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Non-uniform relationship between salt status and aldosterone activity in patients with chronic kidney disease.
Clin Sci (Lond). 2018 01 31; 132(2):285-294.CS

Abstract

BACKGROUND

Hypertension is prevalent in chronic kidney disease (CKD). Studies suggest that reduction in dietary salt intake reduces blood pressure (BP). We studied relationships between salt intake, BP and renin-angiotensin system regulation in order to establish if it is disordered in CKD.

METHODS

Mechanistic crossover study of CKD patients versus non-CKD controls. Participants underwent modified saline suppression test prior to randomization to either low or high salt diet for 5 days and then crossed over to the alternate diet. Angiotensin-II stimulation testing was performed in both salt states. BP, urea and electrolytes, and plasma aldosterone concentration (PAC) were measured.

RESULTS

Twenty-seven subjects were recruited (12 CKD, 15 control). There was no difference in age and baseline BP between the groups. Following administration of intravenous saline, systolic BP increased in CKD but not controls (131 ± 16 to 139 ± 14 mmHg, P=0.016 vs 125 ± 20 to 128 ± 22 mmHg, P=0.38). Median PAC reduced from 184 (124,340) to 95 (80,167) pmol in controls (P=0.003), but failed to suppress in CKD (230 (137,334) to 222 (147,326) pmol (P=0.17)). Following dietary salt modification, there was no change in BP in either group. Median PAC was lower following high salt compared with low salt diet in CKD and controls. There was a comparable increase in systolic BP in response to angiotensin-II in both groups.

DISCUSSION

We demonstrate dysregulation of aldosterone in CKD in response to salt loading with intravenous saline, but not to dietary salt modification.

Authors+Show Affiliations

Institute of Cardiovascular and Medical Sciences, University of Glasgow, U.K.Institute of Cardiovascular and Medical Sciences, University of Glasgow, U.K. alastair.rankin@nhs.net. Queen Elizabeth University Hospital, Glasgow, U.K.Queen Elizabeth University Hospital, Glasgow, U.K.Queen Elizabeth University Hospital, Glasgow, U.K.Queen's Medical Research Institute, University of Edinburgh, U.K.Queen's Medical Research Institute, University of Edinburgh, U.K.Institute of Cardiovascular and Medical Sciences, University of Glasgow, U.K. Queen Elizabeth University Hospital, Glasgow, U.K.Institute of Cardiovascular and Medical Sciences, University of Glasgow, U.K. Queen Elizabeth University Hospital, Glasgow, U.K.

Pub Type(s)

Journal Article
Randomized Controlled Trial
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

29321218

Citation

Taylor, Alison H M., et al. "Non-uniform Relationship Between Salt Status and Aldosterone Activity in Patients With Chronic Kidney Disease." Clinical Science (London, England : 1979), vol. 132, no. 2, 2018, pp. 285-294.
Taylor AHM, Rankin AJ, McQuarrie EP, et al. Non-uniform relationship between salt status and aldosterone activity in patients with chronic kidney disease. Clin Sci. 2018;132(2):285-294.
Taylor, A. H. M., Rankin, A. J., McQuarrie, E. P., Freel, E. M., Homer, N. Z. M., Andrew, R., Jardine, A. G., & Mark, P. B. (2018). Non-uniform relationship between salt status and aldosterone activity in patients with chronic kidney disease. Clinical Science (London, England : 1979), 132(2), 285-294. https://doi.org/10.1042/CS20171603
Taylor AHM, et al. Non-uniform Relationship Between Salt Status and Aldosterone Activity in Patients With Chronic Kidney Disease. Clin Sci. 2018 01 31;132(2):285-294. PubMed PMID: 29321218.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Non-uniform relationship between salt status and aldosterone activity in patients with chronic kidney disease. AU - Taylor,Alison H M, AU - Rankin,Alastair J, AU - McQuarrie,Emily P, AU - Freel,E Marie, AU - Homer,Natalie Z M, AU - Andrew,Ruth, AU - Jardine,Alan G, AU - Mark,Patrick B, Y1 - 2018/01/25/ PY - 2017/12/11/received PY - 2017/12/28/revised PY - 2018/01/07/accepted PY - 2018/1/13/pubmed PY - 2019/2/12/medline PY - 2018/1/12/entrez KW - Hypertension KW - aldosterone KW - chronic kidney disease KW - renin-angiotensin system KW - salt SP - 285 EP - 294 JF - Clinical science (London, England : 1979) JO - Clin. Sci. VL - 132 IS - 2 N2 - BACKGROUND: Hypertension is prevalent in chronic kidney disease (CKD). Studies suggest that reduction in dietary salt intake reduces blood pressure (BP). We studied relationships between salt intake, BP and renin-angiotensin system regulation in order to establish if it is disordered in CKD. METHODS: Mechanistic crossover study of CKD patients versus non-CKD controls. Participants underwent modified saline suppression test prior to randomization to either low or high salt diet for 5 days and then crossed over to the alternate diet. Angiotensin-II stimulation testing was performed in both salt states. BP, urea and electrolytes, and plasma aldosterone concentration (PAC) were measured. RESULTS: Twenty-seven subjects were recruited (12 CKD, 15 control). There was no difference in age and baseline BP between the groups. Following administration of intravenous saline, systolic BP increased in CKD but not controls (131 ± 16 to 139 ± 14 mmHg, P=0.016 vs 125 ± 20 to 128 ± 22 mmHg, P=0.38). Median PAC reduced from 184 (124,340) to 95 (80,167) pmol in controls (P=0.003), but failed to suppress in CKD (230 (137,334) to 222 (147,326) pmol (P=0.17)). Following dietary salt modification, there was no change in BP in either group. Median PAC was lower following high salt compared with low salt diet in CKD and controls. There was a comparable increase in systolic BP in response to angiotensin-II in both groups. DISCUSSION: We demonstrate dysregulation of aldosterone in CKD in response to salt loading with intravenous saline, but not to dietary salt modification. SN - 1470-8736 UR - https://www.unboundmedicine.com/medline/citation/29321218/Non_uniform_relationship_between_salt_status_and_aldosterone_activity_in_patients_with_chronic_kidney_disease_ L2 - https://portlandpress.com/clinsci/article-lookup/doi/10.1042/CS20171603 DB - PRIME DP - Unbound Medicine ER -