Urinary Sodium Levels Research Articles

Citrus aurantium Ameliorates Cisplatin-Induced Nephrotoxicity.

We aimed to study the effects of Citrus aurantium (C. aurantium) on renal functions in cisplatin-induced nephrotoxicity in rats. The study involved male Wistar rats weighing 250–300 g that were fed and kept under standard conditions. Rats were randomly divided into control, cisplatin administered, C. aurantium 200 mg/kg, and C. aurantium 400 mg/kg groups. Cisplatin was administered at 5 mg/kg i.p. once at the start of study to induce nephrotoxicity. Blood and urine samples were obtained at alternative days for analysis. The body weight and urine output were monitored at regular intervals. Plasma and urinary sodium, potassium, and creatinine levels were measured at the end of study duration. Absolute excretion of sodium and potassium; sodium to potassium ratio; kidney weights; fractional excretion of sodium and potassium; and absolute creatinine clearance were determined to analyze the effects of C. aurantium. Histopathological changes of kidney tissues were studied to determine relevant effects. The results indicate that cisplatin lowered the total body weights while raising the urinary output and kidney weights, reversed by C. aurantium both dose and time dependently. Similarly, C. aurantium markedly normalized plasma, urinary sodium, potassium, and creatinine levels. Cisplatin-induced absolute sodium clearance, absolute potassium clearance, absolute creatinine clearance, sodium to potassium ratio, and fractional excretion of sodium and potassium were significantly reversed by C. aurantium. Histopathological analysis showed notable improvement in C. aurantium administered groups as compared to cisplatin-induced group. Study suggests that C. aurantium possesses excellent nephroprotective effects against cisplatin-induced toxicity.

Embracing Different Decision-making Styles

Embracing Different Decision-making Styles

Monosodium Glutamate (MSG) Renders Alkalinizing Properties and Its Urinary Metabolic Markers of MSG Consumption in Rats.

Monosodium glutamate (MSG) is widely used as a flavor enhancer and its effects on human health are still debated. We aimed to investigate whether MSG can act as alkalinizing agent in murine models and if its metabolites are biomarkers of MSG consumption. For this purpose, adult male Wistar rats were given water added with 1 g% MSG or three types of control water, including sodium chloride (NaCl) and sodium bicarbonate (NaHCO3). At 14 days, urinary pH, electrolytes, urinary metabolites and ion-exchanger gene expression were determined. The results revealed that MSG-treated rats had significantly more alkaline urine and higher levels of urinary sodium and bicarbonate similar to NaHCO3 controls. These changes correlated with a lower expression of ion-exchanger genes, namely, CAII, NBC1, and AE1, which are involved in bicarbonate kidney reabsorption. The urinary metabolic profiles also revealed similar patterns for the MSG and NaHCO3 groups. In conclusion, MSG exhibits similar properties to NaHCO3, an alkalinizing agent, with regard to inducing alkaline urine, reducing bicarbonate kidney reabsorption, and generating a specific urinary metabolic pattern. We believe that these observations will be useful to further study the MSG effects in humans.

Dietary reference values for chloride.

Following a request from the European Commission, the EFSA Panel on Nutrition, Novel Foods and Food Allergens (NDA) has derived dietary reference values (DRVs) for chloride. There are no appropriate biomarkers of chloride status, no balance studies and no adequate evidence on the relationship between chloride intake and health outcomes that can be used to set DRVs for chloride. There is a close relationship between sodium and chloride balances in the body. Sodium chloride is the main source of both electrolytes in European diets and similar urinary excretion levels of sodium and chloride (on a molar basis) are typically observed in Western populations. Hence, the Panel considered that reference values for chloride can be set at values equimolar to the reference values for sodium for all population groups, and are as follows: 1.7 g/day for children aged 1–3 years, 2.0 g/day for children aged 4–6 years, 2.6 g/day for children aged 7–10 years, 3.1 g/day for children aged 11–17 years and 3.1 g/day for adults including pregnant and lactating women. Consistent with the reference values for sodium, these levels of chloride intake are considered to be safe and adequate for the general EU population, under the consideration that the main dietary source of chloride intake is sodium chloride. For infants aged 7–11 months, an adequate intake of 0.3 g/day is set.

Sodium Status and Its Association with Overweight and Obesity in Adults Living in Yazd, Iran

Background: Studies on the relationship of urinary sodium with overweight and obesity led to controversial results. Furthermore, no study has ever investigated the association between sodium status and obesity in Iranian adults. The present study examined the association of urinary sodium levels with overweight and obesity in adults living in Yazd, Iran. Methods: The present study recruited 240 adults randomly selected from adults, who participated in Yazd Health Study (YaHS). A 24-hour urine sample was collected from the participants. Participants' demographic information, history of chronic diseases, and smoking status were obtained. The height and weight of the participants were also assessed using standard methods. We compared the weight and body mass index (BMI) of the participants based on the urinary sodium excretion tertiles. The logistic regression model in crude and multivariable adjusted models was used to compare the odds of obesity between urinary sodium tertiles. Results: The findings showed that the mean urinary sodium was not significantly different among overweight, obese, and individuals with normal BMI (P > 0.05) using the crude and multivariable models. Furthermore, no significant difference was observed in the mean BMI according to urinary sodium excretion tertiles. In addition, the analyses showed that the sodium status was not significantly associated with odds of developing obesity in crude and in multivariable adjusted models. Conclusion: No significant relationship was seen between sodium status and overweight or obesity. Future prospective studies are highly recommended to confirm these results.

ASSOCIATION OF LOW SODIUM-POTASSIUM RATIO WITH ATRIAL FIBRILLATION IN PATIENTS WITH PRIMARY ALDOSTERONISM

Objective: Atrial fibrillation (AF) is the most common cardiac arrhythmia with an increasing incidence and prevalence. Mechanisms of AF in patients with RHTN are not well studied. Obesity, high dietary salt intake and primary aldosteronism (PA) are commonly found. We have previously shown that AF is more common in patients with PA. Epidemiological studies suggest that the urinary sodium-to-potassium ratio may be a superior metric as compared to separate sodium and potassium values for determining the relation to blood pressure and cardiovascular disease risks. In this cross-sectional study we investigated the role of 24 h urinary sodium-to-potassium (24hUNaK) ratio in patients with AF and PA versus AF and non-PA. Design and method: This cross-sectional study of a large cohort of 2,375 black and white resistant hypertensive patients seen at the University of Alabama at Birmingham investigated the association of 24hUNaK ratio in patients with AF and PA vs AF and non-PA. PA was defined as renin activity <1ng/mL/h, aldosterone-renin-ratio >20, and 24 h UAldo >12mcg. Resistant hypertension was defined as blood pressure (BP) > 130/80 mmHg while taking 3 or more different antihypertensive medications, including a diuretic, if tolerated Results: Prevalence of AF in patients with PA vs non-PA was higher(18.5 vs 6.9%, p = 0.009). Patients with AF and PA were younger and more often male while rates of obesity, dyslipidemia, heart failure, obstructive sleep apnoea, diabetes, and coronary artery disease. There was no difference in clinic BP levels, duration of hypertension, and number of antihypertensive medications. Patients with AF and PA had a significant lower serum potassium (3.8+/−0.4 vs 4.2+/−0.5 mEq/dL, p < 0.001), higher 24 h urinary potassium levels (82.8+/−34.2 vs 53.1+/−22.8 mEq), higher 24 h urinary sodium levels (179.6+/−77.5 vs 149.1+/−69.2 mEq, p = 0.007), and lower 24 h UNaK ratio compared to patients with AF and non-PA (2.35+/−1.1 vs 3.05+/−1.3, p = 0.0003). Conclusions: A significant lower 24 h UNaK ratio was associated with AF in PA patients. Benefits for a reduction in sodium and an increase in potassium have been shown in patients with hypertension. Using the UNaK ratio as tool and improvement through diet and medical therapy, i.e. mineralocorticoid receptor antagonism may be key to prevent AF.

FNEE3 Dietary Factors Associated with Urinary Sodium to Potassium Ratio in Japanese Preschool Children

Background Japanese preschool children's normal range of urinary sodium (Na) level is higher and potassium (K) level lower than those of WHO, resulting in high urinary sodium/potassium ratio (U-Na/K). Objective The aim of this study is to investigate the dietary factors that influence U-Na/K and to create a basis for salt-reduction education. Study Design, Setting, Participants The target population was four to five-year-old preschool children attending collaborating kindergartens, whose parents agreed to their participating after a briefing of informed consent. Measurable Outcome/Analysis We asked the parents to take two samples of their child's first urination on two consecutive days and to answer a dietary questionnaire called BDHQ3y (Brief-type Self-administered Diet History Questionnaire for Japanese children aged three to six years). U-Na/K was calculated by the target child's Na (mEq/L) /g Cr and K (mEq/L) /g Cr. The results of the dietary questionnaire were corrected by the density method (g/1000 kcal). The correlation of two groups of values was calculated by Spearman rank correlation coefficient. Multiple regression analysis was performed where differences were significant. Results Out of the 452 parents who attended the informed consent briefing: 87 did not agree; 27 did not hand in data. The remaining 338 were registered as final target population. They were an average of 58 months old; 103.0cm tall; 16.7kg by weight, with a U-Na/K value of 4.47. Concerning U-Na/K and nutrients, positive correlation was found with sodium, potassium, calcium, and phosphorus intake, and only sodium (β = 0.189) was a significant predictor when assessed by multiple regression analysis. For food: positive significant correlation was found with noodles, pickles, soft drinks, and seasoning·splices; negative significant correlation with fruits and milk products. Multiple regression analysis showed, noodles (β = 0.132), fruits (β = -0.154), soft drinks (β = 0.155), and seasoning·splices (β = 0.113) as significant predictors. There was no correlation with sex or region. Conclusion The urinary sodium to potassium ratio correlated positively with noodles, soft drinks, and seasoning·spice, and correlated negatively with fruits, in Japanese preschool children.

Derivation and Validation of a Novel Risk Score to Predict Overcorrection of Severe Hyponatremia: The Severe Hyponatremia Overcorrection Risk (SHOR) Score.

Osmotic demyelination syndrome is the most concerning complication of severe hyponatremia, occurring with an overly rapid rate of serum sodium correction. There are limited clinical tools to aid in identifying individuals at high risk of overcorrection with severe hyponatremia. We identified all patients who presented to a tertiary-care hospital emergency department in Ottawa, Canada (catchment area 1.2 million) between January 1, 2003 and December 31, 2015, with serum sodium (corrected for glucose levels) <116 mmol/L. Overcorrection was determined using 14 published criteria. Latent class analysis measured the independent association of baseline factors with a consensus overcorrection status on the basis of the 14 criteria, and was summarized as a risk score, which was validated in two cohorts. A total of 623 patients presented with severe hyponatremia (mean initial value 112 mmol/L; SD 3.2). The prevalence of no, unlikely, possible, and definite overcorrection was 72%, 4%, 10%, and 14%, respectively. Overcorrection was independently associated with decreased level of consciousness (2 points), vomiting (2 points), severe hypokalemia (1 point), hypotonic urine (4 points), volume overload (-5 points), chest tumor (-5 points), patient age (-1 point per decade, over 50 years), and initial sodium level (<110 mmol/L: 4 points; 110-111 mmol/L: 2 points; 112-113 mmol/L: 1 point). These points were summed to create the Severe Hyponatremic Overcorrection Risk (SHOR) score, which was significantly associated with overcorrection status (Spearman correlation 0.45; 95% confidence interval, 0.36 to 0.49) and was discriminating (average dichotomized c-statistic 0.77; 95% confidence interval, 0.73 to 0.81). The internal (n=119) and external (n=95) validation cohorts had significantly greater use of desmopressin, which was significantly associated with the SHOR score. The SHOR score was significantly associated with overcorrection status in the internal (P<0.001) but not external (P=0.39) validation cohort. In patients presenting with severe hyponatremia, overcorrection was common and predictable using baseline information. Further external validation of the SHOR is required before generalized use.

Association between 24 h urinary sodium excretion and microalbuminuria among Chinese people aged from 18 to 69 years old

Objective: To analyze the association between 24 h urinary sodium excretion and microalbuminuria (MAU) among Chinese people aged from 18 to 69 years old. Methods: 2 400 subjects aged from 18 to 69 years old were selected form Gaomi and Fushan sites of Shandong Province and Xinyi and Ganyu sites of Jiangsu Province in 2013 by using multi-stage stratified cluster random sampling method. Questionnaire survey, physical measurement and 24 h urine collection were conducted. 2 262 subjects were finally included in the analysis. According to the quartile of 24 h urinary sodium, all subjects were divided into Q1-Q4 groups and the levels of urinary microalbumin and MAU among different groups were compared. The relationship between urinary sodium and MAU was analyzed by multivariate logistic regression analysis. Results: The age of subjects was (42.1±13.5) years old, including 1 124 males (49.7%). The 24 h urine volume, urinary sodium, urine albumin M (P(25), P(75)) and MAU detection rate were (1 411±495) ml, (166.4±71.6) mmol/d, 12.5 (9.6, 17.4) mg/d and 9.0% (203 cases), respectively. With the increase of urinary sodium level, the level of urinary albumin increased (P(trend)<0.001), and the prevalence of MAU also showed an upward trend (P(trend)<0.001). Multivariate logistic regression analysis showed that after adjusting for age, gender, smoking, alcohol consumption, BMI, hypertension and diabetes, the risk of MAU in Q4 group increased by 174% compared with Q1 group, and OR (95%CI) value was 2.74 (1.80-4.16). Conclusion: 24 h urinary sodium is associated with the prevalence of MAU and salt reduction can help reduce MAU.

Salt Loading Effects on ENaC and Blood Pressure in Aged 129Sv Mice

Essential hypertension in the elderly population is a major public health problem because these patients usually do not respond well to antihypertensive drugs. More than half the cases of essential hypertension are thought to be associated with salt sensitivity from excessive dietary salt intake. We hypothesized that salt loading augments renal epithelial sodium channel expression and blood pressure in aged 129Sv mice. The renal epithelial sodium channel regulates total body salt balance and blood pressure, but mechanisms for its regulation by dietary salt intake in the aged kidney are not completely known. Twelve month old 129Sv mice were subject to salt loading for 4 weeks. Water intake, urine production, blood pressure, and electrolytes in the urine were measured before and after salt loading. Both the total and cleaved forms of ENaC subunits were assessed by Western blotting and densitometric analysis. ENaC alpha protein was augmented in the kidneys of salt‐loaded hypertensive 129Sv mice compared to non‐salt loaded mice. Water intake, urine output, and systolic blood pressure significantly increased in the 129Sv mice after salt‐loading. Salt loading resulted in an increase in urinary sodium levels and a decrease in urinary potassium levels. These findings may provide new links between salt‐sensitivity, ENaC expression, and blood pressure regulation in the aged kidney.Support or Funding InformationThis project was funded by the U.S. National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases (Grant K01 DK099617; to A.A.A.) and the University of Florida College of Medicine.This abstract is from the Experimental Biology 2019 Meeting. There is no full text article associated with this abstract published in The FASEB Journal.

Sex Differences in Aged Hypertensive 129Sv Mice

Salt‐sensitive hypertension has become an enormous public health problem due to the recent increase of dietary salt intake in many countries. It is already known that female sex hormones have a protective effect regarding the increase of blood pressure. However, little is known about sex differences in the aged kidney. The goal of this study was to determine whether or not there are differences in blood pressure, ENaC alpha protein expression, and filamin protein expression in the aged kidneys of salt‐sensitive male mice when compared to female mice after salt loading. Male and female 129Sv mice were aged for 12 months and maintained on a normal salt diet (0.4% NaCl) before being salt loaded (8% NaCl) for 4 weeks. During this time, blood pressure was measured by tail cuff and electrolytes in the urine were measured using an electrolyte analyzer. Protein expression of ENaC alpha and filamin were measured by Western blotting and immunohistochemistry. The difference in blood pressure before and after salt loading was greater in the aged male 129Sv mice compared to the females. Before and after salt loading, the male mice showed higher urinary sodium levels than the female mice. There were no differences observed in urinary potassium levels between the male and female mice. Although ENaC alpha protein expression did not change, filamin A protein expression was augmented in the hypertensive aged male mice compared to the females. This data suggests that there are sex differences in the aged kidneys of hypertensive 129Sv mice that do not involve changes in ENaC alpha protein expression but may involve changes in actin cytoskeleton associated proteins.Support or Funding InformationThis project was funded by the U.S. National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases (Grant K01 DK099617; to A.A.A.) and the University of Florida College of Medicine.This abstract is from the Experimental Biology 2019 Meeting. There is no full text article associated with this abstract published in The FASEB Journal.

Evaluation of an education program based on the theory of planned behavior for salt intake in individuals at risk of hypertension.

This study was conducted to evaluate an education program based on the theory of planned behavior (TPB) for salt intake in individuals at risk of hypertension. This randomized controlled trial was conducted from February 2017 to December 2017 in Shahediyeh, Yazd Province, Iran. For this purpose, 140 people were selected and assigned to two groups of 70 each, namely, intervention and control. Data were gathered by a self-administered TPB based questionnaire, and also 24-h urinary sodium and potassium levels and systolic and diastolic blood pressure were measured. The intervention group received TPB based on a training package, while the control group received no intervention. Post-test was administered 2 months after completion of the intervention. Independent and paired t-tests, χ2 and analysis of covariance (ANCOVA) were used for data analysis. All mean scores on TPB constructs increased significantly except motivation to comply and power of control for intervention group. Average salt intake decreased in intervention group compared with the control group (-4.73 g/day �0.73 versus -0.24 g/day �0.94, P < 0.001), but systolic and diastolic blood pressure did not change significantly in intervention group compared with control group. TPB can be implemented along with other approaches in educational programs to reduce salt intake. Code: IRCT201701108803N3.

Pituitary macroadenoma presenting as severe hyponatremia: a case report

BackgroundHyponatremia is defined as a serum sodium level of less than 135 mEq/L in a patient. Although hyponatremia is not an uncommon laboratory finding, especially in the elderly, hunting for the etiology is a challenging issue for any clinician. The three first-line investigations that are required for further analysis are urine osmolality, serum osmolality, and urinary sodium levels in addition to clinical assessment of volume status.Case presentationA 69-year-old previously well Sinhalese man presented with lethargy, loss of appetite, vomiting, and altered behavior of 1 week’s duration. An examination revealed Glasgow Coma Scale of 13/15 and marginally low blood pressure. Initial serum sodium level was 104 mmol/L, and plasma and urinary osmolalities were 251 mOsm/kg and 305 mOsm/kg, respectively. His urinary sodium level of 158 mmol/L was suggestive of a clinical picture of a syndrome of inappropriate secretion of antidiuretic hormone. Even after correction of hyponatremia with intravenously administered 3% saline, a persistent altered behavior necessitated cerebral imaging that confirmed the presence of pituitary macroadenoma. Meanwhile, his hormone profile showed very low serum cortisol and low free tetraiodothyronine levels. An ultrasound scan of his abdomen affirmed the presence of normal adrenal glands. With intravenously administered hydrocortisone and orally administered levothyroxine replacement, he showed marked clinical improvement that supported the diagnosis of hypopituitarism.ConclusionHyponatremia in the elderly is not an uncommon presentation. However, etiological diagnosis is a challenging task as there are multiple overlapping differential diagnoses.

A Case Report on Bartter Syndrome as Urinary Tract Stone and Poor Weight Gain in a One-Year Old Child

Introduction: Bartter syndrome (BS) is a rare metabolic disorder causing defect in sodium and chloride absorption in the thick ascending limb of Henle’s loop and increased urinary loss of sodium chloride (Na), chloride (Cl), and prostaglandins. Case Presentation: We present the case of a 1-year-old girl with BS presenting with vomiting, poor feeding, and agitation. Physical examination revealed muscle weakness, developmental delay, and failure to thrive. Laboratory investigations revealed hypokalemia, metabolic alkalosis, hyponatremia, and hypokalemia. Urinary investigations revealed raised urinary chloride, sodium, potassium, and calcium levels. Renal ultrasound revealed a renal calculus in the lower calyx of the right kidney with hydronephrosis. Conclusions: The basic defect in BS is the loss of one of the transporters involved in sodium reabsorption in the thick ascending limb on the Henle’s loop or apical K channel. BS is characterized by severe hypokalemia, metabolic alkalosis, hyponatremia, hypochloremia, and hyperaldosteronism. In BS, increased urinary loss of sodium, potassium, and chloride is observed.

Does the Urinary Calcium/Citrate Ratio Add to the Diagnostic Workup of Children at Risk of Kidney Stones? A Cross-Sectional Study

The purpose of the study was to evaluate urinary citrate/creatinine (UCi/UCr) and urinary calcium/citrate (UCa/UCi) ratios for distinguishing stone formers (SF) from non-stone formers (NSF) in an at-risk population. This was a retrospective study that included all pediatric patients who underwent urinary citrate testing from April 2017 to March 2018. The urinary levels of citrate, calcium, sodium, potassium, creatinine, oxalate, urate, pH, and specific gravity (SG) were measured in our clinical laboratory. Diagnosis of kidney stones was obtained through chart review.A total of 97 patients were included (46 NSF and 51 SF). The UCi/UCr ratio was not significantly different between NSF and SF. Median UCa/UCr ratio was higher in SF (0.67) compared with NSF (0.21, p &lt; 0.0001). The median ratio of UCa/UCi was also higher in SF (1.30) than in NSF (0.65, p = 0.001). Oxalate, urate, pH, SG, and urinary sodium/potassium ratio did not differentiate between the SF and NSF. Positive correlation was seen between UCa/UCr and urinary sodium/creatinine UNa/UCr (p &lt; 0.0001), as well as between UCa/UCr and UCi/UCr (p &lt; 0.0001).The study has demonstrated significantly higher UCa/UCi and UCa/UCr in SF compared with NSF, while the use of urinary oxalate, urate, pH, and SG did not differentiate between SF from NSF. We also confirmed a positive correlation between UNa/UCr and UCa/UCr. While the utility of UCa/UCr is well established, our data suggest that UCa/UCi rather than UCi/UCr may be more predictive in the clinical setting when evaluating for nephrolithiasis.

EVALUATION OF SODIUM LEVELS IN CHILDRENS SUFFERED FROM PNEUMONIA IN HOSPITAL FROM BIHAR REGION

Hyponatremia is the most common electrolyte abnormality. Patho physiologically, hyponatremia are classified into two groups: hyponatremia due to non-osmotic hypersecretion of vasopressin (hypovolemic, hypervolemic, euvolemic) and hyponatremia of non-hyper vasopressinemic origin (pseudo hyponatremia, water intoxication, cerebral salt wasting syndrome). The aim of this study was to identify the incidence of hyponatremia in children with pneumonia and to investigated whether there is a link between hyponatremia and the severity and outcome of pneumonia.&#x0D; The present study was planned on 25 children diagnosed with pneumonia in department of Paediatrics in Nalanda Medical College and Hospital, Patna, from March 2016 to Dec 2016. At the time of admission, the patient’s clinical history was recorded in prefixed proforma. Serum sodium was measured by a process known as potentiometry. This method measures the voltage that develops between the inner and outer surfaces of an ion selective electrode.&#x0D; Based on the above findings it can be concluded that serum electrolytes should be measured in children hospitalized for pneumonia; the appropriate fluid therapy must be carefully arranged in children with hyponatremia, and both serum and urine sodium levels should be closely monitored. Regular follow up of serum sodium level during the period of hospital stay should be considered to pick up the high risk cases at an early stage.&#x0D; Keywords: pneumonia, sodium level, Hyponatremia, etc.

The Role of Tolvaptan Administration After Cardiac Surgery: A Meta-Analysis

To evaluate the efficacy and safety of tolvaptan in fluid management after cardiac surgery compared with conventional diuretic treatment. Systematic review of the literature with meta-analyses. The Medline, Scopus, Cochrane Central Register of Controlled Trials, Clinicaltrials.gov, and Google Scholar databases were searched from inception to July 30, 2018. The study comprised 759 patients undergoing cardiac surgery. Tolvaptan administration (n = 397) or standard diuretic therapy (n = 398). Ten studies were included in the present meta-analysis. Tolvaptan administration was associated with a significantly faster return to preoperative body weight (mean difference [MD)] -1.48 d, 95% confidence interval [CI] -1.92 to 1.03), shorter duration of hospital stay (MD -2.58 d, 95% CI -5.09 to -0.07), lower incidence of acute kidney injury (odds ratio 0.34, 95% CI 0.16-0.69), and greater urine output (MD 0.47 L/d, 95% CI 0.25-0.69) and sodium levels (MD 2.85 mEq/L, 95% CI 1.90-3.80). No significant differences were present regarding duration of intensive care unit stay (MD -0.09 d, 95% CI -0.33 to 0.15), arrhythmia incidence (odds ratio 0.58, 95% CI 0.33-1.02), and serum creatinine values (MD -0.08 mg/dL, 95% CI -0.20 to 0.04). The outcomes of the present meta-analysis suggest the promising role of tolvaptan administration in the management of fluid retention in patients after cardiac surgery. Future large-scale clinical trials should be conducted to fully elucidate its efficacy and to assess the optimal treatment protocol to be applied in the clinical setting.

Astrocytes-Derived VEGF Induces Blood-Brain Barrier Disruption Under High Salt Condition

Background: Excess salt (sodium chloride, NaCl) intake is closely related to a variety of central nervous system (CNS) diseases, which show a core feature of the blood-brain barrier (BBB) disruption. However, less study focus on the link between high salt diet (HSD) and the breakdown of BBB, especially the molecular mechanism remains unclearly elucidated. Methods: First we noticed a positive correlation between urinary sodium levels and first onset acute ischemic stroke patients. A rat model of HSD was established to verify the damage effects on BBB and expression of Vascular Endothelial Growth Factor (VEGF). Then we explore the potential molecular mechanism by a co-cultured model of endothelial cells and astrocytes. Finally, we antagonize VEGF to defend our hypothesis. Findings: In the current study, we reported that HSD suppresses the expression of tight junction proteins, leading to BBB impairment. The effect depends on activation of astrocytes via NFIob/MMP-9 signaling pathway, resulting in a marked increase expression of VEGF. VEGF, in turn, induces disruption of tight junction by activating phosphorylation of ERK and eNOS. Inhibition of VEGF by specific monoclonal antibodies, Bevacizumab, attenuated the effect both in vivo and in vitro, respectively. Interpretation: These results reveal a new axis linking dietary habits to BBB disruption through a VEGF-initiated inflammation response, which may be a potent target to counter the deleterious brain effects. Funding: National Natural Science Foundation of China. Declaration of Interest: None. Ethical Approval: This study was approved by the ethics committee of the Third Affiliated Hospital of Sun Yat-sen University, and all participants signed informed consent forms.

Associations of urinary sodium levels with overweight and central obesity in a population with a sodium intake

BackgroundPrevious studies have reported an association between dietary sodium intake and overweight/central obesity. However, dietary survey methods were prone to underestimate sodium intake. Therefore, this study investigated the associations of calculated 24-h urinary sodium excretion, an index of dietary sodium intake, with various obesity parameters including body mass index (BMI) and waist circumference (WC) in a population with a relatively high sodium intake.MethodsA total of 16,250 adults (aged ≥19 years) and 1476 adolescents (aged 10-18 years), with available information on spot urine sodium levels and anthropometric measurements from the Korea National Health and Nutrition Examination Survey (KNHANES) were included in this study. We calculated 24-h urine sodium excretion levels from spot urine sodium levels using the Tanaka formula.ResultsIn adults, those with high sodium excretion levels (≥ 3200 mg) showed increased odds of overweight and central obesity compared to those with low urinary sodium excretion level (< 2200 mg) (odds ratio [OR] = 2.17, 95% confidence interval [CI] = 1.90-2.49 for overweight; OR = 2.50, 95% CI = 2.13-2.94 for central obesity). These associations were also observed in adolescents (OR = 5.80, 95% CI = 3.17-10.60 for overweight; OR = 4.19, 95% CI = 1.78-9.89 for central obesity).ConclusionsThe present study suggests that reducing salt intake might be important for preventing overweight and central obesity, especially in adolescents. However, because the present study was conducted with cross-sectional study design, further longitudinal studies are warranted to confirm the causal relationship between urinary sodium excretion and overweight/central obesity.

The association between urinary sodium excretion and blood pressure in a community-based population: the Yamagata (Takahata) study.

The association between salt intake and blood pressure levels is still inconclusive, and may be influenced by patient characteristics. We thus conducted a community-based cross-sectional study. This study included 2297 subjects aged ≥ 40years not on antihypertensive medication at the time of a health check-up. We examined the association between blood pressure levels and the estimated amount of 24-h urinary sodium excretion (e24hUNa) stratified by background characteristics. The 24-h urinary excretion levels of sodium and potassium were estimated from Kawasaki's equation using a spot urine sample. The association of systolic blood pressure (SBP) and diastolic blood pressure (DBP) with e24hUNa was significantly positive in a multiple linear regression model adjusted for confounders including age, sex, smoking, alcohol consumption, body mass index, diabetes, hypercholesterolemia, renal function, and potassium excretion. The regression coefficients of changes in SBP and DBP per 1 SD increase in e24hUNa (53mEq/day) were + 1.91mmHg and + 0.94mmHg, respectively. In the subgroup analyses, the increase in SBP was especially greater in the elderly, in subjects with diabetes, and in subjects with reduced renal function compared to those in the counterparts. The association between SBP and e24hUNa was insignificant in subjects with eGFR ≥ 90ml/min/1.73m2, while the association with progression of renal dysfunction was stronger and significant. These results demonstrated that the association between blood pressure and urinary sodium excretion was strengthened by characteristics of subjects such as aging, presence of diabetes, and renal impairment in the community-based population.