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Rossitto G, Maiolino G, Lerco S, Ceolotto G, Blackburn G, Mary S, Antonelli G, Berton C, Bisogni V, Cesari M, Seccia TM, Lenzini L, Pinato A, Montezano A, Touyz RM, Petrie MC, Daly R, Welsh P, Plebani M, Rossi GP, Delles C. High sodium intake, glomerular hyperfiltration, and protein catabolism in patients with essential hypertension. Cardiovasc Res 2021; 117:1372-1381. [PMID: 33053160 PMCID: PMC8064429 DOI: 10.1093/cvr/cvaa205] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 05/28/2020] [Accepted: 07/10/2020] [Indexed: 01/01/2023] Open
Abstract
AIMS A blood pressure (BP)-independent metabolic shift towards a catabolic state upon high sodium (Na+) diet, ultimately favouring body fluid preservation, has recently been described in pre-clinical controlled settings. We sought to investigate the real-life impact of high Na+ intake on measures of renal Na+/water handling and metabolic signatures, as surrogates for cardiovascular risk, in hypertensive patients. METHODS AND RESULTS We analysed clinical and biochemical data from 766 consecutive patients with essential hypertension, collected at the time of screening for secondary causes. The systematic screening protocol included 24 h urine (24 h-u-) collection on usual diet and avoidance of renin-angiotensin-aldosterone system-confounding medications. Urinary 24 h-Na+ excretion, used to define classes of Na+ intake (low ≤2.3 g/day; medium 2.3-5 g/day; high >5 g/day), was an independent predictor of glomerular filtration rate after correction for age, sex, BP, BMI, aldosterone, and potassium excretion [P = 0.001; low: 94.1 (69.9-118.8) vs. high: 127.5 (108.3-147.8) mL/min/1.73 m2]. Renal Na+ and water handling diverged, with higher fractional excretion of Na+ and lower fractional excretion of water in those with evidence of high Na+ intake [FENa: low 0.39% (0.30-0.47) vs. high 0.81% (0.73-0.98), P < 0.001; FEwater: low 1.13% (0.73-1.72) vs. high 0.89% (0.69-1.12), P = 0.015]. Despite higher FENa, these patients showed higher absolute 24 h Na+ reabsorption and higher associated tubular energy expenditure, estimated by tubular Na+/ATP stoichiometry, accordingly [Δhigh-low = 18 (12-24) kcal/day, P < 0.001]. At non-targeted liquid chromatography/mass spectrometry plasma metabolomics in an unselected subcohort (n = 67), metabolites which were more abundant in high versus low Na+ intake (P < 0.05) mostly entailed intermediates or end products of protein catabolism/urea cycle. CONCLUSION When exposed to high Na+ intake, kidneys dissociate Na+ and water handling. In hypertensive patients, this comes at the cost of higher glomerular filtration rate, increased tubular energy expenditure, and protein catabolism from endogenous (muscle) or excess exogenous (dietary) sources. Glomerular hyperfiltration and the metabolic shift may have broad implications on global cardiovascular risk independent of BP.
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Affiliation(s)
- Giacomo Rossitto
- Institute of Cardiovascular and Medical Sciences, BHF Glasgow Cardiovascular Research Centre 126 University Place, University of Glasgow, Glasgow G12 8TA, UK
- Clinica dell’Ipertensione, DIMED, University of Padua, University Hospital, via Giustiniani 2, Padua 35126, Italy
| | - Giuseppe Maiolino
- Clinica dell’Ipertensione, DIMED, University of Padua, University Hospital, via Giustiniani 2, Padua 35126, Italy
| | - Silvia Lerco
- Clinica dell’Ipertensione, DIMED, University of Padua, University Hospital, via Giustiniani 2, Padua 35126, Italy
| | - Giulio Ceolotto
- Clinica dell’Ipertensione, DIMED, University of Padua, University Hospital, via Giustiniani 2, Padua 35126, Italy
| | - Gavin Blackburn
- Glasgow Polyomics, University of Glasgow, Wolfson Wohl Cancer Research Centre, Garscube Campus, Bearsden, Glasgow G61 1BD, UK
| | - Sheon Mary
- Institute of Cardiovascular and Medical Sciences, BHF Glasgow Cardiovascular Research Centre 126 University Place, University of Glasgow, Glasgow G12 8TA, UK
| | - Giorgia Antonelli
- Laboratory Medicine, DIMED, University of Padua, University Hospital, via Giustiniani 2, Padua 35126, Italy
| | - Chiara Berton
- Clinica dell’Ipertensione, DIMED, University of Padua, University Hospital, via Giustiniani 2, Padua 35126, Italy
| | - Valeria Bisogni
- Clinica dell’Ipertensione, DIMED, University of Padua, University Hospital, via Giustiniani 2, Padua 35126, Italy
| | - Maurizio Cesari
- Clinica dell’Ipertensione, DIMED, University of Padua, University Hospital, via Giustiniani 2, Padua 35126, Italy
| | - Teresa Maria Seccia
- Clinica dell’Ipertensione, DIMED, University of Padua, University Hospital, via Giustiniani 2, Padua 35126, Italy
| | - Livia Lenzini
- Clinica dell’Ipertensione, DIMED, University of Padua, University Hospital, via Giustiniani 2, Padua 35126, Italy
| | - Alessio Pinato
- Laboratory Medicine, DIMED, University of Padua, University Hospital, via Giustiniani 2, Padua 35126, Italy
| | - Augusto Montezano
- Institute of Cardiovascular and Medical Sciences, BHF Glasgow Cardiovascular Research Centre 126 University Place, University of Glasgow, Glasgow G12 8TA, UK
| | - Rhian M Touyz
- Institute of Cardiovascular and Medical Sciences, BHF Glasgow Cardiovascular Research Centre 126 University Place, University of Glasgow, Glasgow G12 8TA, UK
| | - Mark C Petrie
- Institute of Cardiovascular and Medical Sciences, BHF Glasgow Cardiovascular Research Centre 126 University Place, University of Glasgow, Glasgow G12 8TA, UK
| | - Ronan Daly
- Glasgow Polyomics, University of Glasgow, Wolfson Wohl Cancer Research Centre, Garscube Campus, Bearsden, Glasgow G61 1BD, UK
| | - Paul Welsh
- Institute of Cardiovascular and Medical Sciences, BHF Glasgow Cardiovascular Research Centre 126 University Place, University of Glasgow, Glasgow G12 8TA, UK
| | - Mario Plebani
- Laboratory Medicine, DIMED, University of Padua, University Hospital, via Giustiniani 2, Padua 35126, Italy
| | - Gian Paolo Rossi
- Clinica dell’Ipertensione, DIMED, University of Padua, University Hospital, via Giustiniani 2, Padua 35126, Italy
| | - Christian Delles
- Institute of Cardiovascular and Medical Sciences, BHF Glasgow Cardiovascular Research Centre 126 University Place, University of Glasgow, Glasgow G12 8TA, UK
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