Dr Bliwise and colleagues speculate on the beneficial and protective effects of sleep on the risk of mortality among patients receiving hemodialysis, but temporal changes in renal function also may have played a key role in their findings. On the one hand, the renal system is organized according to a specific temporal order that is oscillatory in nature. Most, if not all, renal functions exhibit temporal changes; for example, glomerular filtration rate, urine production, and renal excretion of solutes all significantly increase during daytime and reach their minimum at night. On the other hand, such periodic differences in the physiological status of the renal system give rise to rhythmic variations in its susceptibility to morbid events. It is the delicate temporal balance between such susceptibility and the ability of physiopathogenetic mechanisms to precipitate overt disease that gives rise to a significant temporal pattern of risk (the so-called chronorisk). Usually, the temporal variation of physiological mechanisms and disease factors is not large enough to be of clinical interest when taken alone, but may become harmful when a time-related synergistic effect is exerted, such as for the cardiovascular risk at certain times of the day. A suggested chronobiological therapeutic approach to cardiovascular disease may also be applicable to kidney disease. In fact, a time-related decrease of renal hemodynamics depresses renal plasma flow, glomerular filtration rate, and blood and ultrafiltration volumes, thus increasing the intraluminal tubular concentration of toxic substances and, in the end, the damage to the proximal tubular cells. This is the explanation of the circadian variations in nephrotoxicity of heavy metals, antibiotics, and cyclosporine. Another example is the increased nighttime concentration of urine, which may represent a predisposing factor for nephrolithiasis, leading to a higher incidence of renal colic attacks in the morning. Little is known about the temporal patterns of kidney function and its neurohumoral determinants in patients who receive hemodialysis. We believe that a full comprehension of the different survival associated with morning vs afternoon hemodialysis will be possible only if future studies take into account the temporal patterns of pathophysiological mechanisms.

Does time of day of hemodialysis affect survival?

MANFREDINI, Roberto;BOARI, Benedetta;PORTALUPPI, Francesco
2002

Abstract

Dr Bliwise and colleagues speculate on the beneficial and protective effects of sleep on the risk of mortality among patients receiving hemodialysis, but temporal changes in renal function also may have played a key role in their findings. On the one hand, the renal system is organized according to a specific temporal order that is oscillatory in nature. Most, if not all, renal functions exhibit temporal changes; for example, glomerular filtration rate, urine production, and renal excretion of solutes all significantly increase during daytime and reach their minimum at night. On the other hand, such periodic differences in the physiological status of the renal system give rise to rhythmic variations in its susceptibility to morbid events. It is the delicate temporal balance between such susceptibility and the ability of physiopathogenetic mechanisms to precipitate overt disease that gives rise to a significant temporal pattern of risk (the so-called chronorisk). Usually, the temporal variation of physiological mechanisms and disease factors is not large enough to be of clinical interest when taken alone, but may become harmful when a time-related synergistic effect is exerted, such as for the cardiovascular risk at certain times of the day. A suggested chronobiological therapeutic approach to cardiovascular disease may also be applicable to kidney disease. In fact, a time-related decrease of renal hemodynamics depresses renal plasma flow, glomerular filtration rate, and blood and ultrafiltration volumes, thus increasing the intraluminal tubular concentration of toxic substances and, in the end, the damage to the proximal tubular cells. This is the explanation of the circadian variations in nephrotoxicity of heavy metals, antibiotics, and cyclosporine. Another example is the increased nighttime concentration of urine, which may represent a predisposing factor for nephrolithiasis, leading to a higher incidence of renal colic attacks in the morning. Little is known about the temporal patterns of kidney function and its neurohumoral determinants in patients who receive hemodialysis. We believe that a full comprehension of the different survival associated with morning vs afternoon hemodialysis will be possible only if future studies take into account the temporal patterns of pathophysiological mechanisms.
Manfredini, Roberto; Boari, Benedetta; O., La Cecilia; Portaluppi, Francesco
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Utilizza questo identificativo per citare o creare un link a questo documento: http://hdl.handle.net/11392/533858
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