Impact of Kidney Function on Effects of the Dietary Approaches to Stop Hypertension (Dash) Diet.

OBJECTIVES: Although the Dietary Approaches to Stop Hypertension (DASH) diet lowers blood pressure in adults with hypertension, how kidney function impacts this effect is not known. We evaluated whether Estimated Glomerular Filtration Rate (eGFR) modifies the effect of the DASH diet on blood pressure, markers of mineral metabolism, and markers of kidney function. METHODS: Secondary analysis of the DASH-Sodium trial, a multicenter, randomized, controlled human feeding study that evaluated the blood pressure lowering effect of the DASH diet at three levels of sodium intake. Data from 92 participants with pre-hypertension or stage 1 hypertension during the 3450 mg /day sodium diet assignment contributed to this analysis. Stored frozen plasma and urine specimens were used to measure kidney related laboratory outcomes. RESULTS: Effects of the DASH diet on blood pressure, phosphorus, intact parathyroid hormone, creatinine, and albuminuria were not modified by baseline eGFR (mean 84.5 ± 18.0 ml/min/1.73 m(2), range 44.1 to 138.6 ml/min/1.73 m(2)) or the presence of chronic kidney disease (N=13%). CONCLUSIONS: The impact of the DASH diet on blood pressure, markers of mineral metabolism, and markers of kidney function does not appear to be modified by eGFR in this small subset of DASH-Sodium trial participants with relatively preserved kidney function. Whether greater reduction in eGFR modifies the effects of DASH on kidney related measures is yet to be determined. A larger study in individuals with more advanced kidney disease is needed to establish the efficacy and safety of the DASH diet in this patient population.

A Possible Role Of Alpha-Amylase Isoenzymes From The Style Of The Mussel Choromytilus-Meridionalis (Krauss) Following Thermal-Acclimation

Separation of the proteins comprising the crystalline style of the mussel Choromytilus meridionalis (Krauss) by anion exchange chromatography shows that there are three fractions displaying α-amylase activity in both warm- and cold-acclimated mussels. These fractions correspond with one or more proteins which remain unbound to the resin (Peak I), a bound fraction which is eluted at 100–150 mM NaCl (Peak II) and a further fraction which is eluted at 200–250 mM NaCl (Peak III) but which may represent contamination carried over from Peak II. Cold-acclimation to 8°C results in the appearance of a fourth α-amylase fraction (Peak IV) which is eluted from the column between 300–400 mM NaCl. Thermal acclimation also results in changes in the activities of Fractions I–IV such that a specific activity of 0.47 mg glucose liberated per A280 unit of protein per 8 min incubation at 8°C in Fraction IV is increased nearly 10-fold to a specific rate of 4.10 in protein Fraction I following acclimation to 22°C. It is suggested that an increased of digestive activity may be of equal importance to a suppression of metabolic costs in the maintenance of energy flow into growth and reproduction in ectothermic organisms which experience an increase of environmental temperature, especially in bivalves such as C. meridionalis which do not show a compensatory increase in filtration rate.

Combined Effects Of Body Size Food Concentration And Season On Physiology Of Mytilus-Edulis

Multivariate experiments are used to study the effects of body size, food concentration, and season on the oxygen consumption, ammonia excretion, food assimilation efficiency and filtration rate of Mytilus edulis adults. Food concentrations and season affect both the intercept and the slope of the allometric equation describing oxygen uptake as a function of body size. Multiple regression and response surface techniques are used to describe and illustrate the complex relationship between metabolic rate, ration, season and the body size of M. edulis. Filtration rate has a relatively low weight exponent Q> = 038) and the intercept for the allometric equation is not significantly affected by food concentration, season or acclimation temperatures between 5 and 20 °C. Food assimilation efficiency declines exponentially with increasing food concentration and is dependent on body size at high food levels. The rate of ammonia excretion shows a similar seasonal cycle to that of oxygen consumption. They are both minimal in the autumn/winter and reach a maximum in the spring /summer.

Rates Of Nitrogen-Excretion By Species Of Mytilus (Bivalvia - Mollusca)

The results of experiments recorded by Bayne & Scullard (1977) confirmed earlier studies (Bayne, 1973) in describing a decline in the rate of oxygen uptake (Vo2) by Mytilus edulis during starvation, eventually reaching a steady-state value, called the standard rate of oxygen consumption. Earlier experiments had also shown that if such starved mussels were fed, oxygen uptake increased rapidly to a high level called the active rate of oxygen consumption (Thompson & Bayne, 1972; Bayne, Thompson & Widdows, 1973). Some of this increase in metabolic rate is undoubtedly due to an increased filtration rate that is stimulated by the presence of food (the ‘mechanical cost of feeding’ discussed by Bayne et al. 1976), and part is due to the ‘physiological costs of feeding’, which includes energy utilized in digestion and assimilation of the food, and energy that is lost during deamination and other catabolic processes that accompany digestion (Warren & Davis, 1967). Increases in metabolic rate associated with feeding have been called the specific dynamic action (SDA) of the ration (see Harper, 1971, for a discussion) or the apparent SDA (Beamish, 1974)5 and they have been related to aspects of protein metabolism (Krebs, 1964). This paper describes the results of some experiments designed to examine the relationships between SDA and ammonia excretion in Mytilus edulis L.

Apparent Specific Dynamic Action In Mytilus-Edulis L

The results of experiments recorded by Bayne & Scullard (1977) confirmed earlier studies (Bayne, 1973) in describing a decline in the rate of oxygen uptake (Vo2) by Mytilus edulis during starvation, eventually reaching a steady-state value, called the standard rate of oxygen consumption. Earlier experiments had also shown that if such starved mussels were fed, oxygen uptake increased rapidly to a high level called the active rate of oxygen consumption (Thompson & Bayne, 1972; Bayne, Thompson & Widdows, 1973). Some of this increase in metabolic rate is undoubtedly due to an increased filtration rate that is stimulated by the presence of food (the ‘mechanical cost of feeding’ discussed by Bayne et al. 1976), and part is due to the ‘physiological costs of feeding’, which includes energy utilized in digestion and assimilation of the food, and energy that is lost during deamination and other catabolic processes that accompany digestion (Warren & Davis, 1967). Increases in metabolic rate associated with feeding have been called the specific dynamic action (SDA) of the ration (see Harper, 1971, for a discussion) or the apparent SDA (Beamish, 1974)5 and they have been related to aspects of protein metabolism (Krebs, 1964). This paper describes the results of some experiments designed to examine the relationships between SDA and ammonia excretion in Mytilus edulis L.

Physiological Adaptation Of Mytilus-Edulis To Cyclic Temperatures

Mytilus edulis adapted to cyclic temperatures by reducing the amplitude of response of oxygen consumption and filtration rate over a period of approximately two weeks, and thereby increasing their independence of temperature within the range of the fluctuating regime. When acclimated to cyclic temperature regimes within the range from 6 to 20°C, the metabolic and feeding rates, measured at different temperatures in the cycle, were not significantly different from the adapted response to equivalent constant temperatures. Physiological adaptation ofMytilus edulis to different thermal environments was reflected in their metabolic and feeding rate-temperature curves. Animals subjected to marked diel fluctuations in environmental temperature showed an appropriate region of temperature-independence, whereas animals from a population not experiencing large diel temperature fluctuations showed no region of temperature-independence. In a fluctuating thermal environment which extended above the normal environmental maxima, respiratory adaptation occurred at higher temperatures than was possible in a constant thermal environment. The feeding rate was also maintained at higher temperatures in a cyclic regime than was possible under constant thermal conditions. This represented a shortterm extension of the zone of activity in a fluctuating thermal environment. The net result of these physiological responses to high cyclic and constant temperatures has been assessed in terms of ‘scope for growth’. Animals acclimated to cyclic temperatures between 21 and 29°C had a higher scope for growth at 29°C and were less severely stressed than those maintained at the constant temperature of 29°C.

Level of renal function and serum erythropoietin levels independently predict anaemia post-renal transplantation

Background. Post-renal transplant anaemia is a potentially reversible cardiovascular risk factor. Graft function, immunosuppressive agents and inhibition of the renin-angiotensin system have been implicated in its aetiology. The evaluation of erythropoietin (EPO) levels may contribute to understanding the relative contributions of these factors. Methods. Two-hundred and seven renal transplant recipients attending the Belfast City Hospital were studied. Clinical and laboratory data were extracted from the medical records and laboratory systems. Results. Of the 207 patients (126 male), 47 (22.7%) were found to be anaemic (males, haemoglobin (Hb) <12 g/dl, females Hb <11g/dl). The anaemic group had a significantly higher mean serum creatinine level (162.8 µmol/l vs 131.0 µmol/l, P <0.001) and lower mean estimated glomerular filtration rate (eGFR) (41.5 ml/min vs 54.9 ml/min, P <0.001) than the non-anaemic group. Individual immunosuppressive regimens were comparable between those with and those without anaemia. Angiotensin converting enzyme inhibitor (ACE-I) or angiotensin receptor blocker (ARB) administration was not more prevalent in those with anaemia compared with those without (36.2 vs 38.8, P = 0.88). There was a significant inverse correlation between Hb levels and serum EPO levels (R = -0.29, P <0.001), but not between EPO levels and eGFR (R = 0.02, P = 0.74). Higher EPO levels were predictive of anaemia, independent of eGFR in multivariate analysis. Conclusion. Anaemia is common in post-renal transplant patients. The levels of renal function and serum EPO and not immunosuppressive regimens or ACE-I/ARB use, are strong and independent predictors of anaemia. © The Author [2007]. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved.

Elevated serum phosphate predicts mortality in renal transplant recipients

BACKGROUND.: High serum phosphate has been identified as an important contributor to the vascular calcification seen in patients with chronic kidney disease (Block et al., Am J Kidney Dis 1998; 31: 607). In patients on hemodialysis, elevated serum phosphate levels are an independent predictor of mortality (Block et al., Am J Kidney Dis 1998; 31: 607; Block, Curr Opin Nephrol Hypertens 2001; 10: 741). The aim of this study was to investigate whether an elevated serum phosphate level was an independent predictor of mortality in patients with a renal transplant.
METHODS.: Three hundred seventy-nine asymptomatic renal transplant recipients were recruited between June 2000 and December 2002. Serum phosphate was measured at baseline and prospective follow-up data were collected at a median of 2441 days after enrolment.
RESULTS.: Serum phosphate was significantly higher in those renal transplant recipients who died at follow-up when compared with those who were still alive at follow-up (P<0.001). In Kaplan-Meier analysis, serum phosphate concentration was a significant predictor of mortality (P=0.0001). In multivariate Cox regression analysis, serum phosphate concentration remained a statistically significant predictor of all-cause mortality after adjustment for traditional cardiovascular risk factors, estimated glomerular filtration rate, and high sensitivity C reactive protein (P=0.036) and after adjustment for renal graft failure (P=0.001).
CONCLUSIONS.: The results of this prospective study are the first to show that a higher serum phosphate is a predictor of mortality in patients with a renal transplant and suggest that serum phosphate provides additional, independent, prognostic information to that provided by traditional risk factors in the risk assessment of patients with a renal transplant.

Prevalence and Management of Anaemia in Renal Transplant Recipients: Data from Ten European Centres.

Background: Although it is a known predictor of mortality, there is a relative lack of recent information about anaemia in kidney transplant recipients. Thus, we now report data about the prevalence and management of post-transplant anaemia (PTA) in Europe 5 years after the TRansplant European Survey on Anemia Management (TRESAM) study. Methods: In a cross-sectional study enrolling the largest number of patients to date, data were obtained from 5,834 patients followed at 10 outpatient transplant clinics in four European countries using the American Society of Transplantation anaemia guideline. Results: More than one third (42%) of the patients were anaemic. The haemoglobin (Hb) concentration was significantly correlated with the estimated glomerular filtration rate (eGFR) (r = 0.4, p < 0.001). In multivariate analysis, eGFR, serum ferritin, age, gender, time since transplantation and centres were independently and significantly associated with Hb. Only 24% of the patients who had a Hb concentration <110 g/l were treated with an erythropoiesis-stimulating agent. The prevalence of anaemia and also the use of erythropoiesis-stimulating agents were significantly different across the different centres, suggesting substantial practice variations. Conclusions: PTA is still common and under-treated. The prevalence and management of PTA have not changed substantially since the TRESAM survey.

Predicting the risk of bleomycin lung toxicity in patients with germ-cell tumours

Background: Bleomycin pulmonary toxicity (BPT) has been known since the early clinical trials of bleomycin in the 1960s. Postulated risk factors include cumulative bleomycin dose, reduced glomerular filtration rate (GFR), raised creatinine, older age and supplemental oxygen exposure.

Stroma-free hemoglobin increases blood pressure and GFR in the hypotensive rat: role of nitric oxide.

The short-term systemic and renal hemodynamic effects of two stroma-free hemoglobin (SFH) solutions, one unmodified and the other modified by cross-linking, were examined in anesthetized rats after hemorrhagic hypotension. Both forms of SFH increased mean arterial pressure (MAP) and glomerular filtration rate (GFR) to baseline (prehemorrhage) values. The increase in MAP induced by unmodified SFH was greater than the increase in MAP caused by an albumin solution isoncotic to the unmodified SFH solution. Similarly, the increase in MAP caused by the modified SFH was also substantially greater than that induced by an albumin solution of comparable oncotic pressure to the modified SFH solution. Both unmodified and modified SFH increased GFR. As with MAP, the increase in GFR induced by both SFH solutions was greater than that associated with the oncotically matched albumin solutions. In separate experiments, the effects of nitric oxide (NO) inhibition with N omega-nitro-L-arginine methyl ester (L-NAME) on MAP after hemorrhagic hypotension and subsequent infusion of unmodified SFH or albumin were also examined. In the albumin-infused rats, L-NAME increased MAP. In marked contrast, NO inhibition with L-NAME had no further effect on MAP when infused after SFH. We conclude that both unmodified and modified SFH solutions acutely improve MAP and GFR by the combined effects of intravascular volume expansion resulting from the colloid effect of the protein and by inactivation of NO.

Unravelling the genetic basis of renal diseases; from single gene to multifactorial disorders

Chronic kidney disease is common with up to 5% of the adult population reported to have an estimated glomerular filtration rate of

Application of STOPP and START criteria: interrater reliability among pharmacists

BACKGROUND: Inappropriate prescribing is a well-documented problem in older people. The new screening tools, STOPP (Screening Tool of Older Peoples' Prescriptions) and START (Screening Tool to Alert doctors to Right Treatment) have been formulated to identify potentially inappropriate medications (PIMs) and potential errors of omissions (PEOs) in older patients. Consistent, reliable application of STOPP and START is essential for the screening tools to be used effectively by pharmacists. OBJECTIVE: To determine the interrater reliability among a group of clinical pharmacists in applying the STOPP and START criteria to elderly patients' records. METHODS: Ten pharmacists (5 hospital pharmacists, 5 community pharmacists) were given 20 patient profiles containing details including the patients' age and sex, current medications, current diagnoses, relevant medical histories, biochemical data, and estimated glomerular filtration rate. Each pharmacist applied the STOPP and START criteria to each patient record. The PIMs and PEOs identified by each pharmacist were compared with those of 2 academic pharmacists who were highly familiar with the application of STOPP and START. An interrater reliability analysis using the k statistic (chance corrected measure of agreement) was performed to determine consistency between pharmacists. RESULTS: The median ? coefficients for hospital pharmacists and community pharmacists compared with the academic pharmacists for STOPP were 0.89 and 0.88, respectively, while those for START were 0.91 and 0.90, respectively. CONCLUSIONS: Interrater reliability of STOPP and START tools between pharmacists working in different sectors is good. Pharmacists working in both hospitals and in the community can use STOPP and START reliably during their everyday practice to identify PIMs and PEOs in older patients.

The effects of ibuprofen and indomethacin on renal function in the presence and absence of frusemide in healthy volunteers on a restricted sodium diet

1. Since salt depletion stimulates the renal prostaglandin system to maintain renal function, the effects of indomethacin and ibuprofen upon renal haemodynamics, electrolyte excretion and renin release were examined in eight healthy male volunteers on a salt restricted diet, before and after frusemide administration. 2. Neither indomethacin (50 mg) nor ibuprofen (400 mg and 800 mg) affected renal blood flow, glomerular filtration rate or electrolyte excretion before frusemide. 3. Renal blood flow and glomerular filtration rate were significantly increased in the first 20 min after frusemide. These changes were significantly attenuated by indomethacin compared with placebo and ibuprofen 400 mg. Frusemide-induced diuresis but not natriuresis was inhibited by all treatments. 4. Both nonsteroidal agents inhibited equally the rise in renin activity seen after frusemide. 5. In this group of healthy volunteers on a salt restricted diet, ibuprofen and indomethacin had no detrimental effects on renal function in the absence of frusemide. The changes in renal haemodynamics due to frusemide were suppressed more by indomethacin than by ibuprofen, probably reflecting the more potent nature of indomethacin as an inhibitor of prostaglandin synthesis.

A comparison of the effects of ibuprofen and indomethacin upon renal haemodynamics and electrolyte excretion in the presence and absence of frusemide

1. This study has compared the effects of ibuprofen and indomethacin upon renal haemodynamics, electrolyte excretion and renin release in the presence and absence of frusemide under sodium replete conditions in eight healthy volunteers. 2. Neither ibuprofen (400 mg and 800 mg) nor indomethacin (50 mg) affected renal blood flow, glomerular filtration rate or electrolyte excretion in the basal state. 3. Frusemide had no effect on renal blood flow, but significantly increased glomerular filtration rate. This latter change was suppressed significantly only by ibuprofen 400 mg. Frusemide-induced diuresis was inhibited by all treatments, while natriuresis following frusemide was inhibited by indomethacin only. 4. Significant increments in plasma renin activity, which were suppressed by all treatments, were observed after frusemide. The degree of inhibition of the renin responses was significantly greater in the presence of indomethacin than with either dose of ibuprofen. 5. In a sodium replete setting in healthy volunteers, indomethacin and ibuprofen had no detrimental effects on basal renal function. In the presence of frusemide, indomethacin had more anti-natriuretic and renin-suppressing effect than ibuprofen. There was no evidence for a dose-related effect of ibuprofen.