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Dietary nitrate by beetroot juice can lower renal resistive index in patients with chronic kidney disease

Authors:
Artery Research
ISSN (Online): 1876-4401 ISSN (Print): 1872-9312
Journal Home Page: https://www.atlantis-press.com/journals/artres
P6.9: DIETARY NITRATE BY BEETROOT JUICE CAN LOWER
RENAL RESISTIVE INDEX IN PATIENTS WITH CHRONIC
KIDNEY DISEASE
S. Kemmner, K. Burkhardt, U. Heemann, M. Baumann
To cite this article: S. Kemmner, K. Burkhardt, U. Heemann, M. Baumann (2014) P6.9:
DIETARY NITRATE BY BEETROOT JUICE CAN LOWER RENAL RESISTIVE INDEX IN PATIENTS
WITH CHRONIC KIDNEY DISEASE, Artery Research 8:4, 147148, DOI:
https://doi.org/10.1016/j.artres.2014.09.160
To link to this article: https://doi.org/10.1016/j.artres.2014.09.160
Published online: 7 December 2019
Material and Metho ds: 80 patients with severe untreated p eriodontitis
were subjected to anti-infective periodontal therapy, comprising bacterial
biofilm removal by scaling and root planning either with or without admin-
istration of systemic antibiotics. The following parameters were assessed at
baseline and 12 month post-therapy: periodontal bleeding on probing, rep-
resenting a clinical parameter for a ctive inflammation (BoP), pulse wave
velocity (PWV), augmentation index (AIx), central systolic pressure (SBPao)
and central pulse pr essure (PPao) using an oscillometric device
(Arteriograph).
Results: Preliminary data evaluation demonstrated, that 12 months post
therapy reduction of periodontal bleeding on probing correlated significantly
with decreased values of PWV, SBPao, PPao, AIx, and AugP (p<0.05, respec-
tively) whereas peripheral blood pressure remained unchanged.
Conclusions: Successful reduction of periodontal inflammation is associated
with improved markers of arterial dysfunction.
P6.6
A DOUBLE BLIND, RANDOMISED TRIAL INVESTIGATING IF ARTERIAL
STIFFNESS CAN BE REDUCED INDEPENDENTLY OF BLOOD PRESSURE IN
PARTICIPANTS WITH OR AT RISK OF TYPE 2 DIABETES
C. Mills, F. Iqbal, H. Crickmore, V. Govoni, A. Webb, J. K. Cruickshank
King’s College London, London, UK
Background: Arterial stiffness (AS) as pulse wave velocity (PWV), is a power-
ful independent predictor of cardiovascular events, and commonly compli-
cates Type 2 diabetes (T2D). The VaSera machine measures cardiac (by
2nd sound phonogram)-ankle PWV, expressed as a cardio-ankle vascular in-
dex (CAVI), aimed to be independent of blood pressure (BP). Our factorial
trial tests whether separately randomised dietary nitrate or placebo, and
an aldosterone antagonist reduce CAVI and PWV in those at risk of or diag-
nosed with T2D.
Method: Double-blind, randomised trial assessing AS at baseline, 3 and 6
months. Target recruitment is 120 patients, 18-90 years, excluding those
with serious illness or eGFR <45mL/min. Daily interventions are spironolac-
tone (50mg) or doxazosin (16mg), to control for BP change, with a nitrate
donor (0.4g nitrate) or an identical nitrate-free juice.
Results: 74 participants are screened, 54 randomised and 34 completed.
MeanSD baseline age and body mass index were 59.712.1 years and
32.85.5kg/m
2
, respectively; 40% female.
No differences in CAVI or PWV were observed between screening and
randomisation (8.301.4 to 7.971.3 units and 9.302.0 to 9.171.8m/s,
respectively). Systolic (S) and diastolic (D) BP dropped between these visits
(13817 to 13317mmHg, p<0.005 and 8112 to 7112mmHg, p<0.001,
respectively). Bland-Altman analysis between screening and randomisation
for CAVI, PWV, SBP and DBP shows <6% of mean differences fall outside of
the 95% limits; mean differencelimits of agreement; -0.132.12,
-0.321.85, -526 and -419, respectively.
Conclusion: A trial focused on PWV is practical and effective within our
target population, with simple recruitment and a low drop-out rate.
P6.7
SUBLINGUAL NITROGLYCERIN IN PATIENTS WITH HEART FAILURE AND
PRESERVED EJECTION FRACTION: IMPACT ON CENTRAL AND REGIONAL
CAROTID AND RADIAL INPUT IMPEDANCE AND HEMODYNAMICS
F. London
˜o
a
, P. Segers
a
, P. Shiva-Kumar
b
, S. Peddireddy
b
, J. Chirinos
b,c
a
Ghent University, Gent, Belgium
b
UPenn, Philadelphia, USA
c
VA Medical center, Philadelphia, USA
Background: The systolic blood pressure lowering effect of sublingual nitro-
glycerin (NTG) administration is thought to primarily arise from its action on
wave reflection, although recent invasive data indicate that at least part of
the blood pressure reduction can be ascribed to an effect on left ventricular
dynamics.
Methods: Carotid and radial pressure waveforms and aortic, carotid and
radial flow were measured in 19 HFpEF patients using applanation tonometry
and pulsed Doppler ultrasound, respectively. Signals were time-aligned and
global systemic as well as regional impedance and wave reflection analysis
was applied.
Results: NTG lowered carotid systolic (130.826 at baseline vs.
110.418.4mmHg after NTG, P<0.01) and mean (92.518.4 vs.85.414.3)
blood pressure. Global systemic effects included a decrease in systemic
vascular resistance (1.000.32 vs. 0.880.28 mmHg.ml
-1
.s, P<0.05), charac-
teristic impedance (0.1330.089 vs. 0.0890.034 mmHg.ml
-1
.s, P<0.05) and
an increase in total arterial compliance (1.200.58 vs. 1.520.53 ml.mmHg
-
1
,P<0.01). NTG had a major impact on the amplitude of the forward pres-
sure wave (5824.3 vs. 40.613.3 mmHg, P<0.01), with no significant
change in reflection magnitude. Regional analysis demonstrated a large ef-
fect of NTG on carotid input impedance, lowering impedance over the entire
frequency spectrum, with radial artery input impedance did not demon-
strate any significant changes (despite large effects on pressure and flow
waveform morphology).
Conclusions: Our data in patients with HFpEF confirm the absence of impact
of NTG on reflection magnitude, and demonstrate large effects of NTG on
the input impedance of the cerebral vascular district, with little effect on
the distal forearm circulation.
P6.8
EFFECT OF ORGANIC NITRATES ON INTRAVENTRICULAR PRESSURE
GRADIENTS IN HEART FAILURE PATIENTS WITH PRESERVED EJECTION
FRACTION
F. Londono
1
, B. Meyers
2
, P. Vlachos
2
, P. Segers
1
, J. Chirinos
3
1
IBitech-bioMMeda (Ghent University), Ghent, Belgium
2
Faculty School of Biomedical Engineering and Sciences (Virginia Tech),
Blacksburg, USA
3
Department of Cardiology & Radiology (University of Pennsylvania), PA,
USA
Introduction: Heart Failure with preserved ejection fraction (HFpEF) is a
highly prevalent condition for which no pharmacologic therapy is available.
Diastolic dysfunction is thought to be central to its pathophysiology. Organic
nitrates have pharmacologic effects on preload, afterload and myocardial
contraction/relaxation that may favourably influence ventricular filling.
However, the effect of sublingual nitro-glycerine (NTG) on diastolic param-
eters in this population has not been studied. We aimed to assess the effect
of NTG on intraventricular pressure gradients (IVPG) and other measures of
diastolic function.
Methods: Colour M-mode Doppler (CMM) is a non-invasive ultrasound tech-
nique used to obtain left ventricular (LV) blood flow velocities during early
filling and to calculate IVPG. CMM recordings of 20 patients (HFpEF) at
rest and after the administration of 0.4 mg of NTG were obtained and pro-
cessed. Average values of the parameters were calculated and compared
(Wilconox test) at rest and after NTG.
Results: NTG induced a non-significant increase in early diastolic IVPG
(pZ0.286) due to a reduction in the early diastolic convective component
(pZ0.026). Similarly, the early diastolic reversal convective component
was reduced (pZ0.009). In contrast, the late diastolic IVPG was increased
(pZ0.017), due to an increased inertial component (pZ0.034). There was
a reduction in peak E wave velocity (pZ0.004), E wave acceleration
(pZ0.003) and deceleration (pZ0), while the acceleration time
(pZ0.034) and the heart rate (HR) (pZ0.016) increased.
Conclusion: Organic nitrates exert effects on diastolic filling in HFpEF:
increased HR and myocardial contractility and decreased peak E-wave veloc-
ity possibly related to a preload reduction.
P6.9
DIETARY NITRATE BY BEETROOT JUICE CAN LOWER RENAL RESISTIVE
INDEX IN PATIENTS WITH CHRONIC KIDNEY DISEASE
S. Kemmner
a
, K. Burkhardt
b
, U. Heemann
a
, M. Baumann
a
a
Technical University, Munich, Germany
b
Nephrological Clinic Weissenburg, Weissenburg, Germany
Introduction: Beetroot has a high concentration of nitrate. In circulation ni-
trate converts to nitrite. Nitrite-derived NO is a potent vasodilatator.
Increased renal resistive index (RI) are associated with higher mortality in
patients with chronic kidney disease (CKD) and predict cardiovascular events
in these patients. Here we investigated if the ingestion of beetroot juice can
reduce RI-values.
Methods: Using a randomized cross-over study design 12 CKD patients were
investigated within 4 hours (h) after one ingestion of dietary nitrate load
(300 mg) by highly concentrated beetroot juice (30g beetroot powder dis-
pended in 200 ml water) versus 200 ml water. Plasma nitrite concentration
as well as renal segemental arterial RI in duplex doppler ultrasonography
was measured before and 4 hours after ingestion of beetroot or water. BP
was measured every 15 minutes within the 4 hours.
Results: In 12 CKD patients (7 females) the eGFR was 40.713.8 ml/min.
Three patients had a hypertensive nephropathy, 2 diabetic nephropathy
and 7 seven patients had a combined hypertensive/diabetic nephropathy.
Abstracts 147
The RI value was significantly reduced by beetroot ingestion (pre-beetroot
RIZ0.750.05 versus post-beetroot RIZ0.720.05; pre-water
RIZ0.750.06 versus post-water RIZ0.760.05; PZ0.02).
Conclusion: Our findings suggest that the supplementation of pharmacologic
therapy with diatary nitrate through beetroot juice could prevent cardiovas-
cular events and progression of renal disease in CKD patients.
P6.10
PROPIONYL-L-CARNITINE FOR INTERMITTENT CLAUDICATION. A
COCHRANE REVIEW.
T. De Backer
a,b
, V. Kamoen
b
, R. Vander Stichele
a
, L. Campens
b
,
D. De Bacquer
c
, L. Van Bortel
a
a
Heymans Institute of Pharmacology, Ghent, Belgium
b
Cardiovascular Center, Ghent, Belgium
c
Dept of Epidemiology and Public Health, Ghent, Belgium
Intermittent claudication (IC) is a symptomatic form of peripheral arterial
disease (PAD) (pain in the lower limbs with walking and relieved by rest).
Propionyl-L-carnitine (PLC) is a drug which may lower the symptoms of PAD.
Is PLC efficacious in improving clinical outcomes in IC patients?
For this Cochrane review randomized controlled trials in patients with IC
receiving PLC compared with placebo or other intervention were selected.
Pain-free and maximal walking performance were analyzed by standardized
exercise test. ABI, quality of life and adverse events were assessed. 13
Studies were included in this review (1423 patients). The results of the
selected trials were brought together in patient pools. For the maximal
walking distance, the mean difference in walking performance after use of
PLC compared to placebo was an absolute increase of 50.86 m (95% CI 50.34
to 51.38) or a 26% relative improvement (23 to 28%). For the pain-free
walking distance, the improvement in walking performance with PLC
compared to placebo was an absolute increase of 32.98 m (32.60 to 33.37)
or a 31 % relative improvement (28 to 34%) . PLCs had an 0.09 (0.08 to 0.09)
improvement in ABI over placebo. The adverse events of PLC were similar as
in the control group and PLC seemed well tolerated and safe. PLC 1-2g a day
costs 0.30 to 0.70 V.
PLC for IC shows a significant, though mild to moderate improvement of
walking distances and ABI compared to placebo. The safety of PLC is
comparable to placebo. In practice, PLC could be useful adjuvant to classic
IC-therapies or when these are contra-indicated, not feasible or ineffective.
This work is a Cochrane review. The data presented here presented are
provisional (as the review has not yet been published).
The citation for the Cochrane protocol is: de Backer TLM, Campens L, Vander
Stichele R, Van Bortel L, De Bacquer D. Propionyl-L-carnitine for intermit-
tent claudication (Protocol). Cochrane Database of Systematic Reviews
2012, Issue 9. Art. No.: CD010117. DOI: 10.1002/14651858.CD010117.
The authors acknowledge the Cochrane Peripheral Vascular Diseases Group.
P6.11
PHOSPHODIESTERASE TYPE-5 INHIBITOR USE IN TYPE 2 DIABETES IS
ASSOCIATED WITH A REDUCTION IN ALL CAUSE MORTALITY
S. Anderson
a
, D. Hutchings
a
, C. Kwok
a
, A. Trafford
a
, A. Heald
a,b
a
University of Manchester, Manchester, UK
b
Leighton Hospital, Crewe, UK
Background: Phosphodiesterase type-5 inhibitors (PDE5is) exert cardiopro-
tective effects in small mammal models of myocardial ischaemia. There is
currently little data on whether a similar effect exists in humans. We deter-
mined whether PDE5i use in males with type 2 diabetes (T2DM) was associ-
ated with reduced mortality.
Methods: We retrospectively analysed the pseudoanonymised records of 48
GP practices in Cheshire, UK and identified all 7029 men (mean age 72.8
years) diagnosed with T2DM before 1 January 2007. Baseline clinical charac-
teristics and PDE5i treatment data were obtained. Mean follow-up was 6.4
years (January 31, 2014) and all deaths were ascertained from GP records.
Findings: Of the 1,663 (23.7%) men prescribed a PDE5i, the proportion of
deaths was significantly lower than those never prescribed (16.9% versus
29.4%). All-cause mortality rates (per 1000 person-years) were similarly
lower (21.1 (19.1-24.5) versus 34.4 (32.5e36.5); P<0.0001). There was a
38% reduction in all-cause mortality (univariate Cox proportional hazards
HR: 0.62 (0,54-0.71); P<0.0001) in men on a PDE5i over the period. This
reduction remained but was attenuated (HR: 0.80 (0.65, 0.98); P<0.05) after
multivariate regression adjusting for age (1.11 (1.09e1.12); P<0.0001 per
year), smoking history (1.31 (1.16-1.47); P<0.0001), HbA1c, systolic BP,
creatinine levels, prescribed statins, aspirin and beta-blocker use.
Interpretation: Around 70% of deaths in T2DM are attributable to cardiovas-
cular disease. Our data demonstrates that PDE5i use is associated with
significantly reduced mortality in men with T2DM at high risk of CVD. Further
evidence is required to elucidate the role of PDE5is in cardioprotection.
P7.1
ACUTE EFFECTS OF SMOKING OVER THE ENDOTHELIAL FUNCTION AND
CENTRAL ARTERIAL HEMODYNAMICS IN YOUNG HEALTHY PEOPLE
T. Pereira
a
, J. Maldonado
b
, R. Branda
˜o
a
, J. Conde
a
a
Instituto Polite
´cnico de Coimbra, Coimbra, Portugal
b
Instituto de Investigac¸a
˜o e Formac¸a
˜o Cardiovascular, Coimbra, Portugal
Introduction: The aim of this study was to assess the acute effects of smok-
ing over the endothelial function and central arterial hemodynamics, in
healthy and young smokers.
Methods: Thirty healthy young individuals, were allocated into two groups,
matched for gender and age, according to their smoking habits: control
group (CG; nZ15 non-smokers) and intervention group (IG; nZ15 smokers).
All the individuals were submitted to two clinical evaluations, basal and
following 30 minutes (after smoking a cigar in the IG). Weight, height,
body mass index (BMI), systolic blood pressure (SBP), diastolic blood pressure
(DBP), heart rate (HR), flow-mediated dilation (FMD), aortic pulse wave ve-
locity (PWV) and pulse wave analysis over the carotid artery (PWA) were
assessed.
Results: CG and IG groups had similar baseline clinical and demographic
characteristics, although the IG showed lower baseline FMD values
(7.532.80% versus 12.474.63% in the CG; pZ0.001). The pairwise analysis
revealed significant variations in the IG, but not in the CG, with an increase
in HR, brachial and central BP and PWV, and a significant decrease in FMD,
revealing an important acute compromise of endothelium-dependent vaso-
dilation after the cigar in the IG, with no changes in the CG.
Conclusion: Smoking has an acute and noteworthy pernicious effect over the
vascular function in young and healthy individuals, compromising endothe-
lium-dependent vasodilation, increasing heart rate, blood pressure and
aortic stiffness.
P7.2
IDENTIFICATION OF VASCULAR AND CIRCULATING BIOMARKERS TO
PREDICT OUTCOME IN PATIENTS AFFECTED BY SEPTIC SHOCK
P. Vallerio
b
, O. Belli
b
, F. Musca
b
, G. Monti
c
, L. Bonacchini
a
,
M. Cazzaniga
a
, M. Stucchi
a
, P. Meani
a
, L. Frigerio
a
, M. Molteni
a
,
F. Panzeri
a
, M. Alloni
b
, R. Fumagalli
c,a
, A. De Gasperi
d
,
C. Giannattasio
a,b
a
Milano-Bicocca University, Milano, Italy
b
Cardiologia IV, Ospedale Niguarda Ca’ Granda, Milano, Italy
c
Intensive Care Unit 2, Ospedale Niguarda Ca’ Granda, Milano, Italy
d
Intensive Care Unit 3, Ospedale Niguarda Ca’ Granda, MIlano, Italy
Introduction: Cardiovascular dysfunction is a well-recognized early compli-
cation of septic shock (SS). A hallmark of SS is a change in microvascular
function and endothelial cell (EC) activation, contributing to multiple organ
failure. Angiopoietin (Ang1-2) pathway has been reported associated with
severity of illness and mortality.
Aim: to evaluate prognostic and clinical role of functional vascular assess-
ment in patients with SS.
Methods: We enrolled 20 patients from intensive care units with a diagnosis
of SS. Clinical, hemodynamic, instrumental evaluation s and blood sample
collection were obtained at hospitalization (T1), and one week later
(T2). We assessed echo cardiographic left ventricular systolic function
(LVEF) and functional arterie s evaluation with caro tid-femoral PWV
(Complior).
Results: During the follow-up 11 patients survived (S) and 9 died (D). S and D
had similar ages (628vs6611 yrs, meansSD), MAP (8012vs8112 mmHg,
meansSD) and SOFA score (134vs154, meansSD). At T1, D had a signif-
icantly higher cf-PWV than S (123vs92 m/s, meansSD; p0.05). Further-
more considering all patients toghether, we found an inverse correlation
between PWV and LVEF (p<0.01). Finally, S had a significant T1-T2 increase
in Ang1 (7339[4587-17010]vs47384[10658-53645] medians[25-75th]; p<0.05)
and a decrease in Ang2 levels (2778317625vs90085565 means+SD;
p<0.01); D patients showed an inverse trend.
Conclusions: In SS endothelial dysfunction caused by EC-activation is
expressed by an increase of PWV, which was significantly different depend-
ing on outcome of patients. PWV also has a correlation with LVEF. The values
of PWV could express an alteration of ventricular-vascular coupling, useful
148 Abstracts
... The effects of vegetable-sources of dietary nitrate on renal function have also been reported. Considering these observations, we speculated that dietary nitrate from vegetable sources, over and above the effects on vascular function, could reduce risk of HTN through regulation of body weight and renal function [45]. ...
Article
There is growing evidence of the potential properties of nitrate-rich foods against development of hypertension (HTN) and vascular disease. In this study, we investigated the association of nitrate-containing vegetables (NCVs) with risk of HTN after 3 years of follow-up. This prospective study was conducted on 1546 non-hypertensive subjects, aged 20-70 years. Blood pressure was measured at baseline and after 3 years and HTN was defined by the Joint National Committee on prevention, detection, evaluation and treatment of high blood pressure criteria. Dietary intake was collected using a validated semi-quantitative food frequency questionnaire (FFQ). NCVs and high-, medium- and low-NCV subcategories were defined, and the odds of HTN after 3 years according to tertiles of NCV and NCV-category intake were estimated by logistic regression and adjusted for potential variables. Mean age of participants was 38.0 ± 12.0 years at baseline and 57.0 % were women. Mean dietary intake of energy-adjusted NCV was 298.0 ± 177.3 g/day. After adjustment for total energy intake, fiber, sodium, potassium and processed meat, a significant inverse association was observed between NCV and the risk of HTN in the highest tertile category (odds ratio 0.63, 95 % confidence interval: 0.41-0.98, p for trend = 0.05). There was no significant association of 3 year risk of HTN across tertiles of low nitrate-, medium nitrate- and high-nitrate vegetables. Higher dietary nitrate intake from vegetables sources may have a protective effect against development of HTN.
Article
Full-text available
Chronic kidney disease (CKD) is debilitating, increasing in incidence worldwide, and a financial and social burden on health systems. Kidney failure, the final stage of CKD, is life-threatening if untreated with kidney replacement therapies. Current therapies using commercially-available drugs, such as angiotensin-converting enzyme inhibitors, angiotensin II receptor blockers and calcium channel blockers, generally only delay the progression of CKD. This review article focuses on effective alternative therapies to improve the prevention and treatment of CKD, using plants or plant extracts. Three mechanistic processes that are well-documented in CKD pathogenesis are inflammation, fibrosis, and oxidative stress. Many plants and their extracts are already known to ameliorate kidney dysfunction through antioxidant action, with subsequent benefits on inflammation and fibrosis. In vitro and in vivo experiments using plant-based therapies for pre-clinical research demonstrate some robust therapeutic benefits. In the CKD clinic, combination treatments of plant extracts with conventional therapies that are seen as relatively successful currently may confer additive or synergistic renoprotective effects. Therefore, the aim of recent research is to identify, rigorously test pre-clinically and clinically, and avoid any toxic outcomes to obtain optimal therapeutic benefit from medicinal plants. This review may prove to be a filtering tool to researchers into complementary and alternative medicines to find out the current trends of using plant-based therapies for the treatment of kidney diseases, including CKD.
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