Salt wars

Nephrology Dialysis Transplantation, Mar 2009

David A. McCarron, Tilman B. Drueke

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Salt wars

0 Department of Nutrition, University of California at Davis , CA , USA David A. McCarron Tilman B. Drueke 1. Taubes G. The (political) science of salt. Science 1998; 281: 898-901, 903-907 2. Paterna S, Gaspare P, Fasullo S et al. Normal-sodium diet compared with low-sodium diet in compensated congestive heart failure: is sodium an old enemy or a new friend? Clin Sci (Lond) 2008; 114: 221-230 - Conflict of interest statement. T.D. declares consulting fees and grant support from the Comite des Salines de France. The research of D.A.M. was funded by grants from the NIH, USDA, NASA, NKF and AHA. He is a consultant to the Salt Institute among a wide variety of advisory positions. Sir, We read the recently published study by Gritters et al. that evaluated the role of the extracorporeal circuit (ECC) and of the low-molecular-weight heparin (LMWH) in platelet (PLT) activation. Using the PLT surface marker CD62p, they concluded that various parts of ECC are responsible for PLT activation during the haemodialysis (HD) procedure. However, LMWH had no effect on PLT activation, but it contributes to the HD-induced bioincompatibility by releasing platelet factor 4 by the endothelium [1]. Our team has also evaluated the effect of the HD procedure on PLT function [2]. We used propyl gallate (PG) slide aggregometry. PG-induced platelet aggregation and tyrosine phosphorylation of multiple proteins are substantially abolished by aspirin, apyrase and abciximab, suggesting that PG is associated with activation of platelet cyclooxygenase 1, adenosine phosphate receptors and GpIIb/IIIa, respectively [3]. It thus seems that PG is a suitable reagent for a global evaluation of platelet aggregation. We found an effect of the type of dialysis membrane on PLT function and that in HD patients PLT aggregation is impaired. The last is in accordance with the study by Gritters et al. that, considering the lower levels of serotonin in PLTs of HD patients, suggests that repetitive stimulation by HD results in a state of PLT depletion and exhaustion [1]. However, we found that LMWH affects PLT function in HD patients. A statistically significant negative correlation was almost reached between the dose of tinzaparin sodium, calculated as units/kg of dry body weight and the time needed for platelet aggregation as measured before the start of the HD session (r = 0.332, P = 0.056). This negative correlation became much stronger and statistically significant after the HD procedure (r = 0.428, P = 0.009), i.e. near tinzaparin administration indicating a short-term effect of this LMWH on platelet aggregation.


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David A. McCarron, Tilman B. Drueke. Salt wars, Nephrology Dialysis Transplantation, 2009, 1063-1063, DOI: 10.1093/ndt/gfn781