Altered circulating marinobufagenin levels and recurrent intradialytic hypotensive episodes in chronic hemodialysis patients: a pilot, prospective study

Bolignano, Davide; Greco, Marta; Presta, Pierangela; Crugliano, Giuseppina; Sabatino, Jolanda; Carullo, Nazareno; Arena, Roberta; Leo, Isabella; Comi, Alessandro; Andreucci, Michele; Dragone, Francesco; Strangio, Antonio; Indolfi, Ciro; Foti, Daniela; Rosa, Salvatore De; Coppolino, Giuseppe

doi:10.31083/j.rcm2204163

Cited by 8 publications

(13 citation statements)

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“…Consistent with a previous study 9 , our results showed that HD patients who were over 65 years old and with a higher CCI index level had higher risks of IDH. Midodrine is the most commonly used vasopressor, and the more it is used, the higher the number of IDH episodes in dialysis patients 25 . In our study, 30.9% of HD patients used midodrine, and its prescription rate was higher in CHM non-users than in CHM users.…”

Section: Discussionmentioning

confidence: 99%

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Chinese Herbal Medicine as an Adjunctive Therapy Ameliorated the Incidence of Hypotension in Patients with End-Stage Renal Disease: A Nationwide Population-Based Cohort Study

Chen

Liu

Chin

et al. 2023

Preprint

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Hypotension during hemodialysis (HD) is a common complication of dialytic patients that imposes an enormous burden on the healthcare system. A few studies show that Chinese herbal medicine (CHM) treatments confer a protective effect on hypotension in HD patients, but the long-term impact remains unclear. This study investigated the adjuvant therapy of CHM in HD patients to prevent the risk of hypotension in HD patients. We extracted data from the Taiwanese National Health Insurance Registry for Catastrophic Illness Patient Database (NHI_RCIPD) from 2008 and 2018 and analyzed them using multivariate Cox proportional hazard regression models. After 1:1 frequency-matching by age, index date, HD duration, monthly income, residential area, and medical comorbidities, 3820 HD patients who were using CHM and 3820 who were not using CHM were identified as CHM users and CHM non-users, respectively. The occurrence of taking vasopressors was identified as intradialytic hypotension (IDH). The Kaplan–Meier method was used to estimate the cumulative incidence curves of vasopressors of the subjects during the follow-up period. During 12 years of follow-up, 1710 CHM users and 1927 CHM non-users were prescribed vasopressors, representing IDH incidence rates of 119.8 and 246.2 per 1000 person-years, respectively. CHM users had significantly lower IDH risk compared with CHM non-users (adjusted HR = 0.51; 95%CI = 0.48, 0.55). A markedly predominant effect was observed in those receiving CHM for more than 180 days (adjusted HR = 0.43; 95%CI = 0.39, 0.48). Lower vasopressor use and IDH risk among HD patients correlated with the use of CHM treatments. Further studies about specific CHM modalities or medications for IDH are still needed.

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Section: Discussionmentioning

confidence: 99%

“…There is no consensus de nition of IDH; however, current de nitions based on symptoms and/or interventions are clinically relevant 9 . Vasopressors are usually administered to prevent and control hypotension episodes during HD 25 . This is why our study used vasopressors to correlate the incidence of hypotension in HD patients.…”

Section: Discussionmentioning

confidence: 99%

Chinese Herbal Medicine as an Adjunctive Therapy Ameliorated the Incidence of Hypotension in Patients with End-Stage Renal Disease: A Nationwide Population-Based Cohort Study

Chen

Liu

Chin

et al. 2023

Preprint

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“…Na/K-ATPase signaling is another major driver of pathological cardiac fibrogenesis. This holds true particularly in UCM, in which a hyperstimulation of this pump is triggered by endogenous steroids, such as marinobufagenin (MBG), which accumulates in the bloodstream as uremic toxins [ 34 , 35 ]. Na/K-ATPase signaling involves downstream signaling proteins, such as Src [ 36 ], Akt and PKCs [ 37 ], which culminate in the enhancement of various pro-fibrotic pathways [ 38 ].…”

Section: Mirnas Ucm and The Na/k-atpase Signaling Pathwaymentioning

confidence: 99%

miRNAs in Uremic Cardiomyopathy: A Comprehensive Review

D'Agostino

Mauro

Zicarelli

et al. 2023

IJMS

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Uremic Cardiomyopathy (UCM) is an irreversible cardiovascular complication that is highly pervasive among chronic kidney disease (CKD) patients, particularly in End-Stage Kidney Disease (ESKD) individuals undergoing chronic dialysis. Features of UCM are an abnormal myocardial fibrosis, an asymmetric ventricular hypertrophy with subsequent diastolic dysfunction and a complex and multifactorial pathogenesis where underlying biological mechanisms remain partly undefined. In this paper, we reviewed the key evidence available on the biological and clinical significance of micro-RNAs (miRNAs) in UCM. miRNAs are short, noncoding RNA molecules with regulatory functions that play a pivotal role in myriad basic cellular processes, such as cell growth and differentiation. Deranged miRNAs expression has already been observed in various diseases, and their capacity to modulate cardiac remodeling and fibrosis under either physiological or pathological conditions is well acknowledged. In the context of UCM, robust experimental evidence confirms a close involvement of some miRNAs in the key pathways that are known to trigger or worsen ventricular hypertrophy or fibrosis. Moreover, very preliminary findings may set the stage for therapeutic interventions targeting specific miRNAs for ameliorating heart damage. Finally, scant but promising clinical evidence may suggest a potential future application of circulating miRNAs as diagnostic or prognostic biomarkers for improving risk stratification in UCM as well.

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“…The kidney plays a key role in maintaining systemic MBG balance by regulating urinary excretion [ 3 ]. Hence, not surprisingly, MBG accumulates in the blood of anuric individuals necessitating chronic dialysis [ 6 , 7 , 8 ], while in kidney transplant recipients, higher circulating MBG levels be associated with the severity of the graft function impairment [ 9 ].…”

Section: Introductionmentioning

confidence: 99%

Urinary Marinobufagenin in Patients with Non-Advanced Chronic Kidney Disease: A Cross-Sectional Study

Bolignano,

Greco,

D’Agostino

et al. 2023

Medicina

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Background and Objectives: The global prevalence of chronic kidney disease (CKD) is on the rise, posing important challenges for healthcare systems. Thus, the search for new factors potentially involved in the pathogenesis, progression and complications of early CKD remains urgent. Marinobufagenin (MBG) is a natriuretic endogenous cardiotonic steroid, and increased circulating levels of it may accelerate kidney damage. In this study, we explored the possible clinical significance of measuring urinary marinobufagenin (uMBG) in patients with non-advanced CKD. Materials and Methods: One hundred and eight adult CKD patients (mean age 71.6 ± 10 years, 70.4% male; mean eGFR 40.54 ± 17 mL/min/1.73 m2) were enrolled in this cross-sectional study. uMBG was measured together with a series of clinical, anthropometric, laboratory and instrumental analyses. Twenty-five healthy matched subjects served as controls for the uMBG measurement. Results: The uMBG values were lower in the patients with CKD as compared to those of the controls (0.37 [IQR: 0.25–0.45] vs. 0.64 [0.46–0.78] nmol/L. p = 0.004), and a significant trend in eGFR levels was noticed across the decreasing uMBG tertiles (p = 0.03). Regarding the correlation analyses, the uMBG values remained robustly associated with the eGFR in multivariate models employing either uMBG or eGFR as the dependent variable (β = 0.248; p = 0.01 and β = 0.139; p = 0.04, respectively). Besides the eGFR, the independent predictors of uMBG values in this population were the use of statins (β = −0.326; p = 0.001), the presence of diabetes (β = 0.243; p = 0.009) and urine sodium (β = 0.204; p = 0.01). Conclusions: Reduced uMBG excretion may reflect impaired renal clearance, which may contribute to the detrimental effects attributed to this hormone due to systemic accumulation. Future studies are needed to clarify the biological mechanisms placing uMBG at the crossroad of sodium intake and the presence of diabetes in CKD-suffering individuals and to verify whether a statin treatment may somewhat limit the detrimental effects of MBG in the presence of impaired renal function.

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Altered circulating marinobufagenin levels and recurrent intradialytic hypotensive episodes in chronic hemodialysis patients: a pilot, prospective study

Cited by 8 publications

References 0 publications

Chinese Herbal Medicine as an Adjunctive Therapy Ameliorated the Incidence of Hypotension in Patients with End-Stage Renal Disease: A Nationwide Population-Based Cohort Study

Chinese Herbal Medicine as an Adjunctive Therapy Ameliorated the Incidence of Hypotension in Patients with End-Stage Renal Disease: A Nationwide Population-Based Cohort Study

miRNAs in Uremic Cardiomyopathy: A Comprehensive Review

Urinary Marinobufagenin in Patients with Non-Advanced Chronic Kidney Disease: A Cross-Sectional Study

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