;2,300 mg/day and those in the control group received no dietary intervention. Twenty-four hour urine samples and dietary recalls, blood pressure, weight, and questionnaire data was collected at baseline, 12 weeks and 24 weeks. Mixed effects models were used to examine the intervention effect. Results: Study participants were an average of 65.6 years old, 72% African American, and 48% women. Median baseline ACR was 180.3 mg/g in the intervention and 157.4 mg/g in the control group, respectively. Urinary sodium excretion was reduced by 15.5% and 0.0% in the intervention and control groups, respectively. Results for the primary and key secondary outcomes are presented in the Table. Conclusions: The dietician-led dietary sodium reduction intervention succeeded in significantly reducing dietary sodium and BP in patients with CKD and albuminuria. However, no significant differences were observed in ACR, albuminuria, or eGFR between treatment groups.

Abstract P429: Adiposity: Full or Partial Mediator of the Association of Diet With Blood Pressure?

Background: Recently published results suggest body mass index (BMI) fully mediates the association of Dietary Approaches to Stop Hypertension (DASH) diet score with hypertension in women from the United Kingdom. The DASH diet has been shown to reduce systolic and diastolic blood pressure (SBP &amp; DBP) while keeping BMI constant in United-States-(US)-based trials. Thus, we quantified the mediation of adiposity in the association of DASH diet with SBP and DBP in a US nationally representative sample. Methods: Using National Health and Nutrition Examination Survey (NHANES) data, years 2011-2018, the association of DASH score (scale: 8 - 40) with SBP and DBP was quantified with and without BMI or waist circumference (WC) in models adjusted for age, sex, education, income, and physical activity. Percent mediation was calculated from all sets of models. Results: The included sample (n=11,662) was aged 20 years or older (median 41 years), was not taking blood pressure medication, and was weighted to be representative of the US population. For SBP, in models without BMI or WC, a one-point higher DASH score was associated with a -0.21 mmHg lower SBP in the adjusted base model (p &lt; 0.001). With the addition of BMI to the adjusted base model, the effect estimate was -0.12 mmHg (p = 0.005) for DASH score. With the addition of WC to the base model, the effect estimate was -0.13 mmHg (p=0.006) for DASH score. Thus, BMI and WC mediated 34% and 41% of the association between DASH and SBP in adjusted models, respectively. For DBP, in models without BMI or WC, a one-point higher DASH score was associated with a -0.15 mmHg lower DBP in the adjusted model (p &lt; 0.001). With the addition of BMI to the base model, the effect estimate was -0.10 mmHg (p = 0.004). With the addition of WC to the base model, the effect estimate was -0.11 mmHg (p = 0.003) for DASH score. Thus, BMI and WC mediated 29% and 52% of the association between DASH and DBP in adjusted models, respectively. Conclusion: Adiposity is a partial mediator of the association of DASH score with SBP and DBP. The mechanisms that explain the greater mediation of WC than BMI in the association of DASH score with SBP and DBP require further elucidation. The effect of the DASH diet on blood pressure may have multiple mechanistic pathways: one that works through adiposity and others that work through non-adiposity-based mechanisms including higher potassium consumption and lower sodium consumption.

Renin, Aldosterone, and Cortisol in Pregnancy-Induced Hypertension.

We aimed to assess renin, aldosterone, and cortisol in the early stages of pregnancy-induced hypertension (PIH), i. e., at the time of diagnosis. During the postural test, we measured aldosterone, renin [Liason DiaSorin Inc. (Italy)], as well as cortisol, sodium, potassium, and 24-h urinary sodium and potassium excretion in 62 women with newly diagnosed PIH, 70 healthy women during the 3rd trimester of pregnancy, and in 22 healthy non-pregnant women. In all groups, there was a significant increase in aldosterone and renin in upright versus supine posture (p<0.01). Both supine and upright aldosterone concentrations were higher in healthy pregnant women than in women with PIH and the lowest in healthy not-pregnant [supine (median±intequartile range): 25.04±18.4 ng/dL, 18.03±12.58 ng/dL, and 7.48±4.78 ng/dL, p<0.001, upright: 31.60±21.32 ng/dL, 25.11±13.15 ng/dL, and 12.4±12.4 ng/dL, p<0.001, for healthy pregnant, pregnant with PIH, and non-pregnant, respectively]. Supine renin concentrations were higher only in healthy pregnant (p<0.001), while in the upright position, there was a difference only between healthy pregnant and women with PIH (p=0.002). Both in supine and upright positions, there was no difference in the aldosterone-to-renin ratio between healthy pregnant women and women with PIH, though, in both groups, the ratio was higher than in non-pregnant women (p<0.001). Morning cortisol concentrations and 24-h urinary sodium excretion were lower in women with PIH than in healthy pregnant (p<0.001, p=0.002, respectively). Hyperaldosteronism is not involved in the etiology of PIH. In PIH, there is also a tendency towards lower sodium excretion and lower morning cortisol concentrations.

Impact of KCl and ultrasound on the structural properties of myofibrillar proteins in low sodium semi-dried large yellow croaker (Pseudosciaena crocea)

The effect of ultrasound treatment combined with KCl instead of NaCl on the structure of myofibrillar proteins of semi-dried large yellow croaker was investigated by measuring protein oxidation indicators and observing structural changes. Compared with the fillets treated with NaCl combined with ultrasound, the fillets treated with KCl combined with ultrasound had high carbonyl content, low sulfhydryl content, small particle size, and strong surface hydrophobicity. In contrast, when KCl replaced 50% of NaCl, it was found that the oxidation was effectively alleviated, and intermolecular force was enhanced. According to structural changes, the irregular curvature of myofibrillar proteins accounted for a large number of smaller and more stable structures in KCl substitution with 50% NaCl. In conclusion, partial substitution of KCl for NaCl combined with ultrasound in the preparation of semi-dried rhubarb can protect myofibrillar protein structure and reduce oxidation to some extent.

A gut-brain axis mediates sodium appetite via gastrointestinal peptide regulation on a medulla-hypothalamic circuit.

Salt homeostasis is orchestrated by both neural circuits and peripheral endocrine factors. The colon is one of the primary sites for electrolyte absorption, while its potential role in modulating sodium intake remains unclear. Here, we revealed that a gastrointestinal hormone, secretin, is released from colon endocrine cells under body sodium deficiency and is indispensable for inducing salt appetite. As the neural substrate, circulating secretin activates specific receptors in the nucleus of the solitary tracts, which further activates the downstream paraventricular nucleus of the hypothalamus, resulting in enhanced sodium intake. These results demonstrated a previously unrecognized gut-brain pathway for the timely regulation of sodium homeostasis.

A Boy with Reset Osmostat Who Developed Chronic Hyponatremia due to Hypothalamic Injury Caused by a Giant Arachnoid Cyst.

Reset osmostat (RO) is classified as type C among the four subtypes of the syndrome of inappropriate secretion of antidiuretic hormone based on antidiuretic hormone (ADH) secretion. It is characterized by a lower plasma osmolality threshold for ADH excretion when plasma sodium concentration is reduced. We report the case of a boy with RO and a giant arachnoid cyst (AC). The patient had been suspected of having AC since the fetal period, and a giant AC in the prepontine cistern was confirmed by brain magnetic resonance imaging 7 days after birth. During the neonatal period, there were no abnormalities in the general condition or blood tests, and he was discharged from the NICU at the 27 after birth. He was born with a -2 standard deviation short stature and mild mental retardation. When he was 6 years old, he was diagnosed with infectious impetigo and had hyponatremia of 121 mmol/L. Investigations revealed normal adrenal and thyroid functions, plasma hyposmolality, high urinary sodium, and high urinary osmolality. The 5% hypertonic saline and water load tests confirmed that ADH was secreted under low sodium and osmolality conditions, and the ability to concentrate urine and excrete a standard water load; therefore, RO was diagnosed. In addition, an anterior pituitary hormone secretion stimulation test was performed, which confirmed growth hormone secretion deficiency and gonadotropin hyperreactivity. Hyponatremia was untreated, but fluid restriction and salt loading were started at age 12 because of the risk of growth obstacles. The diagnosis of RO is important from the viewpoint of clinical hyponatremia treatment options.

Joint modeling of longitudinal changes of blood pressure and time to remission of hypertensive patients receiving treatment: Bayesian approach.

Hypertension is a widespread condition when the blood's force on the artery walls is extremely high to develop adverse health effects. This paper aimed to jointly model the longitudinal change of blood pressures (systolic and diastolic) and time to the first remission of hypertensive outpatients receiving treatment. A retrospective study design was used to collect appropriate data on longitudinal changes in blood pressure and time-to-event from the medical charts of 301 hypertensive outpatients under follow-up at Felege Hiwot referral hospital, Ethiopia. The data exploration was done using summary statistics measures, individual profile plots, Kaplan-Meier plots, and log-rank tests. To get wide-ranging information about the progression, joint multivariate models were employed. A total of 301 hypertensive patients who take treatment was taken from Felege Hiwot referral hospital recorded between Sep. 2018 to Feb. 2021. Of this 153 (50.8%) were male, and 124 (49.2%) were residents from rural areas. About 83(27.6%), 58 (19.3%), 82 (27.2%), and 25 (8.3%) have a history of diabetes mellitus, cardiovascular disease, stroke, and HIV respectively. The median time of hypertensive patients to have first remission time was 11 months. The hazard of the patient's first remission time for males was 0.63 times less likely than the hazard for females. The time to attain the first remission for patients who had a history of diabetes mellitus was 46% lower than for those who had no history of diabetes mellitus. Blood pressure dynamics significantly affect the time to the first remission of hypertensive outpatients receiving treatment. The patients who had a good follow-up, lower BUN, lower serum calcium, lower serum sodium, lower hemoglobin, and take the treatment enalapril showed an opportunity in decreasing their blood pressure. This compels patients to experience the first remission early. Besides, age, patient's history of diabetes, patient's history of cardiovascular disease, and treatment type were the joint determinant factors for the longitudinal change of BP and the first remission time. The Bayesian joint model approach provides specific dynamic predictions, wide-ranging information about the disease transitions, and better knowledge of disease etiology.

Low sodium intake ameliorates hypertension and left ventricular hypertrophy in mice with primary aldosteronism.

The goal of this paper is to elucidate the effects of sodium restriction on hypertension and left ventricular (LV) hypertrophy in a mouse model with primary aldosteronism (PA). Mice with genetic deletion of TWIK-related acid-sensitive K (TASK)-1 and TASK-3 channels (TASK-/-) were used as the animal model of PA. Parameters of the LV were assessed using echocardiography and histomorphology analysis. Untargeted metabolomics analysis was conducted to reveal the mechanisms underlying the hypertrophic changes in the TASK-/- mice. The TASK-/- adult male mice exhibited the hallmarks of PA, including hypertension, hyperaldosteronism, hypernatremia, hypokalemia, and mild acid-base balance disorders. Two weeks of low sodium intake significantly reduced the 24-h average systolic and diastolic BP in TASK-/- but not TASK+/+ mice. In addition, TASK-/- mice showed increasing LV hypertrophy with age, and 2weeks of the low-sodium diet significantly reversed the increased BP and LV wall thickness in adult TASK-/- mice. Furthermore, a low-sodium diet beginning at 4weeks of age protected TASK-/- mice from LV hypertrophy at 8-12weeks of age. Untargeted metabolomics demonstrated that the disturbances in heart metabolism in the TASK-/- mice (e.g., Glutathione metabolism; biosynthesis of unsaturated fatty acids; amino sugar and nucleotide sugar metabolism; pantothenate and CoA biosynthesis; D-glutamine and D-glutamate metabolism), some of which were reversed after sodium restriction, might be involved in the development of LV hypertrophy. In conclusion, adult male TASK-/- mice exhibit spontaneous hypertension and LV hypertrophy, which are ameliorated by a low-sodium intake.

The Sodium Concentration of Enteral Diets Does Not Influence Absorption of Nutrients but Induces Intestinal Secretion of Water in Miniature Pigs

Contradictory opinions exist as to whether the sodium concentration of enteral diets influences absorption of macronutrients and transepithelial movement of sodium and water. Therefore, we investigated the effects of various sodium concentrations of enteral diets on absorption of macronutrients and on net fluxes of sodium and water. In unanesthetized miniature pigs, a 150-cm jejunal segment was perfused with an oligopeptide (Peptisorb), an oligomeric and a polymeric diet. The polymeric diet was supplemented with pancreatic enzymes. The sodium concentrations varied between 30 and 150 mmol/L. The energy density was 3.4 MJ/L. The sodium concentration of the diets did not influence absorption of macronutrients and of total energy. However, increasing sodium concentrations of the diets were associated with increasing osmolality of the solutions, resulting in a linear increase in net secretion of water and flow rate of chyme. With all diets and sodium concentrations net secretion of sodium occurred. The sodium secretion was independent of the initial sodium concentration of the diets. It was linearly correlated with net flux of water and was largest in miniature pigs infused with the oligomeric diet. The sodium concentration of the jejunal effluent did not correspond to the initial sodium concentration of the diets. The present results indicate that enteral feeding of diets with high energy density inevitably increases net secretion of water and sodium as sodium concentration increases. Therefore, the sodium concentration of diets should be as low as possible to meet only the minimal daily requirement of sodium. Low sodium concentrations of diets have no negative effects on absorption of macronutrients.

Using poultry litter for cotton phosphorus nutrition in Australia

AbstractIn the Riverina, NSW, Australia, abundant poultry litter (PL) could offer an alternative P nutrition source for irrigated cotton (Gossypium hirsutum L.). We assessed soil P availability, sequentially extracted P fractions, crop P uptake, and cotton yields using PL applications compared with mono‐ammonium phosphate (MAP) fertilizer in an alkaline Vertosol during the 2020–2021 season. Treatments were control, 150 kg MAP ha–1, 150 kg MAP ha–1 plus 4 Mg PL ha–1, and 4, 10, and 15 Mg PL ha–1. Crop P uptake (22–38 kg ha–1) at defoliation, seed P export (14–20 kg ha–1), P use efficiency (5.1–6.6 kg seed‐P Mg–1 lint), and lint yield (2,654–3,118 kg ha–1) were not different across treatments. Apparent recovery of P treatments was low (&lt;15%). Across treatments, soil Colwell‐P (0.5 M NaHCO3) were invariably high (23–70 mg kg–1) during crop‐growing season and did not differ from planting to first‐flower. Residual inorganic‐P (conc‐HCl‐Pi + H2SO4‐H2O2‐Pi) declined by 12% with concurrent increases in labile NaHCO3‐Pi (4%) and organic‐P (dil‐HCl‐Po [4%] and conc‐HCl‐Po [3%]) over 18‐mo (from pre‐trial baseline sampling to defoliation) across treatments. At defoliation, the 15 Mg PL ha–1 treatment had lower soil pH and exchangeable sodium percentage and higher soil total C, moderately‐labile soil organic‐P (dil‐HCl‐Po), Colwell‐P, and extractable K than the control, MAP, or 4 Mg PL ha–1 treatments. Although P applications may not improve lint productivity because of inherent soil P release within a single cropping‐season, PL (15 Mg ha–1) may fully substitute for commercial MAP fertilizer for soil P maintenance and improving soil conditions in surface‐irrigated high‐yielding cotton in southeastern Australia.

Validation of spot urine in estimating 24-h urinary sodium, potassium and sodium-to-potassium ratio during three different sodium diets in healthy adults

Purpose To evaluate the validity of spot urine assay methods in estimating the 24-h urinary sodium, potassium and sodium-to-potassium ratio during three different sodium diets. Materials and methods Twelve healthy volunteers were asked to adhere to 3 dietary sodium targets (3.3–5.0g/day,<3.3 g/day and >5.0 g/day) for three consecutive weeks and to measure salt excretion daily in spot urine samples using a self-monitoring device. On day 7 of each week, 24-h urine was collected to compare measured with estimated 24-h salt excretion (by the Kawasaki, Tanaka and INTERSALT equations). Results Correlation coefficients relating measured and estimated 24-h sodium excretion were low and not significant for Kawasaki and INTERSALT and moderate for the Tanaka equation (τ 0.56–0.64,p<.05). Bland–Altman plots showed considerable differences between estimated and measured sodium excretion across all salt diets. Over 40% of the participants showed an absolute difference between measured and estimated 24-h sodium of more than 1000 mg/day. The correlation coefficients between 24-h and spot Na/K ratio were 0.67, 0.94 and 0.85(p<.05), and mean differences were 0.59, 0.06 and 0.48 for the intermediate, low and high sodium diets, respectively. Conclusion These findings do not support estimation of individual 24-h salt excretion from spot urine by the Kawasaki, Tanaka, or INTERSALT formula.

No Good Deed: Acidosis in Chronic Kidney and Liver Disease

Studies have shown that low or high serum bicarbonate levels (reflecting metabolic acidosis or alkalosis)are associated with increased all-cause mortality rates in moderate and advanced chronic kidney disease (CKD) cases. Correction of presumed acidosis using sodium bicarbonate, targeting serum levels around 22 mmol/l, has proven beneficial in delaying the progression of the disease and provided mortality benefit. A similar prognostic association may exist between uncorrected metabolic acidosis in chronic liver disease. Correcting it with sodium-containing salts may require more interventions due to increased sodium/fluid load. In patients with liver failure, a naturally alkalotic state, where sodium load is a concern, the impact of this intervention is unclear. This study aims to generate proof of concept through a retrospective chart review in individuals with CKD-related metabolic acidosis and liver cirrhosis. We extrapolate that lowering bicarbonate targets in other clinical scenarios like liver failure, pregnancy, and cardiac failure may be prudent and will lead to a lower sodium load.

Serum sodium, cognition and incident dementia in the general population

Low serum sodium may be associated with cognitive impairment and dementia in the general population, but the data remain inconclusive. Therefore, we aimed to determine the association of low serum sodium with cognitive function and incident dementia in the general population. Participants from a prospective population-based cohort were eligible if data on serum sodium (collected between 1997 and 2008), dementia prevalence and dementia incidence were available (follow-up until 2018). Global cognitive function was assessed with the Mini-Mental State Examination (MMSE) and the general cognitive factor (G-factor, derived from principal component analysis of individual tests). Linear regression and Cox proportional-hazards models were used to assess associations of standardised continuous and categorised low serum sodium (mean - 1.96*SD: cut-off of 137mmol/L) with overall cognitive function and incident dementia, respectively. In all, 8,028 participants free of dementia at baseline (mean age 63.6years, 57% female, serum sodium 142 ± 2mmol/L), including 217 participants with low serum sodium, were included. Cross-sectionally, continuous serum sodium and/or low serum sodium were not associated with the MMSE or G-factor. However, participants with low serum sodium performed worse on the Stroop and Purdue Pegboard tests. During a median follow-up of 10.7years, 758 subjects developed dementia. Continuous serum sodium (hazard ratio (HR) 0.98, 95% confidence interval (CI) 0.92;1.05) and low serum sodium (HR 1.27, 95% CI 0.90;1.79) were not associated with a higher risk of incident dementia. We identified no significant associations of low serum sodium with overall cognitive functioning and risk of dementia. However, low serum sodium-including levels above the clinical cut-off for hyponatremia-was associated with impairments in selected cognitive domains including attention and psychomotor function.

Efficacy and Safety of Bendamustine in the Conditioning Regiment for Autologous Hematopoietic Stem Cell Transplantation in Patients with Lymphoma

To investigate the clinical efficacy and safety of bendamustine in the conditioning regimen for autologous stem cell transplantation in patients with lymphoma. The clinical data of 35 patients with lymphoma, including 5 patients of Hodgkin lymphoma and 30 patients of non-Hodgkin lymphoma, who underwent autologous stem cell transplantation after pretreatment with BeEAM regimen from January 2020 to June 2022 in Gansu Provincial Hospital were retrospectively analyzed. Hematopoietic reconstitution, disease outcome after transplantation and the side effects were analyzed. All 35 patients achieved hematopoietic reconstitution after AHSCT，the median time to neutrophil engraftment was 11 (8-15) days, and the median time to platelet engraftment was 12 (9-17) days. Among the 35 patients, 4 patients died at the end of follow-up, including 3 patients died of lymphoma recurrence or progression and 1 patient died of cerebral hemorrhage. Among 34 patients, 30 had no disease progression at the end of follow-up. The OS rates of patients at 12 and 24 months after transplantation were 90.97% and 90.97%, respectively. The 12 and 24 months PFS rates were 89.64% and 84.92%, respectively. Thiry-five patients underwent grade 3-4 bone marrow suppression. The non-hematological toxicity of BeEAM pretreatment regimen mainly included nausea, vomiting, diarrhea, and oral mucositis, 35 patients experienced nausea and vomiting, but only 4 patients had grade 3-4 nausea and vomiting. Eight patients experienced Grade 1-2 diarrhea. Oral mucositis occurred in 12 patients, including 1 patient of grade 3 oral mucositis. One patient with grade 3 oral mucositis also had grade 3-4 hypokalemia and hypon atremia. 8.6% of patients experienced Grade 1-2 abnormal liver and kidney function. An addition, infectious fever occurred in 18 patients during neutropenia. All patients improved after symptomatic treatment, and there were no transplant-related death. Bendamustine as a pretreatment regimen for autologous stem cell transplantation in lymphoma is effective, and the side effects are tolerable.