Publications by authors named "Michel Burnier"

491 Publications

Global warming applied to dialysis: facts and figures.

Nephrol Dial Transplant 2021 Sep 6. Epub 2021 Sep 6.

Department of Nephrology, Nutrition and Dialysis, University of Lyon, Hospital Lyon-SUD, F-69495, Pierre-Bénite, France.

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http://dx.doi.org/10.1093/ndt/gfab260DOI Listing
September 2021

Hip Position Acutely Affects Oxygenation and Perfusion of Kidney Grafts as Measured by Functional Magnetic Resonance Imaging Methods-The Bent Knee Study.

Front Med (Lausanne) 2021 10;8:697055. Epub 2021 Aug 10.

Departments of Biomedical Research and Radiology, University of Bern, Bern, Switzerland.

Kidney perfusion and oxygenation are two important determinants of kidney graft function. In kidney transplantation, repeated graft hypoperfusion may occur during hip flexion, for example in the sitting position, due to the progressive development of fibrotic tissue around iliac arteries. The aim of this study was to assess the changes in oxygenation and perfusion of kidney grafts during hip flexion and extension using a new functional magnetic resonance imaging (fMRI) protocol. Nineteen kidney graft recipients prospectively underwent MRI on a 3T scanner including diffusion-weighted, blood oxygenation level dependent (BOLD), and arterial spin labeling sequences in hip positions 0° and >90° before and after intravenous administration of 20 mg furosemide. Unexpectedly, graft perfusion values were significantly higher in flexed compared to neutral hip position. Main diffusion-derived parameters were not affected by hip position. BOLD-derived cortico-medullary R2 ratio was significantly modified during hip flexion suggesting an intrarenal redistribution of the oxygenation in favor of the medulla and to the detriment of the cortex. Furthermore, the increase in medullary oxygenation induced by furosemide was significantly blunted during hip flexion ( < 0.001). Hip flexion has an acute impact on perfusion and tissue oxygenation in kidney grafts. Whether these position-dependent changes affect the long-term function and outcome of kidney transplants needs further investigation.
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http://dx.doi.org/10.3389/fmed.2021.697055DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8384256PMC
August 2021

Hypertension healthcare professional beliefs and behaviour regarding patient medication adherence: a survey conducted among European Society of Hypertension Centres of Excellence.

Blood Press 2021 Aug 14:1-9. Epub 2021 Aug 14.

Institute of Clinical Pharmacology and Toxicology, Humboldt-Universität zu Berlin, Berlin, Germany.

Purpose: Little is known on the beliefs, perceptions and practices of hypertension specialists in addressing non-adherence to therapy. Therefore, a survey was undertaken amongst healthcare professionals (HCPs) managing hypertension in the European Society of Hypertension (ESH) Centres of Excellence.

Materials And Methods: Cross-sectional data were obtained between December 2020 and April 2021 using an online anonymous structured questionnaire including 26 questions/136 items, that was sent to all ESH Excellence centres.

Results: Overall 67 from 187 centres (37.3%) responded and 200 HCPs from 30 countries answered the questionnaire. Participants (60% men) were mainly physicians (91%) and nurses (8%) from University hospitals (77%). Among physicians, 83% had >10 years professional experience. Average time dedicated to discuss medications was 1-5 min in 48% and 6-10 min in 29% of cases. Interviews with patients about adherence were the most frequently used assessment method. Chemical detection of medications in urine was available in 36% of centres. One third of physicians involved their patients regularly in treatment decisions. The most frequent methods to improve adherence included simplification of medication therapy, more frequent visits, and home blood pressure monitoring.

Conclusions: The level of implementation of tools to detect and improve adherence in hypertension management by HCPs in ESH excellence centres is low. Structured educational activities focussing on adherence management and access to the newest objective measures to detect non-adherence might improve these deficits.
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http://dx.doi.org/10.1080/08037051.2021.1963209DOI Listing
August 2021

Sodium-glucose cotransporter 2 (SGLT-2) inhibition and kidney protection: Does improvement in kidney hypoxia play a role?

Authors:
Michel Burnier

EClinicalMedicine 2021 Jul 28;37:100983. Epub 2021 Jun 28.

Service of Nephrology and Hypertension, University Hospital, Lausanne, Switzerland.

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http://dx.doi.org/10.1016/j.eclinm.2021.100983DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8343241PMC
July 2021

Renal denervation for patients with chronic kidney disease and resistant hypertension: effective and safe but still not the panacea.

Authors:
Michel Burnier

Nephrol Dial Transplant 2021 Aug 12. Epub 2021 Aug 12.

Service of Nephrology and Hypertension, University Hospital, Lausanne, Switzerland.

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http://dx.doi.org/10.1093/ndt/gfab208DOI Listing
August 2021

Clinical benefits of hypertension management: a look to the past to strengthen the future.

Authors:
Michel Burnier

Eur J Prev Cardiol 2021 Aug 2. Epub 2021 Aug 2.

Service of Nephrology and Hypertension, Department of Medicine, University Hospital, Rue du Bugnon 17, 1011 Lausanne, Switzerland.

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http://dx.doi.org/10.1093/eurjpc/zwab110DOI Listing
August 2021

Cuff-less measurements of blood pressure: are we ready for a change?

Blood Press 2021 Aug 26;30(4):205-207. Epub 2021 Jul 26.

Vascular Biology and Hypertension Program, Department of Medicine, University of Alabama at Birmingham, AL, USA.

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http://dx.doi.org/10.1080/08037051.2021.1956178DOI Listing
August 2021

Home blood pressure monitoring: methodology, clinical relevance and practical application: a 2021 position paper by the Working Group on Blood Pressure Monitoring and Cardiovascular Variability of the European Society of Hypertension.

J Hypertens 2021 Sep;39(9):1742-1767

Department of Hygiene and Public Health, Teikyo University School of Medicine, Tokyo, Japan.

The present paper provides an update of previous recommendations on Home Blood Pressure Monitoring from the European Society of Hypertension (ESH) Working Group on Blood Pressure Monitoring and Cardiovascular Variability sequentially published in years 2000, 2008 and 2010. This update has taken into account new evidence in this field, including a recent statement by the American Heart association, as well as technological developments, which have occurred over the past 20 years. The present document has been developed by the same ESH Working Group with inputs from an international team of experts, and has been endorsed by the ESH.
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http://dx.doi.org/10.1097/HJH.0000000000002922DOI Listing
September 2021

Sex- and age-specific reference intervals for diagnostic ratios reflecting relative activity of steroidogenic enzymes and pathways in adults.

PLoS One 2021 8;16(7):e0253975. Epub 2021 Jul 8.

Department of Nephrology and Hypertension and Department of Clinical Research, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.

Objective: Diagnostic ratios calculated from urinary steroid hormone metabolites are used as a measure for the relative activity of steroidogenic enzymes or pathways in the clinical investigation of steroid metabolism disorders. However, population-based sex- and age-specific reference intervals and day-night differences in adults are lacking.

Methods: Sixty-five diagnostic ratios were calculated from steroid metabolites measured by GC-MS in day- and night-time and in 24-hour urine from 1128 adults recruited within the Swiss Kidney Project on Genes in Hypertension (SKIPOGH), a population-based, multicenter cohort study. Differences related to sex, age and day- and night-time were evaluated and reference curves in function of age and sex were modelled by multivariable linear mixed regression for diagnostic ratios and were compared to values from the literature.

Results: Most ratios had sex- and age-specific relationships. For each ratio, percentiles were plotted in function of age and sex in order to create reference curves and sex- and age-specific reference intervals derived from 2.5th and 97.5th percentiles were obtained. Most ratios reflected a higher enzyme activity during the day compared to the night.

Conclusions: Sex- and age-specific references for 24 hours, day and night urine steroid metabolite ratios may help distinguishing between health and disease when investigating human disorders affecting steroid synthesis and metabolism. The day-night differences observed for most of the diagnostic ratios suggest a circadian rhythm for enzymes involved in human steroid hormones metabolism.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0253975PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8266106PMC
July 2021

Reply to comment on: Glatz et al. Associations of sodium, potassium and protein intake with blood pressure and hypertension in Switzerland.

Authors:
Michel Burnier

Swiss Med Wkly 2021 Jun 9;151:w20182. Epub 2021 Jun 9.

Service of Nephrology and Hypertension, Department of Medicine, Lausanne University Hospital, Switzerland.

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http://dx.doi.org/10.4414/smw.2021.20182DOI Listing
June 2021

Assessment of a strategy combining ambulatory blood pressure, adherence monitoring and a standardised triple therapy in resistant hypertension.

Blood Press 2021 Jul 6:1-9. Epub 2021 Jul 6.

Service of Nephrology and Hypertension, Lausanne University Hospital and Lausanne University, CHUV, Lausanne, Switzerland.

Purpose: Poor adherence to drug therapy and inadequate drug regimens are two frequent factors responsible for the poor blood pressure (BP) control observed in patients with apparent resistant hypertension. We evaluated the efficacy of an antihypertensive management strategy combining a standardised therapy with three long acting drugs and electronic monitoring of drug adherence in patients with apparent resistant hypertension.

Materials And Methods: In this multicentric observational study, adult patients with residual hypertension on 24 h ambulatory BP monitoring (ABMP) despite the use of three or more antihypertensive drugs could be included. Olmesartan/amlodipine (40/10 mg, single pill fixed-dose combination) and chlorthalidone (25 mg) were prescribed for 3 months in two separated electronic pills boxes (EPB). The primary outcome was 24 h ambulatory systolic BP (SBP) control at 3 months, defined as mean SBP <130 mmHg.

Results: We enrolled 48 patients (36.0% women) of whom 35 had complete EPB data. After 3 months, 52.1% of patients had 24 h SBP <130 mmHg. 24 h SBP decreased by respectively -9.1 ± 15.5 mmHg, -22.8 ± 30.6 mmHg and -27.7 ± 16.6 mmHg from the tertile with the lowest adherence to the tertile with the highest adherence to the single pill combination ( = 0.024). A similar trend was observed with tertiles of adherence to chlorthalidone. Adherence superior to 90% was associated with 24 h systolic and diastolic blood pressure control in multiple logistic regression analysis (odds ratio = 14.1 (95% confidence interval 1.1-173.3,  = 0.039).

Conclusions: A simplified standardised antihypertensive therapy combined with electronic monitoring of adherence normalises SBP in about half of patients with apparent resistant hypertension. Such combined management strategy enables identifying patients who need complementary investigations and those who rather need a long-term support of their adherence.
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http://dx.doi.org/10.1080/08037051.2021.1907174DOI Listing
July 2021

Smartphone based blood pressure measurement: accuracy of the OptiBP mobile application according to the AAMI/ESH/ISO universal validation protocol.

Blood Press Monit 2021 Jun 15. Epub 2021 Jun 15.

Department of Anesthesiology Service of Nephrology and Hypertension, Lausanne University Hospital and University of Lausanne, Lausanne CSEM, Swiss Center for Electronics and Microtechnology, Neuchâtel Biospectal SA, Lausanne, Switzerland.

Objective: The aim of this study was to assess the accuracy of the OptiBP mobile application based on an optical signal recorded by placing the patient's fingertip on a smartphone's camera to estimate blood pressure (BP). Measurements were carried out in a general population according to existing standards of the Association for the Advancement of Medical Instrumentation (AAMI), the European Society of Hypertension (ESH) and the International Organization for Standardization (ISO).

Methods: Participants were recruited during a scheduled appointment at the hypertension clinic of Lausanne University Hospital in Switzerland. Age, gender and BP distribution were collected to fulfill AAMI/ESH/ISO universal standards. Both auscultatory BP references and OptiBP were measured and compared using the opposite arm simultaneous method as described in the 81060-2:2018 ISO norm.

Results: A total of 353 paired recordings from 91 subjects were analyzed. For validation criterion 1, the mean ± SD between OptiBP and reference BP recordings was respectively 0.5 ± 7.7 mmHg and 0.4 ± 4.6 mmHg for SBP and DBP. For validation criterion 2, the SD of the averaged BP differences between OptiBP and reference BP per subject was 6.3 mmHg and 3.5 mmHg for SBP and DBP. OptiBP acceptance rate was 85%.

Conclusion: The smartphone embedded OptiBP cuffless mobile application fulfills the validation requirements of AAMI/ESH/ISO universal standards in a general population for the measurement of SBP and DBP.
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http://dx.doi.org/10.1097/MBP.0000000000000556DOI Listing
June 2021

Hypertension in kidney transplantation: a consensus statement of the 'hypertension and the kidney' working group of the European Society of Hypertension.

J Hypertens 2021 Aug;39(8):1513-1521

Associazione Ipertensione, Nefrologia e Trapianto Renal (IPNET) C/O CNR-IFC, Ospedali Riuniti, Reggio Calabria, Italy.

Hypertension is common in kidney transplantation recipients and may be difficult to treat. Factors present before kidney transplantation, related to the transplantation procedure itself and factors developing after transplantation may contribute to blood pressure (BP) elevation in kidney transplant recipients. The present consensus is based on the results of three recent systematic reviews, the latest guidelines and the current literature. The current transplant guidelines, which recommend only office BP assessments for risk stratification in kidney transplant patients should be reconsidered, given the presence of white-coat hypertension and masked hypertension in this population and the better prediction of adverse outcomes by 24-h ambulatory BP monitoring as indicated in recent systematic reviews. Hypertension is associated with adverse kidney and cardiovascular outcomes and decreased survival in kidney transplant recipients. Current evidence suggests calcium channel blockers could be the preferred first-step antihypertensive agents in kidney transplant patients, as they improve graft function and reduce graft loss, whereas no clear benefit is documented for renin-angiotensin system inhibitor use over conventional treatment in the current literature. Randomized control trials demonstrating the clinical benefits of BP lowering on kidney and major cardiovascular events and recording patient-related outcomes are still needed. These trials should define optimal BP targets for kidney transplant recipients. In the absence of kidney transplant-specific evidence, BP targets in kidney transplant recipients should be similar to those in the wider chronic kidney disease population.
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http://dx.doi.org/10.1097/HJH.0000000000002879DOI Listing
August 2021

Mineralocorticoid receptor antagonists for nephroprotection and cardioprotection in patients with diabetes mellitus and chronic kidney disease.

Nephrol Dial Transplant 2021 May 4. Epub 2021 May 4.

Department of Nephrology, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece.

Diabetic kidney disease develops in about 40% of patients with diabetes and is the commonest cause of chronic kidney disease worldwide. Patients with chronic kidney disease, especially those with diabetes mellitus, are at high risk of both developing kidney failure and cardiovascular death. The use of renin-angiotensin system blockers to reduce the incidence of kidney failure in patients with diabetic kidney disease dates back to studies that are now 20 or more years old. During the last few years sodium-glucose co-transporter-2 inhibitors have shown beneficial renal effects in randomized trials. However, even in response to combined treatment with renin-angiotensin system blockers and sodium-glucose co-transporter-2 inhibitors, the renal residual risk remains high with kidney failure only deferred, but not avoided. The risk of cardiovascular death also remains high even with optimal current treatment. Steroidal mineralocorticoid receptor antagonists reduce albuminuria and surrogate markers of cardiovascular disease in patients already on optimal therapy. However, their use has been curtailed by the significant risk of hyperkalaemia. In The FInerenone in reducing kiDnEy faiLure and dIsease prOgression in Diabetic Kidney Disease (FIDELIO-DKD) study comparing the actions of the non-steroidal mineralocorticoid receptor antagonist finerenone with placebo, finerenone reduced the progression of diabetic kidney disease and the incidence of cardiovascular events with a relatively safe adverse event profile. This document presents in detail the available evidence on the cardioprotective and nephroprotective effects of mineralocorticoid receptor antagonists, analyses the potential mechanisms involved and discusses their potential future place in the treatment of patients with diabetic chronic kidney disease.
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http://dx.doi.org/10.1093/ndt/gfab167DOI Listing
May 2021

Better drug adherence improves blood pressure control and lowers cardiovascular disease outcomes - from single pill combinations to monitoring of a nationwide health insurance database.

Blood Press 2021 06 29;30(3):143-144. Epub 2021 Apr 29.

Vascular Biology and Hypertension Program, Department of Medicine, University of Alabama at Birmingham, AL, USA.

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http://dx.doi.org/10.1080/08037051.2021.1917192DOI Listing
June 2021

Sex differences in the progression of kidney injury and risk of death in CKD patients: is different ambulatory blood pressure control the underlying cause?

Nephrol Dial Transplant 2021 Apr 12. Epub 2021 Apr 12.

Service of Nephrology and Hypertension, Lausanne University Hospital, Lausanne, Switzerland.

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http://dx.doi.org/10.1093/ndt/gfab115DOI Listing
April 2021

Blood pressure monitoring in kidney transplantation: a systematic review on hypertension and target organ damage.

Nephrol Dial Transplant 2021 Mar 25. Epub 2021 Mar 25.

CNR-Institute of Clinical Physiology; Clinical Epidemiology and Physiopathology of Renal Diseases and Hypertension, Reggio Calabria, Italy.

Background: Sparse studies show that ambulatory blood pressure monitoring (ABPM) is superior to office BP (oBP) measurements to predict target organ damage and cardiovascular (CV) events in kidney transplant recipients (KTRs). We performed a systematic review aimed at determining the potential associations between BP recordings by different methods and renal and CV outcomes in this population.

Methods: Major medical databases were searched for studies enrolling adult KTRs undergoing 24h ABPM compared to office or home BP measurements. Main outcomes were: associations between different BP recordings and renal and CV outcomes. Additionally, any association between the circadian BP pattern (dipping/non-dipping status) and outcomes was assessed.

Results: Twenty-two studies (2078 participants) were reviewed. Amongst 12 studies collecting data on renal endpoints, ten studies found that BP assessed by ABPM was a stronger predictor of renal function decline, assessed by serum creatinine (SCr) and/or creatinine clearance (CrCl) or estimated glomerular filtration rate (eGFR), than traditional office measurements. Twelve studies analyzed the relation between different BP recordings and CV target organ damages and reported robust correlations between echocardiographic abnormalities [i.e. left ventricular mass index (LVM/LVMI)] and 24h ABPM, but not with office BPs. Furthermore, 24h ABPM correlated better than oBP with markers of vascular damage, such as carotid intima-media thickness (IMT), diffuse thickening, and endothelial dysfunction. Additionally, abnormal circadian BP pattern (non-dippers and reverse dippers) identified a group of kidney recipients at risk for kidney function loss and CV abnormalities.

Conclusions: In our systematic review, ABPM reflected target organ damage more closely than oBP in KTRs. Furthermore, altered circadian BP profile associated with renal and CV target organ damages.
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http://dx.doi.org/10.1093/ndt/gfab076DOI Listing
March 2021

Interprofessional Medication Adherence Program for Patients With Diabetic Kidney Disease: Protocol for a Randomized Controlled and Qualitative Study (PANDIA-IRIS).

JMIR Res Protoc 2021 Mar 19;10(3):e25966. Epub 2021 Mar 19.

School of Pharmaceutical Sciences, University of Geneva, Geneva, Switzerland.

Background: Despite effective treatments, more than 30% of patients with diabetes will present with diabetic kidney disease (DKD) at some point. Patients with DKD are among the most complex as their care is multifactorial and involves different groups of health care providers. Suboptimal adherence to polypharmacy is frequent and contributes to poor outcomes. As self-management is one of the keys to clinical success, structured medication adherence programs are crucial. The PANDIA-IRIS (patients diabétiques et insuffisants rénaux: un programme interdisciplinaire de soutien à l'adhésion thérapeutique) study is based on a routine medication adherence program led by pharmacists.

Objective: The aim of this study is to define the impact of the duration of this medication adherence program on long-term adherence and clinical outcomes in patients with DKD.

Methods: This monocentric adherence program consists of short, repeated motivational interviews focused on patients' medication behaviors combined with the use of electronic monitors containing patients' medications. When patients open the electronic monitor cap to take their medication, the date and hour at each opening are registered. In total, 73 patients are randomized as 1:1 in 2 parallel groups; the adherence program will last 6 months in the first group versus 12 months in the second group. After the intervention phases, patients continue using their electronic monitors for a total of 24 months but without receiving feedback. Electronic monitors and pill counts are used to assess medication adherence. Persistence and implementation will be described using Kaplan-Meier curves and generalized estimating equation multimodeling, respectively. Longitudinal adherence will be presented as the product of persistence and implementation and modelized by generalized estimating equation multimodeling. The evolution of the ADVANCE (Action in Diabetes and Vascular disease: Preterax and Diamicron Modified-Release Controlled Evaluation) and UKPDS (United Kingdom Prospective Diabetes Study) clinical scores based on medication adherence will be analyzed with generalized estimating equation multimodeling. Patients' satisfaction with this study will be assessed through qualitative interviews, which will be transcribed verbatim, coded, and analyzed for the main themes.

Results: This study was approved by the local ethics committee (Vaud, Switzerland) in November 2015. Since then, 2 amendments to the protocol have been approved in June 2017 and October 2019. Patients' recruitment began in April 2016 and ended in October 2020. This study was introduced to all consecutive eligible patients (n=275). Among them, 73 accepted to participate (26.5%) and 202 (73.5%) refused. Data collection is ongoing and data analysis is planned for 2022.

Conclusions: The PANDIA-IRIS study will provide crucial information about the impact of the medication adherence program on the adherence and clinical outcomes of patients with DKD. Monitoring medication adherence during the postintervention phase is innovative and will shed light on the duration of the intervention on medication adherence.

Trial Registration: Clinicaltrials.gov NCT04190251_PANDIA IRIS; https://clinicaltrials.gov/ct2/show/NCT04190251.

International Registered Report Identifier (irrid): DERR1-10.2196/25966.
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http://dx.doi.org/10.2196/25966DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8088877PMC
March 2021

Editorial: Hypertension in the Elderly.

Front Cardiovasc Med 2021 24;8:645580. Epub 2021 Feb 24.

Service of Nephrology and Hypertension, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.

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http://dx.doi.org/10.3389/fcvm.2021.645580DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7959793PMC
February 2021

Blood pressure target in patients with hypertension and type-2 diabetes older than 65 years. Is <130/80 mmHg the right target or an excessive objective preventing from achieving the clinical goals we are aiming at?

Blood Press 2021 04 29;30(2):79-81. Epub 2021 Jan 29.

Vascular Biology and Hypertension Program, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA.

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http://dx.doi.org/10.1080/08037051.2021.1878324DOI Listing
April 2021

Dietary sodium intake does not alter renal potassium handling and blood pressure in healthy young males.

Nephrol Dial Transplant 2021 Jan 25. Epub 2021 Jan 25.

Service of Nephrology and Hypertension, University Hospital Geneva, Switzerland.

Background: The effects of sodium intakes on renal handling of potassium are insufficiently studied.

Methods: We assessed the effect of sodium on renal potassium handling in 16 healthy males assigned to three 7-day periods on low (LSD, 3 g NaCl/d), normal (NSD, 6 g NaCl/d) and high (HSD, 15 g NaCl/d) sodium diet with constant potassium intake. Contributions of distal NaCl co-transporter and epithelial sodium channel in the collecting system on potassium and sodium handling were assessed at steady-state by acute response to 100 mg oral hydrochlorothiazide and with addition of 10 mg of amiloride to hydrochlorothiazide, respectively.

Results: Diurnal blood pressure slightly increased from 119.30 ± 7.95 mmHg under LSD to 123.00 ± 7.50 mmHg, (P = 0.02) under HSD, while estimated glomerular filtration rate increased from 133.20 ± 34.68 ml/min under LSD to 187.00 ± 49.10 under HSD, (P = 0.005). Twenty-four hours potassium excretion remained stable on all sodium intakes (66.28 ± 19.12 mmol/24h under LSD; 55.91 ± 21.17 mmol/24h under NSD and 66.81 ± 20.72 under HSD, P = 0.9). The hydrochlorothiazide-induced natriuresis was the highest under HSD (30.22 ± 12.53 mmol/h), and the lowest under LSD (15.38 ± 8.94 mmol/h, P = 0.02). Hydrochlorothiazide increased kaliuresis and amiloride decreased kaliuresis similarly on all 3 diets.

Conclusion: Neither spontaneous nor diuretic-induced potassium excretion were influenced by sodium intake in healthy male subjects. However, the respective contribution of the distal convoluted tubule and the collecting duct to renal sodium handling was dependent on dietary sodium intake.
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http://dx.doi.org/10.1093/ndt/gfaa381DOI Listing
January 2021

How Do I Manage Hypertension in Patients with Advanced Chronic Kidney Disease Not on Dialysis? Perspectives from Clinical Practice.

Vasc Health Risk Manag 2021 6;17:1-11. Epub 2021 Jan 6.

Service of Nephrology and Hypertension, University Hospital, Lausanne, Switzerland.

In the general population, the prevalence of moderate and severe chronic kidney disease (CKD) is usually below 5% but this figure is often higher in specific groups of patients such as those with type 2 diabetes. Patients with advanced CKD (CKD stage 3b and 4) are at high or very high cardiovascular risk, and their risk of progressing towards end-stage kidney disease (CKD stage 5) and the need of renal replacement therapy are elevated. Hypertension is a major cause of poor cardiovascular and renal outcomes in severe CKD. Therefore, an adequate control of blood pressure (BP) is mandatory. However, normalizing BP is often challenging in these patients because the clinical management of hypertension in advanced CKD is not well defined and rarely supported by large randomized controlled trials. In the present review, we discuss the characteristics of hypertension in advanced CKD, excluding dialysis, and its management integrating data from recent clinical studies and a pragmatic approach enriched by a long-standing clinical experience.
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http://dx.doi.org/10.2147/VHRM.S292522DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7797323PMC
January 2021

Cortical perfusion as assessed with contrast-enhanced ultrasound is lower in patients with chronic kidney disease than in healthy subjects but increases under low salt conditions.

Nephrol Dial Transplant 2021 Jan 11. Epub 2021 Jan 11.

Service of Nephrology, University Hospital of Lausanne and University of Lausanne, Switzerland.

Background: Disturbances in renal microcirculation play an important role in the pathophysiology of chronic kidney disease (CKD), but the lack of easy accessible techniques hampers our understanding of the regulation of the renal microcirculation in humans. We assessed whether contrast-enhanced ultrasonography (CEUS) can identify differences in cortical perfusion and alterations induced by different dietary salt intakes in CKD patients and controls.

Methods: Participants underwent CEUS twice: once after 5 days of high salt intake (HS), and again after 5 days of low salt diet (LS). Sonovue® (0.015 ml/kg/min) was perfused as contrast agent and four consecutive destruction-reperfusion sequences were analyzed per visit. Primary outcome measure was the (change in) mean perfusion index (PI) of the renal cortex.

Results: Forty healthy volunteers (mean age±SD 50±8 years) and 18 CKD stage 2-4 patients (aged 55±11 years, eGFR 54±28 ml/min/1.73m²) were included and underwent CEUS without side effects. Under HS conditions, cortical PI was significantly lower in CKD patients (1618±1352 vs 3176 ±2278 arbitrary units in controls, p = 0.034). Under LS, renal PI increased in CKD patients (with +1098 to 2716 ±1540 a.u., p = 0.048), whereas PI remained stable in controls. In continuous analysis, PI correlated with eGFR (spearman's r = 0.54, p = 0.005) but not with age, sex, blood pressure or aldosterone levels.

Conclusion: CEUS identified important reductions in cortical micro-perfusion in patients with moderate CKD. Lowering salt intake increased perfusion in CKD patients, but not in controls, underlining the benefits of a low salt diet in CKD patients. Whether a low perfusion index is an early sign of kidney damage and predicts renal function decline needs further study.
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http://dx.doi.org/10.1093/ndt/gfab001DOI Listing
January 2021

The unsolved challenge of implementing sustained reductions of sodium intake in patients with chronic kidney disease.

Nephrol Dial Transplant 2020 Dec 26. Epub 2020 Dec 26.

Department of Nephrology, Nutrition and Dialysis, University of Lyon, Hospital Lyon-SUD, Pierre-Bénite, France.

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http://dx.doi.org/10.1093/ndt/gfaa268DOI Listing
December 2020

Potential protective effects of antihypertensive treatments during the Covid-19 pandemic: from inhibitors of the renin-angiotensin system to beta-adrenergic receptor blockers.

Blood Press 2021 02 21;30(1):1-3. Epub 2020 Dec 21.

Vascular Biology and Hypertension Program, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA.

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http://dx.doi.org/10.1080/08037051.2021.1862483DOI Listing
February 2021

In memoriam: Jiří Widimský Sr. 1925-2020.

Blood Press 2021 04 21;30(2):140-142. Epub 2020 Dec 21.

University of Milano-Bicocca, Milan, Italy.

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http://dx.doi.org/10.1080/08037051.2020.1859212DOI Listing
April 2021
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