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Addition of hydrochlorothiazide to angiotensin receptor blocker therapy can achieve a lower sodium balance with no acceleration of intrarenal renin angiotensin system in patients with chronic kidney disease.

Fuwa D, Fukuda M, Ogiyama Y, Sato R, Mizuno M, Miura T, Abe-Dohmae S, Michikawa M, Kobori H, Ohte N - J Renin Angiotensin Aldosterone Syst (2016)

Bottom Line: Add-on HCTZ decreased GFR, tubular Na load, and tubular Na reabsorption (t(Na)), although 24-hour urinary Na excretion (U(Na)V) remained constant.Daily urinary angiotensinogen excretion (U(AGT)V, 152±10→82±17 μg/g Cre) reduced (p=0.02).A further study is needed to demonstrate that the reduction of U(AGT)V by additional diuretics to ARBs prevents the progression of nephropathy or cardiovascular events.

View Article: PubMed Central - PubMed

Affiliation: Department of Cardio-Renal Medicine and Hypertension, Nagoya City University Graduate School of Medical Sciences, Japan.

No MeSH data available.


Related in: MedlinePlus

The effect of intrarenal renin-angiotensin system (RAS) activity during angiotensin receptor blocker (ARB) treatment on the changes in glomerulotubular sodium (Na) balance by additional treatment with hydrochlorothiazide. In patients, whose intra-renal RAS activity was suppressed during ARB therapy, greater decrease of changes in tubular Na load and tubular Na reabsorption was shown. Intra-renal RAS activity was indicated by daily urinary angiotensinogen excretion. AGT: angiotensinogen; tNa: tubular Na reabsorption (mmol/day); UAGTV: urinary angiotensinogen excretion (log(μg/g Cre)).
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Figure 1: The effect of intrarenal renin-angiotensin system (RAS) activity during angiotensin receptor blocker (ARB) treatment on the changes in glomerulotubular sodium (Na) balance by additional treatment with hydrochlorothiazide. In patients, whose intra-renal RAS activity was suppressed during ARB therapy, greater decrease of changes in tubular Na load and tubular Na reabsorption was shown. Intra-renal RAS activity was indicated by daily urinary angiotensinogen excretion. AGT: angiotensinogen; tNa: tubular Na reabsorption (mmol/day); UAGTV: urinary angiotensinogen excretion (log(μg/g Cre)).

Mentions: The glomerulotubular balances of Na before and during addition of HCTZ to ARB therapy are summarized in Table 3. Filtered Na (i.e. tubular Na load, p=0.03), and tNa (p=0.03) were both significantly reduced by add-on HCTZ, but 24-hour UNaV remained constant (p=0.6), indicating that a lower steady Na balance had been achieved. As mentioned above, HCTZ significantly decreased daily excretion of urinary AGT (p=0.02). Changes in tubular Na load (r=0.51, r2=0.26, p=0.01) and tNa (r=0.50, r2=0.25, p=0.01) correlated positively with baseline 24-hour UAGTV (Figure 1). The change in filtered Na load correlated positively with changes in 24-hour SBP (r=0.40, r2=0.16, p=0.05), DBP (r=0.47, r2=0.22, p=0.02) and MAP (r=0.46, r2=0.21, p=0.03) and with changes in nighttime SBP (r=0.41, r2=0.17, p=0.04), DBP (r=0.46, r2=0.21, p=0.02), and MAP (r=0.45, r2=0.21, p=0.03); but did not correlate with changes in daytime SBP (p=0.1), DBP (p=0.06), and MAP (p=0.05).


Addition of hydrochlorothiazide to angiotensin receptor blocker therapy can achieve a lower sodium balance with no acceleration of intrarenal renin angiotensin system in patients with chronic kidney disease.

Fuwa D, Fukuda M, Ogiyama Y, Sato R, Mizuno M, Miura T, Abe-Dohmae S, Michikawa M, Kobori H, Ohte N - J Renin Angiotensin Aldosterone Syst (2016)

The effect of intrarenal renin-angiotensin system (RAS) activity during angiotensin receptor blocker (ARB) treatment on the changes in glomerulotubular sodium (Na) balance by additional treatment with hydrochlorothiazide. In patients, whose intra-renal RAS activity was suppressed during ARB therapy, greater decrease of changes in tubular Na load and tubular Na reabsorption was shown. Intra-renal RAS activity was indicated by daily urinary angiotensinogen excretion. AGT: angiotensinogen; tNa: tubular Na reabsorption (mmol/day); UAGTV: urinary angiotensinogen excretion (log(μg/g Cre)).
© Copyright Policy - permissions-link - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4940185&req=5

Figure 1: The effect of intrarenal renin-angiotensin system (RAS) activity during angiotensin receptor blocker (ARB) treatment on the changes in glomerulotubular sodium (Na) balance by additional treatment with hydrochlorothiazide. In patients, whose intra-renal RAS activity was suppressed during ARB therapy, greater decrease of changes in tubular Na load and tubular Na reabsorption was shown. Intra-renal RAS activity was indicated by daily urinary angiotensinogen excretion. AGT: angiotensinogen; tNa: tubular Na reabsorption (mmol/day); UAGTV: urinary angiotensinogen excretion (log(μg/g Cre)).
Mentions: The glomerulotubular balances of Na before and during addition of HCTZ to ARB therapy are summarized in Table 3. Filtered Na (i.e. tubular Na load, p=0.03), and tNa (p=0.03) were both significantly reduced by add-on HCTZ, but 24-hour UNaV remained constant (p=0.6), indicating that a lower steady Na balance had been achieved. As mentioned above, HCTZ significantly decreased daily excretion of urinary AGT (p=0.02). Changes in tubular Na load (r=0.51, r2=0.26, p=0.01) and tNa (r=0.50, r2=0.25, p=0.01) correlated positively with baseline 24-hour UAGTV (Figure 1). The change in filtered Na load correlated positively with changes in 24-hour SBP (r=0.40, r2=0.16, p=0.05), DBP (r=0.47, r2=0.22, p=0.02) and MAP (r=0.46, r2=0.21, p=0.03) and with changes in nighttime SBP (r=0.41, r2=0.17, p=0.04), DBP (r=0.46, r2=0.21, p=0.02), and MAP (r=0.45, r2=0.21, p=0.03); but did not correlate with changes in daytime SBP (p=0.1), DBP (p=0.06), and MAP (p=0.05).

Bottom Line: Add-on HCTZ decreased GFR, tubular Na load, and tubular Na reabsorption (t(Na)), although 24-hour urinary Na excretion (U(Na)V) remained constant.Daily urinary angiotensinogen excretion (U(AGT)V, 152±10→82±17 μg/g Cre) reduced (p=0.02).A further study is needed to demonstrate that the reduction of U(AGT)V by additional diuretics to ARBs prevents the progression of nephropathy or cardiovascular events.

View Article: PubMed Central - PubMed

Affiliation: Department of Cardio-Renal Medicine and Hypertension, Nagoya City University Graduate School of Medical Sciences, Japan.

No MeSH data available.


Related in: MedlinePlus