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Xu H, Xiang QY, Zhan JK, Wang Y, Wang YJ, Li S, Liu YS. Association between macro- and microvascular damage and sarcopenia index in individuals with type 2 diabetes mellitus. Appl Physiol Nutr Metab 2024; 49:762-772. [PMID: 38346295 DOI: 10.1139/apnm-2023-0476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/20/2024]
Abstract
Sarcopenia was recently reported to be relevant to an increased macro-and microvascular disease risk. Sarcopenia index (SI) has been identified as a surrogate marker for sarcopenia. The aim of the present study was to investigate the association between macro- and microvascular disease and SI in patients with type 2 diabetes mellitus (T2DM). A total of 783 patients with T2DM were enrolled in this cross-sectional study. The SI was calculated by (serum creatinine [mg/dL]/cystatin C [mg/L]) × 100. The subjects were divided into three groups according to SI tertiles: T1 (41.27-81.37), T2 (81.38- 99.55), and T3 (99.56-192.31). Parameters of macro- and microvascular complications, including diabetic retinopathy (DR), micro- and macroalbuminuria (MAU), diabetic peripheral neuropathy (DPN), and lower extremity peripheral artery disease (LEAD) were evaluated. Multivariate logistic regression analysis revealed that when taking the top tertile of SI as a reference, an increasing trend of the prevalence of DR, MAU, DPN, and LEAD were presented (all P for trend < 0.05), where the OR (95% CI) for DR prevalence was 1.967 (1.252-3.090) in T2, 2.195 (1.278-3.769) in T1, for MAU was 1.805 (1.149-2.837) in T2, 2.537 (1.490-4.320) in T1, for DPN was 2.244 (1.485-3.391) in T2, 3.172 (1.884-5.341) in T1, and for LEAD was 2.017 (1.002-4.057) in T2, 2.405 (1.107-5.225) in T1 (all P < 0.05). Patients with lower SI were more inclined to have an increased risk of macro- and microvascular damage in T2DM population, which may be related to sarcopenia.
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Affiliation(s)
- Hui Xu
- Department of Geriatrics, Peking University First Hospital, Beijing, 100034, China
- Institute of Aging and Age-related Disease Research, Central South University, Changsha, Hunan, 410011, China
| | - Qun-Yan Xiang
- Institute of Aging and Age-related Disease Research, Central South University, Changsha, Hunan, 410011, China
- Department of Geriatrics, The Second Xiangya Hospital of Central South University, Changsha, Hunan, 410011, China
| | - Jun-Kun Zhan
- Institute of Aging and Age-related Disease Research, Central South University, Changsha, Hunan, 410011, China
- Department of Geriatrics, The Second Xiangya Hospital of Central South University, Changsha, Hunan, 410011, China
| | - Yi Wang
- Institute of Aging and Age-related Disease Research, Central South University, Changsha, Hunan, 410011, China
- Department of Geriatrics, The Second Xiangya Hospital of Central South University, Changsha, Hunan, 410011, China
| | - Yan-Jiao Wang
- Institute of Aging and Age-related Disease Research, Central South University, Changsha, Hunan, 410011, China
- Department of Geriatrics, The Second Xiangya Hospital of Central South University, Changsha, Hunan, 410011, China
| | - Shuang Li
- Institute of Aging and Age-related Disease Research, Central South University, Changsha, Hunan, 410011, China
- Department of Geriatrics, The Second Xiangya Hospital of Central South University, Changsha, Hunan, 410011, China
| | - You-Shuo Liu
- Institute of Aging and Age-related Disease Research, Central South University, Changsha, Hunan, 410011, China
- Department of Geriatrics, The Second Xiangya Hospital of Central South University, Changsha, Hunan, 410011, China
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Shao X, Lu J, Tao R, Wu L, Wang Y, Lu W, Li H, Zhou J, Yu X. Clinically relevant stratification of patients with type 2 diabetes by using continuous glucose monitoring data. Diabetes Obes Metab 2024; 26:2082-2091. [PMID: 38409633 DOI: 10.1111/dom.15512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Revised: 01/30/2024] [Accepted: 02/07/2024] [Indexed: 02/28/2024]
Abstract
AIM The wealth of data generated by continuous glucose monitoring (CGM) provides new opportunities for revealing heterogeneities in patients with type 2 diabetes mellitus (T2DM). We aimed to develop a method using CGM data to discover T2DM subtypes and investigate their relationship with clinical phenotypes and microvascular complications. METHODS The data from 3119 patients with T2DM who wore blinded CGM at an academic medical centre was collected, and a glucose symbolic pattern (GSP) metric was created that combined knowledge-based temporal abstraction with numerical vectorization. The k-means clustering was applied to GSP to obtain subgroups of patients with T2DM. Clinical characteristics and the presence of diabetic retinopathy and albuminuria were compared among the subgroups. The findings were validated in an independent population comprising 773 patients with T2DM. RESULTS By using GSP, four subgroups were identified with distinct features in CGM profiles and parameters. Moreover, the clustered subgroups differed significantly in clinical phenotypes, including indices of pancreatic β-cell function and insulin resistance (all p < .001). After adjusting for confounders, group C (the most insulin resistant) had a significantly higher risk of albuminuria (odds ratio = 1.24, 95% confidence interval: 1.03-1.39) relative to group D, which had the best glucose control. These findings were confirmed in the validation set. CONCLUSION Subtyping patients with T2DM using CGM data may help identify high-risk patients for microvascular complications and provide insights into the underlying pathophysiology. This method may help refine clinically meaningful stratification of patients with T2DM and inform personalized diabetes care.
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Affiliation(s)
- Xiaopeng Shao
- College of Information Science and Engineering, Northeastern University, Shenyang, China
| | - Jingyi Lu
- Department of Endocrinology and Metabolism, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai Clinical Center for Diabetes, Shanghai Diabetes Institute, Shanghai Key Laboratory of Diabetes Mellitus, Shanghai, China
| | - Rui Tao
- College of Information Science and Engineering, Northeastern University, Shenyang, China
| | - Liang Wu
- Department of Endocrinology and Metabolism, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai Clinical Center for Diabetes, Shanghai Diabetes Institute, Shanghai Key Laboratory of Diabetes Mellitus, Shanghai, China
| | - Yaxin Wang
- Department of Endocrinology and Metabolism, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai Clinical Center for Diabetes, Shanghai Diabetes Institute, Shanghai Key Laboratory of Diabetes Mellitus, Shanghai, China
| | - Wei Lu
- Department of Endocrinology and Metabolism, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai Clinical Center for Diabetes, Shanghai Diabetes Institute, Shanghai Key Laboratory of Diabetes Mellitus, Shanghai, China
| | - Hongru Li
- College of Information Science and Engineering, Northeastern University, Shenyang, China
| | - Jian Zhou
- Department of Endocrinology and Metabolism, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai Clinical Center for Diabetes, Shanghai Diabetes Institute, Shanghai Key Laboratory of Diabetes Mellitus, Shanghai, China
| | - Xia Yu
- College of Information Science and Engineering, Northeastern University, Shenyang, China
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Lin TC, Lin KJ, Chiang YJ, Chu SH, Liu KL, Lin CT, Pan PY, Chen SY, Wang JC, Wang HH. Prediction of Early Kidney Transplant Graft Outcome: Insulin Resistance Index. Transplant Proc 2024; 56:550-553. [PMID: 38395658 DOI: 10.1016/j.transproceed.2024.01.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 01/16/2024] [Indexed: 02/25/2024]
Abstract
BACKGROUND New-onset diabetes after transplantation and increased insulin resistance have both been shown to affect graft performance and survival after kidney transplantation. Thus, we aimed to evaluate the predictive roles of different insulin resistance indices on early graft function in kidney transplant recipients. MATERIALS AND METHODS We conducted a retrospective analysis of non-diabetic patients who received kidney transplantation between January 1, 2018 and December 31, 2021. The primary outcome was the predictive role of different insulin resistance indices on early graft function of serum creatinine level and estimated glomerular filtration rate at 1, 3, 6, and 12 months. The secondary outcome analyzed was the possible clinical predictive factors for poor kidney graft function at 12 months. RESULTS Among 123 kidney transplantation patients, stratification with homeostatic model assessment for insulin resistance showed no significant difference in kidney graft function outcome at 1, 3, 6, and 12 months. However, patients with a higher insulin-to-glucose ratio exhibited a significantly higher serum creatinine level at 3 and 6 months and a significantly lower estimated glomerular filtration rate level at 3, 6, and 12 months. Using multivariate logistic regression analysis, patients with a higher insulin-to-glucose ratio were associated with a poorer kidney graft function 12 months after transplantation. CONCLUSION Patients with a higher baseline insulin resistance with an insulin-to-glucose ratio ≥of 0.092 exhibited a significantly worse early kidney graft function. Thus, with the identification of patients with increased insulin resistance, early intervention, and preventive measures can be implemented to enhance graft performance further.
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Affiliation(s)
- Tsu-Chen Lin
- Department of Urology, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Kuo-Jen Lin
- Department of Urology, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan; School of Medicine, Chang Gung University, Taoyuan, Taiwan; Chang Gung Transplant Institute, Taoyuan, Taiwan
| | - Yang-Jen Chiang
- Department of Urology, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan; School of Medicine, Chang Gung University, Taoyuan, Taiwan; Chang Gung Transplant Institute, Taoyuan, Taiwan
| | - Sheng-Hsien Chu
- Department of Urology, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan; School of Medicine, Chang Gung University, Taoyuan, Taiwan; Chang Gung Transplant Institute, Taoyuan, Taiwan
| | - Kuan-Lin Liu
- School of Medicine, Chang Gung University, Taoyuan, Taiwan; Chang Gung Transplant Institute, Taoyuan, Taiwan; Department of Urology, Keelung Chang Gung Memorial Hospital, Keelung, Taiwan
| | - Chih-Te Lin
- Department of Urology, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan; School of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Pai-Yen Pan
- Department of Urology, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan; Chang Gung Transplant Institute, Taoyuan, Taiwan
| | - Sy-Yuan Chen
- Department of Urology, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan; Chang Gung Transplant Institute, Taoyuan, Taiwan
| | - Jui-Chung Wang
- Department of Electrical Engineering, University of Southampton Southampton, United Kingdom
| | - Hsu-Han Wang
- Department of Urology, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan; School of Medicine, Chang Gung University, Taoyuan, Taiwan; Chang Gung Transplant Institute, Taoyuan, Taiwan.
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Yoon J, Han T, Heo SJ, Kwon YJ. Comprehensive assessment of the combined impact of dyslipidemia and inflammation on chronic kidney disease development: A prospective cohort study. J Clin Lipidol 2024; 18:e251-e260. [PMID: 38233308 DOI: 10.1016/j.jacl.2024.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 12/28/2023] [Accepted: 01/01/2024] [Indexed: 01/19/2024]
Abstract
BACKGROUND There remains a limited comprehensive understanding of how dyslipidemia and chronic inflammation collectively contribute to the development of chronic kidney disease (CKD). OBJECTIVE We aimed to identify clusters of individuals with five variables, including lipid profiles and C-reactive protein (CRP) levels, and to assess whether the clusters were associated with incident CKD risk. METHODS We used the Korean Genome and Epidemiology Study-Ansan and Ansung data. K-means clustering analysis was performed to identify distinct clusters based on total cholesterol, triglyceride, non-high-density lipoprotein (HDL)-C, HDL-C, and CRP levels. Cox proportional hazards models were used to examine the association between incident CKD risk and the different clusters. RESULTS During the mean 10-year follow-up period, CKD developed in 1,645 participants (690 men and 955 women) among a total of 8,053 participants with a mean age of 51.8 years. Four distinct clusters were identified: C1, low cholesterol group (LC); C2, high-density lipoprotein cholesterol group (HC); C3, insulin resistance and inflammation group (IIC); and C4, dyslipidemia and inflammation group (DIC). Cluster 4 had a significantly higher risk of incident CKD compared to clusters 2 (hazard ratio (HR) 1.455 [95% confidence interval (CI) 1.234-1.715]; p < 0.001) and cluster 1 (HR 1.264 [95% CI 1.067-1.498]; p = 0.007) after adjusting for confounders. Cluster 3 had a significantly higher risk of incident CKD compared to clusters 2 and 1. CONCLUSION Clusters 4 and 3 had higher risk of incident CKD compared to clusters 2 and 1. The combination of dyslipidemia with inflammation or insulin resistance with inflammation appears to be pivotal in the development of incident CKD.
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Affiliation(s)
- Jihyun Yoon
- Department of Family Medicine, Korean University Anam Hospital, 73 Goryeodae-ro, Seongbuk-gu, Seoul 02481, Republic of Korea (Dr Yoon)
| | - Taehwa Han
- Health-IT Center, Yonsei University Severance Hospital, Seoul, 03722, Republic of Korea (Dr Han)
| | - Seok-Jae Heo
- Division of Biostatistics, Department of Biomedical Systems Informatics, Yonsei University College of Medicine, Seoul 03722, Republic of Korea (Dr Heo).
| | - Yu-Jin Kwon
- Department of Family Medicine, Yongin Severance Hospital, Yonsei University of College of Medicine, Seoul, 03722, Republic of Korea (Dr Kwon).
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Lu F, Fan J, Li F, Liu L, Chen Z, Tian Z, Zuo L, Yu D. Abdominal adipose tissue and type 2 diabetic kidney disease: adipose radiology assessment, impact, and mechanisms. Abdom Radiol (NY) 2024; 49:560-574. [PMID: 37847262 DOI: 10.1007/s00261-023-04062-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 09/09/2023] [Accepted: 09/11/2023] [Indexed: 10/18/2023]
Abstract
Diabetic kidney disease (DKD) is a significant healthcare burden worldwide that substantially increases the risk of kidney failure and cardiovascular events. To reduce the prevalence of DKD, extensive research is being conducted to determine the risk factors and consequently implement early interventions. Patients with type 2 diabetes mellitus (T2DM) are more likely to be obese. Abdominal adiposity is associated with a greater risk of kidney damage than general obesity. Abdominal adipose tissue can be divided into different fat depots according to the location and function, including visceral adipose tissue (VAT), subcutaneous adipose tissue (SAT), perirenal adipose tissue (PAT), and renal sinus adipose tissue (RSAT), which can be accurately measured by radiology techniques, such as computed tomography (CT) and magnetic resonance imaging (MRI). Abdominal fat depots may affect the development of DKD through different mechanisms, and radiologic abdominal adipose characteristics may serve as imaging indicators of DKD risk. This review will first describe the CT/MRI-based assessment of abdominal adipose depots and subsequently describe the current studies on abdominal adipose tissue and DKD development, as well as the underlying mechanisms in patients of T2DM with DKD.
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Affiliation(s)
- Fei Lu
- School of Medical Imaging, Weifang Medical University, Weifang, 261053, Shandong, China
- Department of Radiology, Qilu Hospital of Shandong University, Jinan, 250012, Shandong, China
| | - Jinlei Fan
- Department of Radiology, Qilu Hospital of Shandong University, Jinan, 250012, Shandong, China
| | - Fangxuan Li
- Department of Ultrasound, Qilu Hospital of Shandong University, Jinan, 250012, Shandong, China
| | - Lijing Liu
- Department of Imaging, Yantaishan Hospital, Yantai, 264001, Shandong, China
| | - Zhiyu Chen
- Department of Radiology, Qilu Hospital of Shandong University, Jinan, 250012, Shandong, China
| | - Ziyu Tian
- Department of Radiology, Qilu Hospital of Shandong University, Jinan, 250012, Shandong, China
| | - Liping Zuo
- Department of Radiology, Qilu Hospital of Shandong University, Jinan, 250012, Shandong, China
| | - Dexin Yu
- School of Medical Imaging, Weifang Medical University, Weifang, 261053, Shandong, China.
- Department of Radiology, Qilu Hospital of Shandong University, Jinan, 250012, Shandong, China.
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Di Sessa A, Passaro AP, Colasante AM, Cioffi S, Guarino S, Umano GR, Papparella A, Miraglia Del Giudice E, Marzuillo P. Kidney damage predictors in children with metabolically healthy and metabolically unhealthy obesity phenotype. Int J Obes (Lond) 2023; 47:1247-1255. [PMID: 37689826 DOI: 10.1038/s41366-023-01379-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Revised: 08/25/2023] [Accepted: 08/30/2023] [Indexed: 09/11/2023]
Abstract
BACKGROUND Obesity and kidney damage have been closely linked in adults, but little is still known in childhood. OBJECTIVE To identify predictors of kidney damage in children with metabolically healthy (MHO) and metabolically unhealthy (MUO) obesity phenotypes. METHODS We retrospectively examined 396 children with obesity (mean age 10.72 ± 2.71 years, body mass index-standard deviation score, BMI-SDS, 2.23 ± 0.57) stratified according to metabolic phenotypes. Kidney damage was defined as the presence of reduced estimated glomerular filtration rate (eGFR < 90 mL/min/1.73m2) and/or albuminuria (≥ 30 mg/g urinary creatinine). RESULTS Kidney damage was found in 20.9% of the study population. Children with kidney damage had higher BMI-SDS, homeostasis model assessment of insulin resistance (HOMA-IR), and inflammation markers levels and increased prevalence of non-alcoholic fatty liver disease (NAFLD) than those without kidney damage (all p < 0.005). MUO and MHO subjects had respectively an odds ratio (OR) to show kidney damage of of 1.92 (95%CI:1.22-3.01; p = 0.005) and 1.05 (95%CI:1.00-1.09; p = 0.028) after adjustments. Moreover, we found that only HOMA-IR was closely associated to kidney damage in MUO group (OR = 2.07;95%CI:1.20-3.57; p = 0.007), while HOMA-IR (OR = 1.15;95%CI:1.02-1.29; p = 0.011) and uric acid (OR = 1.15;95% CI:1.02-1.30; p = 0.010) were the only significant risk factors for kidney damage in MHO group. CONCLUSION An increased risk of kidney damage has been observed in children with obesity and in particular in those with MUO phenotype. As their role on kidney function, HOMA-IR should be monitored in MUO children and both HOMA-IR and uric acid in MHO children.
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Affiliation(s)
- Anna Di Sessa
- Department of Woman, Child, and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy.
| | - Antonio Paride Passaro
- Department of Woman, Child, and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Alberto Maria Colasante
- Department of Woman, Child, and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy
| | | | - Stefano Guarino
- Department of Woman, Child, and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Giuseppina Rosaria Umano
- Department of Woman, Child, and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Alfonso Papparella
- Department of Woman, Child, and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Emanuele Miraglia Del Giudice
- Department of Woman, Child, and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Pierluigi Marzuillo
- Department of Woman, Child, and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy
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Fan J, Zuo L, Hou M, Wang B, An Y, Hao B, Yu D. Sex-Specific Computed Tomography Abdominal Fat and Skeletal Muscle Characteristics in Type 2 Diabetic Retinopathy Patients With/Without Comorbid Diabetic Kidney Disease. Acad Radiol 2023; 30:2686-2695. [PMID: 36828721 DOI: 10.1016/j.acra.2023.01.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 01/25/2023] [Accepted: 01/25/2023] [Indexed: 02/25/2023]
Abstract
RATIONALE AND OBJECTIVES To investigate differences in sex-specific computed tomography abdominal fat and skeletal muscle (SM) characteristics between type 2 diabetic retinopathy (DR) patients with and without diabetic kidney disease (DKD). MATERIALS AND METHODS This retrospective study included type 2 diabetes mellitus DR patients with/without DKD between January 2019 and July 2021. Visceral adipose tissue (VAT), subcutaneous adipose tissue, perirenal adipose tissue (PAT), intramuscular adipose tissue, and SM areas were measured. Univariate and multivariate logistic regression analyses were used to analyze risk factors for DKD. Correlation and multiple linear regression analyses were used to clarify the association between computed tomography abdominal fat, SM characteristics, and cystatin C. RESULTS Two hundred and forty-one patients were enrolled and divided into DR with DKD group (n = 142) and DR without DKD group (n = 99). In men, hypertension (OR: 5.21; 95%CI: 1.93-14.05; p = 0.001), diastolic pressure (OR: 1.07; 95%CI: 1.01-1.12; p = 0.011), hemoglobin (OR: 0.94; 95%CI: 0.92-0.97; p < 0.001) and PAT attenuation value (OR: 1.09; 95%CI: 1.01-1.17; p = 0.026) were independent risk factors for DKD progression in DR patients, while the VAT index (VATI) (OR: 1.03; 95%CI: 1.01-1.05; p = 0.014) was an independent risk factor for female patients. Multiple linear regression analysis revealed significant correlations between hypertension (β = 0.22, p = 0.002) and hemoglobin (β = -0.53, p < 0.001) with cystatin C in men, and a significant correlation between VATI and cystatin C (β = 0.35, p = 0.037) in women after adjustment for confounders. CONCLUSION Female DR patients with elevated VAT level may suffer from a higher risk of DKD than that in male patients.
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Affiliation(s)
- Jinlei Fan
- Department of Radiology, Qilu Hospital of Shandong University, Jinan, Shandong, 250012, China
| | - Liping Zuo
- Department of Radiology, Qilu Hospital of Shandong University, Jinan, Shandong, 250012, China
| | - Mingyuan Hou
- Department of Radiology, Qilu Hospital of Shandong University, Jinan, Shandong, 250012, China
| | - Bowen Wang
- Department of Radiology, Qilu Hospital of Shandong University, Jinan, Shandong, 250012, China
| | - Yueming An
- Department of Radiology, Qilu Hospital of Shandong University, Jinan, Shandong, 250012, China
| | - Baoli Hao
- Department of Radiology, Qilu Hospital of Shandong University, Jinan, Shandong, 250012, China
| | - Dexin Yu
- Department of Radiology, Qilu Hospital of Shandong University, Jinan, Shandong, 250012, China.
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Li H, Zheng J, Wu Y, Zhou H, Zeng S, Li Q. Dendrobium officinale polysaccharide decreases podocyte injury in diabetic nephropathy by regulating IRS-1/AKT signal and promoting mitophagy. Aging (Albany NY) 2023; 15:10291-10306. [PMID: 37812195 PMCID: PMC10599763 DOI: 10.18632/aging.205075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 09/08/2023] [Indexed: 10/10/2023]
Abstract
BACKGROUNDS High glucose (HG) caused oxidative stress and mitochondrial dysfunction, resulting in insulin resistance in podocytes, a key mechanism of diabetic nephropathy. Dendrobium officinale polysaccharide (DOP) was able to improve insulin resistance and antioxidant capability. OBJECTIVE The purpose of this study is to explore the mechanism by which DOP decreases the podocyte injury induced by HG. METHODS MPC5 cells were treated with HG, DOP, and IRS-1/2 inhibitor NT157. Afterwards, glucose consumption, generations of ROS and MDA were measured using the detection kits. Mitophagy was monitored using both MtphagTracyker and LysoTracker. The mitochondrial membrane potential was evaluated by JC-1 staining. DOP was also used in a mouse model of diabetes, with the measurements of urine albumin, blood creatinine and blood urea nitrogen. RESULTS Treatment with DOP suppressed the HG-induced reduction of glucose consumption, the phosphorylation of IRS-1 (phospho Y632), AKT (phospho Ser473 and Thr308) and Nephrin. In addition, HG-induced augment of ROS and MDA, formation of γ-H2A.X foci and translocation of AKT to nucleus were inhibited by DOP. DOP enhanced mitophagy, which was associated with decreased mitochondrial membrane potential and ROS production. DOP conferred protective effect on podocyte in the diabetic mouse by reducing the albumin/creatinine ratio and blood urea nitrogen, and restoring Nephrin expression in podocytes. CONCLUSIONS DOP alleviates HG-induced podocyte injuryby regulating IRS-1/AKT signal and promoting mitophagy.
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Affiliation(s)
- Huahua Li
- Department of Geriatric, Hunan Provincial People’s Hospital, The First Affiliated Hospital of Hunan Normal University, Furong, Changsha 410005, P.R. China
| | - Jin Zheng
- Department of Geriatric, Hunan Provincial People’s Hospital, The First Affiliated Hospital of Hunan Normal University, Furong, Changsha 410005, P.R. China
| | - Yacen Wu
- Department of Rehabilitation, Hunan Provincial People’s Hospital, The First Affiliated Hospital of Hunan Normal University, Furong, Changsha 410005, P.R. China
| | - Hong Zhou
- Department of Geriatric, Hunan Provincial People’s Hospital, The First Affiliated Hospital of Hunan Normal University, Furong, Changsha 410005, P.R. China
| | - Suli Zeng
- Department of Geriatric, Hunan Provincial People’s Hospital, The First Affiliated Hospital of Hunan Normal University, Furong, Changsha 410005, P.R. China
| | - Quanqing Li
- Department of Geriatric, Hunan Provincial People’s Hospital, The First Affiliated Hospital of Hunan Normal University, Furong, Changsha 410005, P.R. China
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Chen H, Tsai Y, Huang C. Triglyceride glucose index and renal function decline in Han Chinese hypertensive patients. J Clin Hypertens (Greenwich) 2023; 25:951-956. [PMID: 37688309 PMCID: PMC10560973 DOI: 10.1111/jch.14720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 08/12/2023] [Accepted: 08/20/2023] [Indexed: 09/10/2023]
Abstract
Elevated triglyceride glucose (TyG) index is associated with an increased risk of cardiovascular disease. The current study aimed to investigate whether the TyG index was correlated with renal function decline in patients with hypertension. Han Chinese participants with essential hypertension were included. The TyG index was calculated as ln[fasting triglycerides (mg/dL) * fasting glucose (mg/dL)/2]. Renal function decline was defined as >25% decline in estimated glomerular filtration rate (eGFR). The Cox proportional hazard regression model was used to examine the independent effect of the TyG index on renal events. In total, 548 Han Chinese hypertensive participants with a mean age of 62.1 ± 14.3 years were eligible for enrollment. During a mean follow-up period of 4.7 ± 3.1 years, 97 patients suffered from >25% decline in eGFR. When compared to those without eGFR decline, patients with eGFR decline had higher fasting triglyceride levels (P = .056), fasting glucose levels (P = .014), and TyG indexes (P = .014). The Cox proportional hazard regression model revealed that the TyG index (hazard ratio [HR] = 1.490; 95% confidence interval [CI] = 1.016-2.185, P = .041), office systolic blood pressure (HR = 1.013; 95% CI = 1.000-1.026, P = .047), diabetes mellitus (HR = 1.797, 95% CI = 1.026-3.147, P = .040), and baseline eGFR (HR = 1.015; 95% CI = 1.002-1.028, P = .025) were associated with renal events. In conclusions, an elevated TyG index is independently associated with an increased risk of eGFR decline in hypertensive patients.
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Affiliation(s)
- Hung‐Chang Chen
- Department of Medical EducationTaipei Veterans General HospitalTaipeiTaiwan
- School of MedicineCollege of MedicineNational Yang Ming Chiao Tung UniversityTaipeiTaiwan
| | - Yun‐Hsuan Tsai
- Department of Medical EducationTaipei Veterans General HospitalTaipeiTaiwan
- School of MedicineCollege of MedicineNational Yang Ming Chiao Tung UniversityTaipeiTaiwan
- Department of Medical EducationTaichung Veterans General HospitalTaichungTaiwan
| | - Chin‐Chou Huang
- School of MedicineCollege of MedicineNational Yang Ming Chiao Tung UniversityTaipeiTaiwan
- Division of CardiologyDepartment of MedicineTaipei Veterans General HospitalTaipeiTaiwan
- Institute of PharmacologyNational Yang Ming Chiao Tung UniversityTaipeiTaiwan
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10
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Wang Z, Qian H, Zhong S, Gu T, Xu M, Yang Q. The relationship between triglyceride-glucose index and albuminuria in United States adults. Front Endocrinol (Lausanne) 2023; 14:1215055. [PMID: 37680883 PMCID: PMC10482035 DOI: 10.3389/fendo.2023.1215055] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 08/07/2023] [Indexed: 09/09/2023] Open
Abstract
Purpose Triglyceride-glucose (TyG) index is a simple and reliable indicator of metabolic dysfunction. We aimed to investigate a possible relationship between TyG index and albuminuria in the United States adult population. Methods This cross-sectional study was conducted among adults with complete TyG index and urinary albumin/urinary creatinine (UACR) from 2011-2018 National Health and Nutrition Examination Survey (NHANES). The independent relationship between TyG index and albuminuria (UACR>30mg/g) was evaluated. TyG index was compared with insulin resistance represented by homeostatic model assessment of insulin resistance (HOMA-IR), and metabolic syndrome. Subgroup analysis was also performed. Results A total of 9872 participants were included in this study, and the average TyG index was 8.53 ± 0.01. The proportion of albuminuria gradually increased with the increase of TyG index quartile interval. Elevated TyG index was independently associated with albuminuria, and this association persisted after additional adjustments for HOMA-IR or dichotomous metabolic syndrome. The area under the ROC curve (AUC) of TyG index was larger than that of log (HOMA-IR). Subgroup analysis suggested that the relationship between TyG index and albuminuria is of greater concern in age<60, overweight/obese, diabetic, and metabolic syndrome patients. Conclusion The TyG index may be a potential epidemiological tool to quantify the role of metabolic dysfunction, rather than just insulin resistance, in albuminuria in the United States adult population. Further large-scale prospective studies are needed to confirm our findings.
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Affiliation(s)
- Zhaoxiang Wang
- Department of Endocrinology, Affiliated Kunshan Hospital of Jiangsu University, Kunshan, Jiangsu, China
| | - Han Qian
- Department of Cardiology, Affiliated Taicang Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Shao Zhong
- Department of Endocrinology, Affiliated Kunshan Hospital of Jiangsu University, Kunshan, Jiangsu, China
| | - Tian Gu
- Department of Endocrinology, Affiliated Wujin Hospital of Jiangsu University, Changzhou, Jiangsu, China
| | - Mengjiao Xu
- Department of Endocrinology, Affiliated Wujin Hospital of Jiangsu University, Changzhou, Jiangsu, China
| | - Qichao Yang
- Department of Endocrinology, Affiliated Wujin Hospital of Jiangsu University, Changzhou, Jiangsu, China
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11
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Yang X, Hu R, Wang Z, Hou Y, Song G. Associations Between Serum Folate Level and HOMA-IR in Chinese Patients with Type 2 Diabetes Mellitus. Diabetes Metab Syndr Obes 2023; 16:1481-1491. [PMID: 37229352 PMCID: PMC10204713 DOI: 10.2147/dmso.s409291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 05/02/2023] [Indexed: 05/27/2023] Open
Abstract
Background Adequate intake of folic acid (FA) has been proven essential for metabolism, cellular homeostasis, and antioxidant effects in diabetic patients. Our aim was to evaluate the association between serum folate levels and the risk of insulin resistance in patients with type 2 diabetes mellitus (T2DM) and to provide new ideas and approaches for reducing the risk of T2DM. Methods This was a case-control study involving 412 participants (206 with T2DM). Anthropometric parameters, islet function, biochemical parameters and body composition of T2DM group and control group were determined. Correlation analysis and logistic regression were used to evaluate the risk factors associated with the onset of insulin resistance in T2DM. Results The folate levels in type 2 diabetic patients with insulin resistance were significantly lower than those in patients without insulin resistance. Logistic regression showed that FA and high-density lipoprotein were independent influencing factors for insulin resistance in diabetic patients (P < 0.05). After adjusting for confounding factors, the degree of insulin resistance in diabetic patients was in a significant inverse relationship with folate levels (P< 0.05). We also found that below the serum FA threshold of 7.09 ng/mL insulin resistance was significantly more elevated. Conclusion Our findings suggest that the risk of insulin resistance increases with the decrease in serum FA levels in T2DM patients. Monitoring folate levels in these patients and FA supplementation are warranted preventive measures.
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Affiliation(s)
- Xiaoyue Yang
- Department of Internal Medicine, Hebei Medical University, Shijiazhuang, Hebei, 050017, People’s Republic of China
| | - Rui Hu
- Department of Internal Medicine, Hebei Medical University, Shijiazhuang, Hebei, 050017, People’s Republic of China
| | - Zhen Wang
- Department of Internal Medicine, Hebei Medical University, Shijiazhuang, Hebei, 050017, People’s Republic of China
| | - Yilin Hou
- Department of Internal Medicine, Hebei Medical University, Shijiazhuang, Hebei, 050017, People’s Republic of China
| | - Guangyao Song
- Department of Internal Medicine, Hebei Medical University, Shijiazhuang, Hebei, 050017, People’s Republic of China
- Endocrinology Department, Hebei General Hospital, Shijiazhuang, Hebei, 050051, People’s Republic of China
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12
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Nabipoorashrafi SA, Adeli A, Seyedi SA, Rabizadeh S, Arabzadeh Bahri R, Mohammadi F, Yadegar A, Nakhjavani M, Esteghamati A. Comparison of insulin resistance indices in predicting albuminuria among patients with type 2 diabetes. Eur J Med Res 2023; 28:166. [PMID: 37161502 PMCID: PMC10170852 DOI: 10.1186/s40001-023-01134-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 05/05/2023] [Indexed: 05/11/2023] Open
Abstract
PURPOSE Diabetes is the leading cause of kidney disease. Up to 40% of the population with diabetes experience diabetic kidney disease (DKD). The correlation of DKD with insulin resistance (IR) indices has been shown in previous studies. In this study, the objective was to evaluate surrogate IR indices, including the Triglyceride-Glucose (TyG) index, Visceral Adiposity Index (VAI), Lipid Accumulation Product (LAP), and Homeostasis Model Assessment of Insulin Resistance (HOMA-IR) to find the most valuable index for the correlation between albuminuria and IR in the type 2 diabetes (T2D) population. Albuminuria is defined as urine albumin excretion of > 30 mg/day. METHODS In this cross-sectional study, 2934 participants were enrolled and evaluated for urinary albumin excretion, and albuminuria was detected in 526 of the entries. The logistic regression models and Receiver Operating Characteristic (ROC) curve analysis were performed to assess the relationship of TyG index, VAI, LAP, and HOMA-IR's with albuminuria in patients with T2D. RESULTS The TyG index had the highest association (OR 1.67) with the presence of albuminuria in patients with T2D, followed by HOMA-IR (OR 1.127), VAI (OR 1.028), and LAP (OR 1.004). These four indices remained independent after adjustment for multiple confounders. Based on the ROC curve, TyG revealed the best area under the curve (AUC) for revealing albuminuria with sufficient accuracy (AUC: 0.62) in comparison with other measured indices. The calculated TyG index cut-off point for the presence of albuminuria was 9.39. CONCLUSION Among the indices, TyG index had the most significant correlation with albuminuria in patients with T2D.
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Affiliation(s)
- Seyed Ali Nabipoorashrafi
- Endocrinology and Metabolism Research Center (EMRC), School of Medicine, Vali-Asr Hospital, P.O.Box 13145784, Tehran, Iran
| | - Azam Adeli
- Endocrinology and Metabolism Research Center (EMRC), School of Medicine, Vali-Asr Hospital, P.O.Box 13145784, Tehran, Iran
| | - Seyed Arsalan Seyedi
- Endocrinology and Metabolism Research Center (EMRC), School of Medicine, Vali-Asr Hospital, P.O.Box 13145784, Tehran, Iran
| | - Soghra Rabizadeh
- Endocrinology and Metabolism Research Center (EMRC), School of Medicine, Vali-Asr Hospital, P.O.Box 13145784, Tehran, Iran
| | - Razman Arabzadeh Bahri
- Endocrinology and Metabolism Research Center (EMRC), School of Medicine, Vali-Asr Hospital, P.O.Box 13145784, Tehran, Iran
| | - Fatemeh Mohammadi
- Endocrinology and Metabolism Research Center (EMRC), School of Medicine, Vali-Asr Hospital, P.O.Box 13145784, Tehran, Iran
| | - Amirhossein Yadegar
- Endocrinology and Metabolism Research Center (EMRC), School of Medicine, Vali-Asr Hospital, P.O.Box 13145784, Tehran, Iran
| | - Manouchehr Nakhjavani
- Endocrinology and Metabolism Research Center (EMRC), School of Medicine, Vali-Asr Hospital, P.O.Box 13145784, Tehran, Iran
| | - Alireza Esteghamati
- Endocrinology and Metabolism Research Center (EMRC), School of Medicine, Vali-Asr Hospital, P.O.Box 13145784, Tehran, Iran.
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13
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Zhang H, Chen R, Xu X, Yang M, Xu W, Xiang S, Wang L, Jiang X, Hua F, Huang X. Metabolically healthy obesity is associated with higher risk of both hyperfiltration and mildly reduced estimated glomerular filtration rate: the role of serum uric acid in a cross-sectional study. J Transl Med 2023; 21:216. [PMID: 36959674 PMCID: PMC10035285 DOI: 10.1186/s12967-023-04003-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 02/16/2023] [Indexed: 03/25/2023] Open
Abstract
BACKGROUND The impact of metabolically healthy obesity (MHO) on kidney dysfunction remains debatable. Moreover, few studies have focused on the early stages of kidney dysfunction indicated by hyperfiltration and mildly reduced eGFR. Thus, we aimed to investigate the association between the MHO and early kidney dysfunction, which is represented by hyperfiltration and mildly reduced estimated glomerular filtration rate (eGFR), and to further explore whether serum uric acid affects this association. METHODS This cross-sectional study enrolled 1188 residents aged ≥ 40 years old from Yonghong Communities. Metabolically healthy phenotypes were categorized based on Adult Treatment Panel III criteria. Obesity was defined as body mass index (BMI) ≥ 25 kg/m2. Mildly reduced eGFR was defined as being in the range 60 < eGFR ≤ 90 ml/min/1.73m2. Hyperfiltration was defined as eGFR > 95th percentile after adjusting for sex, age, weight, and height. RESULTS Overall, MHO accounted for 12.8% of total participants and 24.6% of obese participants. Compared to metabolically healthy non-obesity (MHNO), MHO was significantly associated with an increased risk of mildly reduced eGFR (odds ratio [OR] = 1.85, 95% confidence interval [CI] 1.13-3.01) and hyperfiltration (OR = 2.28, 95% CI 1.03-5.09). However, upon further adjusting for uric acid, the association between the MHO phenotype and mildly reduced eGFR was reduced to null. Compared with MHNO/non-hyperuricemia, MHO/non-hyperuricemia was associated with an increased risk of mildly reduced eGFR (OR = 2.04, 95% CI 1.17-3.58), whereas MHO/hyperuricemia was associated with an observably increased risk (OR = 3.07, 95% CI 1.34-7.01). CONCLUSIONS MHO was associated with an increased risk of early kidney dysfunction, and the serum uric acid partially mediated this association. Further prospective studies are warranted to clarify the causality.
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Affiliation(s)
- Hong Zhang
- Department of Endocrine and Metabolic Diseases, The First People's Hospital of Changzhou, Third Affiliated Hospital of Soochow University, 185 Juqianjie Road, Changzhou, 213000, Jiangsu, China
| | - Rui Chen
- Department of Endocrine and Metabolic Diseases, The First People's Hospital of Changzhou, Third Affiliated Hospital of Soochow University, 185 Juqianjie Road, Changzhou, 213000, Jiangsu, China
| | - Xiaohong Xu
- Department of Nephrology, Nanjing Drum Tower Hospital Group Suqian Hospital, Suqian, 223800, Jiangsu, China
- Department of Nephrology, The Affiliated Suqian Hospital of Xuzhou Medical University, Suqian, 223800, Jiangsu, China
| | - Minxing Yang
- Department of Endocrine and Metabolic Diseases, The First People's Hospital of Changzhou, Third Affiliated Hospital of Soochow University, 185 Juqianjie Road, Changzhou, 213000, Jiangsu, China
| | - Wenrong Xu
- Department of Immunization Program, Liangxi District Center for Disease Control and Prevention, Wuxi, 214000, Jiangsu, China
| | - Shoukui Xiang
- Department of Endocrine and Metabolic Diseases, The First People's Hospital of Changzhou, Third Affiliated Hospital of Soochow University, 185 Juqianjie Road, Changzhou, 213000, Jiangsu, China
| | - Long Wang
- Department of Endocrine and Metabolic Diseases, The First People's Hospital of Changzhou, Third Affiliated Hospital of Soochow University, 185 Juqianjie Road, Changzhou, 213000, Jiangsu, China
| | - Xiaohong Jiang
- Department of Endocrine and Metabolic Diseases, The First People's Hospital of Changzhou, Third Affiliated Hospital of Soochow University, 185 Juqianjie Road, Changzhou, 213000, Jiangsu, China
| | - Fei Hua
- Department of Endocrine and Metabolic Diseases, The First People's Hospital of Changzhou, Third Affiliated Hospital of Soochow University, 185 Juqianjie Road, Changzhou, 213000, Jiangsu, China.
| | - Xiaolin Huang
- Department of Endocrine and Metabolic Diseases, The First People's Hospital of Changzhou, Third Affiliated Hospital of Soochow University, 185 Juqianjie Road, Changzhou, 213000, Jiangsu, China.
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14
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Wang K, Zhao Y, Xu L, Liao X, Xu Z. Health outcomes of 100% orange juice and orange flavored beverage: A comparative analysis of gut microbiota and metabolomics in rats. Curr Res Food Sci 2023; 6:100454. [PMID: 36815996 PMCID: PMC9932342 DOI: 10.1016/j.crfs.2023.100454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 01/08/2023] [Accepted: 02/01/2023] [Indexed: 02/05/2023] Open
Abstract
A high intake of sugar-sweetened fruity beverage (FB) is associated with a higher risk of metabolic syndromes, but the health outcome of 100% fruit juice (FJ) intake remains unclear. We aim to reveal health outcomes of diet intervention (FJ or FB) with system profiling via interaction of gut microbiota and metabolomics in a rat (Rattus norvegicus) model. Firstly, the glucose, sucrose, fructose, and bioactive metabolites of FJ and FB were analyzed, and FJ possessed higher sucrose and flavonoids, while FB showed higher glucose and fructose. Secondly, C0 was set as the control group on Day 0, and a 4-week diet invention was performed to control, FJ-intake, and FB-intake groups with normal saline, FJ, and FB, respectively. The results showed that FJ improved alpha diversity and decreased the Firmicutes/Bacteroidota ratio (F/B ratio) of gut microbiota and prevented insulin resistance. However, FB possessed unchanged microbial diversity and enhanced F/B ratio, causing insulin resistance with renal triglyceride accumulation. In summary, FJ, although naturally containing similar amounts of total free sugars as FB, could be a healthier drink choice.
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Affiliation(s)
- Kewen Wang
- College of Food Science and Nutritional Engineering, China Agricultural University, Beijing, 100083, China
- Institute of Quality Standard & Testing Technology for Agro-Products, Key Laboratory of Agro-food Safety and Quality, Ministry of Agriculture and Rural Affairs, Chinese Academy of Agricultural Sciences, Beijing, 100081, China
| | - Yang Zhao
- College of Food Science and Nutritional Engineering, China Agricultural University, Beijing, 100083, China
| | - Lei Xu
- College of Food Science and Nutritional Engineering, China Agricultural University, Beijing, 100083, China
- Institute of Quality Standard & Testing Technology for Agro-Products, Key Laboratory of Agro-food Safety and Quality, Ministry of Agriculture and Rural Affairs, Chinese Academy of Agricultural Sciences, Beijing, 100081, China
| | - Xiaojun Liao
- College of Food Science and Nutritional Engineering, China Agricultural University, Beijing, 100083, China
- Corresponding author.
| | - Zhenzhen Xu
- College of Food Science and Nutritional Engineering, China Agricultural University, Beijing, 100083, China
- Institute of Quality Standard & Testing Technology for Agro-Products, Key Laboratory of Agro-food Safety and Quality, Ministry of Agriculture and Rural Affairs, Chinese Academy of Agricultural Sciences, Beijing, 100081, China
- Corresponding author. College of Food Science and Nutritional Engineering, China Agricultural University, Beijing, 100083, China.
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15
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Yamaguchi S, Shimabukuro M, Tanaka A, Imai T, Hiramitsu S, Takahashi N, Kadokami T, Ajioka M, Suzuki M, Node K. Canagliflozin reduces proteinuria by targeting hyperinsulinaemia in diabetes patients with heart failure: A post hoc analysis of the CANDLE trial. Diabetes Obes Metab 2023; 25:354-364. [PMID: 36193841 DOI: 10.1111/dom.14876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Revised: 09/19/2022] [Accepted: 09/28/2022] [Indexed: 02/02/2023]
Abstract
AIM To investigate factors associated with proteinuria regression in patients with type 2 diabetes mellitus (T2DM) treated with canagliflozin. MATERIALS AND METHODS This study was a post hoc analysis of the CANDLE trial (UMIN000017669), which compared the effect of 24 weeks of treatment with canagliflozin or glimepiride for changes in N-terminal pro-brain natriuretic peptide in patients with T2DM and chronic heart failure (CHF). Factors associated with regression of proteinuria at 24 weeks were evaluated with multivariate logistic models. RESULTS The rate of regression of proteinuria was higher (28/102, 27.5% vs. 12/112, 10.7%), and that of progression was lower (9/102, 8.8% vs. 26/112, 23.2%), in the canagliflozin versus the glimepiride group (P = .0001). There were no differences in the change in the estimated glomerular filtration rate category between groups. Insulin level, homeostatic model assessment of β-cell function, homeostatic model assessment for insulin resistance and estimated plasma volume were decreased at 24 weeks in the regression subclass but not in the progression subclass, suggesting that regression of proteinuria is associated with the declines in these values in the canagliflozin group. Higher insulin level at baseline was solely associated with proteinuria regression in the multivariate logistic regression model (baseline insulin, as per a 1-mlU/L increase, odds ratio 1.24 [1.05-1.47], P = .011). CONCLUSIONS In patients with T2DM and CHF, regression of proteinuria with canagliflozin treatment was associated with the pretreatment insulin level. These results may provide clinicians with novel mechanistic insights into the beneficial effects of canagliflozin on renal outcomes and may warrant discussion for selecting preferred patient profiles, including pretreatment insulin levels.
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Affiliation(s)
- Satoshi Yamaguchi
- Department of Diabetes, Endocrinology, and Metabolism, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Michio Shimabukuro
- Department of Diabetes, Endocrinology, and Metabolism, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Atsushi Tanaka
- Department of Cardiovascular Medicine, Saga University, Saga, Japan
| | - Takumi Imai
- Department of Medical Statistics, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
| | | | - Naohiko Takahashi
- Department of Cardiology and Clinical Examination, Oita University Faculty of Medicine, Yufu, Japan
| | - Toshiaki Kadokami
- Cardiovascular Medicine, Fukuoka Saiseikai Futsukaichi Hospital, Chikushino, Japan
| | - Masayoshi Ajioka
- Department of Cardiovascular Internal Medicine, Tosei General Hospital, Seto, Japan
| | - Makoto Suzuki
- Department of Cardiology, Yokohama Minami Kyosai Hospital, Yokohama, Japan
| | - Koichi Node
- Department of Cardiovascular Medicine, Saga University, Saga, Japan
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16
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He P, Ye Z, Liu M, Li H, Zhang Y, Zhou C, Wu Q, Zhang Y, Yang S, Liu C, Qin X. Association of handgrip strength and/or walking pace with incident chronic kidney disease: A UK biobank observational study. J Cachexia Sarcopenia Muscle 2023; 14:805-814. [PMID: 36708151 PMCID: PMC10067488 DOI: 10.1002/jcsm.13180] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Revised: 11/27/2022] [Accepted: 01/02/2023] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND The individual and combined relations of handgrip strength and walking pace with the risk of chronic kidney disease (CKD) remain uncertain. We aimed to investigate the relationship of handgrip strength and/or walking pace with incident CKD, using data from the large-scale, observational UK Biobank. METHODS A total of 417 504 participants free of prior kidney diseases were included from UK Biobank. Handgrip strength was assessed by dynamometer. The walking pace was self-reported as slow, average, or brisk. Cox proportional hazards models were applied to calculate hazard ratios (HRs) and 95% confidence intervals (CIs) for incident CKD. RESULTS The average age of the study population was 56.3 (SD, 8.1) years. 192 012 (46.0%) of the participants were male. The mean handgrip strength was 23.5 (SD, 6.2) and 40.0 (SD, 8.8) kg for females and males, respectively. Over a median follow-up duration of 12.1 years, 11 064 (2.7%) participants developed incident CKD. Handgrip strength was significantly inversely associated with the risk of incident CKD in both males and females (both P for trend <0.001). When handgrip strength was assessed as sex-specific quartiles, compared with those in the first quartile, the adjusted HRs (95% CI) of incident CKD in participants in the second, third and fourth quartiles were 0.84 (0.79, 0.89), 0.76 (0.71, 0.81) and 0.72 (0.67, 0.77), respectively. Compared with those with slow walking pace, participants with average (HR, 0.64; 95% CI: 0.60-0.68) or brisk (HR, 0.53; 95% CI: 0.49-0.57) walking pace had significantly lower risks of incident CKD. Compared with those with both lower handgrip strength (the first quartile) and slow walking pace, the lowest risk of incident CKD was observed in participants with both higher handgrip strength (the 2-4 quartiles) and average or brisk walking pace (HR, 0.51; 95% CI: 0.46-0.55). CONCLUSIONS Handgrip strength and walking pace were significantly inversely associated with incident CKD in the general population.
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Affiliation(s)
- Panpan He
- Division of Nephrology, Nanfang Hospital, Southern Medical University, Guangzhou, China.,National Clinical Research Center for Kidney Disease, Guangzhou, China.,State Key Laboratory of Organ Failure Research, Guangzhou, China.,Guangdong Provincial Institute of Nephrology, Guangdong Provincial Key Laboratory of Renal Failure Research, Guangdong Provincial Clinical Research Center for Kidney Disease, Guangzhou Regenerative Medicine and Health Guangdong Laboratory, Guangdong Provincial Clinical Research Center for Kidney Disease, Guangzhou, China
| | - Ziliang Ye
- Division of Nephrology, Nanfang Hospital, Southern Medical University, Guangzhou, China.,National Clinical Research Center for Kidney Disease, Guangzhou, China.,State Key Laboratory of Organ Failure Research, Guangzhou, China.,Guangdong Provincial Institute of Nephrology, Guangdong Provincial Key Laboratory of Renal Failure Research, Guangdong Provincial Clinical Research Center for Kidney Disease, Guangzhou Regenerative Medicine and Health Guangdong Laboratory, Guangdong Provincial Clinical Research Center for Kidney Disease, Guangzhou, China
| | - Mengyi Liu
- Division of Nephrology, Nanfang Hospital, Southern Medical University, Guangzhou, China.,National Clinical Research Center for Kidney Disease, Guangzhou, China.,State Key Laboratory of Organ Failure Research, Guangzhou, China.,Guangdong Provincial Institute of Nephrology, Guangdong Provincial Key Laboratory of Renal Failure Research, Guangdong Provincial Clinical Research Center for Kidney Disease, Guangzhou Regenerative Medicine and Health Guangdong Laboratory, Guangdong Provincial Clinical Research Center for Kidney Disease, Guangzhou, China
| | - Huan Li
- Division of Nephrology, Nanfang Hospital, Southern Medical University, Guangzhou, China.,National Clinical Research Center for Kidney Disease, Guangzhou, China.,State Key Laboratory of Organ Failure Research, Guangzhou, China.,Guangdong Provincial Institute of Nephrology, Guangdong Provincial Key Laboratory of Renal Failure Research, Guangdong Provincial Clinical Research Center for Kidney Disease, Guangzhou Regenerative Medicine and Health Guangdong Laboratory, Guangdong Provincial Clinical Research Center for Kidney Disease, Guangzhou, China
| | - Yuanyuan Zhang
- Division of Nephrology, Nanfang Hospital, Southern Medical University, Guangzhou, China.,National Clinical Research Center for Kidney Disease, Guangzhou, China.,State Key Laboratory of Organ Failure Research, Guangzhou, China.,Guangdong Provincial Institute of Nephrology, Guangdong Provincial Key Laboratory of Renal Failure Research, Guangdong Provincial Clinical Research Center for Kidney Disease, Guangzhou Regenerative Medicine and Health Guangdong Laboratory, Guangdong Provincial Clinical Research Center for Kidney Disease, Guangzhou, China
| | - Chun Zhou
- Division of Nephrology, Nanfang Hospital, Southern Medical University, Guangzhou, China.,National Clinical Research Center for Kidney Disease, Guangzhou, China.,State Key Laboratory of Organ Failure Research, Guangzhou, China.,Guangdong Provincial Institute of Nephrology, Guangdong Provincial Key Laboratory of Renal Failure Research, Guangdong Provincial Clinical Research Center for Kidney Disease, Guangzhou Regenerative Medicine and Health Guangdong Laboratory, Guangdong Provincial Clinical Research Center for Kidney Disease, Guangzhou, China
| | - Qimeng Wu
- Division of Nephrology, Nanfang Hospital, Southern Medical University, Guangzhou, China.,National Clinical Research Center for Kidney Disease, Guangzhou, China.,State Key Laboratory of Organ Failure Research, Guangzhou, China.,Guangdong Provincial Institute of Nephrology, Guangdong Provincial Key Laboratory of Renal Failure Research, Guangdong Provincial Clinical Research Center for Kidney Disease, Guangzhou Regenerative Medicine and Health Guangdong Laboratory, Guangdong Provincial Clinical Research Center for Kidney Disease, Guangzhou, China
| | - Yanjun Zhang
- Division of Nephrology, Nanfang Hospital, Southern Medical University, Guangzhou, China.,National Clinical Research Center for Kidney Disease, Guangzhou, China.,State Key Laboratory of Organ Failure Research, Guangzhou, China.,Guangdong Provincial Institute of Nephrology, Guangdong Provincial Key Laboratory of Renal Failure Research, Guangdong Provincial Clinical Research Center for Kidney Disease, Guangzhou Regenerative Medicine and Health Guangdong Laboratory, Guangdong Provincial Clinical Research Center for Kidney Disease, Guangzhou, China
| | - Sisi Yang
- Division of Nephrology, Nanfang Hospital, Southern Medical University, Guangzhou, China.,National Clinical Research Center for Kidney Disease, Guangzhou, China.,State Key Laboratory of Organ Failure Research, Guangzhou, China.,Guangdong Provincial Institute of Nephrology, Guangdong Provincial Key Laboratory of Renal Failure Research, Guangdong Provincial Clinical Research Center for Kidney Disease, Guangzhou Regenerative Medicine and Health Guangdong Laboratory, Guangdong Provincial Clinical Research Center for Kidney Disease, Guangzhou, China
| | - Chengzhang Liu
- Division of Nephrology, Nanfang Hospital, Southern Medical University, Guangzhou, China.,National Clinical Research Center for Kidney Disease, Guangzhou, China.,State Key Laboratory of Organ Failure Research, Guangzhou, China.,Guangdong Provincial Institute of Nephrology, Guangdong Provincial Key Laboratory of Renal Failure Research, Guangdong Provincial Clinical Research Center for Kidney Disease, Guangzhou Regenerative Medicine and Health Guangdong Laboratory, Guangdong Provincial Clinical Research Center for Kidney Disease, Guangzhou, China
| | - Xianhui Qin
- Division of Nephrology, Nanfang Hospital, Southern Medical University, Guangzhou, China.,National Clinical Research Center for Kidney Disease, Guangzhou, China.,State Key Laboratory of Organ Failure Research, Guangzhou, China.,Guangdong Provincial Institute of Nephrology, Guangdong Provincial Key Laboratory of Renal Failure Research, Guangdong Provincial Clinical Research Center for Kidney Disease, Guangzhou Regenerative Medicine and Health Guangdong Laboratory, Guangdong Provincial Clinical Research Center for Kidney Disease, Guangzhou, China
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17
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Farhadnejad H, Teymoori F, Jahromi MK, Asghari G, Mokhtari E, Mirmiran P, Azizi F. High insulinemic potential of diet and lifestyle is associated with increased risk of chronic kidney disease incident in adults. BMC Nephrol 2023; 24:6. [PMID: 36624389 PMCID: PMC9830921 DOI: 10.1186/s12882-023-03059-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Accepted: 01/05/2023] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND The role of higher insulinemic effects of dietary pattern and lifestyle factors on the risk of chronic kidney disease (CKD) is not well-studied. In the current study, we aimed to investigate the relationship between the insulinemic potential of diet and lifestyle with the risk of CKD in adults. METHODS A total of 6044 individuals without CKD, aged>18 years, were recruited from among participants of the Tehran Lipid and Glucose Study (third and fourth surveys) and followed a mean of 6.03 years(follow-up rate:94.95%). The dietary intake data were collected using a food frequency questionnaire. The insulinemic potential of diet and lifestyle was determined based on four empirical indices, including the empirical dietary index for hyperinsulinemia (EDIH), the empirical dietary index for insulin resistance (EDIR), the empirical lifestyle index for hyperinsulinemia (ELIH), and the empirical lifestyle index for insulin resistance (ELIR). RESULTS Mean ± SD age of all study participants (54.3% women) was 37.8 ± 12.8 years. During the 6.03 years of follow-up (46,889.8 person-years), 1216(20.1%) new cases of CKD were identified. According to the multivariable-adjusted model, the risk of CKD incident is increased across quintiles of EDIR (OR = 1.29;95% CI: 1.06-1.57), ELIH (OR = 1.35; 95%CI: 1.10-1.67), and ELIR (OR = 1.24; 95%CI:1.02-1.51). However, no significant relationship was found between the EDIH score and the risk of CKD. CONCLUSION Results of the current study showed that dietary pattern with a high EDIR score and a lifestyle with higher ELIH and ELIR scores may be related to increasing the risk of CKD incident. However, no significant association was observed between EDIH score and CKD incident.
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Affiliation(s)
- Hossein Farhadnejad
- grid.411600.2Nutrition and Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Farshad Teymoori
- grid.411600.2Nutrition and Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran ,grid.411746.10000 0004 4911 7066Department of Nutrition, School of Public Health, Iran University of Medical Sciences, Tehran, Iran
| | - Mitra Kazemi Jahromi
- grid.412237.10000 0004 0385 452XEndocrinology and Metabolism Research Center, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - Golaleh Asghari
- grid.411600.2Nutrition and Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran ,grid.411600.2Department of Clinical Nutrition and Dietetics, Faculty of Nutrition Sciences and Food Technology, National Nutrition and Food Technology Research Institute, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ebrahim Mokhtari
- grid.411600.2Nutrition and Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Parvin Mirmiran
- grid.411600.2Nutrition and Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran ,grid.411600.2Department of Clinical Nutrition and Dietetics, Faculty of Nutrition Sciences and Food Technology, National Nutrition and Food Technology Research Institute, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Fereidoun Azizi
- grid.411600.2Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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18
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Zhang W, Zhou J, Wang C, Wang X, Zhang S, Jia W, Jiang Y, Lin L, Gong Y. Efficacy and safety of Keluoxin capsule in combination with Western medicine for diabetic kidney disease: A systematic review and meta-analysis. Front Pharmacol 2023; 13:1052852. [PMID: 36686708 PMCID: PMC9845565 DOI: 10.3389/fphar.2022.1052852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Accepted: 11/28/2022] [Indexed: 01/06/2023] Open
Abstract
Objective: Keluoxin capsule (KLXC) has been widely used in diabetic kidney disease (DKD), but its efficacy and safety have not yet been clarified. A systematic review and meta-analysis were performed to assess the efficacy and safety of KLXC for DKD. Methods: The randomized control trials (RCTs) included KLXC searched from seven major English and Chinese databases up until 3 June 2022. The methodological quality and risk of bias were assessed by version 2 of the Cochrane risk-of-bias tool (RoB 2) for the RCTs from the Cochrane Handbook. The analyses were conducted by RevMan 5.4 and Stata 17.0. Results: A total of 20 trials with 1,500 participants were identified. The meta-analysis showed that KLXC combined with Western medicine was superior to the use of Western medicine alone for DKD which included improvements in the estimated glomerular filtration rate (eGFR) [MD = 3.04, 95% CI (0.30, 5.78), p = 0.03], reduction in microalbuminuria (mALB) [MD = -25.83, 95% CI (-41.20, -10.47), p = 0.001], urinary albumin excretion rate (UAER) [SMD = -0.97, 95% CI (-1.50, -0.44), p = 0.0003], 24-h urine protein (24hUpro) [SMD = -1.31, 95% CI (-1.82, -0.80), p < 0.00001], serum creatinine (Scr) [MD = -11.39, 95% CI (-18.76, -4.02), p = 0.002], blood urea nitrogen (BUN) [MD = -1.28, 95% CI (-1.67, -0.88), p < 0.00001], fasting blood glucose (FBG) [MD = -0.51, 95% CI (-0.90, -0.11), p = 0.01], total cholesterol (TC) [MD = -1.04, 95% CI (-1.40, -0.68), p < 0.00001], triglycerides (TG) [MD = -0.36, 95% CI (-0.50, -0.23), p < 0.00001], and low-density lipoprotein cholesterol (LDL) [MD = -0.39, 95% CI (-0.71, -0.07), p = 0.02]. Results showed no statistically significant difference in glycated hemoglobin (HbA1c) (p = 0.14) or adverse events (p = 0.81) between the two groups. Conclusion: The combination of KLXC and Western medicine had a positive effect on DKD. However, due to the high clinical heterogeneity and low quality of included studies, further standardized, large-scale, rigorously designed RCTs for DKD in the definitive stage are still necessary to achieve more accurate results. Systematic Review Registration: https://inplasy.com/inplasy-2021-11-0067/, identifier INPLASY 2021110067.
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Affiliation(s)
- Wenhua Zhang
- Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Jingxin Zhou
- Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Churan Wang
- Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Xu Wang
- Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Shuwen Zhang
- Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Weiyu Jia
- Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Yijia Jiang
- Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Lan Lin
- Guang’anmen Hospital China Academy of Chinese Medicine Sciences, Beijing, China
| | - Yanbing Gong
- Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China,*Correspondence: Yanbing Gong,
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19
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Shah CH, Dave CV. Healthcare costs associated with comorbid cardiovascular and renal conditions among persons with diabetes, 2008-2019. Diabetol Metab Syndr 2022; 14:179. [PMID: 36443803 PMCID: PMC9703659 DOI: 10.1186/s13098-022-00957-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 11/16/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND There is paucity of data examining healthcare costs among persons with comorbid diabetes and cardiorenal conditions. OBJECTIVE To elucidate the longitudinal trends and quantify the incremental healthcare costs associated with the following cardiorenal conditions: atherosclerotic cardiovascular disease (ASCVD), heart failure (HF), and kidney disease, among persons with diabetes. METHODS Medical Expenditure Panel Survey data (2008-2019) were used to identify adults with diabetes and comorbid cardiorenal conditions. Overall, medical and pharmaceutical costs were ascertained (in 2019 US dollars). Analyses were adjusted for 14 variables using a two-part regression model. RESULTS Among 32,519 adults with diabetes, the mean (standard error [SE]) annual healthcare costs were $13,829 ($213), with medical and prescription components contributing $9301 ($172) and $4528 ($98), respectively. Overall healthcare costs rose by 26.8% from $12,791 (2008-2009) to $16,215 (2018-2019) over the study period, driven by 42.5% and 20.3% increase in pharmaceutical and medical spending, respectively. Similar trends were observed for subgroup of persons with cardiorenal conditions. Compared to their counterparts without cardiorenal conditions and prior to adjustment, persons with ASCVD, HF and kidney disease incurred healthcare costs that were approximately 2.2, 3.3, and 2.7 times greater. After adjustment, comorbid ASCVD, HF and kidney disease were associated with annual excess spending of $8651 (95% CI $7729-$9573), $9373 (95% CI $9010-$9736), and $9995 (95% CI $8781-$11,209), respectively. CONCLUSIONS Study results are generalizable to non-institutionalized US persons. Healthcare costs associated with the management of diabetes are high-especially among those with comorbid cardiorenal conditions, and have risen in recent years.
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Affiliation(s)
- Chintal H Shah
- Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, 220 N. Arch Street, 12th floor, Baltimore, MD, 21201, USA.
| | - Chintan V Dave
- Center for Pharmacoepidemiology and Treatment Science, Institute for Health, Health Care Policy and Aging Research, Rutgers University, New Brunswick, NJ, USA
- Department of Pharmacy Practice and Administration, Ernest Mario School of Pharmacy, Rutgers University, Piscataway, NJ, USA
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20
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Killian AC, Reed RD, McLeod MC, MacLennan PA, Kumar V, Pittman SE, Maynor AG, Stanford LA, Baker GA, Schinstock CA, Silkensen JR, Roll GR, Segev DL, Orandi BJ, Lewis CE, Locke JE. Diabetes-free survival among living kidney donors and non-donors with obesity: A longitudinal cohort study. PLoS One 2022; 17:e0276882. [PMID: 36399462 PMCID: PMC9674148 DOI: 10.1371/journal.pone.0276882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 10/13/2022] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Approval of living kidney donors (LKD) with end-stage kidney disease (ESKD) risk factors, such as obesity, has increased. While lifetime ESKD development data are lacking, the study of intermediate outcomes such as diabetes is critical for LKD safety. Donation-attributable diabetes risk among persons with obesity remains unknown. The purpose of this study was to evaluate 10-year diabetes-free survival among LKDs and non-donors with obesity. METHODS This longitudinal cohort study identified adult, LKDs (1976-2020) from 42 US transplant centers and non-donors from the Coronary Artery Risk Development in Young Adults (1985-1986) and the Atherosclerosis Risk in Communities (1987-1989) studies with body mass index ≥30 kg/m2. LKDs were matched to non-donors on baseline characteristics (age, sex, race, body mass index, systolic and diastolic blood pressure) plus diabetes-specific risk factors (family history of diabetes, impaired fasting glucose, smoking history). Accelerated failure time models were utilized to evaluate 10-year diabetes-free survival. FINDINGS Among 3464 participants, 1119 (32%) were LKDs and 2345 (68%) were non-donors. After matching on baseline characteristics plus diabetes-specific risk factors, 4% (7/165) LKDs and 9% (15/165) non-donors developed diabetes (median follow-up time 8.5 (IQR: 5.6-10.0) and 9.1 (IQR: 5.9-10.0) years, respectively). While not significant, LKDs were estimated to live diabetes-free 2 times longer than non-donors (estimate 1.91; 95% CI: 0.79-4.64, p = 0.15). CONCLUSIONS LKDs with obesity trended toward living longer diabetes-free than non-donors with obesity, suggesting within the decade following donation there was no increased diabetes risk among LKDs. Further work is needed to evaluate donation-attributable diabetes risk long-term.
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Affiliation(s)
- A. Cozette Killian
- Comprehensive Transplant Institute, University of Alabama at Birmingham, Birmingham, AL, United States of America
| | - Rhiannon D. Reed
- Comprehensive Transplant Institute, University of Alabama at Birmingham, Birmingham, AL, United States of America
| | - M. Chandler McLeod
- Comprehensive Transplant Institute, University of Alabama at Birmingham, Birmingham, AL, United States of America
| | - Paul A. MacLennan
- Comprehensive Transplant Institute, University of Alabama at Birmingham, Birmingham, AL, United States of America
| | - Vineeta Kumar
- Comprehensive Transplant Institute, University of Alabama at Birmingham, Birmingham, AL, United States of America
| | - Sydney E. Pittman
- Comprehensive Transplant Institute, University of Alabama at Birmingham, Birmingham, AL, United States of America
| | - Andrew G. Maynor
- Comprehensive Transplant Institute, University of Alabama at Birmingham, Birmingham, AL, United States of America
| | - Luke A. Stanford
- Comprehensive Transplant Institute, University of Alabama at Birmingham, Birmingham, AL, United States of America
| | - Gavin A. Baker
- Comprehensive Transplant Institute, University of Alabama at Birmingham, Birmingham, AL, United States of America
| | - Carrie A. Schinstock
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota, United States of America
| | - John R. Silkensen
- Department of Medicine, Hennepin County Medical Center, Minneapolis, Minnesota, United States of America
| | - Garrett R. Roll
- Division of Transplant, Department of Surgery, University of California San Francisco, San Francisco, CA, United States of America
| | - Dorry L. Segev
- Department of Surgery, New York University Grossman School of Medicine, New York, New York, United States of America
| | - Babak J. Orandi
- Comprehensive Transplant Institute, University of Alabama at Birmingham, Birmingham, AL, United States of America
| | - Cora E. Lewis
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, United States of America
| | - Jayme E. Locke
- Comprehensive Transplant Institute, University of Alabama at Birmingham, Birmingham, AL, United States of America
- * E-mail:
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21
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Oh D, Park SH, Lee S, Yang E, Choi HY, Park HC, Jhee JH. High Triglyceride-Glucose Index with Renal Hyperfiltration and Albuminuria in Young Adults: The Korea National Health and Nutrition Examination Survey (KNHANES V, VI, and VIII). J Clin Med 2022; 11:jcm11216419. [PMID: 36362646 PMCID: PMC9655420 DOI: 10.3390/jcm11216419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 10/22/2022] [Accepted: 10/26/2022] [Indexed: 11/16/2022] Open
Abstract
Background: High triglyceride-glucose (TyG) index, a surrogate marker of insulin resistance, is associated with an increased risk of albuminuria in adults. However, the relationship between high TyG index associated with renal hyperfiltration (RHF) and albuminuria among young adults is unclear. Methods: A total of 5420 participants aged 19−39 years were enrolled from the Korean National Health and Nutrition Examination Survey (2011−2014 and 2019) and their TyG index levels were analyzed. RHF was defined as eGFR with residuals > 90th percentile after adjusting for age, sex, weight, and height. Albuminuria was defined as urinary albumin-to-creatinine ratio ≥ 30 mg/g Cr. Logistic regression analyses were used to evaluate the association between TyG index, RHF, and albuminuria. Results: The mean age was 30.7 ± 6.0 years and 46.4% were male. The prevalence of albuminuria and RHF was higher in the higher tertiles of TyG index. In our multivariable model, high TyG index showed higher risk of albuminuria (odds ratio (OR) per 1.0 increase in TyG index, 1.56; 95% confidence interval (CI), 1.24−1.95 and OR in the highest tertile, 1.65; 95% CI, 1.08−2.52). High TyG index was associated with higher risk of RHF (OR per 1.0 increase in TyG index, 1.56; 95% CI, 1.32−1.84 and OR in the highest tertile, 1.73; 95% CI, 1.31−2.30). When participants were divided into with or without RHF, high-TyG index-associated high risk of albuminuria was only observed in those with RHF. Participants with concurrent high TyG index and RHF showed the highest risk of albuminuria. Mediation analysis showed that 54.2% of the relation between TyG index and albuminuria was mediated by RHF (95% CI of indirect effect, 0.27−0.76). Finally, incorporating TyG index into our basic model improved the predictive value for albuminuria only in participants with RHF. Conclusion: High TyG index associated with RHF was the strongest risk factor for albuminuria in this study. Early identification of high TyG index with RHF may prevent future development of CKD in relatively healthy and young adults.
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Affiliation(s)
- Donghwan Oh
- Division of Nephrology, Department of Internal Medicine, Gangnam Severance Hospital, Seoul 06273, Korea
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul 03722, Korea
| | - Sang Ho Park
- Division of Nephrology, Department of Internal Medicine, Gangnam Severance Hospital, Seoul 06273, Korea
| | - Seoyoung Lee
- Division of Nephrology, Department of Internal Medicine, Gangnam Severance Hospital, Seoul 06273, Korea
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul 03722, Korea
| | - Eunji Yang
- Division of Nephrology, Department of Internal Medicine, Gangnam Severance Hospital, Seoul 06273, Korea
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul 03722, Korea
| | - Hoon Young Choi
- Division of Nephrology, Department of Internal Medicine, Gangnam Severance Hospital, Seoul 06273, Korea
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul 03722, Korea
- Severance Institute for Vascular and Metabolic Research, Yonsei University College of Medicine, Seoul 03722, Korea
| | - Hyeong Cheon Park
- Division of Nephrology, Department of Internal Medicine, Gangnam Severance Hospital, Seoul 06273, Korea
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul 03722, Korea
- Severance Institute for Vascular and Metabolic Research, Yonsei University College of Medicine, Seoul 03722, Korea
| | - Jong Hyun Jhee
- Division of Nephrology, Department of Internal Medicine, Gangnam Severance Hospital, Seoul 06273, Korea
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul 03722, Korea
- Correspondence: ; Tel.: +82-2-2019-4368; Fax: +82-2-3463-3882
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22
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Liaw J, Harhay M, Setoguchi S, Gerhard T, Dave CV. Trends in Prescribing Preferences for Antidiabetic Medications Among Patients With Type 2 Diabetes in the U.K. With and Without Chronic Kidney Disease, 2006-2020. Diabetes Care 2022; 45:2316-2325. [PMID: 35984049 DOI: 10.2337/dc22-0224] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 07/05/2022] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To evaluate trends in antidiabetic medication initiation patterns among patients with type 2 diabetes mellitus (T2DM) with and without chronic kidney disease (CKD). RESEARCH DESIGN AND METHODS A retrospective cohort study using the UK Clinical Practice Research Datalink (2006-2020) was conducted to evaluate the overall, first-, and second line (after metformin) medication initiation patterns among patients with CKD (n = 38,622) and those without CKD (n = 230,963) who had T2DM. RESULTS Relative to other glucose-lowering therapies, metformin initiations declined overall but remained the first-line treatment of choice for both patients with and those without CKD. Sodium-glucose cotransporter-2 (SGLT2i) use increased modestly among patients with CKD, but this increase was more pronounced among patients without CKD; by 2020, patients without CKD, compared with patients with CKD, were three (28.5% vs. 9.4%) and six (46.3% vs. 7.9%) times more likely to initiate SGLT2i overall and as second-line therapy, respectively. Glucagon-like peptide 1 receptor agonist (GLP-1RA) use was minimal regardless of CKD status (<5%), whereas both dipeptidyl peptidase-4 inhibitor (DPP4i) and sulfonylurea use remained high among patients with CKD. For instance, by 2020, and among patients with CKD, DPP4i and sulfonylureas constituted 28.3% and 20.6% of all initiations, and 57.4% and 30.3% of second-line initiations, respectively. CONCLUSIONS SGLT2i use increased among patients with T2DM, but this increase was largely driven by patients without CKD. Work is needed to identify barriers associated with the uptake of therapies with proven cardiorenal benefits (e.g., SGLT2i, GLP-1RA) among patients with CKD.
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Affiliation(s)
- Julia Liaw
- Center for Pharmacoepidemiology and Treatment Science, Institute for Health, Health Care Policy and Aging Research, Rutgers University, New Brunswick, NJ.,Department of Pharmacy Practice and Administration, Ernest Mario School of Pharmacy, Rutgers University, Piscataway, NJ
| | - Meera Harhay
- Department of Medicine, Drexel University College of Medicine, Philadelphia, PA.,Department of Epidemiology and Biostatistics, Drexel University Dornsife School of Public Health, Philadelphia, PA.,Department of Medicine, Renal Electrolyte and Hypertension Division, University of Pennsylvania Health System, Philadelphia, PA
| | - Soko Setoguchi
- Center for Pharmacoepidemiology and Treatment Science, Institute for Health, Health Care Policy and Aging Research, Rutgers University, New Brunswick, NJ.,Department of Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Tobias Gerhard
- Center for Pharmacoepidemiology and Treatment Science, Institute for Health, Health Care Policy and Aging Research, Rutgers University, New Brunswick, NJ.,Department of Pharmacy Practice and Administration, Ernest Mario School of Pharmacy, Rutgers University, Piscataway, NJ
| | - Chintan V Dave
- Center for Pharmacoepidemiology and Treatment Science, Institute for Health, Health Care Policy and Aging Research, Rutgers University, New Brunswick, NJ.,Department of Pharmacy Practice and Administration, Ernest Mario School of Pharmacy, Rutgers University, Piscataway, NJ.,Department of Veterans Affairs-New Jersey Health Care System, East Orange, NJ
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23
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Seo DH, Suh YJ, Cho Y, Ahn SH, Seo S, Hong S, Lee YH, Choi YJ, Lee E, Kim SH. Effect of low skeletal muscle mass and sarcopenic obesity on chronic kidney disease in patients with type 2 diabetes. Obesity (Silver Spring) 2022; 30:2034-2043. [PMID: 36062861 DOI: 10.1002/oby.23512] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 05/09/2022] [Accepted: 05/18/2022] [Indexed: 11/07/2022]
Abstract
OBJECTIVE This study aimed to investigate the association between low muscle mass or sarcopenic obesity and the risk of incident chronic kidney disease (CKD) in patients with type 2 diabetes mellitus (T2DM). METHODS A total of 3123 patients with T2DM with preserved renal function were followed up for incident CKD. Skeletal muscle mass was estimated from bioelectrical impedance analysis. CKD was defined as estimated glomerular filtration rate < 60 mL/min/1.73 m2 . Sarcopenic obesity was defined as the coexistence of sarcopenia and abdominal obesity. RESULTS During 8.9 years of follow-up, 530 (17.0%) patients developed incident CKD. When patients were divided into three groups based on sex-specific tertiles, lower muscle mass was not associated with an increased risk of incident CKD after adjustment for risk factors. However, when patients were divided into four groups according to the presence of sarcopenia and obesity, sarcopenic obesity was associated with an increased risk of incident CKD (adjusted hazard ratio 1.77; 95% CI: 1.24-2.51; p = 0.001) compared with the other groups. CONCLUSIONS Sarcopenic obesity, but not low muscle mass alone, may increase the risk of CKD in patients with T2DM.
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Affiliation(s)
- Da Hea Seo
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Inha University College of Medicine, Incheon, Republic of Korea
| | - Young Ju Suh
- Department of Biomedical Sciences, Inha University College of Medicine, Incheon, Republic of Korea
| | - Yongin Cho
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Inha University College of Medicine, Incheon, Republic of Korea
| | - Seong Hee Ahn
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Inha University College of Medicine, Incheon, Republic of Korea
| | - Seongha Seo
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Inha University College of Medicine, Incheon, Republic of Korea
| | - Seongbin Hong
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Inha University College of Medicine, Incheon, Republic of Korea
| | - Yong-Ho Lee
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | | | - Eunjig Lee
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - So Hun Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Inha University College of Medicine, Incheon, Republic of Korea
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24
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Hung CC, Zhen YY, Niu SW, Lin KD, Lin HYH, Lee JJ, Chang JM, Kuo IC. Predictive Value of HbA1c and Metabolic Syndrome for Renal Outcome in Non-Diabetic CKD Stage 1-4 Patients. Biomedicines 2022; 10:biomedicines10081858. [PMID: 36009406 PMCID: PMC9404918 DOI: 10.3390/biomedicines10081858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 07/26/2022] [Accepted: 07/28/2022] [Indexed: 11/16/2022] Open
Abstract
Glycated hemoglobin (HbA1c) levels are commonly used to indicate long-term glycemic control. An HbA1c level of 6.5−5.7% is defined as pre-diabetes and is proposed as a criterion for diagnosing metabolic syndrome (MetS). However, HbA1c levels can be affected by chronic kidney disease (CKD). Whether HbA1c is associated with clinical outcomes in nondiabetic CKD patients with or without MetS is still unknown. This study included 1270 nondiabetic CKD stage 1−4 Asian patients, divided by HbA1c and MetS. Through linear regression, HbA1c was positively associated with age, waist circumference, hemoglobin levels, and C-reactive protein and was negatively associated with malnutrition−inflammation. HbA1c levels were 5.5% (0.6%) and 5.7% (0.6%) in non-MetS and MetS, respectively (p < 0.001). In Cox regression, higher-level HbA1c was associated with worse composite renal outcome in MetS patients, but with better renal outcome in non-MetS patients: Hazard ratio (HR) (95% confidence interval [CI]) of HbA1c ≥5.7%, compared with HbA1c <5%, was 2.00 (1.06−3.78) in MetS and 0.25 (0.14−0.45) in non-MetS. An association between HbA1c and all-cause mortality was not found. In conclusion, higher HbA1c levels are associated with worse renal outcomes in nondiabetic CKD stage 1−4 patients modified by the presence of MetS.
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Affiliation(s)
- Chi-Chih Hung
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 807, Taiwan; (C.-C.H.); (Y.-Y.Z.); (S.-W.N.); (H.Y.-H.L.); (J.-J.L.); (J.-M.C.)
| | - Yen-Yi Zhen
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 807, Taiwan; (C.-C.H.); (Y.-Y.Z.); (S.-W.N.); (H.Y.-H.L.); (J.-J.L.); (J.-M.C.)
| | - Sheng-Wen Niu
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 807, Taiwan; (C.-C.H.); (Y.-Y.Z.); (S.-W.N.); (H.Y.-H.L.); (J.-J.L.); (J.-M.C.)
- Department of Internal Medicine, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung Medical University, Kaohsiung 801, Taiwan
| | - Kun-Der Lin
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 807, Taiwan;
| | - Hugo You-Hsien Lin
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 807, Taiwan; (C.-C.H.); (Y.-Y.Z.); (S.-W.N.); (H.Y.-H.L.); (J.-J.L.); (J.-M.C.)
- Department of Internal Medicine, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung Medical University, Kaohsiung 801, Taiwan
| | - Jia-Jung Lee
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 807, Taiwan; (C.-C.H.); (Y.-Y.Z.); (S.-W.N.); (H.Y.-H.L.); (J.-J.L.); (J.-M.C.)
| | - Jer-Ming Chang
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 807, Taiwan; (C.-C.H.); (Y.-Y.Z.); (S.-W.N.); (H.Y.-H.L.); (J.-J.L.); (J.-M.C.)
| | - I-Ching Kuo
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 807, Taiwan; (C.-C.H.); (Y.-Y.Z.); (S.-W.N.); (H.Y.-H.L.); (J.-J.L.); (J.-M.C.)
- Department of Internal Medicine, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung Medical University, Kaohsiung 801, Taiwan
- Correspondence:
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Caporusso M, Perrini S, Giorgino F, Laviola L. Implicazioni cliniche extraglicemiche dell’insulino-resistenza. L'ENDOCRINOLOGO 2022. [PMCID: PMC9344231 DOI: 10.1007/s40619-022-01131-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
L’insulino-resistenza si definisce come un’alterazione del processo di trasduzione del segnale dell’insulina, per cui concentrazioni di insulina normali o aumentate producono un effetto biologico attenuato. Ciò spesso determina un’iperinsulinemia compensatoria. Considerati i suoi effetti biologici, l’insulino-resistenza si manifesta con un quadro clinico variabile, noto come Sindrome da insulino-resistenza, che include alterazioni metaboliche, obesità viscerale, danno d’organo e associazione con altre patologie: sindrome dell’ovaio policistico (PCOS), sindrome delle apnee ostruttive del sonno (OSAS), malattie neurodegenerative, patologie neoplastiche.
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Saunajoki A, Auvinen J, Bloigu A, Saramies J, Tuomilehto J, Uusitalo H, Hussi E, Cederberg-Tamminen H, Suija K, Keinänen-Kiukaanniemi S, Timonen M. Elevated One-Hour Post-Load Glucose Is Independently Associated with Albuminuria: A Cross-Sectional Population Study. J Clin Med 2022; 11:jcm11144124. [PMID: 35887888 PMCID: PMC9317539 DOI: 10.3390/jcm11144124] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 07/08/2022] [Accepted: 07/14/2022] [Indexed: 02/01/2023] Open
Abstract
The purpose of this study was to examine and compare the associations between albuminuria and fasting (FPG), 1 h post-load (1 h PG) and 2 h post-load plasma glucose (2 h PG) in an oral glucose tolerance test (OGTT). A total of 496 people free of known diabetes (mean age 72 years) participated in the examinations including the OGTT with plasma glucose measurements at 0, 1, and 2 h and levels of HbA1c. Albuminuria was determined by the urinary albumin-to-creatinine ratio and was defined as ≥3.0 mg/mmol. Compared with those without albuminuria, participants with albuminuria had significantly higher 1 h PG and 2 h PG levels, but not FPG or HbA1c levels. An elevated 1 h PG increased the estimated odds ratio of albuminuria more than three times in people with prediabetic 1 h PG (8.6–11.5 mmol/L: OR 3.60; 95% CI 1.70–7.64) and diabetic 1 h PG (≥11.6 mmol/L: OR 3.05; 95% CI 1.29–7.23). After adjusting for blood pressure and age, the association of elevated 1 h PG with albuminuria remained significant. Prediabetic or diabetic FPG, 2 h PG, or HbA1c did not have a statistically significant association with albuminuria. These findings suggest that 1 h PG seems to be the best glycemic parameter and is useful in recognizing persons with an elevated risk of early kidney disease due to hyperglycemia.
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Affiliation(s)
- Anni Saunajoki
- Center for Life Course Health Research, University of Oulu, 90220 Oulu, Finland; (J.A.); (A.B.); (J.S.); (K.S.); (S.K.-K.); (M.T.)
- Correspondence:
| | - Juha Auvinen
- Center for Life Course Health Research, University of Oulu, 90220 Oulu, Finland; (J.A.); (A.B.); (J.S.); (K.S.); (S.K.-K.); (M.T.)
- Medical Research Center Oulu, Oulu University Hospital and University of Oulu, 90220 Oulu, Finland
| | - Aini Bloigu
- Center for Life Course Health Research, University of Oulu, 90220 Oulu, Finland; (J.A.); (A.B.); (J.S.); (K.S.); (S.K.-K.); (M.T.)
| | - Jouko Saramies
- Center for Life Course Health Research, University of Oulu, 90220 Oulu, Finland; (J.A.); (A.B.); (J.S.); (K.S.); (S.K.-K.); (M.T.)
- South Karelia Social and Health Care District, 53130 Lappeenranta, Finland;
| | - Jaakko Tuomilehto
- Department of Public Health and Welfare, Finnish Institute for Health and Welfare, 00271 Helsinki, Finland;
- Diabetes Research Group, King Abdulaziz University, Jeddah 22254, Saudi Arabia
| | - Hannu Uusitalo
- Department of Ophthalmology, Faculty of Medicine and Health Technology, Tampere University, 33014 Tampere, Finland;
- Tays Eye Centre, Tampere University Hospital, 33014 Tampere, Finland
| | - Esko Hussi
- South Karelia Social and Health Care District, 53130 Lappeenranta, Finland;
| | - Henna Cederberg-Tamminen
- Department of Endocrinology, Abdominal Center, Helsinki University Hospital, 00290 Helsinki, Finland;
| | - Kadri Suija
- Center for Life Course Health Research, University of Oulu, 90220 Oulu, Finland; (J.A.); (A.B.); (J.S.); (K.S.); (S.K.-K.); (M.T.)
- Institute of Family Medicine and Public Health, Faculty of Medicine, University of Tartu, 50411 Tartu, Estonia
| | - Sirkka Keinänen-Kiukaanniemi
- Center for Life Course Health Research, University of Oulu, 90220 Oulu, Finland; (J.A.); (A.B.); (J.S.); (K.S.); (S.K.-K.); (M.T.)
- Healthcare and Social Services of Selänne, 98530 Pyhäjärvi, Finland
| | - Markku Timonen
- Center for Life Course Health Research, University of Oulu, 90220 Oulu, Finland; (J.A.); (A.B.); (J.S.); (K.S.); (S.K.-K.); (M.T.)
- Medical Research Center Oulu, Oulu University Hospital and University of Oulu, 90220 Oulu, Finland
- Unit of General Practice, Oulu University Hospital, 90220 Oulu, Finland
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Nawaz S, Chinnadurai R, Al Chalabi S, Evans P, Kalra PA, Syed AA, Sinha S. Obesity and Chronic Kidney Disease A Current Review. Obes Sci Pract 2022; 9:61-74. [PMID: 37034567 PMCID: PMC10073820 DOI: 10.1002/osp4.629] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 06/02/2022] [Accepted: 07/04/2022] [Indexed: 11/08/2022] Open
Abstract
Background Obesity poses significant challenges to healthcare globally, particularly through its bi-directional relationship with co-morbid metabolic conditions such as type 2 diabetes and hypertension. There is also emerging evidence of an association between obesity and chronic kidney disease (CKD) which is less well characterized. Methods A literature search of electronic libraries was conducted to identify and present a narrative review of the interplay between obesity and CKD. Findings Obesity may predispose to CKD directly as it is linked to the histopathological finding of obesity-related glomerulopathy and indirectly through its widely recognized complications such as atherosclerosis, hypertension, and type 2 diabetes. The biochemical and endocrine products of adipose tissue contribute to pathophysiological processes such as inflammation, oxidative stress, endothelial dysfunction, and proteinuria. The prevention and management of obesity may prove critical in counteracting both the development and advancement of CKD. Moreover, measures of abdominal adiposity such as waist circumference, are generally associated with worse morbidity and mortality in individuals receiving maintenance hemodialysis. Conclusion Obesity is a risk factor for the onset and progression of CKD and should be recognized as a potential target for a preventative public health approach to reduce CKD rates within the general population. Future research should focus on the use of glucagon-like peptide-1 receptor agonists and sodium-glucose cotransporter 2 inhibitors in patients with CKD and obesity due to their multi-faceted actions on major outcomes.
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Affiliation(s)
- Saira Nawaz
- Faculty of Biology Medicine and Health University of Manchester Manchester UK
| | - Rajkumar Chinnadurai
- Faculty of Biology Medicine and Health University of Manchester Manchester UK
- Department of Renal Medicine Salford Royal Hospital Northern Care Alliance NHS Foundation Trust Salford UK
| | - Saif Al Chalabi
- Faculty of Biology Medicine and Health University of Manchester Manchester UK
- Department of Renal Medicine Salford Royal Hospital Northern Care Alliance NHS Foundation Trust Salford UK
| | - Philip Evans
- Department of Renal Medicine Liverpool University Hospitals NHS Foundation Trust Liverpool UK
| | - Philip A Kalra
- Faculty of Biology Medicine and Health University of Manchester Manchester UK
- Department of Renal Medicine Salford Royal Hospital Northern Care Alliance NHS Foundation Trust Salford UK
| | - Akheel A. Syed
- Faculty of Biology Medicine and Health University of Manchester Manchester UK
- Department of Diabetes Endocrinology and Obesity Medicine Salford Royal Hospital Northern Care Alliance NHS Foundation Trust Salford UK
| | - Smeeta Sinha
- Faculty of Biology Medicine and Health University of Manchester Manchester UK
- Department of Renal Medicine Salford Royal Hospital Northern Care Alliance NHS Foundation Trust Salford UK
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Xu J, Xue Y, Chen Q, Han X, Cai M, Tian J, Jin S, Lu H. Identifying Distinct Risk Thresholds of Glycated Hemoglobin and Systolic Blood Pressure for Rapid Albuminuria Progression in Type 2 Diabetes From NHANES (1999–2018). Front Med (Lausanne) 2022; 9:928825. [PMID: 35795642 PMCID: PMC9251013 DOI: 10.3389/fmed.2022.928825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 05/12/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundIt is widely recognized that glycated hemoglobin (HbA1c) and systolic blood pressure (SBP) are two key risk factors for albuminuria and renal function impairment in patients with type 2 diabetes mellitus (T2DM). Our study aimed to identify the specific numerical relationship of albumin/creatinine ratio (ACR) with HbA1c and SBP among a large population of adults with T2DM.MethodA total of 8,626 patients with T2DM were included in the data analysis from the National Health and Nutrition Examination Surveys (NHANES) (1999-2018). The multiple linear regressions were used to examine the associations of ACR with HbA1c and SBP. Generalized additive models with smooth functions were performed to identify the non-linear relations between variables and interactions were also tested.ResultsSignificantly threshold effects were observed between ACR and HbA1c or SBP after multivariable adjustment, with the risk threshold values HbA1c = 6.4% and SBP = 127 mmHg, respectively. Once above thresholds were exceeded, the lnACR increased dramatically with higher levels of HbA1c (β = 0.23, 95 CI%:0.14, 0.32, P < 0.001) and SBP (β = 0.03, 95 CI%:0.03, 0.04, P < 0.001). Subgroup analysis showed high protein diet was related to higher ACR. In addition, a higher risk of ACR progression was observed in central obesity participants with HbA1C ≥ 6.4% or hyperuricemia participants with SBP ≥ 127 mmHg among patients withT2DM.ConclusionWe identified thresholds of HbA1c and SBP to stratify patients with T2DM through rapid albuminuria progression. These might provide a clinical reference value for preventing and controlling diabetes kidney disease.
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Affiliation(s)
- Jiahui Xu
- Department of Endocrinology, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Yan Xue
- Laboratory of Cellular Immunity, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Qingguang Chen
- Department of Endocrinology, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Xu Han
- Department of Endocrinology, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Mengjie Cai
- Department of Endocrinology, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Jing Tian
- Department of Endocrinology, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Shenyi Jin
- Department of Endocrinology, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Hao Lu
- Department of Endocrinology, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- *Correspondence: Hao Lu,
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Migdalis IN, Ioannidis IM, Papanas N, Raptis AE, Sotiropoulos AE, Dimitriadis GD. Hypertriglyceridemia and Other Risk Factors of Chronic Kidney Disease in Type 2 Diabetes: A Hospital-Based Clinic Population in Greece. J Clin Med 2022; 11:jcm11113224. [PMID: 35683611 PMCID: PMC9181038 DOI: 10.3390/jcm11113224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Revised: 05/24/2022] [Accepted: 06/03/2022] [Indexed: 02/04/2023] Open
Abstract
Aims/Introduction: Several reports indicate an increasing prevalence of chronic kidney disease (CKD) in type 2 diabetes mellitus (T2DM). Hyperglycemia and hypertension are the main risk factors for CKD development and progression. However, despite the achievement of recommended targets for blood glucose and blood pressure (BP), the residual risk of diabetic chronic kidney disease (DCKD) remains relatively high. The aim of this study is to examine dyslipidemia and other major risk factors to provide support for the prevention and treatment of DCKD. Materials and Methods: Participants are from the Redit-2-Diag study that examines 1759 subjects within a period of 6 months. DCKD severity is staged according to KDIGO criteria. Results: An increase in hemoglobin A1c (1 unit) and systolic blood pressure (1 mm Hg) increases the probability of being classified into a higher CKD stage by 14% and 26%, respectively. Moreover, an increase of triglycerides by 88.5 mg/dL increases the risk of classification to a worse CKD stage by 24%. Conclusions: Elevated triglycerides, systolic blood pressure, and poor glycemic control increase the risk of CKD in T2DM and should be addressed in the treatment strategies.
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Affiliation(s)
- Ilias N. Migdalis
- Second Medical Department and Diabetes Centre, NIMTS Hospital, 115 21 Athens, Greece
- Correspondence:
| | - Ioannis M. Ioannidis
- First Medical Department and Diabetes Centre, Hospital of Nea Ionia Konstantopoulio-Patision, 142 33 Athens, Greece;
| | - Nikolaos Papanas
- Second Department of Internal Medicine and Diabetes Centre, University Hospital of Alexandroupolis, Democritus University of Thrace, 681 00 Alexandroupolis, Greece;
| | - Athanasios E. Raptis
- Second Department of Internal Medicine, Research Institute and Diabetes Centre, Attikon University Hospital, Medical School, National and Kapodistrian University of Athens, 124 62 Athens, Greece; (A.E.R.); (G.D.D.)
| | | | - George D. Dimitriadis
- Second Department of Internal Medicine, Research Institute and Diabetes Centre, Attikon University Hospital, Medical School, National and Kapodistrian University of Athens, 124 62 Athens, Greece; (A.E.R.); (G.D.D.)
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Wang X, Huang C, Liu Y, Han Y, Hu H. Association of estimated glomerular filtration rate and incident pre-diabetes: A secondary 5-year longitudinal cohort study in Chinese people. Front Endocrinol (Lausanne) 2022; 13:965545. [PMID: 36387884 PMCID: PMC9648615 DOI: 10.3389/fendo.2022.965545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 10/14/2022] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE There is still limited evidence regarding the relationship between the estimated glomerular filtration rate (eGFR) and pre-diabetes. For that reason, our research aims to survey the association of eGFR with pre-diabetes. METHODS This study was a retrospective cohort study, which consecutively and non-selectively collected a total of 173301 participants from Rich Healthcare Group in China from January 2010 to 2016. We then used the Cox proportional-hazards regression model to explore the relationship between baseline eGFR and pre-diabetes risk. Using a Cox proportional hazards regression with cubic spline function and smooth curve fitting (cubical spline smoothing), we were able to determine the non-linear relationship between eGFR and pre-diabetes. Additionally, we also conducted a series of sensitivity analyses and subgroup analyses. The DATADRYAD website was updated with data. RESULTS The mean age of the included individuals was 40.95 ± 11.94 years old, and 92318 (53.27%) were male. The mean baseline eGFR was 111.40 ± 14.77 ml/min per 1.73 m2. During a median follow-up time of 3.0 years, 18333 (10.58%) people experienced pre-diabetes. As a result of adjusting for covariates, eGFR had a negative association with incident pre-diabetes (HR=0.993, 95%CI: 0.992-0.995). There was also a U-shaped curve relationship between eGFR and pre-diabetes, and the inflection point of eGFR was 129.793 ml/min per 1.73 m2. HRs on the left and right sides of the inflection point were respectively 0.993 (0.991-0.994) and 1.023 (1.010- 1.037). Our results were robust in the sensitivity analysis. Subgroup analyses indicated that eGFR was strongly associated with the risk of pre-diabetes among participants who were younger than 30 years and 40-70 years, as well as among those who had never smoked. In contrast, the association of eGFR with the risk of pre-diabetes was attenuated among participants who were 30-40 years of age and 70 years of age or older, and among those who currently smoked. CONCLUSION This study demonstrates a negative and U-shaped curve association between eGFR and the risk of pre-diabetes among the general Chinese population. Either reduced renal function or glomerular hyperperfusion status may be associated with an increased risk of prediabetes.
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Affiliation(s)
- Xiaoyu Wang
- Department of Nephrology, Hechi People’s Hospital, Hechi, Guangxi Zhuang Autonomous Region, China
| | - Cheng Huang
- Department of Nephrology, Hechi People’s Hospital, Hechi, Guangxi Zhuang Autonomous Region, China
| | - Yufei Liu
- Department of Neurosurgery, Shenzhen Second People’s Hospital, Shenzhen, Guangdong, China
- Department of Neurosurgery, The First Affiliated Hospital of Shenzhen University, Shenzhen, Guangdong, China
- Shenzhen University Health Science Center, Shenzhen University, Shenzhen, Guangdong, China
| | - Yong Han
- Shenzhen University Health Science Center, Shenzhen University, Shenzhen, Guangdong, China
- Department of Emergency, Shenzhen Second People’s Hospital, Shenzhen, Guangdong, China
- Department of Emergency, The First Affiliated Hospital of Shenzhen University, Shenzhen, Guangdong, China
- *Correspondence: Yong Han, ; Haofei Hu,
| | - Haofei Hu
- Shenzhen University Health Science Center, Shenzhen University, Shenzhen, Guangdong, China
- Department of Nephrology, Shenzhen Second People’s Hospital, Shenzhen, Guangdong, China
- Department of Nephrology, The First Affiliated Hospital of Shenzhen University, Shenzhen, Guangdong, China
- *Correspondence: Yong Han, ; Haofei Hu,
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Liu G, Tao L, Zhu Q, Jiao X, Yan L, Shao F. Association between the metabolic score for insulin resistance (METS-IR) and estimated glomerular filtration rate (eGFR) among health check-up population in Japan: A retrospective cross-sectional study. Front Endocrinol (Lausanne) 2022; 13:1027262. [PMID: 36589854 PMCID: PMC9800885 DOI: 10.3389/fendo.2022.1027262] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 12/05/2022] [Indexed: 12/23/2022] Open
Abstract
AIM This study aimed to investigate the relationship between a new metric-metabolic score for insulin resistance (METS-IR)-and estimated glomerular filtration rate (eGFR) among Japanese participants who underwent health check-ups. METHODS We conducted a cross-sectional study that involved participants in a medical health screening program, which was conducted at the Medical Health Check-up Center in Japan. This retrospective study examined the relationship between METS-IR and eGFR among 881 individuals that joined the program between March 1, 2004, and December 31, 2012. Covariates consisted of serum laboratory tests and lifestyle questionnaires. Multivariate linear regression analysis was used to explore the association between METS-IR and eGFR. In addition, subgroup and interaction analyses were done based on age, sex, body mass index (BMI), alcohol use, smoking status, and hyperuricemia. RESULTS A total of 881 individuals participated in this study. High METS-IR was highly linked with reduced eGFR (adjusted β = -5.04, 95% confidence interval (CI): -7.65 to -2.43), while METS-IR was utilized as a categorical variable inside the multiple regression analysis. A decrease in eGFR of 2.54 units was reported for every 10-unit rise in METS-IR (adjusted β = -2.54, 95% CI: -4.04 to -1.05, P-value = 0.001). Stratified analysis suggested no marked interaction between METS-IR and eGFR across age, sex, BMI, and alcohol consumption groups. However, there was an indication of interaction between METS-IR level, smoking status (P-value = 0.001), and uric level (P-value = 0.011) on eGFR decrease. CONCLUSIONS METS-IR is remarkably associated with eGFR among the participants who underwent health check-ups in Gifu, Japan. Although more studies are required to prove it, METS-IR could be applied as a monitoring index for early screening, primary prevention, and diagnostic and treatment management strategies for chronic kidney disease.
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Lin CA, Liu YP, Chen YC, Yu W, Xiong XJ, Huang HY, Li WC, Chen JY. Gender-specific and age-specific associations of the homoeostasis model assessment for IR (HOMA-IR) with albuminuria and renal function impairment: a retrospective cross-sectional study in Southeast China. BMJ Open 2021; 11:e053649. [PMID: 34921082 PMCID: PMC8685940 DOI: 10.1136/bmjopen-2021-053649] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
OBJECTIVES The study aimed to investigate the association of insulin resistance (IR), which was estimated by the homoeostasis model assessment for IR (HOMA-IR), with albuminuria and renal function impairment in a general Chinese population. DESIGN A retrospective cross-sectional study. SETTING AND PARTICIPANTS A total of 13 742 adults (age: ≥18 years) who underwent a health check-up at a hospital in Southeast China during 2013-2014 were enrolled. 216 subjects were excluded due to lack of enough fasting time, be pregnant, have chronic diseases influencing metabolic functions or have glomerulonephritis, renal cancer, kidney transplant. Eventually, 7552 men and 5974 women were included for the present analysis. PRIMARY OUTCOME MEASURES The association of HOMA-IR with albuminuria and renal function impairment were analysed. The HOMA-IR cut-off value for detecting albuminuria and renal function impairment were determined. RESULTS An increase in the HOMA-IR quartile was significantly associated with the prevalence of albuminuria and renal function impairment in all men and women aged >45 years. The multivariable logistic regression analyses revealed a significant association of the HOMA-IR with albuminuria and renal function impairment in subjects aged >45 years of the fourth quartiles compared with those of the first quartile after adjusting for potential confounders (albuminuria: men OR, 2.39; 95% CI 1.51 to 3.79, p<0.001; women OR, 2.40; 95% CI 1.44 to 4.01; p=0.001; renal function impairment: men OR, 2.30; 95% CI 1.50 to 3.51; p<0.001; women OR, 2.20; 95% CI 1.35 to 3.58; p=0.002). The optimal cut-off value of HOMA-IR for detecting albuminuria and renal function impairment was 2.69 in men aged ≤45 years, 1.60 in men aged >45 years and 1.86 in women aged >45 years. CONCLUSIONS Our study revealed that HOMA-IR was significantly associated with albuminuria and renal function impairment in individuals aged >45 years.
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Affiliation(s)
- Chieh-An Lin
- Department of Family Medicine, Chang Gung Memorial Hospital Linkou Main Branch, Taoyuan, Taiwan
| | - Yu-Ping Liu
- Department of Endocrinology and Metabolism, Xiamen Chang Gung Hospital, Xiamen, Fujian, China
| | - Yi-Chuan Chen
- Department of Family Medicine, Chang Gung Memorial Hospital Linkou Main Branch, Taoyuan, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Wei Yu
- Department of Health Management, Xiamen Chang Gung Hospital, Xiamen, Fujian, China
| | - Xue-Jie Xiong
- Department of Oncology, Xiamen Chang Gung Hospital, Xiamen, Fujian, China
| | - Hsiung-Ying Huang
- Department of Pulmonary and Critical Care Medicine, Xiamen Chang Gung Hospital, Xiamen, Fujian, China
| | - Wen-Cheng Li
- Department of Family Medicine, Chang Gung Memorial Hospital Linkou Main Branch, Taoyuan, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Department of Health Management, Xiamen Chang Gung Hospital, Xiamen, Fujian, China
| | - Jau-Yuan Chen
- Department of Family Medicine, Chang Gung Memorial Hospital Linkou Main Branch, Taoyuan, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
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Wang P, Li Q, Guo X, Zhou Y, Li Z, Yang H, Yu S, Sun G, Zheng L, Sun Y, Zhang X. Usefulness of metabolic score for insulin resistance index in estimating the risk of mildly reduced estimate glomerular filtration rate: a cross-sectional study of rural population in China. BMJ Open 2021; 11:e050907. [PMID: 34916312 PMCID: PMC8679137 DOI: 10.1136/bmjopen-2021-050907] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVES This study aimed to reveal the association between metabolic score for insulin resistance (MetS-IR) and the risk of mildly decreased estimated glomerular filtration rate (eGFR), and explore the evaluation effect of MetS-IR on the progress of eGFR decline. STUDY DESIGN A cross-sectional study. SETTING AND PARTICIPANTS A total of 11 956 rural participants (aged ≥35 years) from northeastern China were enrolled in the study. After excluding the subjects whose data were not integrated or who met the exclusion criteria, we finally obtained 11 042 participants in the present study. MAIN OUTCOME MEASURES Mildly decreased eGFR was defined as 60-90 mL/min/1.73 m2. RESULTS The prevalence of mildly decreased eGFR in the general population was 36.9%. After adjustment of covariates, each SD increment of MetS-IR could bring 26.3% additional risk of mildly decreased eGFR (OR: 1.263, 95% CI: 1.066 to 1.497, p=0.007). When MetS-IR was classified into four levels by quartile, we observed participants in the top level had 3.032-fold risk of mildly decreased eGFR (OR: 3.032, 95% CI: 1.841 to 4.991, p<0.001) compared with those from the bottom level. Further, we found the participants with higher MetS-IR score were more likely to aggravate into a worse renal state which presented as higher risk of accelerated decline of eGFR, by additional 28.3% risk in whole participants (OR: 1.283, 95% CI: 1.150 to 1.430, p<0.001) and 41.9% in men (OR: 1.419, 95% CI: 1.183 to 1.701, p<0.001). CONCLUSION High MetS-IR was associated with high risk of mildly reduced eGFR and often accompanied by a high risk of accelerated decline in eGFR. Hence, we believed MetS-IR was a suitable indicator to evaluate the risk of early-stage renal dysfunction.
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Affiliation(s)
- Pengbo Wang
- Department of Cardiology, The First Hospital of China Medical University, Shenyang, Liaoning, China
| | - Qiyu Li
- Department of Cardiology, The First Hospital of China Medical University, Shenyang, Liaoning, China
| | - Xiaofan Guo
- Department of Cardiology, The First Hospital of China Medical University, Shenyang, Liaoning, China
| | - Ying Zhou
- Department of Cardiology, The First Hospital of China Medical University, Shenyang, Liaoning, China
| | - Zhao Li
- Department of Cardiology, The First Hospital of China Medical University, Shenyang, Liaoning, China
| | - Hongmei Yang
- Department of Cardiology, The First Hospital of China Medical University, Shenyang, Liaoning, China
| | - Shasha Yu
- Department of Cardiology, The First Hospital of China Medical University, Shenyang, Liaoning, China
| | - Guozhe Sun
- Department of Cardiology, The First Hospital of China Medical University, Shenyang, Liaoning, China
| | - Liqiang Zheng
- Department of Clinical Epidemiology, Shengjing Hospital of China Medical University, Shenyang, Liaoning, China
| | - Yingxian Sun
- Department of Cardiology, The First Hospital of China Medical University, Shenyang, Liaoning, China
| | - Xingang Zhang
- Department of Cardiology, The First Hospital of China Medical University, Shenyang, Liaoning, China
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Kotsis V, Martinez F, Trakatelli C, Redon J. Impact of Obesity in Kidney Diseases. Nutrients 2021; 13:nu13124482. [PMID: 34960033 PMCID: PMC8703549 DOI: 10.3390/nu13124482] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 12/10/2021] [Accepted: 12/10/2021] [Indexed: 01/14/2023] Open
Abstract
The clinical consequences of obesity on the kidneys, with or without metabolic abnormalities, involve both renal function and structures. The mechanisms linking obesity and renal damage are well understood, including several effector mechanisms with interconnected pathways. Higher prevalence of urinary albumin excretion, sub-nephrotic syndrome, nephrolithiasis, increased risk of developing CKD, and progression to ESKD have been identified as being associated with obesity and having a relevant clinical impact. Moreover, renal replacement therapy and kidney transplantation are also influenced by obesity. Losing weight is key in limiting the impact that obesity produces on the kidneys by reducing albuminuria/proteinuria, declining rate of eGFR deterioration, delaying the development of CKD and ESKD, and improving the outcome of a renal transplant. Weight reduction may also contribute to appropriate control of cardiometabolic risk factors such as hypertension, metabolic syndrome, diabetes, and dyslipidemia which may be protective not only in renal damage but also cardiovascular disease. Lifestyle changes, some drugs, and bariatric surgery have demonstrated the benefits.
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Affiliation(s)
- Vasilios Kotsis
- 3rd Department of Internal Medicine, Hypertension-24h ABPM ESH Center of Excellence, Papageorgiou Hospital, Aristotle University of Thessaloniki, 564 29 Pavlos Melas, Greece; (V.K.); (C.T.)
| | - Fernando Martinez
- Internal Medicine Hospital Clínico de Valencia, 46010 Valencia, Spain;
| | - Christina Trakatelli
- 3rd Department of Internal Medicine, Hypertension-24h ABPM ESH Center of Excellence, Papageorgiou Hospital, Aristotle University of Thessaloniki, 564 29 Pavlos Melas, Greece; (V.K.); (C.T.)
| | - Josep Redon
- Internal Medicine Hospital Clínico de Valencia, 46010 Valencia, Spain;
- Cardiovascular and Renal Research Group, INCLIVA Research Institute, University of Valencia, 46010 Valencia, Spain
- CIBERObn Carlos III Institute, 28029 Madrid, Spain
- Correspondence:
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Kim SH, Kim HS, Min HK, Lee SW. Association between insulin resistance and lung function trajectory over 4 years in South Korea: community-based prospective cohort. BMC Pulm Med 2021; 21:110. [PMID: 33794844 PMCID: PMC8017677 DOI: 10.1186/s12890-021-01478-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 03/24/2021] [Indexed: 11/10/2022] Open
Abstract
Background Hyperglycemic conditions are associated with respiratory dysfunction. Although several studies have reported that insulin resistance (IR) is related to decreased lung function, the association between IR and change in lung function has been rarely studied. This study aimed to investigate the potential association of IR on annual change in lung function using a community-based prospective cohort in Korea. Methods We selected 4827 Korean participants whose serial lung functions were assessed over 4 years using 1:3 propensity score matching. Exposure was baseline IR estimated with homeostatic model assessment (HOMA-IR), and outcomes were annual changes in lung function determined by calculating the regression coefficient using least-square linear regression analysis. Results In the multivariate linear regression, per one unit increased log transformed HOMA-IR was associated with decline in FEV1%-predicted (β: − 0.23, 95% CI: − 0.36 to − 0.11) and FVC %-predicted (β: − 0.20, 95% CI: − 0.33 to − 0.08), respectively. In the generalized additive model plot, HOMA-IR showed a negative linear association with annual changes in FEV1%-predicted and FVC %-predicted. The suggested threshold of HOMA-IR for decline in lung function was 1.0 unit for annual change in FEV1%-predicted and 2.2 unit for annual change in FVC %-predicted. Age showed statistically significant effect modification on the relationship between HOMA-IR and annual change in FEV1%-predicted. Increased HOMA-IR was associated with the decreased annual change in FEV1%-predicted, particularly in older people. Conclusions In South Korea, increased HOMA-IR was associated with decline in lung function. Since IR was related to decline in FEV1%-predicted, particularly in older people, tailored approaches are needed in these populations. The potential pulmonary hazard of IR needs to be confirmed in future studies. Supplementary Information The online version contains supplementary material available at 10.1186/s12890-021-01478-7.
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Affiliation(s)
- Sang Hyuk Kim
- Medical Corps 2nd of Armored Brigade, Republic of Korea Army, Paju, Korea
| | - Hyun Sam Kim
- Division of Nephrology, Department of Internal Medicine, Eulji Medical Center, 68, Hangeulbiseok-ro, Nowon-gu, Seoul, 01735, Korea
| | - Hyang Ki Min
- Division of Nephrology, Department of Internal Medicine, Eulji Medical Center, 68, Hangeulbiseok-ro, Nowon-gu, Seoul, 01735, Korea
| | - Sung Woo Lee
- Division of Nephrology, Department of Internal Medicine, Eulji Medical Center, 68, Hangeulbiseok-ro, Nowon-gu, Seoul, 01735, Korea.
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Zhao J, Tan C, Imai R, Ukon N, Shimoyama S, Maejima Y, Omiya Y, Takahashi K, Ito H, Nan G, Zhao S, Shimomura K. Evaluation of organ glucose metabolism by 18F-FDG accumulation with insulin loading in aged mice compared with young normal mice. Sci Rep 2021; 11:7421. [PMID: 33795778 PMCID: PMC8016832 DOI: 10.1038/s41598-021-86825-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 03/17/2021] [Indexed: 12/20/2022] Open
Abstract
It is important to determine the functional changes of organs that occur as a result of aging, the understanding of which may lead to the maintenance of a healthy life. Glucose metabolism in healthy bodies is one of the potential markers used to evaluate the changes of organ function. Thus, information about normal organ glucose metabolism may help to understand the functional changes of organs. [18F]-Fluoro-2-deoxy-2-d-glucose (18F-FDG), a glucose analog, has been used to measure glucose metabolism in various fields, such as basic medical research and drug discovery. However, glucose metabolism changes in aged animals have not yet been fully clarified. The aim of this study is to evaluate changes in glucose metabolism in organs and brain regions by measuring 18F-FDG accumulation and 18F-FDG autoradiography with insulin loading in aged and young wild-type mice. In the untreated groups, the levels of 18F-FDG accumulation in the blood, plasma, muscle, lungs, spleen, pancreas, testes, stomach, small intestine, kidneys, liver, brain, and brain regions, namely, the cortex, striatum, thalamus, and hippocampus, were all significantly higher in the aged mice. The treated group showed lower 18F-FDG accumulation levels in the pancreas and kidneys, as well as in the cortex, striatum, thalamus, and hippocampus in the aged mice than the untreated groups, whereas higher 18F-FDG accumulation levels were observed in those in the young mice. These results demonstrate that insulin loading decreases effect on 18F-FDG accumulation levels in some organs of the aged mice. Therefore, aging can increase insulin resistance and lead to systemic glucose metabolism dysfunction.
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Affiliation(s)
- Jingmin Zhao
- Department of Neurology, China-Japan Union Hospital of Jilin University, 126 XianTai Street, Changchun, 130031, Jilin, China.,Department of Radiology and Nuclear Medicine, Fukushima Medical University, Fukushima, Japan
| | - Chengbo Tan
- Department of Neurosurgery, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China.,Advanced Clinical Research Center, Fukushima Global Medical Science Center, Fukushima Medical University, Fukushima, 960-1295, Japan
| | - Ryota Imai
- Department of Bioregulation and Pharmacological Medicine, Fukushima Medical University, Fukushima, Japan.,Tsumura Kampo Research Laboratories, Kampo Research & Development Division, Tsumura & Co., Ibaraki, Japan
| | - Naoyuki Ukon
- Advanced Clinical Research Center, Fukushima Global Medical Science Center, Fukushima Medical University, Fukushima, 960-1295, Japan
| | - Saki Shimoyama
- Advanced Clinical Research Center, Fukushima Global Medical Science Center, Fukushima Medical University, Fukushima, 960-1295, Japan
| | - Yuko Maejima
- Department of Bioregulation and Pharmacological Medicine, Fukushima Medical University, Fukushima, Japan
| | - Yuji Omiya
- Tsumura Kampo Research Laboratories, Kampo Research & Development Division, Tsumura & Co., Ibaraki, Japan
| | - Kazuhiro Takahashi
- Advanced Clinical Research Center, Fukushima Global Medical Science Center, Fukushima Medical University, Fukushima, 960-1295, Japan
| | - Hiroshi Ito
- Department of Radiology and Nuclear Medicine, Fukushima Medical University, Fukushima, Japan.,Advanced Clinical Research Center, Fukushima Global Medical Science Center, Fukushima Medical University, Fukushima, 960-1295, Japan
| | - Guangxian Nan
- Department of Neurology, China-Japan Union Hospital of Jilin University, 126 XianTai Street, Changchun, 130031, Jilin, China.
| | - Songji Zhao
- Advanced Clinical Research Center, Fukushima Global Medical Science Center, Fukushima Medical University, Fukushima, 960-1295, Japan. .,Basic Medical College of Jilin University, Changchun, China.
| | - Kenju Shimomura
- Department of Bioregulation and Pharmacological Medicine, Fukushima Medical University, Fukushima, Japan
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Energy Expenditure Improved Risk Factors Associated with Renal Function Loss in NAFLD and MetS Patients. Nutrients 2021; 13:nu13020629. [PMID: 33672073 PMCID: PMC7919687 DOI: 10.3390/nu13020629] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 02/06/2021] [Accepted: 02/10/2021] [Indexed: 12/12/2022] Open
Abstract
To assess the efficacy of three lifestyle interventions on the reduction of liver fat content and metabolic syndrome (MetS), and whether such reductions would influence renal outcomes, we conducted a randomized controlled trial on 128 participants with MetS and non-alcoholic fatty liver disease (NAFLD), as well as available data on estimated glomerular filtration rate (eGFR) and urinary albumin-to-creatine ratio (UACR). Patients were randomized in 1:1:1 ratio to either Conventional Diet, Mediterranean diet (MD)-high meal frequency, and MD-physical activity groups. Each intervention aimed at reducing caloric intake by 25%-30% of baseline intake and increase energy expenditure by 400 kcal/70 kg. Patients attended regular visits and were followed-up for 6 months. Increased albuminuria was present in 13.3% of patients, while 32.8% showed hyperfiltration. UACR reduction was associated with higher levels of UACR at baseline but not with changes in liver fat. eGFR decreased in patients presenting hyperfiltration at baseline and was associated with reduction in liver fat and insulin resistance, as well as with increase in energy expenditure (R2 = 0.248, p = 0.006). No significant differences were observed between the three treatment groups. In patients with NAFLD and MetS, energy expenditure significantly reduced hepatic fat accumulation and insulin resistance, which reduced glomerular hyperfiltration. Increased albuminuria was reduced, but it was not associated with reduced liver fat.
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Grover A, Sharma K, Gautam S, Gautam S, Gulati M, Singh SK. Diabetes and Its Complications: Therapies Available, Anticipated and Aspired. Curr Diabetes Rev 2021; 17:397-420. [PMID: 33143627 DOI: 10.2174/1573399816666201103144231] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 08/26/2020] [Accepted: 09/12/2020] [Indexed: 11/22/2022]
Abstract
Worldwide, diabetes ranks among the ten leading causes of mortality. Prevalence of diabetes is growing rapidly in low and middle income countries. It is a progressive disease leading to serious co-morbidities, which results in increased cost of treatment and over-all health system of the country. Pathophysiological alterations in Type 2 Diabetes (T2D) progressed from a simple disturbance in the functioning of the pancreas to triumvirate to ominous octet to egregious eleven to dirty dozen model. Due to complex interplay of multiple hormones in T2D, there may be multifaceted approach in its management. The 'long-term secondary complications' in uncontrolled diabetes may affect almost every organ of the body, and finally may lead to multi-organ dysfunction. Available therapies are inconsistent in maintaining long term glycemic control and their long term use may be associated with adverse effects. There is need for newer drugs, not only for glycemic control but also for prevention or mitigation of secondary microvascular and macrovascular complications. Increased knowledge of the pathophysiology of diabetes has contributed to the development of novel treatments. Several new agents like Glucagon Like Peptide - 1 (GLP-1) agonists, Dipeptidyl Peptidase IV (DPP-4) inhibitors, amylin analogues, Sodium-Glucose transport -2 (SGLT- 2) inhibitors and dual Peroxisome Proliferator-Activated Receptor (PPAR) agonists are available or will be available soon, thus extending the range of therapy for T2D, thereby preventing its long term complications. The article discusses the pathophysiology of diabetes along with its comorbidities, with a focus on existing and novel upcoming antidiabetic drugs which are under investigation. It also dives deep to deliberate upon the novel therapies that are in various stages of development. Adding new options with new mechanisms of action to the treatment armamentarium of diabetes may eventually help improve outcomes and reduce its economic burden.
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Affiliation(s)
- Anu Grover
- Ipca Laboratories, Mumbai - 400063, India
| | - Komal Sharma
- Bhupal Nobles' Institute of Pharmaceutical Sciences, Udaipur, India
| | - Suresh Gautam
- Department of Biochemistry, Pacific Institute of Medical Sciences, Udaipur, India
| | - Srishti Gautam
- Ravinder Nath Tagore Medical College and Maharana Bhupal Govt. Hospital, Udaipur, India
| | - Monica Gulati
- School of Pharmaceutical Sciences, Lovely Professional University, Phagwara, Punjab- 144411, India
| | - Sachin Kumar Singh
- School of Pharmaceutical Sciences, Lovely Professional University, Phagwara, Punjab- 144411, India
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Lv L, Zhou Y, Chen X, Gong L, Wu J, Luo W, Shen Y, Han S, Hu J, Wang Y, Li Q, Wang Z. Relationship Between the TyG Index and Diabetic Kidney Disease in Patients with Type-2 Diabetes Mellitus. Diabetes Metab Syndr Obes 2021; 14:3299-3306. [PMID: 34305401 PMCID: PMC8296712 DOI: 10.2147/dmso.s318255] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 07/02/2021] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Diabetic kidney disease (DKD) lacks a simple and relatively accurate predictor. The Triglyceride-Glucose (TyG) Index is a proxy of insulin resistance, but the association between the TyG Index and DKD is less certain. We investigated if the TyG Index can predict DKD onset effectively. MATERIALS AND METHODS Cross-sectional and longitudinal analyses were undertaken. In total, 1432 type-2 diabetes mellitus (T2DM) patients were included in the cross-sectional analysis. The TyG Index (calculated by ln [fasting triglycerides (mg/dL) × fasting glucose (mg/dL)/2]) was split into three tertiles. Associations of the TyG Index with microalbuminuria and estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m2 were calculated. Longitudinally, 424 patients without DKD at baseline were followed up for 21 (range, 12-24) months. The main outcome was DKD prevalence as defined with eGFR <60 mL/min/1.73 m2 or continuously increased urinary microalbuminuria: creatinine ratio (>30 mg/mL) over 3 months. Cox regression was used to analyze the association between the TyG Index at baseline and DKD. Receiver operating characteristics curve (ROC) analysis was used to assess the sensitivity and specificity of the TyG Index in predicting DKD. RESULTS In cross-sectional analysis, patients with a higher TyG Index had a higher risk of microalbuminuria (OR = 2.342, 95% CI = 1.744-3.144, p < 0.001), and eGFR <60 mL/min/1.73 m2 (1.696, 95% CI =1.096-2.625, p = 0.018). Longitudinally, 94 of 424 participants developed DKD. After confounder adjustment, patients in the high tertile of the TyG Index at baseline had a greater risk to developing DKD than those in the low tertile (HR = 1.727, 95% CI = 1.042-2.863, p = 0.034). The area under the ROC curve was 0.69 (0.63-0.76). CONCLUSION The TyG Index is a potential predictor for DKD in T2DM patients. CLINICAL TRIAL Clinical Trials identification number = NCT03692884.
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Affiliation(s)
- Liangjing Lv
- Department of Endocrinology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, People’s Republic of China
| | - Yangmei Zhou
- Department of Endocrinology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, People’s Republic of China
| | - Xiangjun Chen
- Department of Endocrinology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, People’s Republic of China
| | - Lilin Gong
- Department of Endocrinology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, People’s Republic of China
| | - Jinshan Wu
- Department of Endocrinology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, People’s Republic of China
| | - Wenjin Luo
- Department of Endocrinology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, People’s Republic of China
| | - Yan Shen
- Department of Endocrinology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, People’s Republic of China
| | - Shichao Han
- Department of Statistics, University of California, Berkeley, CA, USA
| | - Jinbo Hu
- Department of Endocrinology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, People’s Republic of China
| | - Yue Wang
- Department of Endocrinology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, People’s Republic of China
| | - Qifu Li
- Department of Endocrinology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, People’s Republic of China
| | - Zhihong Wang
- Department of Endocrinology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, People’s Republic of China
- Correspondence: Zhihong Wang Department of Endocrinology, The First Affiliated Hospital of Chongqing Medical University, Yuzhong District, Chongqing, People’s Republic of ChinaTel/Fax +86-023-89011552 Email
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Yang X, Jiang Y, Li J, Yang M, Liu Y, Dong B, Li Y. Association between Frailty and Albuminuria among Older Chinese Inpatients. J Nutr Health Aging 2021; 25:197-200. [PMID: 33491034 DOI: 10.1007/s12603-020-1481-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVES Older adults with frailty are vulnerable to cardiovascular event and subsequent mortality. Frailty and albuminuria share atherosclerotic risk factors. The present study investigated the association of frailty and albuminuria among elderly Chinese inpatients. DESIGN Cross-sectional study. SETTINGS AND PARTICIPANTS A total of 202 patients aged over 60 years from the Center of Gerontology and Geriatric, West China Hospital. MEASUREMENTS Frailty was defined using the five-item FRAIL scale. This included measurements of fatigue, resistance, ambulation, illness, and loss of weight. We further determined the random urine albumin/creatinine ratio (UACR) of all patients. Random UACR ≥30 mg/g was defined as albuminuria, and < 30mg/g as normoalbuminuria. The relationship between albuminuria and frailty was assessed through multiple regression analysis. RESULTS The 202 participants (156 men, 77.2%) had an average age of 78.99±7.60 years, which ranged from 60 to 95. Compared to those without albuminuria, elderly patients with albuminuria were of an older age, had a higher prevalence of diabetes and poorer renal function. The prevalence of frailty, pre-frailty and ambulation (one of the FRAIL components) were higher in the albuminuria group than the normoalbuminuria group (23.9% vs. 12.2%, 47.9% vs.37.4%, 33.8% vs. 16.0%, respectively, P<0.05). Following the adjustment for age, eGFR, hypertension, diabetes and using ACEI/ARB, being frail or pre-frail led to an enhanced risk of albuminuria (OR frail 2.60, 95% CI frail 1.01-6.72; OR pre-frail 2.14, 95% CI pre-frail 1.03-4.44). CONCLUSIONS Frailty is independently associated with albuminuria when adjusted for classic cardiovascular risk factors.
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Affiliation(s)
- X Yang
- Ying Li, MD, The Center of Gerontology and Geriatrics, National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University. 37 Guoxuexiang, Chengdu, Sichuan providence, PR. China, 610041; Tel: 86-028-8542 2321; Fax: 86-028-8542 2321; E-mail:
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Trischitta V, Prudente S, Doria A. Disentangling the heterogeneity of adulthood-onset non-autoimmune diabetes: a little closer but lot more to do. Curr Opin Pharmacol 2020; 55:157-164. [PMID: 33271410 DOI: 10.1016/j.coph.2020.10.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 10/13/2020] [Accepted: 10/26/2020] [Indexed: 12/13/2022]
Abstract
Diabetes diagnosed in adults is a highly heterogeneous disorder. It mostly consists of what is referred to as type 2 diabetes but also comprises other entities (i.e. different diseases), including latent autoimmune diabetes, late onset forms of monogenic diabetes and familial diabetes of the adulthood, which has recently been the source of new diabetogenes discovery. Notably, type 2 diabetes is itself heterogeneous as it includes subtypes with onset at the extremes of age and/or weight distributions characterized by different degree of hyperglycemia and cardiovascular risk as compared to common forms of type 2 diabetes occurring in middle-aged, overweight/obese individuals. Understanding whether these are different presentations of one, highly heterogeneous disease or separate nosological entities with different clinical trajectories and requiring different treatments is essential to effectively pursue the path of precision medicine.
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Affiliation(s)
- Vincenzo Trischitta
- Research Unit of Metabolic and Cardiovascular Diseases, Fondazione IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy; Department of Experimental Medicine, Sapienza University, Rome, Italy.
| | - Sabrina Prudente
- Research Unit of Metabolic and Cardiovascular Diseases, Fondazione IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
| | - Alessandro Doria
- Research Division, Joslin Diabetes Center, Boston, MA, USA; Department of Medicine, Harvard Medical School, Boston, MA, USA.
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Rani L, Saini S, Shukla N, Chowdhuri DK, Gautam NK. High sucrose diet induces morphological, structural and functional impairments in the renal tubules of Drosophila melanogaster: A model for studying type-2 diabetes mediated renal tubular dysfunction. INSECT BIOCHEMISTRY AND MOLECULAR BIOLOGY 2020; 125:103441. [PMID: 32735915 DOI: 10.1016/j.ibmb.2020.103441] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Revised: 07/13/2020] [Accepted: 07/20/2020] [Indexed: 06/11/2023]
Abstract
Continuous feeding of high dietary sugar is strongly associated with type 2 diabetes (T2D) and its secondary complications. Diabetic nephropathy (DN) is a major secondary complication that leads to glomerular and renal tubular dysfunction. The present study is aimed to investigate the effects of chronic exposure of high sugar diet (HSD) on renal tubules. Malpighian tubules (MTs), a renal organ of Drosophila, were used as a model in the study. Feeding of HSD develops T2D condition in Drosophila. The MTs showed structural abnormalities in 20 days of HSD fed flies. Impaired insulin signaling, oxidative stress, enhanced levels of AGE-RAGE and induction of apoptosis were observed in the MTs of these flies. Further, altered expression of transporters, enhanced uric acid level and reduced fluid secretion rate confirmed the impaired function of MTs in these flies. RNA-seq and RT-PCR analyses in the MTs of HSD fed-and control-flies revealed the altered expression of candidate genes that regulate several important pathways including extracellular matrix (ECM), advanced glycation end products-receptor for advanced glycation end products (AGE-RAGE), transforming growth factor β (TGF-β), galactose, starch and sucrose metabolism that are well known mediators of renal tubular dysfunction in DN patients. Disruption of insulin signaling in the MTs also causes renal tubular dysfunction similar to HSD fed flies. Overall, the study suggests that phenotypes observed in the MTs of HSD fed flies recapitulate several hallmarks of renal tubular dysfunction in DN patients. Therefore, we conclude that MTs of HSD fed flies may be used for deciphering the underlying mechanisms of T2D mediated renal tubular dysfunction.
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Affiliation(s)
- Lavi Rani
- Embryotoxicology Laboratory, Environmental Toxicology Group, CSIR-Indian Institute of Toxicology Research (CSIR-IITR), Vishvigyan Bhavan, 31 Mahatma Gandhi Marg, Lucknow, 226001, Uttar Pradesh, India; Academy of Scientific and Innovative Research (AcSIR), CSIR-IITR Campus, Lucknow, India
| | - Sanjay Saini
- Embryotoxicology Laboratory, Environmental Toxicology Group, CSIR-Indian Institute of Toxicology Research (CSIR-IITR), Vishvigyan Bhavan, 31 Mahatma Gandhi Marg, Lucknow, 226001, Uttar Pradesh, India; Molecular and Human Genetics Laboratory, Department of Zoology, University of Lucknow, Lucknow, 226007, India
| | - Neha Shukla
- Embryotoxicology Laboratory, Environmental Toxicology Group, CSIR-Indian Institute of Toxicology Research (CSIR-IITR), Vishvigyan Bhavan, 31 Mahatma Gandhi Marg, Lucknow, 226001, Uttar Pradesh, India; Department of Urology and Renal Transplantation, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Raebareli Road, Lucknow, 226014, Uttar Pradesh, India
| | - Debapratim Kar Chowdhuri
- Embryotoxicology Laboratory, Environmental Toxicology Group, CSIR-Indian Institute of Toxicology Research (CSIR-IITR), Vishvigyan Bhavan, 31 Mahatma Gandhi Marg, Lucknow, 226001, Uttar Pradesh, India; Academy of Scientific and Innovative Research (AcSIR), CSIR-IITR Campus, Lucknow, India
| | - Naveen Kumar Gautam
- Embryotoxicology Laboratory, Environmental Toxicology Group, CSIR-Indian Institute of Toxicology Research (CSIR-IITR), Vishvigyan Bhavan, 31 Mahatma Gandhi Marg, Lucknow, 226001, Uttar Pradesh, India; Academy of Scientific and Innovative Research (AcSIR), CSIR-IITR Campus, Lucknow, India; Department of Urology and Renal Transplantation, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Raebareli Road, Lucknow, 226014, Uttar Pradesh, India.
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Jhee JH, Joo YS, Han SH, Yoo TH, Kang SW, Park JT. High muscle-to-fat ratio is associated with lower risk of chronic kidney disease development. J Cachexia Sarcopenia Muscle 2020; 11:726-734. [PMID: 32020762 PMCID: PMC7296269 DOI: 10.1002/jcsm.12549] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Revised: 12/03/2019] [Accepted: 12/19/2019] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Obesity, a known risk factor for chronic kidney disease (CKD), is generally assessed using body mass index (BMI). However, BMI may not effectively reflect body composition, and the impact of muscle-to-fat (MF) mass balance on kidney function has not been elucidated. This study evaluated the association between body muscle and fat mass balance, represented as the MF ratio, and incident CKD development. METHODS Data were retrieved from a prospective community-based cohort study (Korean Genome and Epidemiology Study). Muscle and fat mass were measured using multifrequency bioelectrical impedance analysis. The study endpoint was incident CKD (estimated glomerular filtration rate <60 mL/min/1.73 m2 in at least two or more consecutive measurements during the follow-up period). RESULTS Totally, 7682 participants were evaluated. Their mean age was 51.7 ± 8.7 years, and 48% of the subjects were men. During a median follow-up of 140.0 (70.0-143.0) months, 633 (8.2%) subjects developed incident CKD. When the association between body composition and incident CKD was investigated, multivariable Cox proportional hazard analysis revealed that increase in MF ratio was related with a decreased risk of CKD development [per 1 increase in MF ratio: hazard ratio (HR), 0.86; 95% confidence interval (CI), 0.77-0.96; P = 0.008]. This association was also maintained when MF ratio was dichotomized according to sex-specific median values (high vs. low: HR, 0.83; 95% CI, 0.70-0.98; P = 0.031). Analyses preformed in a propensity score matched group also revealed a similar decreased risk of incident CKD in high MF ratio participants (high vs. low: HR, 0.84; 95% CI, 0.71-0.98; P = 0.037). This relationship between MF ratio and incident CKD risk was consistently significant across subgroups stratified by age, sex, hypertension, estimated glomerular filtration rate categories, and proteinuria. Among different BMI groups (normal, overweight, and obese), the relationship between high MF ratio and lower incident CKD risk was significant only in overweight and obese subjects. CONCLUSIONS Lower fat mass relative to muscle mass may lower the risk of CKD development in individuals with normal renal function. This relationship seems more prominent in overweight and obese subjects than in normal weight subjects.
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Affiliation(s)
- Jong Hyun Jhee
- Division of Nephrology, Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.,Department of Internal Medicine, Institute of Kidney Disease Research, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Young Su Joo
- Division of Nephrology, Department of Internal Medicine, Myongji Hospital, Goyang, Gyeonggi-do, Korea.,Department of Internal Medicine, Institute of Kidney Disease Research, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Seong Hyeok Han
- Department of Internal Medicine, Institute of Kidney Disease Research, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Tae-Hyun Yoo
- Department of Internal Medicine, Institute of Kidney Disease Research, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Shin-Wook Kang
- Department of Internal Medicine, Institute of Kidney Disease Research, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.,Department of Internal Medicine, College of Medicine, Severance Biomedical Science Institute, Brain Korea 21 PLUS, Yonsei University, Seoul, Korea
| | - Jung Tak Park
- Department of Internal Medicine, Institute of Kidney Disease Research, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
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Alkadi MM, Abuhelaiqa E, Jerobin J, Thappy S, Khan S, Abdelhalim MF, Asim M, Fituri O, Hamdi A, Ashour A, Nauman A, Al-Maslamani YK, Jarman M, Dargham SR, Abou-Samra AB, Al-Malki H. Prediabetes and older age increase the risk of post-transplantation diabetes mellitus: Qatar experience. Clin Transplant 2020; 34:e13892. [PMID: 32358902 DOI: 10.1111/ctr.13892] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2019] [Revised: 03/22/2020] [Accepted: 04/22/2020] [Indexed: 12/24/2022]
Abstract
Post-transplantation diabetes mellitus (PTDM) is a major complication in kidney transplant recipients leading to reduced allograft and patient survival. Given the high prevalence of diabetes in Qatar, which is twice the global average, we were interested in determining the incidence of PTDM, identifying risk factors, and comparing clinical outcomes in kidney transplant recipients with and without diabetes. We retrospectively followed up 191 adult kidney allograft recipients transplanted between January 1, 2012, and December 31, 2016, for a median of 41 months. A total of 76 patients (40%) had pre-existing diabetes. A total of 39 patients developed PTDM during follow-up; they represent 34% of patients who did not have diabetes prior to transplantation. Two thirds of PTDM occurred within 3-6 months post-transplantation. Prediabetes before transplant [OR = 6.07 (1.24-29.74), P = .026] older recipient's age at the time of transplantation [OR = 1.10 (1.00-1.20), P = .039] and average fasting blood sugar during 3-6 months post-transplant [OR = 1.06 (1.01-1.11), P = .010] were independently associated with PTDM. Patient and kidney allograft survival rates exceeded 97% in all groups. The incidence of PTDM in kidney transplant recipients living in Qatar is high. Older age and prediabetes are independent risk factors for developing PTDM.
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Affiliation(s)
- Mohamad M Alkadi
- Division of Nephrology, Department of Medicine, Hamad Medical Corporation, Doha, Qatar
| | - Essa Abuhelaiqa
- Division of Nephrology, Department of Medicine, Hamad Medical Corporation, Doha, Qatar
| | - Jayakumar Jerobin
- Division of Endocrinology, Department of Medicine, Hamad Medical Corporation, Doha, Qatar
| | - Shaefiq Thappy
- Division of Nephrology, Department of Medicine, Hamad Medical Corporation, Doha, Qatar
| | - Saifatullah Khan
- Division of Nephrology, Department of Medicine, Hamad Medical Corporation, Doha, Qatar
| | - Mohamed F Abdelhalim
- Division of Nephrology, Department of Medicine, Hamad Medical Corporation, Doha, Qatar
| | - Muhammad Asim
- Division of Nephrology, Department of Medicine, Hamad Medical Corporation, Doha, Qatar
| | - Omar Fituri
- Division of Nephrology, Department of Medicine, Hamad Medical Corporation, Doha, Qatar
| | - Ahmed Hamdi
- Division of Nephrology, Department of Medicine, Hamad Medical Corporation, Doha, Qatar
| | - Adel Ashour
- Division of Nephrology, Department of Medicine, Hamad Medical Corporation, Doha, Qatar
| | - Awais Nauman
- Division of Nephrology, Department of Medicine, Hamad Medical Corporation, Doha, Qatar
| | - Yousuf K Al-Maslamani
- Division of Transplantation Surgery, Department of Surgery, Hamad Medical Corporation, Doha, Qatar
| | - Mona Jarman
- Division of Transplantation Surgery, Department of Surgery, Hamad Medical Corporation, Doha, Qatar
| | - Soha R Dargham
- Biostatistics Core, Weill Cornell Medicine-Qatar, Doha, Qatar
| | - Abdul Badi Abou-Samra
- Division of Endocrinology, Department of Medicine, Hamad Medical Corporation, Doha, Qatar
| | - Hassan Al-Malki
- Division of Nephrology, Department of Medicine, Hamad Medical Corporation, Doha, Qatar
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Gu S, Wang A, Ning G, Zhang L, Mu Y. Insulin resistance is associated with urinary albumin-creatinine ratio in normal weight individuals with hypertension and diabetes: The REACTION study. J Diabetes 2020; 12:406-416. [PMID: 31769936 PMCID: PMC9328436 DOI: 10.1111/1753-0407.13010] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Revised: 11/04/2019] [Accepted: 11/24/2019] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND The relationship between albuminuria and insulin resistance (IR) has not been clarified in previous studies. This study was conducted to examine whether IR is associated with albuminuria in subjects with diverse blood pressure and glycometabolism statuses. METHODS This study included 34 136 participants whose data were drawn from a cross-sectional survey named the 2011 REACTION study. The participants were divided into six groups. The urinary albumin-creatinine ratio (UACR) and glomerular filtration rate (GFR) were used as markers of chronic kidney disease (CKD). Variance tests and logistic regression models were performed for homeostatic model assessment of insulin resistance (HOMA-IR) in relation to UACR and eGFR. RESULTS First, UACR levels and HOMA-IR exhibited a positive correlation among participants (P < 0.05), and a negative correlation existed between GFR and HOMA-IR (P < 0.05). Second, in the hypertension with diabetes group, in individuals whose body mass index (BMI) was 18.5-24.0 kg/m2 , age was 50-60 years old, low density lipoprotein cholesterol (LDL-C) was 2.6-3.4 mmol/L or high density lipoprotein cholesterol (HDL-C) was 0.9-1.55 mmol/L, HOMA-IR was positively associated with UACR (P < 0.05). However, there was a negative correlation between GFR and HOMA-IR in the hypertension with diabetes group in individuals whose BMI was 18.5-24.0 kg/m2 or whose age was over 65 years old (P < 0.05). CONCLUSIONS In the context of different blood pressure and glycometabolism statuses, the positive correlation between UACR levels and HOMA-IR was affected by BMI, age, LDL-C, HDL-C, and GFR. In patients with hypertension and diabetes, the early detection and intervention of IR and related risk factors in patients with normal BMI may reduce the occurrence of microalbuminuria and delay the progression of CKD.
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Affiliation(s)
- Shi Gu
- Chinese PLA General HospitalBeijingChina
- School of MedicineNankai UniversityTianjinChina
| | | | - Guang Ning
- Ruijin HospitalShanghai Jiaotong University School of MedicineShanghaiChina
| | - Linxi Zhang
- Peking University Third HospitalBeijingChina
| | - Yiming Mu
- Chinese PLA General HospitalBeijingChina
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Russo G, Piscitelli P, Giandalia A, Viazzi F, Pontremoli R, Fioretto P, De Cosmo S. Atherogenic dyslipidemia and diabetic nephropathy. J Nephrol 2020; 33:1001-1008. [PMID: 32328901 DOI: 10.1007/s40620-020-00739-8] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Accepted: 04/11/2020] [Indexed: 12/25/2022]
Abstract
Chronic kidney disease is associated with altered lipid metabolism and lipid accumulation. Although it is though that hyperlipemia is a consequence of kidney dysfunction, several lines of evidence support that hyperlipidemia may contribute to the onset and progression of kidney disease, also in diabetes. This review describes the results of recent observational studies supporting the concept that glucose is only partly responsible for kidney damage onset, while a cluster of factors, including hypertriglyceridemia and low HDL-cholesterol, could play a relevant role in inducing onset and progression of DKD. We also report the results of randomized clinical trials investigating in type 2 diabetic patients the role of drug improvement of hypertriglyceridemia on renal outcomes. Finally, we discuss putative mechanisms linking hyperlipidemia (i.e. hypertriglyceridemia or low HDL cholesterol) with kidney disease.
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Affiliation(s)
- Giuseppina Russo
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Pamela Piscitelli
- Unit of Internal Medicine, Department of Medical Sciences, IRCCS Casa Sollievo Della Sofferenza, Viale Cappuccini 1, 71013, San Giovanni Rotondo, FG, Italy
| | - Annalisa Giandalia
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Francesca Viazzi
- University of Genova and Ospedale Policlinico San Martino-IST, Genoa, Italy
| | - Roberto Pontremoli
- University of Genova and Ospedale Policlinico San Martino-IST, Genoa, Italy
| | - Paola Fioretto
- Department of Medicine, University of Padova, Padova, Italy
| | - Salvatore De Cosmo
- Unit of Internal Medicine, Department of Medical Sciences, IRCCS Casa Sollievo Della Sofferenza, Viale Cappuccini 1, 71013, San Giovanni Rotondo, FG, Italy.
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Effects of low skeletal muscle mass and sarcopenic obesity on albuminuria: a 7-year longitudinal study. Sci Rep 2020; 10:5774. [PMID: 32238873 PMCID: PMC7113302 DOI: 10.1038/s41598-020-62841-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Accepted: 03/19/2020] [Indexed: 12/25/2022] Open
Abstract
We aimed to identify the association between low skeletal muscle, sarcopenic obesity, and the incidence of albuminuria in the general population using a longitudinal study. Data from 29,942 subjects who underwent two or more routine health examinations from 2006 to 2013 were retrospectively reviewed. Relative skeletal muscle mass was presented using the skeletal muscle mass index (SMI), a measure of body weight-adjusted appendicular skeletal muscle mass estimated by bioelectrical impedance analysis. The cumulative incidence of albuminuria was 981 (3.3%) during the 7-year follow-up period. The hazard ratio of incident albuminuria was 1.44 (95% CI: 1.22–1.71, p for trend <0.001) in the lowest SMI tertile relative to the highest SMI tertile after multivariable adjustment. After additionally adjusting for general and central obesity, the hazard ratio was 1.35 (95% CI: 1.13–1.61, p for trend = 0.001) and 1.30 (95% CI: 1.08–1.56, p for trend = 0.003), respectively. Furthermore, the risk of developing albuminuria was much higher in the sarcopenic obesity group (HR: 1.49, 95% CI: 1.21–1.81, p for trend <0.001) compared to the other groups. Sarcopenic obesity, as well as low skeletal muscle, may lead to albuminuria in general populations.
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颜 俊, 郑 开, 林 川, 刘 春. [Correlation between sarcopenia and albuminuria in patients with type 2 diabetes]. NAN FANG YI KE DA XUE XUE BAO = JOURNAL OF SOUTHERN MEDICAL UNIVERSITY 2020; 40:407-412. [PMID: 32376579 PMCID: PMC7167324 DOI: 10.12122/j.issn.1673-4254.2020.03.20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 08/10/2019] [Indexed: 06/11/2023]
Abstract
OBJECTIVE To investigate the correlation between sarcopenia and albuminuria in patients with type 2 diabetes mellitus (T2DM). METHODS A total of 360 T2DM patients (including 206 male and 154 female patients) hospitalized in our hospital between January, 2015 and December, 2018 were enrolled. According to their medical history and laboratory test results, the patients were divided into albuminuria group (n=122) and non-albuminuria group (n=238). The clinical and anthropological data were collected and skeletal muscle index (SMI), appendage lean mass, muscle index, total body fat, bone mineral capacity and bone mineral density were measured using dual-energy X-ray absorptiometry. Logistic regression was used to analyze the correlation of these body composition parameters with albuminuria or chronic kidney disease (CKD) in the diabetic patients. RESULTS The disease course of T2DM, history of hypertension, age, systolic blood pressure, low density lipoprotein cholesterol, triglyceride, uric acid, waistline, Urinary albumin creatinine ratio, serum creatinine, and glomerular filtration rate differed significantly between the diabetic patients with albuminuria and those without albuminuria (P < 0.05). The prevalence rate of sarcopenia was significantly higher in patients with albuminuria (31.4% vs 13.1%, P < 0.01). Compared with those without albuminuria, the patients with albuminuria had significantly decreased SMI (t=-2.304, P=0.021) and body mass index (Z=- 5.534, P < 0.01) and significantly increased total body fat (Z=- 2.838, P=0.005). Multivariate logistic regression analysis showed that after adjustment for age, gender, total body fat, smoking history, drinking history, duration of diabetes, HbA1c, history of hypertension, systolic blood pressure, low density lipoprotein cholesterol, body mass index, and triglyceride, the patients with a decreased SMI had a significantly increased risk of albuminuria (P=0.011 and 0.010), but SMI was not correlated with the risk of CKD in patients with T2DM (P > 0.05). CONCLUSIONS Sarcopenia is probably an independent risk factor for albuminuria in patients with T2DM.
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Affiliation(s)
- 俊锋 颜
- 重庆市人民医院肾脏内科,重庆 400013Department of Nephrology, Chongqing General Hospital, Chongqing 400013, China
| | - 开元 郑
- 重庆市人民医院肾脏内科,重庆 400013Department of Nephrology, Chongqing General Hospital, Chongqing 400013, China
| | - 川 林
- 重庆市人民医院内分泌//中西医结合科,重庆 400013Department of Endocrinology/Integrated Chinese and Western Medicine, Chongqing General Hospital, Chongqing 400013, China
| | - 春 刘
- 重庆市人民医院肾脏内科,重庆 400013Department of Nephrology, Chongqing General Hospital, Chongqing 400013, China
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Chen HY, Lu FH, Chang CJ, Wang RS, Yang YC, Chang YF, Wu JS. Metabolic abnormalities, but not obesity per se, associated with chronic kidney disease in a Taiwanese population. Nutr Metab Cardiovasc Dis 2020; 30:418-425. [PMID: 31744713 DOI: 10.1016/j.numecd.2019.09.029] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Revised: 08/15/2019] [Accepted: 09/30/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND AND AIMS It is inconclusive whether obesity itself or metabolic abnormalities are linked to chronic kidney disease (CKD). The aim of this study was to examine the association between different subtypes of obesity and metabolic abnormalities with CKD in adults. METHODS AND RESULTS This study enrolled 14,983 eligible subjects stratified into metabolically healthy normal weight (MHNW), metabolically healthy overweight (MHOW), metabolically healthy obesity (MHO), metabolically unhealthy normal weight (MUNW), metabolically unhealthy overweight (MUOW), and metabolically unhealthy obesity (MUO) according to body mass index and metabolic syndrome status (ATP-III criteria). The metabolic healthy phenotype was defined as the absence of both metabolic syndrome and any known diabetes, coronary artery disease, stroke, hypertension or dyslipidemia. Early and advanced CKD were defined as eGFR<60, proteinuria, or structural abnormalities as detected by renal sonography. The prevalence of CKD was 2.5, 3.0, 4.0, 10.6, 9.5, and 10.5% in subjects with MHNW, MHOW, MHO, MUNW, MUOW, and MUO, respectively. In the multivariate analysis, the MUNW (OR:2.22, P < 0.001), MUOW (OR:2.22, P < 0.001), and MUO (OR:2.45, P < 0.001) groups were associated with early CKD. For advanced CKD, the OR was 2.56 (P < 0.001), 2.31 (P < 0.001), and 3.49 (P < 0.001) in the MUNW, MUOW, and MUO groups, respectively. The associated risks of early and advanced CKD were not significant in the MHOW and MHO group. MUOW and MUO were associated with higher risk of CKD compared with MHOW and MHO after adjusting other variables. CONCLUSIONS Metabolic abnormalities, but neither overweight nor obesity, were associated with a higher risk of CKD in adults.
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Affiliation(s)
- Hung-Yu Chen
- Department of Family Medicine, An Nan Hospital, China Medical University, Tainan, Taiwan
| | - Feng-Hwa Lu
- Department of Family Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Department of Family Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Chih-Jen Chang
- Department of Family Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Department of Family Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Ruh-Sueh Wang
- Department of Family Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Yi-Ching Yang
- Department of Family Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Department of Family Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Yin-Fan Chang
- Department of Family Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
| | - Jin-Shang Wu
- Department of Family Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Department of Family Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
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Five-year kidney outcomes of bariatric surgery differ in severely obese adolescents and adults with and without type 2 diabetes. Kidney Int 2020; 97:995-1005. [PMID: 32229096 DOI: 10.1016/j.kint.2020.01.016] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Revised: 12/09/2019] [Accepted: 01/02/2020] [Indexed: 12/17/2022]
Abstract
Bariatric surgery improves markers of kidney health in severe obesity, yet it is unclear if kidney disease outcomes differ according to age at surgery. Therefore, we examined health effects of Roux-en-Y gastric bypass between 161 adolescents and 396 adults participating in two related but distinct studies. Primary outcomes were elevated urine albumin-to-creatinine ratio (UACR) of 30 mg/g or more and hyperfiltration (an estimated glomerular filtration rate of 135 ml/min/1.73m2 or more). Analyses were stratified by the presence of pre-operative type 2 diabetes. Adolescents with pre-operative type 2 diabetes had a significantly increased prevalence of elevated UACR prior to surgery compared to adults (22.5 vs. 9.0%). Resolution of elevated UACR following surgery differed between adolescents and adults with type 2 diabetes, with adolescents experiencing a significantly earlier improvement following surgery. Adolescents without pre-operative type 2 diabetes demonstrated a significantly increased prevalence of UACR prior to surgery compared to adults (9.4 vs. 4.5%), with no improvement occurring in either group post-operatively. Adolescents with pre-operative type 2 diabetes had a significantly increased prevalence of hyperfiltration that remained throughout the study period, whereas hyperfiltration prevalence was similar among those without type 2 diabetes. Thus, adolescents with pre-operative type 2 diabetes experienced earlier attenuation of elevated UACR compared to adults with pre-operative type 2 diabetes in response to gastric bypass.
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