Salt Loading Aggravates the Relationship between Melatonin and Proteinuria in Patients with Chronic Kidney Disease
Salt Loading Aggravates the Relationship between Melatonin and Proteinuria in Patients with Chronic Kidney Disease
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DOI：
10.2169/internalmedicine.1929-18
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发表时间：
2019-02
影响因子：
1.2
通讯作者：
N. Ohashi;S. Ishigaki;Shinsuke Isobe;T. Matsuyama;Taichi Sato;T. Fujikura;Takayuki Tsuji;Akihiko Kato;H. Yasuda
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文献类型：
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作者：
N. Ohashi;S. Ishigaki;Shinsuke Isobe;T. Matsuyama;Taichi Sato;T. Fujikura;Takayuki Tsuji;Akihiko Kato;H. Yasuda
目的盐负荷可通过活性氧和交感神经活性引起肾损害，而与血压升高无关。褪黑激素是一种调节昼夜节律的激素，具有多种功能，包括抗氧化作用和抑制交感神经活动。我们已经表明，褪黑激素分泌受损与慢性肾脏病（CKD）患者的肾损害有关。然而，盐负荷，褪黑激素分泌，尿白蛋白和蛋白质之间的关联尚未澄清。方法收集32例CKD患者，分别在标准盐（10 g/d）和低盐（6 g/d）饮食条件下，进行24 h动态血压监测，并采集白天和夜间尿液。研究了进食标准盐和低盐饮食的患者白天和夜间尿中白蛋白、蛋白质和褪黑素代谢产物6-硫酸氧褪黑素（aMT 6s）的排泄水平。结果低盐饮食组和标准盐饮食组患者白天和夜间尿aMT 6s水平差异无统计学意义。然而，摄入标准盐饮食的患者的尿aMT 6s水平与日间和夜间尿白蛋白和蛋白水平显著负相关，而摄入低盐饮食的患者则不然。同样，在食用标准盐或低盐饮食的患者中，尿aMT 6s水平与BP水平、肾功能和血浆血管紧张素II水平之间没有发现显著相关性。校正年龄、性别和体重指数的多元回归分析显示，在食用标准盐饮食的患者中，尿白蛋白和蛋白质水平与尿aMT 6水平显著负相关，但在食用低盐饮食的患者中则不相关。结论盐负荷可使褪黑素分泌与蛋白尿或蛋白尿的关系更加密切。
Objective Salt loading induces renal damage independently of blood pressure (BP) elevation via reactive oxygen species and sympathetic activity. Melatonin, a hormone that regulates the circadian rhythm, has multiple functions, including anti-oxidant effects and the inhibition of sympathetic activity. We have shown that impaired melatonin secretion is associated with renal damage in chronic kidney disease (CKD) patients. However, the associations between salt loading, melatonin secretion, and urinary albumin and protein have not been clarified. Methods We recruited 32 CKD patients, conducted 24-hour ambulatory BP monitoring and collected daytime and nighttime urine while the patients were consuming a standard salt (10 g/day) or low salt (6 g/day) diet. The excretion levels of albumin, protein and 6-sulfatoxymelatonin (aMT6s), a metabolite of melatonin, in daytime and nighttime urine were investigated in patients consuming standard salt and low salt diets. Results The urinary aMT6s levels in daytime and nighttime of the patients consuming standard salt and low salt diets did not differ to a statistically significant extent. However, the urinary aMT6s levels in patients consuming a standard salt diet-but not patients consuming a low salt diet-were significantly and negatively correlated with the daytime and nighttime urinary albumin and protein levels. Contrarily, no significant correlations were found between the urinary aMT6s levels and the BP levels, renal function, and plasma angiotensin II levels in patients consuming either a standard salt or low salt diet. A multiple regression analysis adjusted for age, sex, and body mass index revealed that the urinary albumin and protein levels were significantly and negatively associated with the urinary aMT6s levels in patients consuming a standard salt diet, but not in patients consuming a low salt diet. Conclusion Salt loading aggravates the relationship between melatonin secretion and albuminuria or proteinuria.