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Chacra A, Gantz I, Mendizabal G, Durlach L, O'Neill EA, Zimmer Z, Suryawanshi S, Engel SS, Lai E. A randomised, double-blind, trial of the safety and efficacy of omarigliptin (a once-weekly DPP-4 inhibitor) in subjects with type 2 diabetes and renal impairment. Int J Clin Pract 2017; 71:e12955. [PMID: 28449320 PMCID: PMC6681174 DOI: 10.1111/ijcp.12955] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
AIMS To assess the safety and efficacy of omarigliptin in subjects with type 2 diabetes mellitus (T2DM) and chronic renal impairment (RI). METHODS Patients with T2DM with moderate RI (estimated glomerular filtration rate [eGFR] ≥30 to <60 mL/min/1.73 m2 ) (N=114), severe RI (eGFR <30 mL/min/1.73 m2 ) (N=55) or end-stage renal disease on dialysis (N=44), who were either not on an antihyperglycaemic agent therapy for at least 12 weeks at screening, washed-off of oral antihyperglycaemic agent monotherapy or low-dose dual combination therapy, or on insulin monotherapy, with baseline glycated haemoglobin (HbA1c) of 6.5%-10.0% were randomised to omarigliptin or to placebo for 24 weeks (primary end-point) followed by a 30-week period with subjects on placebo switched to blinded glipizide (if not on insulin). RESULTS After 24 weeks, from a mean baseline HbA1c of 8.4% in the omarigliptin group and 8.3% in the placebo group, the least squares mean (95% CI) change from baseline in HbA1c in the overall population (all renal strata combined) was -0.77% (-1.00 to -0.54) in the omarigliptin group and -0.44% (-0.67 to -0.21) in the placebo group; between-group difference of -0.33% (-0.63 to -0.02); P=0.035. After 24 weeks, the incidences of subjects with symptomatic hypoglycaemia, one or more adverse event (AE), drug-related AE, serious AE and discontinuation due to an AE were similar in the omarigliptin and placebo groups. CONCLUSIONS In this study in subjects with T2DM and RI, relative to placebo, omarigliptin provided clinically meaningful reductions in HbA1c, had a similar incidence of symptomatic hypoglycaemia and was generally well tolerated.
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Affiliation(s)
- Antonio Chacra
- Diabetes CenterFederal University of Sao PauloSao PauloBrazil
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152
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Shah K. Teneligliptin in Early Diabetic Kidney Disease: An Observation in Asian Indian Patients with Type 2 Diabetes Mellitus in Real-Life Scenario. J Clin Diagn Res 2017; 11:OC22-OC25. [PMID: 28764219 DOI: 10.7860/jcdr/2017/27013.10003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Accepted: 04/17/2017] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Teneligliptin is a recently developed Dipeptidyl Peptidase 4 (DPP4) inhibitor. Teneligliptin is suitable for glycaemic control with renal impairment including end stage renal disease. AIM To assess the efficacy and safety of teneligliptin in Asian Indian patients of Type 2 Diabetes Mellitus (T2DM) with early Diabetic Kidney Disease (DKD). MATERIALS AND METHODS This was a single centre, retrospective analysis of patients with early DKD, who received teneligliptin 20 mg once daily for 24 weeks. Data related to glycaemic parameters, kidney function, lipid levels, retinopathy, neuropathy and safety variables available at 12 and 24 weeks were analysed. Descriptive statistical analysis was carried out. Statistical significance was assessed at a 5% level. RESULTS Total 37 patients (21 males; 16 females) were analysed. Compared to baseline, significant reduction in Fasting Plasma Glucose (FPG) (mg/dl) (143.89±28.26 vs. 125.78±20.52, p=0.001); Postprandial Glucose (PPG) (mg/dl) (200.62±41.88 vs. 165.76±26.02, p=0.001); Glycated Haemoglobin (HbA1c) (%)(8.65±0.58 vs. 8.17±0.54, p=0.001) was noted at 12 weeks. This trend was further continued for 24 weeks with significant reduction in mean FPG, PPG and HbA1c to 113.73±16.82 mg/ dl (p=0.008); 142.95±20.76 mg/dl (p=0.001); and 7.65±0.45% (p=0.001) respectively. Significant improvement in serum creatinine (mg/dl) (2.45±0.27 vs. 2.26±0.23, p=0.001) and eGFR (CKD-EPI), (ml/min/1.73 m2) (53.35±4.24 vs. 55.08±4.19, p=0.001) was noted at 12 weeks and continued for 24 weeks with reduction in serum creatinine of 0.37±0.18 mg/ dl (p=0.001) and increase of eGFR of 4.60±1.59 ml/min/1.73 m2 (p=0.001). At baseline, proteinuria was noted in all patients while at 24 weeks, 40.5% (p=0.001) patients did not report proteinuria. Significant improvements in lipid parameters with no deterioration in retinopathy and subjective improvement in peripheral neuropathy was also noted. No adverse events were noted. CONCLUSION Teneligliptin reported significant and sustained improvement in glycaemic control in Asian Indian Patients of T2DM with early DKD and was well tolerated. Additionally, Teneligliptin reported significant improvement in renal function.
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Affiliation(s)
- Kiran Shah
- Physician and Diabetologist, Diabetes and Thyroid Care Centre, Mumbai, Maharashtra, India
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153
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Bentata Y, Abouqal R. Albuminuria in patients with young onset type 2 diabetes. J Nephropharmacol 2017. [DOI: 10.15171/npj.2017.14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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154
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Dilla T, Alexiou D, Chatzitheofilou I, Ayyub R, Lowin J, Norrbacka K. The cost-effectiveness of dulaglutide versus liraglutide for the treatment of type 2 diabetes mellitus in Spain in patients with BMI ≥30 kg/m 2. J Med Econ 2017; 20:443-452. [PMID: 28008768 DOI: 10.1080/13696998.2016.1275651] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Dulaglutide 1.5 mg once weekly is a novel glucagon-like peptide 1 (GLP-1) receptor agonist, for the treatment of type two diabetes mellitus (T2DM). The objective was to estimate the cost-effectiveness of dulaglutide once weekly vs liraglutide 1.8 mg once daily for the treatment of T2DM in Spain in patients with a BMI ≥30 kg/m2. METHODS The IMS CORE Diabetes Model (CDM) was used to estimate costs and outcomes from the perspective of Spanish National Health System, capturing relevant direct medical costs over a lifetime time horizon. Comparative safety and efficacy data were derived from direct comparison of dulaglutide 1.5 mg vs liraglutide 1.8 mg from the AWARD-6 trial in patients with a body mass index (BMI) ≥30 kg/m2. All patients were assumed to remain on treatment for 2 years before switching treatment to basal insulin at a daily dose of 40 IU. One-way sensitivity analyses (OWSA) and probabilistic sensitivity analyses (PSA) were conducted to explore the sensitivity of the model to plausible variations in key parameters and uncertainty of model inputs. RESULTS Under base case assumptions, dulaglutide 1.5 mg was less costly and more effective vs liraglutide 1.8 mg (total lifetime costs €108,489 vs €109,653; total QALYS 10.281 vs 10.259). OWSA demonstrated that dulaglutide 1.5 mg remained dominant given plausible variations in key input parameters. Results of the PSA were consistent with base case results. LIMITATIONS Primary limitations of the analysis are common to other cost-effectiveness analyses of chronic diseases like T2DM and include the extrapolation of short-term clinical data to the lifetime time horizon and uncertainty around optimum treatment durations. CONCLUSION The model found that dulaglutide 1.5 mg was more effective and less costly than liraglutide 1.8 mg for the treatment of T2DM in Spain. Findings were robust to plausible variations in inputs. Based on these results, dulaglutide may result in cost savings to the Spanish National Health System.
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155
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Nakamura N, Narita I, Fujita T, Murakami R, Shimada M, Nakamura M, Osawa H, Yamabe H, Okumura K. Factors Associated with Microalbuminuria Remission in Patients with Type 2 Diabetes: Importance of Early Intervention for Microalbuminuric Patients (TSUGARU STUDY). ACTA ACUST UNITED AC 2017; 31:285-290. [PMID: 28438853 DOI: 10.21873/invivo.11057] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Revised: 03/19/2017] [Accepted: 03/21/2017] [Indexed: 11/10/2022]
Abstract
AIM The aim of this study was to clarify the rates of remission and progression for microalbuminuria in patients with type 2 diabetes (T2DM); and factors associated with remission and progression of diabetic nephropathy (DN). PATIENTS AND METHODS T2DM patients with a urinary albumin excretion (UAE) rate of 30-300 mg/gCr who were attending the medical clinic in the Tsugaru region in Japan were enrolled into this prospective, observational study for 36 months (N=317). We investigated the rate of remission (UAE <30 mg/g creatinine (Cr); normal albuminuria) and the rate of progression (UAE ≥300 mg/gCr; overt proteinuria) 36 months after study registration. RESULTS The number of patients whose UAE levels were <30 mg/gCr (DN remission) at 36 months after registration was 64 (27.4%), and the number of patients whose UAE levels were ≥300 mg/gCr (DN progression) at 36 months after registration was 32 (13.7%). From multiple logistic regression analysis, the sole factor that contributed to remission at 36 months after registration was the UAE levels at registration (OR: 0.99; 95% CI: 0.98-1.00, p=0.003), and the factors that contributed to progression at 36 months after registration were the levels of UAE (OR: 1.01; 95% CI: 1.01-1.02, p=0.000) and systolic blood pressure (OR: 0.96; 95% CI: 0.93-1.00, p=0.033) at registration. CONCLUSION Results suggest that patients with less severe microalbuminuria among microalbuminuric patients might more commonly experience DN remission and that earlier intervention is very important for promoting microalbuminuria remission in DN.
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Affiliation(s)
- Norio Nakamura
- Community Medicine, Hirosaki University Graduate School of Medicine, Aomori, Japan .,Department of Cardiology and Nephrology, Hirosaki University Graduate School of Medicine, Aomori, Japan
| | - Ikuyo Narita
- Department of Cardiology and Nephrology, Hirosaki University Graduate School of Medicine, Aomori, Japan
| | - Takeshi Fujita
- Department of Cardiology and Nephrology, Hirosaki University Graduate School of Medicine, Aomori, Japan
| | - Reiichi Murakami
- Department of Cardiology and Nephrology, Hirosaki University Graduate School of Medicine, Aomori, Japan
| | - Michiko Shimada
- Department of Cardiology and Nephrology, Hirosaki University Graduate School of Medicine, Aomori, Japan
| | - Masayuki Nakamura
- Department of Cardiology and Nephrology, Hirosaki University Graduate School of Medicine, Aomori, Japan
| | - Hiroshi Osawa
- Department of General Medicine, Hirosaki University Hospital, Aomori, Japan
| | - Hideaki Yamabe
- Department of Cardiology and Nephrology, Hirosaki University Graduate School of Medicine, Aomori, Japan
| | - Ken Okumura
- Department of Cardiology and Nephrology, Hirosaki University Graduate School of Medicine, Aomori, Japan
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156
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Wu B, Zhang S, Lin H, Mou S. Prevention of renal failure in Chinese patients with newly diagnosed type 2 diabetes: A cost-effectiveness analysis. J Diabetes Investig 2017; 9:152-161. [PMID: 28296280 PMCID: PMC5754528 DOI: 10.1111/jdi.12653] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2016] [Revised: 02/08/2017] [Accepted: 03/02/2017] [Indexed: 02/06/2023] Open
Abstract
Aims/Introduction Diabetic kidney disease (DKD) is the second leading cause (16.4%) of end‐stage renal disease in China. The current study assessed the cost‐effectiveness of preventing DKD in patients with newly diagnosed type 2 diabetes from the Chinese healthcare perspective. Materials and Methods A lifetime Markov decision model was developed according to the disease course of DKD. Patients with newly diagnosed type 2 diabetes might receive treatment according to one of the following three strategies: (i) “do nothing” strategy (control strategy); (ii) treatment with angiotensin‐converting enzyme inhibitors and angiotensin II receptor blockers (universal strategy); (iii) or screening for microalbuminuria followed by angiotensin‐converting enzyme inhibitor/angiotensin II receptor blocker treatment (screening strategy). Clinical and utility data were obtained from the published literature. Direct medical costs and resource utilization in the Chinese healthcare setting were considered. Sensitivity analyses were undertaken to test the impact of a range of variables and assumptions on the results. Results Compared with the control strategy, both the screening and universal strategies were cost‐saving options that showed lower costs and better health benefits. The incremental cost‐effectiveness ratio of the universal strategy over the screening strategy was US $30,087 per quality‐adjusted life‐year, which was higher than the cost‐effectiveness threshold of China. The sensitivity analyses showed robust results, except for the probability of developing macroalbuminuria from microalbuminuria. Conclusions Screening for microalbuminuria could be a cost‐saving option for the prevention of DKD in the Chinese setting.
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Affiliation(s)
- Bin Wu
- Medical Decision and Economic Group, Department of Pharmacy, Ren Ji Hospital, South Campus, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Suhua Zhang
- Department of Nephrology, Ren Ji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Houwen Lin
- Medical Decision and Economic Group, Department of Pharmacy, Ren Ji Hospital, South Campus, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Shan Mou
- Department of Nephrology, Ren Ji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
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157
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Bolignano D, Zoccali C. Non-proteinuric rather than proteinuric renal diseases are the leading cause of end-stage kidney disease. Nephrol Dial Transplant 2017; 32:ii194-ii199. [DOI: 10.1093/ndt/gfw440] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023] Open
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158
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Association of A1538G and C2437T single nucleotide polymorphisms in heat shock protein-70 genes with diabetic nephropathy among South Indian population. Biosci Rep 2017; 37:BSR20160605. [PMID: 28246355 PMCID: PMC5469327 DOI: 10.1042/bsr20160605] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Revised: 02/20/2017] [Accepted: 02/27/2017] [Indexed: 11/18/2022] Open
Abstract
Diabetic Nephropathy (DN) is the leading cause of end-stage renal disease, characterized by progressive albuminuria and conferring additional risk of cardiovascular disease (CVD) and mortality. The crucial role of heat-shock proteins (HSPs) on renal function in patients with DN has been well documented. The present study was aimed to understand the association of HSP-70 gene variants on the susceptibility of Type 2 Diabetes Mellitus (T2DM) and DN. A total of 946 subjects (549 Males; 397 Females) were recruited and divided into four groups according to the levels of urinary albumin excretion (UAE): those with normoalbuminuria (UAE <30 mg/24 h; n=230), those with microalbuminuria (30≤ UAE ≤300 mg/24 h; n=230), and those with macroalbuminuria (UAE> 300 mg/24 h; n=230). The control group randomly enrolled a consecutive population of 256 healthy subjects who had a routine medical check-up in our hospital. Those subjects had no history or clinical symptoms of diabetes. Subjects were genotyped for HSP70-2 (+1538 A/G; rs2763979) and HSP70-hom (+2437 C/T; rs2227956) by PCR-restriction fragment length polymorphism (RFLP). The ‘G’ allele of HSP70-2 (+1538 A/G) single nucleotide polymorphism (SNP) showed relative risk for normoalbuminuria, microalbuminuria and macroalbuminuria subjects whereas the ‘T’ allele of HSP70-hom (+2437 C/T) SNP showed significant protection against macroalbuminuria subjects. In conclusion, our results indicate that the HSP70-2 (+1538 A/G) and HSP70-hom (+2437 C/T) SNPs are highly associated with renal complications in T2DM among the South Indian population.
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159
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Kohno M. Soybean Protein and Peptide as Complementation Medical Food Materials for Treatment of Dyslipidemia and Inflammatory Disorders. FOOD SCIENCE AND TECHNOLOGY RESEARCH 2017. [DOI: 10.3136/fstr.23.773] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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160
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Liu JJ, Ghosh S, Kovalik JP, Ching J, Choi HW, Tavintharan S, Ong CN, Sum CF, Summers SA, Tai ES, Lim SC. Profiling of Plasma Metabolites Suggests Altered Mitochondrial Fuel Usage and Remodeling of Sphingolipid Metabolism in Individuals With Type 2 Diabetes and Kidney Disease. Kidney Int Rep 2016; 2:470-480. [PMID: 29142974 PMCID: PMC5678636 DOI: 10.1016/j.ekir.2016.12.003] [Citation(s) in RCA: 72] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2016] [Revised: 12/06/2016] [Accepted: 12/08/2016] [Indexed: 12/11/2022] Open
Abstract
Introduction Pathophysiology of diabetic kidney disease (DKD) is incompletely understood. We aim to elucidate metabolic abnormalities associated with DKD in type 2 diabetes mellitus (T2DM) by targeted plasma metabolomics. Methods A total of 126 T2DM participants with early DKD (urinary albumin-to-creatinine ratio [ACR] 30−299 mg/g and eGFR ≥ 60 ml/min/1.73 m2), 154 overt DKD (ACR ≥ 300 mg/g or eGFR < 60 ml/min/1.73 m2), and 129 non-DKD T2DM controls (ACR < 30 mg/g and eGFR ≥ 60 ml/min/1.73 m2) were included in discovery study. Findings were subsequently validated in 149 T2DM with macroalbuminuria (ACR ≥ 300 mg/g) and 149 matched non-DKD T2DM controls. Plasma amino acid, acylcarnitine, Krebs cycle organic acid, and sphingolipids/ceramide levels were quantified by liquid chromatography−mass spectrometry and gas chromatography−mass spectrometry. Results Of 123 metabolites included in the data analysis, 24 differed significantly between DKD and controls in the same direction in both discovery and validation subpopulations. A number of short acylcarnitines including their dicarboxylic derivatives (C2−C6) were elevated in DKD, suggesting abnormalities in fatty acids and amino acids metabolic pathways. Five phosphatidylcholines were lower whereas 4 metabolites in the sphingomyelin−ceramide subfamily were higher in DKD. Principal component regression revealed that long-chain ceramides were independently associated with ACR but not eGFR. Conversely, essential amino acids catabolism and short dicarboxylacylcarnitine accumulation were associated with eGFR but not ACR. Discussion DKD is associated with altered fuel substrate use and remodeling of sphingolipid metabolism in T2DM with DKD. Associations of albuminuria and impaired filtration function with distinct metabolomic signatures suggest different pathophysiology underlying these 2 manifestations of DKD.
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Affiliation(s)
- Jian-Jun Liu
- Clinical Research Unit, Khoo Teck Puat Hospital, Singapore
| | | | | | | | - Hyung Won Choi
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | | | - Choon Nam Ong
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | | | | | - E Shyong Tai
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Su Chi Lim
- Diabetes Centre, Khoo Teck Puat Hospital, Singapore
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161
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Altaf QA, Sadiqi H, Piya MK, Tahrani AA. Foot insensitivity is associated with renal function decline in patients with type 2 diabetes: a cohort study. BMC Endocr Disord 2016; 16:64. [PMID: 27876022 PMCID: PMC5120531 DOI: 10.1186/s12902-016-0147-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Accepted: 11/18/2016] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Identifying patients with diabetes at increased risk of chronic kidney disease (CKD) is essential to prevent/slow the progression to end-stage renal disease (ESRD). CKD and diabetic peripheral neuropathy (DPN) share common mechanisms. Hence, we aimed to examine the relationship between foot insensitivity and CKD in patients with Type 2 diabetes. METHODS A prospective observational cohort study in adults with Type 2 diabetes. Patients with ESRD were excluded. Foot insensitivity was assessed using the 10-g monofilament test. Renal function was assessed using estimated glomerular filtration rate (eGFR) based on the MDRD equation. Albuminuria was defined as the presence of urinary albumin/creatinine ratio (ACR) >3.4 mg/mmol. RESULTS Two hundred and twenty eight patients were recruited and followed-up for 2.5 years. One hundred and ninety patients (83.4%) had eGFR ≥ 60 ml/min/1.73 m2. Seventy six (33.3%) patients had foot insensitivity (i.e. abnormal monofilament test). Patients with foot insensitivity had lower eGFR and higher prevalence of albuminuria compared to patients with normal monofilament test. After adjustment for age, gender, ethnicity, diabetes duration, HbA1c, body mass index, insulin treatment, number of anti-hypertensives, history of peripheral vascular disease, and baseline eGFR (R2 0.87), baseline foot insensitivity was associated with study-end eGFR (B = -3.551, p = 0.036). CONCLUSIONS Patients with Type 2 diabetes and foot insensitivity are at increased risk of eGFR decline. Identifying these patients offers an opportunity to intensify metabolic and blood pressure control to prevent/retard the development of CKD. Future studies of larger sample size and longer follow up from multiple centres are needed to assess the diagnostic performance of our findings in predicting CKD development, and to compare the performance of the monofilament test with albuminuria.
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Affiliation(s)
- Quratul A. Altaf
- Department of Diabetes and Endocrinology, Heart of England NHS Foundation Trust, Birmingham, UK
| | - Hamed Sadiqi
- Department of Diabetes and Endocrinology, Heart of England NHS Foundation Trust, Birmingham, UK
| | - Milan K. Piya
- Derby Teaching Hospitals NHS Foundation Trust, Derby, UK
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Abd A. Tahrani
- Department of Diabetes and Endocrinology, Heart of England NHS Foundation Trust, Birmingham, UK
- Institute of Metabolism and Systems, School of Clinical and Experimental Medicine, University of Birmingham, Birmingham, UK
- Centre of Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, Birmingham, B15 2TT UK
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162
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Satman I, R Rea R, Eriksson M, Mosenzon O, Pratley R, M Baeres F, D Ørsted D, F Mann J. LEADER-6: Baseline renal function and associated factors in a high cardiovascular risk type 2 diabetes population. J Diabetes Complications 2016; 30:1631-1639. [PMID: 27320184 DOI: 10.1016/j.jdiacomp.2016.06.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Revised: 05/20/2016] [Accepted: 06/01/2016] [Indexed: 12/31/2022]
Abstract
AIMS To examine the prevalence of chronic kidney disease (CKD) and its associated factors in a multinational population with type 2 diabetes mellitus (T2DM) and prior cardiovascular disease (CVD). METHODS The LEADER trial randomized 9340 participants-81.3% with prior CVD at baseline. CKD was defined as estimated GFR <60ml/min/1.73m2 and/or an albumin-to-creatinine ratio ≥3.0mg/mmol. RESULTS At baseline, 51.9% of participants with prior CVD had CKD. CKD prevalence was highest in Asia (75.8%) and lowest in Europe (43.7%) and the Middle East (43.4%). Baseline factors associated with increased CKD prevalence included increased age, HbA1c, diabetes duration, systolic blood pressure or triglyceride levels; greater number of antihypertensive medications; living in Asia, the Americas or Africa versus Europe; being male; and not receiving oral antidiabetic drugs (most receiving insulin), beta-blockers or ACE inhibitors. Factors associated with decreased CKD prevalence included increased diastolic blood pressure, no diuretic treatment and prior myocardial infarction, angina or stroke. CONCLUSIONS CKD prevalence is high among patients with T2DM and prior CVD. Advanced age, long diabetes duration, poor glycemic control, comorbidities and medications used are associated with CKD. Our results strengthen the rationale for early screening and interventions for CKD in patients with T2DM and prior CVD.
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Affiliation(s)
- Ilhan Satman
- Istanbul Faculty of Medicine, Department of Internal Medicine, Division of Endocrinology and Metabolic Diseases, Istanbul University, Istanbul, Turkey.
| | - Rosangela R Rea
- Diabetes Unity Department of Internal Medicine, Endocrine Division (SEMPR), Federal University of Paraná, Curitiba, Brazil
| | - Mats Eriksson
- Department of Endocrinology, Metabolism and Diabetes, Karolinska University Hospital, Stockholm, Sweden
| | - Ofri Mosenzon
- Diabetes Unit, Division of Internal Medicine, Hadassah Hebrew University Hospital, Ein Kerem, Jerusalem, Israel
| | - Richard Pratley
- Translational Research Institute for Metabolism and Diabetes, Florida Hospital, Orlando, FL, United States
| | | | | | - Johannes F Mann
- Department of Nephrology, Hypertension & Rheumatology, Friedrich Alexander University of Erlangen, Munchen, Germany
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163
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Lu M, Zhang J, Li M, Ge X, Dai X, Zhao J, Fu M, Wang T, Fang X, Li C, Zhang R, Zhao W, Zheng T, Wang F, Yu M, Lei T, Wang N, Bao Y, Liu L, Liu Y, Jia W. The angiotensin-I converting enzyme gene I/D variation contributes to end-stage renal disease risk in Chinese patients with type 2 diabetes receiving hemodialysis. Mol Cell Biochem 2016; 422:181-188. [PMID: 27633502 DOI: 10.1007/s11010-016-2819-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Accepted: 09/08/2016] [Indexed: 11/26/2022]
Abstract
Whether the DD genotype of the angiotensin-I converting enzyme (ACE) I/D variation contributes to end-stage renal disease (ESRD) risk in type 2 diabetes mellitus (T2DM) remains controversial. Differences in study design, case and control definition, sample size and ethnicity may contribute to the discrepancies reported in association studies. We performed a case-control study to evaluate the association of the ACE I/D variation with ESRD risk in Chinese patients with T2DM receiving hemodialysis and analyzed the genotype-phenotype interaction. Unrelated Chinese patients (n = 432) were classified into the non-diabetic nephropathy (DN) control group (n = 222, duration of diabetes >10 years, no signs of renal involvement) and the DN-ESRD group (n = 210; ESRD due to T2DM, receiving hemodialysis). Polymerase chain reaction was used to genotype ACE I/D for all 432 subjects. The frequencies of the ID + DD genotypes were higher in the DN-ESRD group than non-DN control group (65.2 vs. 50.9 %; adjusted OR 1.98 (95 % CI, 1.31-3.00; P = 0.001). In the DN-ESRD group, the DD genotypic subgroup had significantly elevated HbA1c and diastolic blood pressure (DBP) compared to the II subgroup (both P < 0.05). The DD genotype of the ACE I/D variation may be associated with more elevated blood pressure and HbA1c, and therefore may predict the development, progression and severity of DN-ESRD in Chinese patients with T2DM undergoing hemodialysis.
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Affiliation(s)
- Ming Lu
- Department of Endocrinology & Metabolism, Putuo Hospital Attached to Shanghai University of Traditional Chinese Medicine, 164 Lanxi Road, Shanghai, 200000, China
| | - Jianzhong Zhang
- Department of Endocrinology, China-Japan Union Hospital of Jilin University, 829 Xinmin Street, Changchun, China
| | - Ming Li
- Department of Endocrinology & Metabolism, Shanghai Diabetes Institute, Shanghai Jiaotong University Affiliated Sixth People's Hospital, 600 Yishan Road, Shanghai, 200233, China
| | - Xiaoxu Ge
- Department of Endocrinology & Metabolism, Shanghai Diabetes Institute, Shanghai Jiaotong University Affiliated Sixth People's Hospital, 600 Yishan Road, Shanghai, 200233, China
| | - Xu Dai
- Shanghai Jiaotong University School of Medicine, 227 Chongqing South Road, Shanghai, 200025, China
| | - Jiao Zhao
- Shanghai Jiaotong University School of Medicine, 227 Chongqing South Road, Shanghai, 200025, China
| | - Mingzhou Fu
- Shanghai Jiaotong University School of Medicine, 227 Chongqing South Road, Shanghai, 200025, China
| | - Tao Wang
- Shanghai Jiaotong University School of Medicine, 227 Chongqing South Road, Shanghai, 200025, China
| | - Xiyao Fang
- Shanghai Jiaotong University School of Medicine, 227 Chongqing South Road, Shanghai, 200025, China
| | - Can Li
- Department of Endocrinology & Metabolism, Shanghai Diabetes Institute, Shanghai Jiaotong University Affiliated Sixth People's Hospital, 600 Yishan Road, Shanghai, 200233, China
| | - Rong Zhang
- Department of Endocrinology & Metabolism, Shanghai Diabetes Institute, Shanghai Jiaotong University Affiliated Sixth People's Hospital, 600 Yishan Road, Shanghai, 200233, China
| | - Weijing Zhao
- Department of Endocrinology & Metabolism, Shanghai Diabetes Institute, Shanghai Jiaotong University Affiliated Sixth People's Hospital, 600 Yishan Road, Shanghai, 200233, China
| | - Taishan Zheng
- Department of Endocrinology & Metabolism, Shanghai Diabetes Institute, Shanghai Jiaotong University Affiliated Sixth People's Hospital, 600 Yishan Road, Shanghai, 200233, China
| | - Feng Wang
- Department of Nephrology, Shanghai Diabetes Institute, Shanghai Jiaotong University Affiliated Sixth People's Hospital, 600 Yishan Road, Shanghai, 200233, China
| | - Ming Yu
- Department of Endocrinology & Metabolism, Putuo Hospital Attached to Shanghai University of Traditional Chinese Medicine, 164 Lanxi Road, Shanghai, 200000, China
| | - Tao Lei
- Department of Endocrinology & Metabolism, Putuo Hospital Attached to Shanghai University of Traditional Chinese Medicine, 164 Lanxi Road, Shanghai, 200000, China
| | - Niansong Wang
- Department of Nephrology, Shanghai Diabetes Institute, Shanghai Jiaotong University Affiliated Sixth People's Hospital, 600 Yishan Road, Shanghai, 200233, China
| | - Yuqian Bao
- Department of Endocrinology & Metabolism, Shanghai Diabetes Institute, Shanghai Jiaotong University Affiliated Sixth People's Hospital, 600 Yishan Road, Shanghai, 200233, China
| | - Limei Liu
- Department of Endocrinology & Metabolism, Shanghai Diabetes Institute, Shanghai Jiaotong University Affiliated Sixth People's Hospital, 600 Yishan Road, Shanghai, 200233, China.
| | - Yanjun Liu
- Division of Endocrinology, Metabolism, and Molecular Medicine, Charles R. Drew University of Medicine and Sciences, University of California Los Angeles (UCLA) School of Medicine, Los Angeles, CA, USA
| | - Weiping Jia
- Department of Endocrinology & Metabolism, Shanghai Diabetes Institute, Shanghai Jiaotong University Affiliated Sixth People's Hospital, 600 Yishan Road, Shanghai, 200233, China
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Bradley D, Hsueh W. Type 2 Diabetes in the Elderly: Challenges in a Unique Patient Population. JOURNAL OF GERIATRIC MEDICINE AND GERONTOLOGY 2016; 2:14. [PMID: 31692858 PMCID: PMC6831098 DOI: 10.23937/2469-5858/1510014] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
In the older patient population, rates of Type 2 Diabetes (T2D) and obesity are reaching epidemic proportions. In fact, older patients will soon constitute the majority of patients with T2D in most developed countries. The higher prevalence of T2D in older individuals is seen in both men and women and across racial and ethnic groups. However, certain ethnic groups are disproportionately affected and successful strategies must account for these fundamental differences. T2D in old age is associated with traditional diabetes-associated complications including micro- and macro vascular disease, but is also closely related to numerous other comorbidities including cognitive impairment, urinary incontinence, sarcopenia, and increased fall risk. An overall state of chronic inflammation and dysregulated immune system may underlie these increased risks; yet our understanding of immunometabolism during the aging process remains incomplete. In addition, optimal recognition and treatment of diabetes in the elderly is hampered by a lack of relevant, high-quality studies, as the majority of clinical trial data establishing risk profiles, glycemic targets, and therapeutic interventions for T2D are not applicable for large segments of the older patient population. Simply acknowledging this gap is inadequate. We need strong evidence-based data upon which to successfully identify diabetic patients and then intervene in ways that are targeted to specific individuals within a heterogeneous group of elderly patients with T2D.
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Affiliation(s)
- David Bradley
- Department of Internal Medicine, Wexner Medical Center, The Ohio State University, USA
| | - Willa Hsueh
- Department of Internal Medicine, Wexner Medical Center, The Ohio State University, USA
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Luk AO, Li X, Zhang Y, Guo X, Jia W, Li W, Weng J, Yang W, Chan WB, Ozaki R, Tsang CC, Mukhopadhyay M, Ojha AK, Hong EG, Yoon KH, Sobrepena L, Toledo RM, Duran M, Sheu W, Q Do T, Nguyen TK, Ma RC, Kong AP, Chow CC, Tong PC, So WY, Chan JC. Quality of care in patients with diabetic kidney disease in Asia: The Joint Asia Diabetes Evaluation (JADE) Registry. Diabet Med 2016; 33:1230-9. [PMID: 26511783 DOI: 10.1111/dme.13014] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/26/2015] [Indexed: 12/18/2022]
Abstract
AIMS Diabetic kidney disease independently predicts cardiovascular disease and premature death. We examined the burden of chronic kidney disease (CKD, defined as an estimated GFR < 60 ml/min/1.73 m(2) ) and quality of care in a cross-sectional survey of adults (age ≥ 18 years) with Type 2 diabetes across Asia. METHODS The Joint Asia Diabetes Evaluation programme is a disease-management programme implemented using an electronic portal that systematically captures clinical characteristics of all patients enrolled. Between July 2007 and December 2012, data on 28 110 consecutively enrolled patients (China: 3415, Hong Kong: 15 196, India: 3714, Korea: 1651, Philippines: 3364, Vietnam: 692, Taiwan: 78) were analysed. RESULTS In this survey, 15.9% of patients had CKD, 25.0% had microalbuminuria and 12.5% had macroalbuminuria. Patients with CKD were less likely to achieve HbA1c < 53 mmol/mol (7.0%) (36.0% vs. 42.3%) and blood pressure < 130/80 mmHg (20.8% vs. 35.3%), and were more likely to have retinopathy (26.2% vs. 8.7%), sensory neuropathy (29.0% vs. 7.7%), cardiovascular disease (26.6% vs. 8.7%) and self-reported hypoglycaemia (18.9% vs. 8.2%). Despite high frequencies of albuminuria (74.8%) and dyslipidaemia (93.0%) among CKD patients, only 49.0% were using renin-angiotensin system inhibitors and 53.6% were on statins. On logistic regression, old age, male gender, tobacco use, long disease duration, high HbA1c , blood pressure and BMI, and low LDL cholesterol were independently associated with CKD (all P < 0.05). CONCLUSIONS The poor control of risk factors, suboptimal use of organ-protective drugs and high frequencies of hypoglycaemia highlight major treatment gaps in patients with diabetic kidney disease in Asia.
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Affiliation(s)
- A O Luk
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - X Li
- Asia Diabetes Foundation, Prince of Wales Hospital, Hong Kong SAR, China
| | - Y Zhang
- Asia Diabetes Foundation, Prince of Wales Hospital, Hong Kong SAR, China
| | - X Guo
- Department of Endocrinology, Peking University First Hospital, Beijing, China
| | - W Jia
- Department of Endocrinology and Metabolism, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - W Li
- Peking Union Medical College Hospital, Beijing, China
| | - J Weng
- The Third Affiliated Hospital of Sun Yat-Sen University, Guangdong, Beijing, China
| | - W Yang
- Department of Endocrinology, China-Japan Friendship Hospital, Beijing, China
| | - W B Chan
- Qualigenics Diabetes Centre, Hong Kong SAR, China
| | - R Ozaki
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - C C Tsang
- Alice Ho Nethersole Hospital, Hong Kong SAR, China
| | | | | | - E G Hong
- Hallym University College of Medicine, Gangwon-do, Korea
| | - K H Yoon
- The Catholic University of Korea, Seocho-gu, Korea
| | - L Sobrepena
- Heart of Jesus Hospital, San Jose City, Philippines
| | - R M Toledo
- Senor Sto. Nino Hospital, Tarlac, Philippines
| | - M Duran
- New Bilibid Prison Hospital, Bureau of Corrections, Muntinlupa, Philippines
| | - W Sheu
- Taichung Veterans General Hospital, Taichung, Taiwan
| | - T Q Do
- Bach Mai Hospital, Hanoi, Vietnam
| | - T K Nguyen
- HCMC University of Pharmaceutical and Medicine, Ho Chi Minh City, Vietnam
| | - R C Ma
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - A P Kong
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - C C Chow
- Department of Medicine and Therapeutics, Prince of Wales Hospital, Hong Kong SAR, China
| | - P C Tong
- Qualigenics Diabetes Centre, Hong Kong SAR, China
| | - W Y So
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - J C Chan
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong SAR, China
- Asia Diabetes Foundation, Prince of Wales Hospital, Hong Kong SAR, China
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Zhu H, Chen X, Cai G, Zheng Y, Liu M, Liu W, Yao H, Wang Y, Li W, Wu H, Lun L, Zhang J, Guan X, Yin S, Zhuang X, Li J, Liu Y, Zhou C. Telmisartan combined with probucol effectively reduces urinary protein in patients with type 2 diabetes: A randomized double-blind placebo-controlled multicenter clinical study. J Diabetes 2016; 8:677-85. [PMID: 26458146 DOI: 10.1111/1753-0407.12347] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2015] [Revised: 08/30/2015] [Accepted: 10/03/2015] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Persistent proteinuria is an important factor contributing to the progression of diabetic nephropathy. The present randomized double-blind placebo-controlled multicenter clinical study evaluated the efficacy and safety of telmisartan combined with the antioxidant probucol in reducing urinary protein levels in patients with type 2 diabetes (T2D). METHODS Patients with T2D and 24-h proteinuria 0.5-3 g were enrolled in the study and randomly assigned to one of two groups: a telmisartan or a probucol + telmisartan group. Both groups were given telmisartan 80 mg q.d. for 48 weeks. The probucol + telmisartan group was given probucol 500 mg b.i.d. for the first 24 weeks, with the dosage then reduced to 250 mg b.i.d. for the remaining 24 weeks. The telmisartan group was given probucol placebo. RESULTS In all, 160 patients were enrolled in the present study. The 24-h proteinuria levels were significantly reduced in the probucol + telmisartan compared with telmisartan group. For patients with baseline 24-h proteinuria levels <1.0 g, both treatments resulted in significant reductions in 24-h proteinuria levels after 48 weeks treatment. However, in patients with baseline 24-h proteinuria levels ≥1.0 g, 24-h proteinuria levels after 48 weeks treatment were only reduced in the probucol + telmisartan group. There was no significant difference between the two groups for either adverse cardiovascular or other events. CONCLUSIONS In patients with diabetic nephropathy, probucol combined with telmisartan more effectively reduces urinary protein levels than telmisartan alone.
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Affiliation(s)
- Hanyu Zhu
- Department of Nephrology, Chinese PLA General Hospital, Chinese PLA Institute of Nephrology, State Key Laboratory of Kidney Diseases, National Clinical Research Center of Kidney Diseases, Beijing Key Laboratory of Kidney Disease, Beijing, China
| | - Xiangmei Chen
- Department of Nephrology, Chinese PLA General Hospital, Chinese PLA Institute of Nephrology, State Key Laboratory of Kidney Diseases, National Clinical Research Center of Kidney Diseases, Beijing Key Laboratory of Kidney Disease, Beijing, China
| | - Guangyan Cai
- Department of Nephrology, Chinese PLA General Hospital, Chinese PLA Institute of Nephrology, State Key Laboratory of Kidney Diseases, National Clinical Research Center of Kidney Diseases, Beijing Key Laboratory of Kidney Disease, Beijing, China
| | - Ying Zheng
- Department of Nephrology, Chinese PLA General Hospital, Chinese PLA Institute of Nephrology, State Key Laboratory of Kidney Diseases, National Clinical Research Center of Kidney Diseases, Beijing Key Laboratory of Kidney Disease, Beijing, China
| | - Moyan Liu
- Department of Nephrology, Chinese PLA General Hospital, Chinese PLA Institute of Nephrology, State Key Laboratory of Kidney Diseases, National Clinical Research Center of Kidney Diseases, Beijing Key Laboratory of Kidney Disease, Beijing, China
| | - Wenhu Liu
- Department of Nephrology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Hebin Yao
- Department of Endocrinology, Navy General Hospital, Beijing, China
| | - Yaping Wang
- Department of Nephrology, General Hospital of Beijing Military Command, Beijing, China
| | - Wenge Li
- Department of Nephrology, China-Japan Friendship Hospital, Beijing, China
| | - Hua Wu
- Department of Nephrology, Beijing Hospital, Beijing, China
| | - Lide Lun
- Department of Nephrology, Air Force General Hospital, Beijing, China
| | - Jianrong Zhang
- Department of Nephrology, General Hospital of Chinese People's Armed Police Forces, Beijing, China
| | - Xiaohong Guan
- Department of Endocrinology, Air Force General Hospital, Beijing, China
| | - Shinan Yin
- Department of Endocrinology, First Affiliated Hospital of the General Hospital of Chinese People's Liberation Army, Beijing, China
| | - Xiaoming Zhuang
- Department of Endocrinology, Fuxing Hospital, Capital Medical University, Beijing, China
| | - Jijun Li
- Department of Nephrology, First Affiliated Hospital of the General Hospital of Chinese People's Liberation Army, Beijing, China
| | - Yanjun Liu
- Department of Endocrinology, 306th Hospital of Chinese People's Liberation Army, Beijing, China
| | - Chunhua Zhou
- Department of Nephrology, Navy General Hospital, Beijing, China
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167
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Zhang Q, Lu Y, Ma Z, Li Y, Guo J, Meng Q, Bian H. A novel formula from mulberry leaf ameliorates diabetic nephropathy in rats via inhibiting the TGF-β1 pathway. Food Funct 2016; 6:3307-15. [PMID: 26242486 DOI: 10.1039/c5fo00711a] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
INTRODUCTION Based on the hypoglycemia and hypolipidemia of mulberry leaf and its extracts, we investigated the effect of a novel formula, Sang Tong Jian (STJ), from mulberry leaf on rats with diabetic nephropathy (DN). METHODS The DN rats were induced by a long-term high-fat diet and a single streptozotocin injection. STJ was introduced for 12 weeks from the presence of hyperglycemia. The fasting blood glucose of DN rats was determined at weeks 5, 7, 9, and 11 respectively. The serum GSP, GHb and lipid profiles were analyzed by using a colorimetric method and ELISA kits. The kidney function of DN rats was demonstrated through the analysis of urine creatinine, urine albumin, serum urea nitrogen, serum creatinine and the creatinine clearance rate. The H-E (haematoxylin and eosin) and PAS (Periodic Acid-Schiff) staining were adopted to exhibit the morphology of the kidney. The TGF-β1 and p-smad2/3, smad2/3, collagen IV, connexin 43 and E-cadherin were assayed via immunohistochemistry and western blot. RESULTS STJ significantly decreased the fasting blood glucose (p < 0.01) and the glycation end product (p < 0.05), and regulated dyslipidemia. Inhibition of the thickening of the glomerular basement membrane and amelioration of the kidney function were shown in STJ-treated DN rats. Moreover, STJ decreased the levels of TGF-β1, collagen IV, connexin 43 and activation of smad2/3 (p < 0.01), and enhanced E-cadherin (p < 0.01) in the kidney of DN rats. CONCLUSION 12 week administration of STJ improved the metabolic parameters associated with blood glucose and lipid and inhibited the TGF-β1 signaling pathway, which positively contributed to the amelioration of chronic diabetic kidney disease.
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Affiliation(s)
- Qichun Zhang
- Department of Pharmacology, School of Pharmacy, Nanjing University of Chinese Medicine, Nanjing, 210023, People's Republic of China.
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Persson F, Lindhardt M, Rossing P, Parving HH. Prevention of microalbuminuria using early intervention with renin-angiotensin system inhibitors in patients with type 2 diabetes: A systematic review. J Renin Angiotensin Aldosterone Syst 2016; 17:17/3/1470320316652047. [PMID: 27488274 PMCID: PMC5843870 DOI: 10.1177/1470320316652047] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Accepted: 04/23/2016] [Indexed: 12/30/2022] Open
Abstract
Hypothesis/objectives: Early prevention of diabetic nephropathy by way of blocking the renin-angiotensin system (RAS) in patients with normoalbuminuria seems rational, but trials have so far shown conflicting results. The present meta-analysis was undertaken to investigate if such treatment can prevent development of microalbuminuria. Materials and methods: We searched MEDLINE, EMBASE and the Cochrane Library (2 June 2014) for randomised controlled trials, with a population of patients with type 2 diabetes and normoalbuminuria, comparing angiotensin-converting enzyme inhibitors (ACEis) or angiotensin receptor blockers (ARBs) to placebo. Studies had to have at least 50 participants in each arm and one year of follow-up. Random and fixed effect models were performed as well as trial sequential analysis. Results: Six trials were included in the analysis (n=16,921). Overall risk of bias was variable. In a fixed model analysis ACE or ARB treatment was superior to placebo in relation to prevention of development of microalbuminuria, risk ratio 0.84 (95% confidence interval (CI) 0.79–0.88) p<0.001, I2=23%, similar to random model results. Treatment also showed a trend towards a reduction in all-cause mortality(p=0.07). Conclusions: We conclude that in patients with type 2 diabetes and normoalbuminuria, early intervention with ACEis or ARBs reduces the risk for development of microalbuminuria.
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Affiliation(s)
| | | | - Peter Rossing
- Steno Diabetes Center, Denmark Institute for Clinical Medicine, University of Copenhagen, Denmark
| | - Hans-Henrik Parving
- Faculty of Health Sciences, University of Aarhus, Denmark Department of Medical Endocrinology, Rigshospitalet, Copenhagen University Hospital, Denmark
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Buelli S, Perico L, Benigni A. Untangling the Knot in Diabetic Nephropathy: The Unanticipated Role of Glycocalyx in the Antiproteinuric Effect of Endothelin Receptor Antagonists. Diabetes 2016; 65:2115-7. [PMID: 27456616 DOI: 10.2337/dbi16-0020] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Simona Buelli
- IRCCS Istituto di Ricerche Farmacologiche Mario Negri, Centro Anna Maria Astori, Bergamo, Italy
| | - Luca Perico
- IRCCS Istituto di Ricerche Farmacologiche Mario Negri, Centro Anna Maria Astori, Bergamo, Italy
| | - Ariela Benigni
- IRCCS Istituto di Ricerche Farmacologiche Mario Negri, Centro Anna Maria Astori, Bergamo, Italy
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170
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De Cosmo S, Viazzi F, Pacilli A, Giorda C, Ceriello A, Gentile S, Russo G, Rossi MC, Nicolucci A, Guida P, Pontremoli R. Predictors of chronic kidney disease in type 2 diabetes: A longitudinal study from the AMD Annals initiative. Medicine (Baltimore) 2016; 95:e4007. [PMID: 27399078 PMCID: PMC5058807 DOI: 10.1097/md.0000000000004007] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2015] [Revised: 04/28/2016] [Accepted: 05/31/2016] [Indexed: 01/25/2023] Open
Abstract
UNLABELLED The identification of clinical predictors for the development of chronic kidney disease is a critical issue in the management of patients with type 2 diabetes mellitus.We evaluated 27,029 patients with type 2 diabetes mellitus and estimated glomerular filtration rate (eGFR) ≥60 mL/min/1.73 m and normoalbuminuria from the database of the Italian Association of Clinical Diabetologists network. Primary outcomes were eGFR <60 mL/min/1.73 m and normoalbuminuria; albuminuria and eGFR ≥60 mL/min/1.73 m; and eGFR <60 mL/min/1.73 m and albuminuria. Secondary outcomes were eGFR <60 mL/min/1.73 m and albuminuria. MEASUREMENTS eGFR from serum creatinine by chronic kidney disease epidemiology collaboration equation (CKD-EPI), urinary albumin excretion, HbA1c, triglycerides, high-density lipoprotein cholesterol (HDL-c) and low-density lipoprotein cholesterol (LDL-c), blood pressure, and body mass index.Over a 4-year period, 33.2% of patients (n = 8973) developed chronic kidney disease, 10.3% (n = 2788) showed a decline in eGFR <60 mL/min/1.73 m, 18.4% (n = 4978) developed albuminuria, and 4.5% (n = 1207) developed both features. Relative risk ratios (RRRs) for age (1.37, P < 0.001 by 5 years), sex (0.77, P < 0.001 for being male), body mass index (1.03, P < 0.001 by 1 kg/m), triglycerides (1.02, P < 0.001 by 10 mg/dL), and LDL-c (0.97, P = 0.004 by 10 mg/dL) were independently related to the onset of eGFR reduction. Age (1.08, P < 0.001 by 5 years), sex (1.36, P < 0.001 for being male), body mass index (1.02, P < 0.001 by 1 kg/m), triglycerides (1.01, P = 0.02 by 10 mg/dL), HDL-c, and LDL-c (0.97, P = 0.008 and 0.99, P = 0.003 by 5 and 10 mg/dL, respectively) were related to the onset of albuminuria. HbA1c and the intensity of antihypertensive treatment showed a weaker association with renal outcome.Reduction in eGFR and albuminuria showed distinct sets of risk factors, suggesting that different mechanisms are involved in the development of these 2 components of diabetic kidney disease.
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Affiliation(s)
- Salvatore De Cosmo
- Department of Medical Sciences, Scientific Institute “Casa Sollievo della Sofferenza”, San Giovanni Rotondo (FG)
| | - Francesca Viazzi
- Università degli Studi and IRCCS Azienda Ospedaliera Universitaria San Martino-IST, Genova
| | - Antonio Pacilli
- Department of Medical Sciences, Scientific Institute “Casa Sollievo della Sofferenza”, San Giovanni Rotondo (FG)
| | - Carlo Giorda
- Diabetes and Metabolism Unit ASL Turin 5, Chieri (TO), Italy
| | - Antonio Ceriello
- Institut d’Investigacions Biomèdiques August Pii Sunyer (IDIBAPS) and Centro de Investigación Biomédicaen Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Barcelona, Spain
| | - Sandro Gentile
- Department of Clinical and Experimental Medicine, 2 University of Naples, Caserta
| | - Giuseppina Russo
- Department of Clinical and Experimental Medicine, University of Messina, Messina
| | - Maria C. Rossi
- Center for Outcomes Research and Clinical Epidemiology, Pescara
| | | | | | - Roberto Pontremoli
- Università degli Studi and IRCCS Azienda Ospedaliera Universitaria San Martino-IST, Genova
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DiNicolantonio JJ, Bhutani J, O'Keefe JH. Added sugars drive chronic kidney disease and its consequences: A comprehensive review. JOURNAL OF INSULIN RESISTANCE 2016. [DOI: 10.4102/jir.v1i1.3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
The consumption of added sugars (e.g. sucrose [table sugar] and high-fructose corn syrup) over the last 200 years has increased exponentially and parallels the increased prevalence of chronic kidney disease (CKD). Data for animals and humans suggest that the consumption of added sugars leads to kidney damage and related metabolic derangements that increase cardiovascular risk. Importantly, the consumption of added sugars has been found to induce insulin resistance and increase uric acid in humans, both of which increase the conversion of glucose to fructose (i.e. fructogenesis) via the polyol pathway. The polyol pathway has recently been implicated in the contribution and progression of kidney damage, suggesting that even glucose can be toxic to the kidney via its endogenous transformation into fructose in the proximal tubule. Consuming added fructose has been shown to induce insulin resistance, which can lead to hyperglycaemia, oxidative stress, inflammation and the activation of the immune system, all of which can synergistically contribute to kidney damage. CKD guidelines should stress a reduction in the consumption of added sugars as a means to prevent and treat CKD as well as reduce CKD–related morbidity and mortality.
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Screening for Nephropathy in Diabetes Mellitus: Is Micral-Test Valid among All Diabetics? Int J Chronic Dis 2016; 2016:2910627. [PMID: 27294192 PMCID: PMC4887651 DOI: 10.1155/2016/2910627] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2016] [Accepted: 04/27/2016] [Indexed: 01/03/2023] Open
Abstract
Background. Using Micral-test (MT) for screening microalbuminuria (MA) among type 2 diabetics (T2D) is helpful. We aimed at determining prevalence of MA and at describing the MT validity. Methods. We studied 182 T2D followed up in family medicine. Two 24-hour urinary quantitative assays of MA had been used as a gold standard. Results. Prevalence of MA was 23%, CI 95%: 16.9–29.1. MT validity was 77% for sensitivity, 88% for negative predictive value, and 0.2 for Kappa coefficient (p = 0.001). Among subjects having a blood pressure ≥130/80 mmHg, having a CHT/HDL ratio ≥ 3, being a T2D for more than 5 years, and being women, negative predictive values were, respectively, 91%, 89%, 95%, and 91%. The area under the ROC curve was 0.81 in men (p = 0.008) and 0.80 when diabetes duration exceeds 5 years (p = 0.001). The MA value at 100% Sp for MT was 35 mg/L. Conclusion. The use of MT in primary healthcare for yearly screening for MA in T2D must be accentuated especially when diabetes duration exceeds 5 years or when associated with other cardiovascular risks.
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173
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Comparison of the Rate of Renal Function Decline in NonProteinuric Patients With and Without Diabetes. Am J Med Sci 2016; 350:447-52. [PMID: 26624901 DOI: 10.1097/maj.0000000000000583] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Patients with diabetes and chronic kidney disease (CKD) without proteinuria are often believed to have a cause of CKD other than diabetes. It was hypothesized that if this is true, the rate of renal function decline should be similar among nonproteinuric patients with and without diabetes. METHODS Patients seen in the nephrology, endocrinology and general internal medicine clinics at the Medical University of South Carolina (MUSC) between 2008 and 2012 with hypertension and diabetes were identified by ICD9 diagnosis codes. Patients with less than 2 measures of serum creatinine, without urine studies over the study period and with proteinuria were excluded. Four hundred seventy-two patients met the inclusion and exclusion criteria and had an initial estimated glomerular filtration rate (eGFR) between 35 and 80 mL/min per 1.73 m2. The annual rate of decline in eGFR was estimated for each patient from the lowest eGFR in each year by fitting a regression model with random intercept and slope. RESULTS In unadjusted analyses, the rate of eGFR decline was greater in patients with diabetes than without diabetes (-0.71 versus -0.30 mL · min(-1) · yr(-1), P = 0.03). After adjusting for age, race, sex, baseline eGFR and use of renin-angiotensin-aldosterone system blockade, the rate of decline was still greater among patients with diabetes than among those without diabetes (-0.68 versus -0.36 mL · min(-1) · yr(-1), P = 0.03). CONCLUSIONS Patients with diabetes had more rapid decline in kidney function compared with individuals without diabetes, despite the absence of proteinuria. These results suggest that even in the absence of proteinuria, diabetes may be associated with CKD.
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Jahani M, Shokrzadeh M, Vafaei-Pou Z, Zamani E, Shaki F. Potential Role of Cerium Oxide Nanoparticles for Attenuation of Diabetic Nephropathy by Inhibition of Oxidative Damage. ACTA ACUST UNITED AC 2016. [DOI: 10.3923/ajava.2016.226.234] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Lee IT, Sheu WHH, Lin SY. The Impact of Creatinine Clearance Rate, Daily Urinary Albumin, and Their Joint Effect on Predicting Death in Diabetic Inpatients After Discharge: An Observational Study. Medicine (Baltimore) 2016; 95:e2804. [PMID: 26871846 PMCID: PMC4753942 DOI: 10.1097/md.0000000000002804] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Renal clearance function and urinary albumin excretion are important markers for diabetic nephropathy. We assessed whether the creatinine clearance rate (CCR) and daily urinary albumin (DUA) excretion, which both require 24-hour urine data, are better predictors of mortality in diabetic inpatients compared with the estimated glomerular filtration rate (eGFR) and urine albumin-creatinine ratio (ACR).We enrolled 1011 patients who were hospitalized due to poor glucose control, and collected clinical information, including 24-hour urine data, from their medical records. We determined the mortality rate after discharge by examining the national registry data in Taiwan.The subjects had a median follow-up of 6.5 years (interquartile range between 3.5 and 9.6 years). Subjects with a CCR < 60 mL/min and a DUA ≥ 300 mg/d had the highest mortality rate, with a hazard ratio of 3.373 (95% confidence interval = 2.469-4.609), compared with the mortality rate in subjects with a CCR ≥ 60 mL/min and a DUA < 300 mg/d. In terms of predicting mortality in diabetic inpatients, ACR had a similar sensitivity to DUA (40.3% versus 38.0%), but eGFR provided lower sensitivity than CCR (54.5% versus 66.5%).Creatinine clearance rate and DUA have an additive effect on predicting mortality in diabetic inpatients after discharge. Moreover, CCR is a more sensitive predictor of mortality than eGFR. Therefore, determining CCR using 24-hour urine data, as well as either ACR or DUA, should provide better prediction of mortality in diabetic nephropathy patients.
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Affiliation(s)
- I-Te Lee
- From the Department of Internal Medicine, Division of Endocrinology and Metabolism, Taichung Veterans General Hospital (ITL, WHHS, SYL); Chung Shan Medical University, Taichung (ITL, WHHS); School of Medicine, National Yang-Ming University, Taipei (ITL, WHHS); and Center for Geriatrics and Gerontology Taichung Veterans General Hospital (SYL), Taichung, Taiwan
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176
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Renal and cardiovascular risk predictive value of two different microalbuminuria screening methods in patients with hypertension with/without diabetes in Portugal. J Hum Hypertens 2016; 30:726-730. [PMID: 26740337 DOI: 10.1038/jhh.2015.120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2015] [Revised: 10/22/2015] [Accepted: 11/03/2015] [Indexed: 11/08/2022]
Abstract
MicRoAlbuminuria sCreening survEy (RACE) was a multicentre, observational, cross-sectional study conducted in primary health-care settings of Portugal. Here, we present a post-hoc analysis from the RACE study, assessing the renal and cardiovascular (CV) risk predictive value of two different microalbuminuria (MA) screening methods, nephelometry with 24-h urine (MA-24 h) and Micral test with occasional urine (MicralA) in patients with hypertension (HTN) with/without type 2 diabetes mellitus (T2DM). Out of 3065 patients, 1173 (38.3%) were in the HTN group without T2DM (HTN) and 1892 (61.7%) in the HTN group with T2DM (HTN+T2DM). The overall prevalence of MA was 50.6% determined by MicralA and 22.1% with MA-24 h. Urinary albumin excretion data obtained by both techniques correlated significantly (rs=0.586; P<0.001). In all subjects, MicralA showed a sensitivity of 93%, specificity of 62% for detection of MA, with a positive predictive value of 41% and negative predictive value of 97%. With both methods, the presence of MA was independently associated with a higher risk (1.5- to 2.9-fold) of CV and renal organ damage in both HTN and HTN+T2DM groups. MicralA, due to its high sensitivity and negative predictive value, can be considered as a valid and reliable method for MA screening in patients with HTN with/without T2DM.
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177
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Gluhovschi C, Gluhovschi G, Petrica L, Timar R, Velciov S, Ionita I, Kaycsa A, Timar B. Urinary Biomarkers in the Assessment of Early Diabetic Nephropathy. J Diabetes Res 2016; 2016:4626125. [PMID: 27413755 PMCID: PMC4927990 DOI: 10.1155/2016/4626125] [Citation(s) in RCA: 81] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2016] [Accepted: 05/12/2016] [Indexed: 12/12/2022] Open
Abstract
Diabetic nephropathy (DN) is a frequent and severe complication of diabetes mellitus (DM). Its diagnosis in incipient stages may allow prompt interventions and an improved prognosis. Towards this aim, biomarkers for detecting early DN can be used. Microalbuminuria has been proven a remarkably useful biomarker, being used for diagnosis of DN, for assessing its associated condition-mainly cardiovascular ones-and for monitoring its progression. New researches are pointing that some of these biomarkers (i.e., glomerular, tubular, inflammation markers, and biomarkers of oxidative stress) precede albuminuria in some patients. However, their usefulness is widely debated in the literature and has not yet led to the validation of a new "gold standard" biomarker for the early diagnosis of DN. Currently, microalbuminuria is an important biomarker for both glomerular and tubular injury. Other glomerular biomarkers (transferrin and ceruloplasmin) are under evaluation. Tubular biomarkers in DN seem to be of a paramount importance in the early diagnosis of DN since tubular lesions occur early. Additionally, biomarkers of inflammation, oxidative stress, podocyte biomarkers, and vascular biomarkers have been employed for assessing early DN. The purpose of this review is to provide an overview of the current biomarkers used for the diagnosis of early DN.
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Affiliation(s)
- Cristina Gluhovschi
- Division of Nephrology, University of Medicine and Pharmacy “V. Babes”, 300041 Timisoara, Romania
- *Cristina Gluhovschi:
| | | | - Ligia Petrica
- Division of Nephrology, University of Medicine and Pharmacy “V. Babes”, 300041 Timisoara, Romania
| | - Romulus Timar
- Department of Diabetes and Metabolic Diseases, University of Medicine and Pharmacy “V. Babes”, 300041 Timisoara, Romania
| | - Silvia Velciov
- Division of Nephrology, University of Medicine and Pharmacy “V. Babes”, 300041 Timisoara, Romania
| | - Ioana Ionita
- Division of Hematology, University of Medicine and Pharmacy “V. Babes”, 300041 Timisoara, Romania
| | - Adriana Kaycsa
- Department of Biochemistry, University of Medicine and Pharmacy “V. Babes”, 300041 Timisoara, Romania
| | - Bogdan Timar
- Department of Diabetes and Metabolic Diseases, University of Medicine and Pharmacy “V. Babes”, 300041 Timisoara, Romania
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178
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Subclinical Kidney Damage in Hypertensive Patients: A Renal Window Opened on the Cardiovascular System. Focus on Microalbuminuria. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2016; 956:279-306. [PMID: 27873229 DOI: 10.1007/5584_2016_85] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The kidney is one of the major target organs of hypertension.Kidney damage represents a frequent event in the course of hypertension and arterial hypertension is one of the leading causes of end-stage renal disease (ESRD).ESRD has long been recognized as a strong predictor of cardiovascular (CV) morbidity and mortality. However, over the past 20 years a large and consistent body of evidence has been produced suggesting that CV risk progressively increases as the estimated glomerular filtration rate (eGFR) declines and is already significantly elevated even in the earliest stages of renal damage. Data was supported by the very large collaborative meta-analysis of the Chronic Kidney Disease Prognosis Consortium, which provided undisputable evidence that there is an inverse association between eGFR and CV risk. It is important to remember that in evaluating CV disease using renal parameters, GFR should be assessed simultaneously with albuminuria.Indeed, data from the same meta-analysis indicate that also increased urinary albumin levels or proteinuria carry an increased risk of all-cause and CV mortality. Thus, lower eGFR and higher urinary albumin values are not only predictors of progressive kidney failure, but also of all-cause and CV mortality, independent of each other and of traditional CV risk factors.Although subjects with ESRD are at the highest risk of CV diseases, there will likely be more events in subjects with mil-to-moderate renal dysfunction, because of its much higher prevalence.These findings are even more noteworthy when one considers that a mild reduction in renal function is very common in hypertensive patients.The current European Society of Hypertension (ESH)/European Society of Cardiology (ESC) guidelines for the management of arterial hypertension recommend to sought in every patient signs of subclinical (or asymptomatic) renal damage. This was defined by the detection of eGFR between 30 mL/min/1.73 m2 and 60 mL/min/1.73 m2 or the presence of microalbuminuria (MAU), that is an amount of albumin in the urine of 30-300 mg/day or an albumin/creatinine ratio, preferentially on morning spot urine, of 30-300 mg/g.There is clear evidence that urinary albumin excretion levels, even below the cut-off values used to define MAU, are associated with an increased risk of CV events. The relationships of MAU with a variety of risk factors, such as blood pressure, diabetes and metabolic syndrome and with several indices of subclinical organ damage, may contribute, at least in part, to explain the enhanced CV risk conferred by MAU. Nonetheless, several studies showed that the association between MAU and CV disease remains when all these risk factors are taken into account in multivariate analyses. Therefore, the exact pathophysiological mechanisms explaining the association between MAU and CV risk remain to be elucidated. The simple search for MAU and in general of subclinical renal involvement in hypertensive patients may enable the clinician to better assess absolute CV risk, and its identification may induce physicians to encourage patients to make healthy lifestyle changes and perhaps would prompt to more aggressive modification of standard CV risk factors.
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179
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Loh PT, Toh MPHS, Molina JA, Vathsala A. Ethnic disparity in prevalence of diabetic kidney disease in an Asian primary healthcare cluster. Nephrology (Carlton) 2015; 20:216-23. [PMID: 25495003 DOI: 10.1111/nep.12379] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/07/2014] [Indexed: 11/30/2022]
Abstract
AIMS Diabetic kidney disease (DKD) incidence is rising in Singapore. While measures to prevent onset and early detection of diabetes as well as optimal diabetes and blood pressure control are important, early detection and treatment of DKD at primary care are crucial to ameliorate its course. This study aimed to evaluate the prevalence of DKD in a primary care cluster in Singapore and identify its risk factors in a multi-ethnic Asian population. METHODS A total of 57,594 patients with type 2 diabetes mellitus (T2DM) followed-up at the National Healthcare Group Polyclinics with estimated glomerular filtration rate and at least two urine albumin/creatinine ratio (UACR) were stratified into DKD stages: normoalbuminuria (UACR <30 mg/g), microalbuminuria (MI, UACR 30-299 mg/g), macroalbuminuria (MA, ≥300 mg/g) and renal impairment (RI, estimated glomerular filtration rate eGFR <60 mL/min per 1.73 m(2)). Factors associated with DKD stages were evaluated. RESULTS Overall DKD prevalence (T2DM with MI, MA or RI) was high at 52.5%; 32.1% had MI, 5.3% had MA and 15.1% had RI. DKD prevalence within ethnic subpopulations was different: 52.2% of Chinese, 60.4% of Malays and 45.3% of Indians had DKD, respectively. Malays had a 1.42-fold higher DKD prevalence, while Indians had a 0.86-fold lower. Other independent risk factors were age, female gender, duration of diabetes and hypertension, HbA1c and body mass index. CONCLUSION The high prevalence of DKD and its interethnic differences suggest need for additional measures to optimize the care of T2DM at primary care to mitigate its progression.
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Affiliation(s)
- Ping Tyug Loh
- Division of Nephrology, Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
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180
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Thomas MC, Cooper ME, Zimmet P. Changing epidemiology of type 2 diabetes mellitus and associated chronic kidney disease. Nat Rev Nephrol 2015; 12:73-81. [DOI: 10.1038/nrneph.2015.173] [Citation(s) in RCA: 306] [Impact Index Per Article: 30.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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181
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Lee CH, Li TC, Tsai CI, Lin SY, Lee IT, Lee HJ, Wu YC, Su YC. Association between Albuminuria and Different Body Constitution in Type 2 Diabetes Patients: Taichung Diabetic Body Constitution Study. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE : ECAM 2015; 2015:603048. [PMID: 26587046 PMCID: PMC4637481 DOI: 10.1155/2015/603048] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/03/2015] [Accepted: 10/04/2015] [Indexed: 11/17/2022]
Abstract
Objective. Albuminuria in type 2 diabetes mellitus (T2DM) patients increases the risk of diabetic nephropathy, the leading cause of end-stage renal disease worldwide. Because albuminuria is modifiable, identifying relevant risk factors could facilitate prevention and/or management. This cross-sectional study investigated whether body constitution (BC) independently predicts albuminuria. Method. Patients with T2DM (n = 846) received urinalysis, a blood test, and diabetic retinopathy examination. Albuminuria was defined by an elevated urinary albumin/creatinine ratio (≥30 μg/mg). BC type (Yang deficiency, Yin deficiency, and Phlegm stasis) was assessed using a body constitution questionnaire (BCQ). Traditional risk factors for albuminuria were also recorded. Odds ratios (ORs) of albuminuria for BC were estimated using multivariate logistic regression. Results. Albuminuria was more prevalent in patients with Yang deficiency or Phlegm stasis (both P < 0.01). After adjustment, patients with both Yang deficiency and Phlegm stasis exhibited a significantly higher risk of albuminuria (OR = 3.037; 95% confidence interval = 1.572-5.867, and P < 0.001). Conclusion. BC is strongly associated with albuminuria in T2DM patients. Using a BCQ to assess BC is noninvasive, convenient, and inexpensive and can provide information for health care professionals to identify T2DM patients who are at a high risk of albuminuria.
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Affiliation(s)
- Cheng-Hung Lee
- Graduate Institute of Chinese Medicine, College of Chinese Medicine, China Medical University, Taichung 40402, Taiwan
- Department of Traditional Chinese Medicine, Han Ming Hospital, Changhua 50072, Taiwan
- School of Chinese Medicine, College of Chinese Medicine, China Medical University, Taichung 40402, Taiwan
| | - Tsai-Chung Li
- Graduate Institute of Biostatistics, China Medical University, Taichung 40402, Taiwan
- Department of Health Administration, College of Health Science, Asian University, Taichung 41354, Taiwan
| | - Chia-I Tsai
- Department of Traditional Chinese Medicine, Taichung Veterans General Hospital, Taichung 40705, Taiwan
| | - Shih-Yi Lin
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung 40705, Taiwan
| | - I-Te Lee
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung 40705, Taiwan
- Institute of Medicine, Chung Shan Medical University, Taichung 40201, Taiwan
- School of Medicine, National Yang-Ming University, Taipei 11221, Taiwan
| | - Hsin-Jung Lee
- Division of New Drugs, Center for Drug Evaluation, Taipei 11557, Taiwan
| | - Ya-Chi Wu
- Division of New Drugs, Center for Drug Evaluation, Taipei 11557, Taiwan
| | - Yi-Chang Su
- Graduate Institute of Chinese Medicine, College of Chinese Medicine, China Medical University, Taichung 40402, Taiwan
- School of Chinese Medicine, College of Chinese Medicine, China Medical University, Taichung 40402, Taiwan
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182
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Robles NR, Villa J, Gallego RH. Non-Proteinuric Diabetic Nephropathy. J Clin Med 2015; 4:1761-1773. [PMID: 26371050 PMCID: PMC4600158 DOI: 10.3390/jcm4091761] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2015] [Revised: 08/11/2015] [Accepted: 08/26/2015] [Indexed: 12/13/2022] Open
Abstract
Diabetic nephropathy patients traditionally show significant macroalbuminuria prior to the development of renal impairment. However, this clinical paradigm has recently been questioned. Epidemiological surveys confirm that chronic kidney disease (CKD) diagnosed by a low glomerular filtration rate (GFR) is more common in diabetic patients than in the non-diabetic population but a low number of patients had levels of proteinuria above that which traditionally defines overt diabetic nephropathy (>500 mg/g). The large number of patients with low levels of proteinuria suggests that the traditional clinical paradigm of overt diabetic nephropathy is changing since it does not seem to be the underlying renal lesion in most of diabetic subjects with CKD.
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Affiliation(s)
- Nicolas Roberto Robles
- Cátedra de Riesgo Vascular, Facultad de Medicina, Universidad de Salamanca, Salamanca 37007, Spain.
| | - Juan Villa
- Servicio de Nefrologia, Hospital Infanta Cristina, Badajoz 06070, Spain.
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183
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Abstract
Kidney disease is common in patients with type 1 and type 2 diabetes mellitus and is associated with adverse health outcomes, including progression to end-stage renal disease. In the general population, adherence to a healthy lifestyle is known to reduce the risk of cardiovascular events and death. Among individuals with diabetic kidney disease, modifications in lifestyle factors, including diet, physical activity, smoking habits, and body mass index, represent a promising cost-effective therapeutic adjunct to pharmacologic treatment of kidney disease incidence and progression.
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Affiliation(s)
- Chijoke Onyenwenyi
- Department of Medicine, Division of Nephrology, The University of Illinois at Chicago, 820 South Wood Street, 418W CSN, MC 793, Chicago, IL 60612, Phone (312) 996-6736, Fax (312) 996-7378,
| | - Ana C. Ricardo
- Department of Medicine, Division of Nephrology, The University of Illinois at Chicago, 820 South Wood Street, 418W CSN, MC 793, Chicago, IL 60612, Phone (312) 996-8392, Fax (312) 996-7378,
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184
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Abstract
The prevalence of diabetes is increasing globally, particularly in Asia. According to the 2013 Diabetes Atlas, an estimated 366 million people are affected by diabetes worldwide; 36% of those affected live in the Western Pacific region, with a significant proportion in East Asia. The reasons for this marked increase in the prevalence of diabetes can be extrapolated from several distinct features of the Asian region. First, the two most populated countries, China and India, are located in Asia. Second, Asians have experienced extremely rapid economic growth, including rapid changes in dietary patterns, during the past decades. As a result, Asians tend to have more visceral fat within the same body mass index range compared with Westerners. In addition, increased insulin resistance relative to reduced insulin secretory function is another important feature of Asian individuals with diabetes. Young age of disease onset is also a distinctive characteristic of these patients. Moreover, changing dietary patterns, such as increased consumption of white rice and processed red meat, contributes to the deteriorated lifestyle of this region. Recent studies suggest a distinctive responsiveness to novel anti-diabetic agents in Asia; however, further research and efforts to reverse the increasing prevalence of diabetes are needed worldwide.
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Affiliation(s)
- Eun Jung Rhee
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea.
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185
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Shimbo Y, Suzuki S, Ishii H, Shibata Y, Tatami Y, Harata S, Osugi N, Ota T, Tanaka A, Shibata K, Mizukoshi T, Yasuda Y, Maruyama S, Murohara T. Association of Estimated Glomerular Filtration Rate and Proteinuria With Lipid-Rich Plaque in Coronary Artery Disease. Circ J 2015; 79:2263-70. [PMID: 26289834 DOI: 10.1253/circj.cj-15-0460] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Estimated glomerular filtration rate (eGFR) and proteinuria are both important determinants of the risk of cardiovascular disease and mortality. The aim of the present study was to investigate the independent and combined effects of eGFR and proteinuria on tissue characterization of the coronary plaques of culprit lesions. METHODS AND RESULTS Conventional intravascular ultrasound and 3-D integrated backscatter intravascular ultrasound (IB-IVUS) were performed in 555 patients undergoing elective percutaneous coronary intervention. They were divided into 2 groups according to the absence or presence of proteinuria (dipstick result ≥1+). Patients with proteinuria had coronary plaque with significantly greater percentage lipid volume compared with those without (43.6±14.8% vs. 48.6±16.1%, P=0.005). Combined analysis was done using eGFR and absence or presence of proteinuria. Subjects with eGFR 45-59 ml/min/1.73 m2 and proteinuria were significantly more likely to have higher percent lipid volume compared with those with eGFR >60 ml/min/1.73 m2 without proteinuria. After multivariate adjustment for confounders, the presence of proteinuria proved to be an independent predictor for lipid-rich plaque (OR, 1.85; 95% CI: 1.12-3.06, P=0.016). CONCLUSIONS The addition of proteinuria to eGFR level may be of value in the risk stratification of patients with coronary artery disease.
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Affiliation(s)
- Yusaku Shimbo
- Department of Cardiology, Nagoya University Graduate School of Medicine
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186
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Abstract
The kidney is arguably the most important target of microvascular damage in diabetes. A substantial proportion of individuals with diabetes will develop kidney disease owing to their disease and/or other co-morbidity, including hypertension and ageing-related nephron loss. The presence and severity of chronic kidney disease (CKD) identify individuals who are at increased risk of adverse health outcomes and premature mortality. Consequently, preventing and managing CKD in patients with diabetes is now a key aim of their overall management. Intensive management of patients with diabetes includes controlling blood glucose levels and blood pressure as well as blockade of the renin-angiotensin-aldosterone system; these approaches will reduce the incidence of diabetic kidney disease and slow its progression. Indeed, the major decline in the incidence of diabetic kidney disease (DKD) over the past 30 years and improved patient prognosis are largely attributable to improved diabetes care. However, there remains an unmet need for innovative treatment strategies to prevent, arrest, treat and reverse DKD. In this Primer, we summarize what is now known about the molecular pathogenesis of CKD in patients with diabetes and the key pathways and targets implicated in its progression. In addition, we discuss the current evidence for the prevention and management of DKD as well as the many controversies. Finally, we explore the opportunities to develop new interventions through urgently needed investment in dedicated and focused research. For an illustrated summary of this Primer, visit: http://go.nature.com/NKHDzg.
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187
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Migliore CL, Vorderstrasse A, Pan W, Melkus GD. Renal Disease Risk Factors Among Risk Groups Comprised of African American Women With Type 2 Diabetes: A Secondary Analysis. DIABETES EDUCATOR 2015. [PMID: 26202051 DOI: 10.1177/0145721715593814] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
PURPOSE The purpose of this study was to explore and describe the prevalence of renal disease risk factors and the categorization of renal disease risk groups among African American women with type 2 diabetes mellitus (T2DM) who participated in a self-management and coping skills training intervention. We also explored and described the change in renal disease risk factors within and between risk groups, determining if participation in a culturally relevant coping skills training intervention decreased renal disease risk. METHODS This study was a secondary analysis of data from a longitudinal intervention study and included all 109 African American women with T2DM from the primary intervention study. This study examined the prevalence of 4 renal disease risk factors among the women at baseline via descriptive statistics, used cluster analysis to divide the women into risk groups and categorize the risk groups, and also measured the change in risk factors over time among risk groups via mixed modeling. RESULTS A majority of the women had a hemoglobin A1C ≥7% (62.39%) and were obese (75.93%). The high-risk cluster displayed clinically significant declines in mean systolic blood pressure, triglycerides, and A1C in both the control and intervention groups, and the intervention was more effective in reducing triglycerides and A1C levels among high-risk participants than low-risk. Overall, the control, high-risk group exhibited the largest declines in systolic blood pressure, triglycerides, and A1C. CONCLUSIONS This study displays the importance of acknowledging African American women with type 2 diabetes mellitus (T2DM) at high risk for renal disease in health care settings, which is often overlooked, and realizing that renal disease risk reduction is obtainable.
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Affiliation(s)
- Casey L Migliore
- Duke University School of Nursing, Durham, North Carolina (Dr Migliore, Dr Vorderstrasse, Dr Pan)
| | - Allison Vorderstrasse
- Duke University School of Nursing, Durham, North Carolina (Dr Migliore, Dr Vorderstrasse, Dr Pan)
| | - Wei Pan
- Duke University School of Nursing, Durham, North Carolina (Dr Migliore, Dr Vorderstrasse, Dr Pan)
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Pappa M, Dounousi E, Duni A, Katopodis K. Less known pathophysiological mechanisms of anemia in patients with diabetic nephropathy. Int Urol Nephrol 2015; 47:1365-72. [PMID: 26017902 DOI: 10.1007/s11255-015-1012-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2015] [Accepted: 05/12/2015] [Indexed: 12/11/2022]
Abstract
Diabetes mellitus (DM) is currently considered a modern global epidemic, and diabetic nephropathy (DN) is the most common cause of chronic kidney disease (CKD). Anemia is one of the most significant complications of CKD, and it is mainly attributed to insufficient erythropoietin (EPO) production. However, anemia develops earlier in the course of CKD among patients with DM, and the severity of anemia tends to be more marked in these patients compared to nondiabetic subjects, regardless of the stage of CKD. In this review, we focus on the "less known" complex interacting mechanisms which are involved in the pathophysiology of anemia associated with DN. Although the major cause of anemia in DN is considered to be an inappropriate response of the plasma EPO concentration to anemia, several other possible mechanisms have been suggested. Glomerular hyperfiltration, proteinuria, renal tubular dysfunction and interstitial fibrosis are among the main culprits. On the other hand, systemic effects such as chronic inflammation, autonomic neuropathy and the renin-angiotensin system are also involved. Finally, several medications are considered to aggravate anemia associated with DN. Since anemia is an important predictor of quality of life and is implicated in the increased burden of cardiovascular morbidity and mortality, further research is required to elucidate its pathogenesis in diabetic patients.
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Affiliation(s)
- M Pappa
- Department of Nephrology, General Hospital of Arta, Arta, Greece
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189
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Efficacy and safety of tangshen formula on patients with type 2 diabetic kidney disease: a multicenter double-blinded randomized placebo-controlled trial. PLoS One 2015; 10:e0126027. [PMID: 25938778 PMCID: PMC4418676 DOI: 10.1371/journal.pone.0126027] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2014] [Accepted: 03/26/2015] [Indexed: 12/12/2022] Open
Abstract
Background Persons with diabetes are at high risk of developing diabetic kidney disease (DKD), which is associated with high morbidity and mortality. Current drug therapies for DKD, such as angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs), are not entirely satisfactory. This study aimed to evaluate the additional benefit and safety of the Chinese herbal granule Tangshen Formula (TSF) in treating DKD. Methods The study was designed as a six-center randomized, double-blind, placebo-controlled trial. From April 2007 through December 2009, 180 patients with DKD were enrolled. In addition to conventional treatment with ACEIs or ARBs, 122 participants were randomly assigned to receive TSF and 58 participants to receive placebo for 24 weeks. Primary outcome was urinary protein level, measured by urinary albumin excretion rate (UAER) for participants with microalbuminuria, 24-hour urinary protein (24h UP) for participants with macroalbuminuria. Secondary outcomes included renal function, serum lipids, quality of life, symptoms, and adverse events. Findings After 24 weeks of treatment, no statistically significant difference in UAER (TSF −19.53 μg/min compared with placebo −7.01 μg/min, with a mean difference of −12.52 μg/min; 95%CI, −68.67 to 43.63, P = 0.696) was found between TSF and placebo groups. However, TSF displayed a statistically significant decrease in 24h UP (TSF−0.21 g compared with placebo 0.36 g, with a mean difference of −0.57g; 95%CI, −1.05 to −0.09, P = 0.024). Estimated glomerular filtration rate (eGFR) was improved in both patients with microalbuminuria and macroalbuminuria, with a mean difference of 15.51 ml/min/1.73 m2 (95%CI, 3.71 to 27.31), 9.01 ml/min/1.73 m2 (95%CI, −0.10 to 18.13), respectively. Other secondary outcomes showed no statistically significant difference between groups or in the incidence of adverse events. Conclusions Based on conventional treatments, TSF appears to provide additional benefits compared with placebo in decreasing proteinuria and improving eGFR in DKD patients with macroalbuminuria. Nevertheless, further study is needed to evaluate TSF treating patients with microalbuminuria. Trial Registration Chinese Clinical Trial Registry ChiCTR-TRC-10000843
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Al-Sinani S, Al-Mamari A, Woodhouse N, Al-Shafie O, Amar F, Al-Shafaee M, Hassan M, Bayoumi R. Quality of diabetes care at outpatient clinic, sultan qaboos university hospital. Oman Med J 2015; 30:48-54. [PMID: 25830001 DOI: 10.5001/omj.2015.09] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2014] [Accepted: 01/05/2015] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE To assess the clinical care of type 2 diabetes mellitus (T2D) patients at Sultan Qaboos University Hospital (SQUH), a countrywide tertiary referral center in Muscat, Oman. . METHODS We performed a retrospective, observational, cross-sectional study using a total of 673 Omani T2D patients from the Diabetes and Family Medicine Clinics at SQUH. We collected patient data from June 2010 to February 2012 from the Hospital Information System (HIS). Patients had to be Omani, aged more than 18 years old, and have T2D with active follow-up and at least three visits within one year to be included in the study. Ninety-three percent of the patients (n=622) were on oral hypoglycemic drugs and/or insulin, and 70% were on statins. Patients' anthropometric data, biochemical investigations, blood pressure, and duration of diabetes were recorded from the HIS. . RESULTS Using the recommended standards and guidelines of medical care in diabetes (American Diabetes Association and the American National Cholesterol Education Program III NCDP NIII standards), we observed that 22% of the patients achieved a HbA1C goal of <7%, 47% achieved blood pressure goal of <140/80mm Hg, 48% achieved serum low density lipoprotein cholesterol goal of <2.6mmol/L, 67% achieved serum triglycerides goal of <1.7 mmol/L, 59% of males and 43% of females achieved high density lipoprotein cholesterol goals (males>1.0; females >1.3mmol/L). Almost 60% of the patients had urinary microalbumin/creatinine ratio within the normal range. . CONCLUSIONS The clinical outcomes of the care that T2D patients get at SQUH were lower than those reported in Europe and North America. However, it is similar to those reported in other countries in the Arabian Gulf.
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Affiliation(s)
- Sawsan Al-Sinani
- Department of Biochemistry, College of Medicine and Health Sciences, Sultan Qaboos University, Muscat, Oman
| | - Ali Al-Mamari
- Department of Medicine, College of Medicine and Health Sciences, Sultan Qaboos University, Muscat, Oman
| | - Nicolas Woodhouse
- Department of Medicine, College of Medicine and Health Sciences, Sultan Qaboos University, Muscat, Oman
| | - Omaiyma Al-Shafie
- Department of Medicine, College of Medicine and Health Sciences, Sultan Qaboos University, Muscat, Oman
| | - Fatima Amar
- Department of Medicine, College of Medicine and Health Sciences, Sultan Qaboos University, Muscat, Oman
| | - Mohammed Al-Shafaee
- Department of Family & Community Medicine, College of Medicine and Health Sciences, Sultan Qaboos University,
Muscat, Oman
| | - Mohammed Hassan
- Department of Physiology, College of Medicine and Health Sciences, Sultan Qaboos University, Muscat, Oman
| | - Riad Bayoumi
- Department of Biochemistry, College of Medicine and Health Sciences, Sultan Qaboos University, Muscat, Oman
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Yun JS, Ahn YB, Song KH, Yoo KD, Kim HW, Park YM, Ko SH. The association between abnormal heart rate variability and new onset of chronic kidney disease in patients with type 2 diabetes: a ten-year follow-up study. Diabetes Res Clin Pract 2015; 108:31-7. [PMID: 25656759 DOI: 10.1016/j.diabres.2015.01.031] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2014] [Revised: 12/02/2014] [Accepted: 01/18/2015] [Indexed: 01/08/2023]
Abstract
AIMS We investigated the association between cardiovascular autonomic neuropathy (CAN) and the future development of chronic kidney disease (CKD) in patients with type 2 diabetes. METHODS From Jan 2003 to Dec 2004, 1117 patients with type 2 diabetes without CKD (estimated glomerular filtration rate [eGFR] ≥ 60 ml/min/1.73 m(2)), aged 25-75 years, were consecutively enrolled. A cardiovascular autonomic function test (AFT) was performed using heart rate variability parameters. The eGFR was measured at least more than once every year, and new onset CKD was defined as eGFR < 60 ml/min/1.73 m(2) using a Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation. RESULTS Among the 755 (67.6%) patients who completed the follow-up evaluation for 9.6 years, 272 patients (36.0%) showed a CKD stage ≥3. The patients who developed CKD were older, had a longer duration of diabetes, had hypertension, received more insulin and ACE inhibitor/angiotensin receptor blocker (ARB) treatment, and exhibited lower baseline eGFR, HbA1c, and albuminuria levels. Compared to patients without CKD, more patients with CKD at follow-up had CAN at baseline. In a multivariate analysis, after adjustment for age, sex, diabetes duration, presence of hypertension, mean HbA1c, diabetic complications, use of insulin, ACE inhibitor/ARB, statin, and baseline eGFR, the development of CKD was significantly associated with the presence of CAN (HR 2.62, 95% CI 1.87-3.67, P<0.001). CONCLUSIONS In this prospective, longitudinal, observational cohort study, we demonstrated that diabetic CAN was an independent prognostic factor for the future development of CKD in type 2 diabetes.
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Affiliation(s)
- Jae-Seung Yun
- Division of Endocrinology and Metabolism, Department of Internal Medicine, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Yu-Bae Ahn
- Division of Endocrinology and Metabolism, Department of Internal Medicine, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Ki-Ho Song
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Ki-Dong Yoo
- Division of Cardiology, Department of Internal Medicine, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Republic of Korea
| | - Hyung-Wook Kim
- Division of Nephrology, Department of Internal Medicine, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Republic of Korea
| | - Yong-Moon Park
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Seung-Hyun Ko
- Division of Endocrinology and Metabolism, Department of Internal Medicine, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
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192
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Use of auricular acupressure to improve the quality of life in diabetic patients with chronic kidney diseases: a prospective randomized controlled trial. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2015; 2014:343608. [PMID: 25574180 PMCID: PMC4276331 DOI: 10.1155/2014/343608] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/24/2014] [Revised: 10/09/2014] [Accepted: 10/27/2014] [Indexed: 02/05/2023]
Abstract
Background. Diabetic patients with chronic kidney disease (CKD) suffer from low quality of life (QOL). We aim to assess the effectiveness of auricular acupressure for QOL improvement in these patients. Materials and Methods. Sixty-two participants were randomly assigned to an auricular or a control arm in a randomized controlled trial. Participants in the auricular arm were instructed to perform auricular acupressure 3–5 times per day for 3 months, when they were receiving conventional treatments. Participants in the control arm received conventional treatments only. The primary outcome was the summarized score of Kidney Disease and Quality of Life Short-Form (KDQOL-SF) at 3 months after randomization. The secondary outcomes included the 36-Item Short Form Health Survey (SF-36), glycosylated hemoglobin (HbA1c), and estimated glomerular filtration rate (eGFR). Results. The summarized KDQOL differed significantly between the acupressure (76.6, 95% CI, 72.2 to 81.0) and the control group (61.8, 95% CI, 57.7 to 65.9). Similar results were found in the SF-36 scores. HbA1c and eGFR were not found to be significantly different between the arms and neither were the adverse events. Conclusion. Auricular acupressure was well tolerated in diabetic patients with chronic kidney diseases receiving hemodialysis. Future research is needed to confirm these results.
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193
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Ruilope LM, Agarwal R, Chan JC, Cooper ME, Gansevoort RT, Haller H, Remuzzi G, Rossing P, Schmieder RE, Nowack C, Ferreira AC, Pieper A, Kimmeskamp-Kirschbaum N, Bakris GL. Rationale, design, and baseline characteristics of ARTS-DN: a randomized study to assess the safety and efficacy of finerenone in patients with type 2 diabetes mellitus and a clinical diagnosis of diabetic nephropathy. Am J Nephrol 2015; 40:572-81. [PMID: 25591469 DOI: 10.1159/000371497] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2014] [Accepted: 11/20/2014] [Indexed: 01/08/2023]
Abstract
BACKGROUND/AIMS Finerenone decreases albuminuria in patients having heart failure with reduced ejection fraction and mild-to-moderate (stage 2-3) chronic kidney disease. The MinerAlocorticoid Receptor Antagonist Tolerability Study-Diabetic Nephropathy (ARTS-DN; NCT01874431) is a multicenter, randomized, double-blind, placebo-controlled, parallel-group, phase 2b study. ARTS-DN investigated whether the mineralocorticoid receptor antagonist finerenone reduces albuminuria without causing major alterations in serum potassium levels in patients with type 2 diabetes mellitus and a clinical diagnosis of DN who were receiving a renin-angiotensin-system (RAS) inhibitor. METHODS Patients were randomized to oral finerenone 1.25-20 mg or placebo once daily. The primary objectives were to assess the ratio of the urinary albumin-to-creatinine ratio at day 90 to that at baseline in patients receiving finerenone, and to compare it with that in the placebo group. Additional exploratory analyses included evaluating changes from baseline in serum potassium levels, efficacy and safety biomarkers, and health-related quality of life. RESULTS Of 1,501 patients screened, 821 (the sample population) received at least one dose of finerenone/placebo. Baseline characteristics included: male, 77.8%; white, 84.2%; very high albuminuria (formerly macroalbuminuria), 38.4%; high albuminuria (formerly microalbuminuria), 60.3%; median (range) estimated glomerular filtration rate, 66.3 (24.5-130.7) ml/min/1.73 m(2); and systolic blood pressure (mean ± standard deviation), 138.1 ± 14.4 mm Hg. There was a history of cardiovascular disease in 39.6%, diabetic neuropathy in 20.0%, and diabetic retinopathy in 19.9% of patients. CONCLUSION ARTS-DN is the first phase 2b trial of finerenone in combination with a RAS inhibitor in patients with type 2 diabetes mellitus and a clinical diagnosis of DN.
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Affiliation(s)
- Luis M Ruilope
- Institute of Investigation and Hypertension Unit, Hospital 12 de Octubre, Madrid, Spain
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Almualm Y, Zaman Huri H. Chronic kidney disease screening methods and its implication for Malaysia: an in depth review. Glob J Health Sci 2015; 7:96-109. [PMID: 25946939 PMCID: PMC4802081 DOI: 10.5539/gjhs.v7n4p96] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2014] [Accepted: 12/01/2014] [Indexed: 12/17/2022] Open
Abstract
Chronic Kidney Disease has become a public health problem, imposing heath, social and human cost on societies worldwide. Chronic Kidney Disease remains asymptomatic till late stage when intervention cannot stop the progression of the disease. Therefore, there is an urgent need to detect the disease early. Despite the high prevalence of Chronic Kidney Disease in Malaysia, screening is still lacking behind. This review discusses the strengths and limitations of current screening methods for Chronic Kidney Disease from a Malaysian point of view. Diabetic Kidney Disease was chosen as focal point as Diabetes is the leading cause of Chronic Kidney Disease in Malaysia. Screening for Chronic Kidney Disease in Malaysia includes a urine test for albuminuria and a blood test for serum creatinine. Recent literature indicates that albuminuria is not always present in Diabetic Kidney Disease patients and serum creatinine is only raised after substantial kidney damage has occurred. Recently, cystatin C was proposed as a potential marker for kidney disease but this has not been studied thoroughly in Malaysia. Glomerular Filtration Rate is the best method for measuring kidney function and is widely estimated using the Modification of Diet for Renal Disease equation. Another equation, the Chronic Kidney Disease Epidemiology Collaboration Creatinine equation was introduced in 2009. The new equation retained the precision and accuracy of the Modification of Diet for Renal Disease equation at GFR < 60ml/min/1.73m2, showed less bias and improved precision at GFR>60ml/min/1.73m2. In Asian countries, adding an ethnic coefficient to the equation enhanced its performance. In Malaysia, a multi-ethnic Asian population, the Chronic Kidney Disease Epidemiology Collaboration equation should be validated and the Glomerular Filtration Rate should be reported whenever serum creatinine is ordered. Reporting estimated Glomerular Filtration Rate will help diagnose patients who would have been otherwise missed if only albuminuria and serum creatinine are measured.
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Affiliation(s)
- Yasmin Almualm
- 1- (currently)Department of Community Health, Faculty of Medicine, National University of Malaysia 2- (at the time research was conducted ) Clinical Investigation Centre, Faculty of Medicine , University of Malaya.
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195
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Kawabata N, Kawamura T, Utsunomiya K, Kusano E. High salt intake is associated with renal involvement in Japanese patients with type 2 diabetes mellitus. Intern Med 2015; 54:311-7. [PMID: 25748740 DOI: 10.2169/internalmedicine.54.2464] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVE The aim of our study was to investigate clinical and nutritional factors associated with renal involvement in patients with type 2 diabetes. PATIENTS We performed a cross-sectional study of 71 patients with type 2 diabetes who were being educated at our hospital from September 2006 to February 2008. The patients were divided into two groups; Group I consisted of 40 patients with both an estimated glomerular filtration rate (eGFR) of ≥ 60 mL/min/1.73 m(2) and normoalbuminuria, and Group II consisted of 31 patients with either microalbuminuria/overt proteinuria or an eGFR of <60 mL/min/1.73 m(2). We compared the age, body mass index (BMI), blood pressure, duration from onset of diabetes, use of hypoglycemic agents and insulin, biochemistry data, including HbA1c, pulse wave velocity corrected by blood pressure (PWVc) and the daily intake of several nutrients between the two groups. A multivariate logistic regression analysis was performed to identify factors independently associated with renal involvement. RESULTS Group II had significantly higher values for BMI, the duration of diabetes, triglycerides, uric acid and PWVc than Group I. Group II tended to have a high salt intake compared to Group I. The multivariate logistic analysis revealed that the daily salt intake, PWVc and uric acid were independent factors associated with renal involvement (odds ratio, 1.15, 1.84 and 2.00; 95% confidence interval, 1.02-1.31, 1.04-3.27 and 1.04-3.85, respectively). CONCLUSION Our data suggest that a high salt intake, in addition to arteriosclerosis, is associated with renal involvement in our cohort with type 2 diabetes.
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Affiliation(s)
- Nao Kawabata
- Department of Clinical Nutrition, Jichi Medical University Hospital, Japan
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196
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Sheen YJ, Sheu WHH. Risks of rapid decline renal function in patients with type 2 diabetes. World J Diabetes 2014; 5:835-46. [PMID: 25512785 PMCID: PMC4265869 DOI: 10.4239/wjd.v5.i6.835] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2014] [Revised: 07/26/2014] [Accepted: 09/17/2014] [Indexed: 02/05/2023] Open
Abstract
Progressive rising population of diabetes and related nephropathy, namely, diabetic kidney disease and associated end stage renal disease has become a major global public health issue. Results of observational studies indicate that most diabetic kidney disease progresses over decades; however, certain diabetes patients display a rapid decline in renal function, which may lead to renal failure within months. Although the definition of rapid renal function decline remained speculative, in general, it is defined by the decrease of estimated glomerular filtration rate (eGFR) in absolute rate of loss or percent change. Based on the Kidney Disease: Improving Global Outcomes 2012 clinical practice guidelines, a rapid decline in renal function is defined as a sustained decline in eGFR of > 5 mL/min per 1.73 m(2) per year. It has been reported that potential factors contributing to a rapid decline in renal function include ethnic/genetic and demographic causes, smoking habits, increased glycated hemoglobin levels, obesity, albuminuria, anemia, low serum magnesium levels, high serum phosphate levels, vitamin D deficiency, elevated systolic blood pressure, pulse pressure, brachial-ankle pulse wave velocity values, retinopathy, and cardiac autonomic neuropathy. This article reviews current literatures in this area and provides insight on the early detection of diabetic subjects who are at risk of a rapid decline in renal function in order to develop a more aggressive approach to renal and cardiovascular protection.
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197
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Gao P, Li L, Ji L, Wei Y, Li H, Shang G, Zhao Z, Chen Q, Jiang T, Zhang N. Nrf2 ameliorates diabetic nephropathy progression by transcriptional repression of TGFβ1 through interactions with c-Jun and SP1. BIOCHIMICA ET BIOPHYSICA ACTA 2014; 1839:1110-1120. [PMID: 25046864 DOI: 10.1016/j.bbagrm.2014.06.018] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/31/2014] [Revised: 06/24/2014] [Accepted: 06/26/2014] [Indexed: 12/13/2022]
Abstract
Diabetic nephropathy (DN) is one of the major complications in diabetes patients. Reactive oxygen species (ROS) play key roles in DN progression. As a primary transcription factor, Nrf2 controls the antioxidant response to maintain cellular redox homeostasis. Herein we systemically examined the role of Nrf2 in DN progression and its regulatory mechanism in a mouse model bearing type II diabetes and in cultured human renal mesangial cells (HRMCs). We found that Nrf2 could ameliorate DN progression by transcriptional repression of TGFβ1 in vivo and in vitro. Moreover, Nrf2 bound to the specific region in TGFβ1 promoter by interactions with transcription factors c-Jun and SP1. Significant abolishment of Nrf2-mediated TGFβ1 transcriptional repression could be accomplished by knockdown of either c-Jun or SP1, and site-directed mutagenesis of c-Jun and SP1 binding sites in the TGFβ1 promoter specific region. Moreover, after interacting with c-Jun and SP1, Nrf2 inhibited c-Jun and SP1 activations, and thus reversed c-Jun- and SP1-promoted TGFβ1 transcription. In all, Nrf2 could slow down DN progression by repression of TGFβ1 in a c-Jun and SP1-dependent way. Our findings may provide novel clues for DN preventions and interventions in clinic.
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Affiliation(s)
- Pan Gao
- Department of Pathology, School of Basic Medical Sciences, Fudan University, 138 Yixueyuan Road, Xuhui District, Shanghai, China.
| | - Liliang Li
- Department of Forensic Medicine, School of Basic Medical Sciences, Fudan University, 138 Yixueyuan Road, Xuhui District, Shanghai, China.
| | - Lili Ji
- Department of Pathology, Medical School of Nantong University, 19 Qixiu Road, Nantong, Jiangsu Province, China.
| | - Yingze Wei
- Department of Pathology, School of Basic Medical Sciences, Fudan University, 138 Yixueyuan Road, Xuhui District, Shanghai, China.
| | - Hui Li
- Department of Pathology, School of Basic Medical Sciences, Fudan University, 138 Yixueyuan Road, Xuhui District, Shanghai, China.
| | - Guoguo Shang
- Department of Pathology, School of Basic Medical Sciences, Fudan University, 138 Yixueyuan Road, Xuhui District, Shanghai, China.
| | - Zhonghua Zhao
- Department of Pathology, School of Basic Medical Sciences, Fudan University, 138 Yixueyuan Road, Xuhui District, Shanghai, China.
| | - Qi Chen
- Department of Pathology, School of Basic Medical Sciences, Fudan University, 138 Yixueyuan Road, Xuhui District, Shanghai, China.
| | - Tao Jiang
- Department of Pathology, School of Basic Medical Sciences, Fudan University, 138 Yixueyuan Road, Xuhui District, Shanghai, China.
| | - Nong Zhang
- Department of Pathology, School of Basic Medical Sciences, Fudan University, 138 Yixueyuan Road, Xuhui District, Shanghai, China.
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Plasma Ghrelin Concentrations Are Negatively Correlated With Urine Albumin-to-Creatinine Ratio in Newly Diagnosed Type 2 Diabetes. Am J Med Sci 2014; 348:382-6. [DOI: 10.1097/maj.0000000000000297] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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199
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Therapeutic strategies of diabetic nephropathy: recent progress and future perspectives. Drug Discov Today 2014; 20:332-46. [PMID: 25448752 DOI: 10.1016/j.drudis.2014.10.007] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2014] [Revised: 09/20/2014] [Accepted: 10/22/2014] [Indexed: 12/20/2022]
Abstract
Diabetic nephropathy (DN) is one of the most common complications of diabetes with high mortality rates worldwide. The treatment of DN has posed a formidable challenge to the scientific community. Simple control of risk factors has been insufficient to cope with the progression of DN. During the process of anti-DN drug discovery, multiple pathogeneses such as oxidative stress, inflammation and fibrosis should all be considered. In this review, the pathogenesis of DN is summarized. The major context focuses on a few small molecules toward the pathogenesis available in animal models and clinical trials for the treatment of DN. The perspectives of novel anti-DN agents and the future directions for the prevention of DN are discussed.
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200
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A disease modification effect of APOE E4 on the association between urinary albumin excretion and cognition in Korean adults. DISEASE MARKERS 2014; 2014:724281. [PMID: 25530658 PMCID: PMC4230004 DOI: 10.1155/2014/724281] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/30/2014] [Accepted: 09/10/2014] [Indexed: 12/05/2022]
Abstract
Background. No previous study examined a disease modifying effect of APOE E4 status on the association between the urinary albumin-to-creatinine ratio (UACR) and cognition. This study aimed to investigate whether APOE E4 modified the association in Korean adults. Methods. We performed a cross-sectional study in adults aged 45 to 74 who were living in Namwon City, Republic of Korea. Cognitive function was measured with the Korean version of modified Mini-Mental State Examination (K-mMMSE) and cognitive impairment was defined as scores falling below the 25th percentile of the K-mMMSE according to age, sex, and educational attainments. Results. A total of 10,190 participants (4006 men and 6184 women) were analyzed in the present study. Of these, 1698 subjects (16.7%) were APOE E4 carriers. The UACR values were negatively associated with the K-mMMSE scores, even after adjusting for potential confounders including age, sex, education, and vascular risk factors. APOE E4 modified the association significantly, resulting in a steeper decline of cognitive function with the increase in UACR in E4 carriers (P for interaction = 0.021). Conclusion. Higher UACR values were significantly associated with cognitive dysfunction in the general Korean population, with cognition in APOE E4 carriers being more severely affected by increased UACR.
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