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Rossing P, Anker SD, Filippatos G, Pitt B, Ruilope LM, Billings LK, Green JB, Koya D, Mosenzon O, Pantalone KM, Ahlers C, Lage A, Lawatscheck R, Scalise A, Bakris GL. The impact of obesity on cardiovascular and kidney outcomes in patients with chronic kidney disease and type 2 diabetes treated with finerenone: Post hoc analysis of the FIDELITY study. Diabetes Obes Metab 2023; 25:2989-2998. [PMID: 37402696 DOI: 10.1111/dom.15197] [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: 03/13/2023] [Revised: 06/02/2023] [Accepted: 06/09/2023] [Indexed: 07/06/2023]
Abstract
AIM To assess the effect of finerenone on the risk of cardiovascular and kidney outcomes in patients with chronic kidney disease and type 2 diabetes, with and without obesity. MATERIALS AND METHODS A post hoc analysis of the prespecified pooled FIDELITY dataset assessed the association between waist circumference (WC), composite cardiovascular and kidney outcomes, and the effects of finerenone. Participants were stratified by WC risk groups (representing visceral obesity) as low-risk or high-very high-risk (H-/VH-risk). RESULTS Of 12 986 patients analysed, 90.8% occupied the H-/VH-risk WC group. Incidence of the composite cardiovascular outcome was similar between finerenone and placebo in the low-risk WC group (hazard ratio [HR] 1.03; 95% confidence interval [CI], 0.72-1.47); finerenone reduced the risk in the H-/VH-risk WC group (HR 0.85; 95% CI, 0.77-0.93). For the kidney outcome, the risk was similar in the low-risk WC group (HR 0.98; 95% CI, 0.66-1.46) and reduced within the H-/VH-risk WC group (HR 0.75; 95% CI, 0.65-0.87) with finerenone versus placebo. There was no significant heterogeneity between the low-risk and H-/VH-risk WC groups for cardiovascular and kidney composite outcomes (P interaction = .26 and .34, respectively). The apparent greater benefit of finerenone on cardiorenal outcomes but lack of significant heterogeneity observed in H-/VH-risk WC patients may be because of the small size of the low-risk group. Adverse events were consistent across WC groups. CONCLUSION In FIDELITY, benefits of finerenone in lowering the risk of cardiovascular and kidney outcomes were not significantly modified by patient obesity.
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Affiliation(s)
- Peter Rossing
- Steno Diabetes Center Copenhagen, Herlev, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Stefan D Anker
- Department of Cardiology (CVK) of German Heart Center Charité; Institute of Health Center for Regenerative Therapies (BCRT), German Centre for Cardiovascular Research (DZHK) Partner Site Berlin, Charité Universitätsmedizin, Berlin, Germany
- Institute of Heart Diseases, Wroclaw Medical University, Wroclaw, Poland
| | - Gerasimos Filippatos
- Department of Cardiology, School of Medicine, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Bertram Pitt
- Department of Medicine, School of Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Luis M Ruilope
- Cardiorenal Translational Laboratory and Hypertension Unit, Institute of Research imas12, Madrid, Spain
- CIBER-CV, Hospital Universitario 12 de Octubre, Madrid, Spain
- Faculty of Sport Sciences, European University of Madrid, Madrid, Spain
| | - Liana K Billings
- Department of Medicine, NorthShore University HealthSystem, University of Chicago Pritzker School of Medicine, Skokie, Illinois, USA
| | - Jennifer B Green
- Division of Endocrinology, Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina, USA
| | - Daisuke Koya
- Department of Diabetology and Endocrinology, Kanazawa Medical University, Uchinada, Japan
- General Internal Medicine, Omi Medical Center, Kusatu, Japan
| | - Ofri Mosenzon
- Diabetes Unit, Department of Endocrinology and Metabolism, Hadassah Medical Center, Jerusalem, Israel
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Kevin M Pantalone
- Endocrinology and Metabolism Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | | | - Andrea Lage
- Cardiology and Nephrology Clinical Development, Bayer SA, São Paulo, Brazil
| | - Robert Lawatscheck
- Cardiology and Nephrology Clinical Development, Bayer AG, Berlin, Germany
| | - Andrea Scalise
- Cardiology and Nephrology Clinical Development, Bayer Hispania S.L., Barcelona, Spain
| | - George L Bakris
- Department of Medicine, University of Chicago Medicine, Chicago, Illinois, USA
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Perdomo CM, Avilés-Olmos I, Dicker D, Frühbeck G. Towards an adiposity-related disease framework for the diagnosis and management of obesities. Rev Endocr Metab Disord 2023; 24:795-807. [PMID: 37162651 PMCID: PMC10492748 DOI: 10.1007/s11154-023-09797-2] [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] [Accepted: 03/10/2023] [Indexed: 05/11/2023]
Abstract
Obesity is a complex disease that relapses frequently and associates with multiple complications that comprise a worldwide health priority because of its rising prevalence and association with numerous complications, including metabolic disorders, mechanic pathologies, and cancer, among others. Noteworthy, excess adiposity is accompanied by chronic inflammation, oxidative stress, insulin resistance, and subsequent organ dysfunction. This dysfunctional adipose tissue is initially stored in the visceral depot, overflowing subsequently to produce lipotoxicity in ectopic depots like liver, heart, muscle, and pancreas, among others. People living with obesity need a diagnostic approach that considers an exhaustive pathophysiology and complications assessment. Thus, it is essential to warrant a holistic diagnosis and management that guarantees an adequate health status, and quality of life. The present review summarizes the different complications associated with obesity, at the same time, we aim to fostering a novel framework that enhances a patient-centered approach to obesity management in the precision medicine era.
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Affiliation(s)
- Carolina M Perdomo
- Department of Endocrinology and Nutrition. Clínica, Universidad de Navarra, Pamplona, Spain
- IdiSNA (Instituto de Investigación en la Salud de Navarra), Pamplona, Spain
- CIBEROBN, Instituto de Salud Carlos III, Madrid, Spain
| | - Icíar Avilés-Olmos
- IdiSNA (Instituto de Investigación en la Salud de Navarra), Pamplona, Spain
- Department of Neurology, Clínica Universidad de Navarra, Pamplona, Spain
| | - Dror Dicker
- Department of Internal Medicine D, Rabin Medical Center, Hasharon Hospital, Petah Tikva, Israel
- Sackler School of Medicine, Tel Aviv University, Tel-Aviv, Israel
| | - Gema Frühbeck
- Department of Endocrinology and Nutrition. Clínica, Universidad de Navarra, Pamplona, Spain.
- IdiSNA (Instituto de Investigación en la Salud de Navarra), Pamplona, Spain.
- CIBEROBN, Instituto de Salud Carlos III, Madrid, Spain.
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Yu F, Liu A, Deng Z, Gan S, Zhou Q, Long H. Association Between Chinese Visceral Adipose Index and Albuminuria in Chinese Adults: A Cross-Sectional Study. Int J Gen Med 2023; 16:2271-2283. [PMID: 37304903 PMCID: PMC10254699 DOI: 10.2147/ijgm.s411416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 05/30/2023] [Indexed: 06/13/2023] Open
Abstract
Purpose To explore the correlation between Chinese visceral adipose index (CVAI) and urinary microalbumin/creatinine ratio (UACR) and urinary albumin, and whether there is any difference in correlation between Han and Tujia ethnicity. Methods This cross-sectional study was conducted in Changde, Hunan, China from May 2021 to December 2021. Biochemical indicators including anthropometric parameters, blood pressure, blood glucose, blood lipids, and UACR of the participants were measured. Univariate analysis, multivariate analyses and multinomial logistic regression analysis were carried out to assess the association between CVAI and albuminuria. In addition, curve fitting and threshold effect analysis were used to explore the nonlinear association between CVAI and albuminuria, and to observe whether there were ethnic differences in this association. Results A total of 2026 adult residents were enrolled in this study, 500 of whom had albuminuria. Population-standardized prevalence of albuminuria is 19.06%. In the multivariable model adjusted for confounding factors, the odds ratio (OR) of albuminuria for pre-unit increase of CVAI and pre-SD increase of CVAI were 1.007 (1.003-1.010) and 1.298 (1.127-1.496), respectively. Multinomial logistic regression analysis confirmed the robustness and consistency of the results.The generalized additive model showed that CVAI and albuminuria had a nonlinear relationship with inflection point at 97.201 using the threshold effect. Compared with Han ethnic groups, the threshold between CVAI and albuminuria in Tujia people moved backward. The thresholds were 159.785 and 98.527, respectively. Conclusion There was a positive nonlinear dose-response relationship between increased CVAI and higher levels of albuminuria. Maintaining appropriate CVAI levels may be important for the prevention of albuminuria.
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Affiliation(s)
- Fang Yu
- Department of Endocrinology, The First People’s Hospital of Changde City, Changde, Hunan, People’s Republic of China
| | - Aizhong Liu
- Hunan Provincial Key Laboratory of Clinical Epidemiology, Xiangya School of Public Health, Central South University, Changsha, Hunan, People’s Republic of China
| | - Zhiming Deng
- Department of Endocrinology, The First People’s Hospital of Changde City, Changde, Hunan, People’s Republic of China
| | - Shenglian Gan
- Department of Endocrinology, The First People’s Hospital of Changde City, Changde, Hunan, People’s Republic of China
| | - Quan Zhou
- Department of Science and Education Section, The First People’s Hospital of Changde City, Changde, Hunan, People’s Republic of China
| | - Haowen Long
- Department of Radiology, The First People’s Hospital of Changde City, Changde, Hunan, People’s Republic of China
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Hojs R, Ekart R, Bevc S, Vodošek Hojs N. Chronic Kidney Disease and Obesity. Nephron Clin Pract 2023; 147:660-664. [PMID: 37271131 DOI: 10.1159/000531379] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 05/29/2023] [Indexed: 06/06/2023] Open
Abstract
There is a pandemic of obesity worldwide and in Europe up to 30% of the adult population is already obese. Obesity is strongly related to the risk of CKD, progression of CKD, and end-stage renal disease (ESRD), also after adjustment for age, sex, race, smoking status, comorbidities, and laboratory tests. In the general population, obesity increases the risk of death. In nondialysis-dependent CKD patients, the association between body mass index and weight with mortality is controversial. In ESRD patients, obesity is paradoxically associated with better survival. There are only a few studies investigating changes in weight in these patients and in most weight loss was associated with higher mortality. However, it is not clear if weight change was intentional or unintentional and this is an important limitation of these studies. Management of obesity includes life-style interventions, bariatric surgery, and pharmacotherapy. In the last 2 years, a long-acting glucagon-like peptide-1 (GLP-1) receptor agonist and GLP-1 and glucose-dependent insulinotropic polypeptide receptor agonist were shown to be effective in managing weight loss in non-CKD patients, but we are awaiting results of more definitive studies in CKD patients.
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Affiliation(s)
- Radovan Hojs
- Department of Nephrology, Clinic for Internal Medicine, University Clinical Centre Maribor, Maribor, Slovenia
- Faculty of Medicine, University of Maribor, Maribor, Slovenia
| | - Robert Ekart
- Faculty of Medicine, University of Maribor, Maribor, Slovenia
- Department of Dialysis, Clinic for Internal Medicine, University Clinical Centre Maribor, Maribor, Slovenia
| | - Sebastjan Bevc
- Department of Nephrology, Clinic for Internal Medicine, University Clinical Centre Maribor, Maribor, Slovenia
- Faculty of Medicine, University of Maribor, Maribor, Slovenia
| | - Nina Vodošek Hojs
- Department of Nephrology, Clinic for Internal Medicine, University Clinical Centre Maribor, Maribor, Slovenia
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Zhang Y, Gao W, Ren R, Liu Y, Li B, Wang A, Tang X, Yan L, Luo Z, Qin G, Chen L, Wan Q, Gao Z, Wang W, Ning G, Mu Y. Body roundness index is related to the low estimated glomerular filtration rate in Chinese population: A cross-sectional study. Front Endocrinol (Lausanne) 2023; 14:1148662. [PMID: 37056676 PMCID: PMC10086436 DOI: 10.3389/fendo.2023.1148662] [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: 01/20/2023] [Accepted: 03/17/2023] [Indexed: 03/30/2023] Open
Abstract
BACKGROUND Kidney disease is related to visceral obesity. As a new indicator of obesity, body roundness index (BRI) has not been fully revealed with kidney disease. This study's objective is to assess the relationship between estimated glomerular filtration rate (eGFR) and BRI among the Chinese population. METHODS This study enrolled 36,784 members over the age of 40, they were from 7 centers in China by using a random sampling method. BRI was computed using height and waist circumference, eGFR ≤ 90 mL/min/1.73 m2 was considered to indicate low eGFR. To lessen bias, propensity score matching was employed, multiple logistic regression models were utilized to examine the connection between low eGFR and BRI. RESULTS The age, diabetes and coronary heart disease rates, fasting blood glucose, and triglycerides were all greater in participants with low eGFR. The BRI quartile was still positively connected with low eGFR after controlling for confounding variables, according to multivariate logistic regression analysis. (OR [95%CI] Q2:1.052 [1.021-1.091], OR [95%CI] Q3:1.189 [1.062-1.284], OR [95%CI] Q4:1.283 [1.181-1.394], P trend < 0.001). Stratified research revealed that the elders, women, habitual smokers, and those with a history of diabetes or hypertension experienced the connection between BRI level and low eGFR. According to ROC, BRI was able to detect low eGFR more accurately. CONCLUSION Low eGFR in the Chinese community is positively connected with BRI, which has the potential to be used as an effective indicator for screening kidney disease to identify high-risk groups and take appropriate measures to prevent subsequent complications.
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Affiliation(s)
- Yue Zhang
- Department of Endocrinology, the First Clinical Medical Center of Chinese People’s Liberation Army General Hospital, Beijing, China
- Medical School of Chinese People’s Liberation Army, Beijing, China
| | - Wenxing Gao
- Medical School of Chinese People’s Liberation Army, Beijing, China
| | - Rui Ren
- Department of Endocrinology, the First Clinical Medical Center of Chinese People’s Liberation Army General Hospital, Beijing, China
- Medical School of Chinese People’s Liberation Army, Beijing, China
| | - Yang Liu
- Department of Endocrinology, the First Clinical Medical Center of Chinese People’s Liberation Army General Hospital, Beijing, China
- Medical School of Chinese People’s Liberation Army, Beijing, China
| | - Binqi Li
- Medical School of Chinese People’s Liberation Army, Beijing, China
- School of Medicine, Nankai University, Tianjin, China
| | - Anping Wang
- Department of Endocrinology, the First Clinical Medical Center of Chinese People’s Liberation Army General Hospital, Beijing, China
| | - Xulei Tang
- Department of Endocrinology, The First Hospital of Lanzhou University, Lanzhou, Gansu, China
| | - Li Yan
- Zhongshan University Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Zuojie Luo
- Department of Endocrinology, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Guijun Qin
- Department of Endocrinology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Lulu Chen
- Union Hospital, Tongji Medical College, Wuhan, Hubei, China
| | - Qin Wan
- Department of Endocrinology, Affiliated Hospital of Luzhou Medical College, Luzhou, Sichuan, China
| | - Zhengnan Gao
- Department of Endocrinology, Dalian Municipal Central Hospital, Dalian, Liaoning, China
| | - Weiqing Wang
- Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Guang Ning
- Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yiming Mu
- Department of Endocrinology, the First Clinical Medical Center of Chinese People’s Liberation Army General Hospital, Beijing, China
- *Correspondence: Yiming Mu,
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Martin WP, Nair M, Chuah YH, Malmodin D, Pedersen A, Abrahamsson S, Hutter M, Abdelaal M, Elliott JA, Fearon N, Eckhardt H, Godson C, Brennan EP, Fändriks L, le Roux CW, Docherty NG. Dietary restriction and medical therapy drives PPARα-regulated improvements in early diabetic kidney disease in male rats. Clin Sci (Lond) 2022; 136:1485-1511. [PMID: 36259366 PMCID: PMC7613831 DOI: 10.1042/cs20220205] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 10/14/2022] [Accepted: 10/18/2022] [Indexed: 11/17/2022]
Abstract
The attenuation of diabetic kidney disease (DKD) by metabolic surgery is enhanced by pharmacotherapy promoting renal fatty acid oxidation (FAO). Using the Zucker Diabetic Fatty and Zucker Diabetic Sprague Dawley rat models of DKD, we conducted studies to determine if these effects could be replicated with a non-invasive bariatric mimetic intervention. Metabolic control and renal injury were compared in rats undergoing a dietary restriction plus medical therapy protocol (DMT; fenofibrate, liraglutide, metformin, ramipril, and rosuvastatin) and ad libitum-fed controls. The global renal cortical transcriptome and urinary 1H-NMR metabolomic profiles were also compared. Kidney cell type-specific and medication-specific transcriptomic responses were explored through in silico deconvolution. Transcriptomic and metabolomic correlates of improvements in kidney structure were defined using a molecular morphometric approach. The DMT protocol led to ∼20% weight loss, normalized metabolic parameters and was associated with reductions in indices of glomerular and proximal tubular injury. The transcriptomic response to DMT was dominated by changes in fenofibrate- and peroxisome proliferator-activated receptor-α (PPARα)-governed peroxisomal and mitochondrial FAO transcripts localizing to the proximal tubule. DMT induced urinary excretion of PPARα-regulated metabolites involved in nicotinamide metabolism and reversed DKD-associated changes in the urinary excretion of tricarboxylic acid (TCA) cycle intermediates. FAO transcripts and urinary nicotinamide and TCA cycle metabolites were moderately to strongly correlated with improvements in glomerular and proximal tubular injury. Weight loss plus pharmacological PPARα agonism is a promising means of attenuating DKD.
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Affiliation(s)
- William P. Martin
- Diabetes Complications Research Centre, School of Medicine, Conway Institute of Biomolecular and Biomedical Research, University College Dublin, Belfield, D04 V1W8 Dublin, Ireland
| | - Meera Nair
- Diabetes Complications Research Centre, School of Medicine, Conway Institute of Biomolecular and Biomedical Research, University College Dublin, Belfield, D04 V1W8 Dublin, Ireland
| | - Yeong H.D. Chuah
- Diabetes Complications Research Centre, School of Medicine, Conway Institute of Biomolecular and Biomedical Research, University College Dublin, Belfield, D04 V1W8 Dublin, Ireland
| | - Daniel Malmodin
- Swedish NMR Centre, University of Gothenburg, 40530 Gothenburg, Sweden
| | - Anders Pedersen
- Swedish NMR Centre, University of Gothenburg, 40530 Gothenburg, Sweden
| | - Sanna Abrahamsson
- Bioinformatics Core Facility, Sahlgrenska Academy, University of Gothenburg, 40530 Gothenburg, Sweden
| | - Michaela Hutter
- Diabetes Complications Research Centre, School of Medicine, Conway Institute of Biomolecular and Biomedical Research, University College Dublin, Belfield, D04 V1W8 Dublin, Ireland
| | - Mahmoud Abdelaal
- Diabetes Complications Research Centre, School of Medicine, Conway Institute of Biomolecular and Biomedical Research, University College Dublin, Belfield, D04 V1W8 Dublin, Ireland
| | - Jessie A. Elliott
- Diabetes Complications Research Centre, School of Medicine, Conway Institute of Biomolecular and Biomedical Research, University College Dublin, Belfield, D04 V1W8 Dublin, Ireland
| | - Naomi Fearon
- Diabetes Complications Research Centre, School of Medicine, Conway Institute of Biomolecular and Biomedical Research, University College Dublin, Belfield, D04 V1W8 Dublin, Ireland
| | - Hans Eckhardt
- Diabetes Complications Research Centre, School of Medicine, Conway Institute of Biomolecular and Biomedical Research, University College Dublin, Belfield, D04 V1W8 Dublin, Ireland
| | - Catherine Godson
- Diabetes Complications Research Centre, School of Medicine, Conway Institute of Biomolecular and Biomedical Research, University College Dublin, Belfield, D04 V1W8 Dublin, Ireland
| | - Eoin P. Brennan
- Diabetes Complications Research Centre, School of Medicine, Conway Institute of Biomolecular and Biomedical Research, University College Dublin, Belfield, D04 V1W8 Dublin, Ireland
| | - Lars Fändriks
- Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, 40530 Gothenburg, Sweden
| | - Carel W. le Roux
- Diabetes Complications Research Centre, School of Medicine, Conway Institute of Biomolecular and Biomedical Research, University College Dublin, Belfield, D04 V1W8 Dublin, Ireland
- Diabetes Research Group, Ulster University, Coleraine BT52 1SA, UK
| | - Neil G. Docherty
- Diabetes Complications Research Centre, School of Medicine, Conway Institute of Biomolecular and Biomedical Research, University College Dublin, Belfield, D04 V1W8 Dublin, Ireland
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Martin WP, Malmodin D, Pedersen A, Wallace M, Fändriks L, Aboud CM, Petry TBZ, Cunha da Silveira LP, da Costa Silva ACC, Cohen RV, le Roux CW, Docherty NG. Urinary Metabolomic Changes Accompanying Albuminuria Remission following Gastric Bypass Surgery for Type 2 Diabetic Kidney Disease. Metabolites 2022; 12:139. [PMID: 35186675 PMCID: PMC7612403 DOI: 10.3390/metabo12020139] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
In the Microvascular Outcomes after Metabolic Surgery randomised clinical trial (MOMS RCT, NCT01821508), combined metabolic surgery (gastric bypass) plus medical therapy (CSM) was superior to medical therapy alone (MTA) as a means of achieving albuminuria remission at 2-year follow-up in patients with obesity and early diabetic kidney disease (DKD). In the present study, we assessed the urinary 1H-NMR metabolome in a subgroup of patients from both arms of the MOMS RCT at baseline and 6-month follow-up. Whilst CSM and MTA both reduced the urinary excretion of sugars, CSM generated a distinctive urinary metabolomic profile characterised by increases in host–microbial co-metabolites (N-phenylacetylglycine, trimethylamine N-oxide, and 4-aminobutyrate (GABA)) and amino acids (arginine and glutamine). Furthermore, reductions in aromatic amino acids (phenylalanine and tyrosine), as well as branched-chain amino acids (BCAAs) and related catabolites (valine, leucine, 3-hydroxyisobutyrate, 3-hydroxyisovalerate, and 3-methyl-2-oxovalerate), were observed following CSM but not MTA. Improvements in BMI did not correlate with improvements in metabolic and renal indices following CSM. Conversely, urinary metabolites changed by CSM at 6 months were moderately to strongly correlated with improvements in blood pressure, glycaemia, triglycerides, and albuminuria up to 24 months following treatment initiation, highlighting the potential involvement of these shifts in the urinary metabolomic profile in the metabolic and renoprotective effects of CSM.
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Affiliation(s)
- William P. Martin
- Diabetes Complications Research Centre, School of Medicine, Conway Institute of Biomolecular and Biomedical Research, University College Dublin, Belfield, D04 V1W8 Dublin, Ireland; (W.P.M.); (C.W.l.R.)
| | - Daniel Malmodin
- Swedish NMR Centre, University of Gothenburg, 40530 Gothenburg, Sweden; (D.M.); (A.P.)
| | - Anders Pedersen
- Swedish NMR Centre, University of Gothenburg, 40530 Gothenburg, Sweden; (D.M.); (A.P.)
| | - Martina Wallace
- Institute of Food and Health, School of Agriculture and Food Science, University College Dublin, Belfield, D04 V1W8 Dublin, Ireland;
| | - Lars Fändriks
- Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, 40530 Gothenburg, Sweden;
| | - Cristina M. Aboud
- The Centre for Obesity and Diabetes, Oswaldo Cruz German Hospital, São Paulo 01333-010, Brazil; (C.M.A.); (T.B.Z.P.); (L.P.C.d.S.); (A.C.C.d.C.S.); (R.V.C.)
| | - Tarissa B. Zanata Petry
- The Centre for Obesity and Diabetes, Oswaldo Cruz German Hospital, São Paulo 01333-010, Brazil; (C.M.A.); (T.B.Z.P.); (L.P.C.d.S.); (A.C.C.d.C.S.); (R.V.C.)
| | - Lívia P. Cunha da Silveira
- The Centre for Obesity and Diabetes, Oswaldo Cruz German Hospital, São Paulo 01333-010, Brazil; (C.M.A.); (T.B.Z.P.); (L.P.C.d.S.); (A.C.C.d.C.S.); (R.V.C.)
| | - Ana C. Calmon da Costa Silva
- The Centre for Obesity and Diabetes, Oswaldo Cruz German Hospital, São Paulo 01333-010, Brazil; (C.M.A.); (T.B.Z.P.); (L.P.C.d.S.); (A.C.C.d.C.S.); (R.V.C.)
| | - Ricardo V. Cohen
- The Centre for Obesity and Diabetes, Oswaldo Cruz German Hospital, São Paulo 01333-010, Brazil; (C.M.A.); (T.B.Z.P.); (L.P.C.d.S.); (A.C.C.d.C.S.); (R.V.C.)
| | - Carel W. le Roux
- Diabetes Complications Research Centre, School of Medicine, Conway Institute of Biomolecular and Biomedical Research, University College Dublin, Belfield, D04 V1W8 Dublin, Ireland; (W.P.M.); (C.W.l.R.)
- Diabetes Research Group, Ulster University, Coleraine BT52 1SA, UK
| | - Neil G. Docherty
- Diabetes Complications Research Centre, School of Medicine, Conway Institute of Biomolecular and Biomedical Research, University College Dublin, Belfield, D04 V1W8 Dublin, Ireland; (W.P.M.); (C.W.l.R.)
- Correspondence:
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Martin WP, Chuah YHD, Abdelaal M, Pedersen A, Malmodin D, Abrahamsson S, Hutter M, Godson C, Brennan EP, Fändriks L, le Roux CW, Docherty NG. Medications Activating Tubular Fatty Acid Oxidation Enhance the Protective Effects of Roux-en-Y Gastric Bypass Surgery in a Rat Model of Early Diabetic Kidney Disease. Front Endocrinol (Lausanne) 2022; 12:757228. [PMID: 35222262 PMCID: PMC8867227 DOI: 10.3389/fendo.2021.757228] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 12/23/2021] [Indexed: 01/03/2023] Open
Abstract
Background Roux-en-Y gastric bypass surgery (RYGB) improves biochemical and histological parameters of diabetic kidney disease (DKD). Targeted adjunct medical therapy may enhance renoprotection following RYGB. Methods The effects of RYGB and RYGB plus fenofibrate, metformin, ramipril, and rosuvastatin (RYGB-FMRR) on metabolic control and histological and ultrastructural indices of glomerular and proximal tubular injury were compared in the Zucker Diabetic Sprague Dawley (ZDSD) rat model of DKD. Renal cortical transcriptomic (RNA-sequencing) and urinary metabolomic (1H-NMR spectroscopy) responses were profiled and integrated. Transcripts were assigned to kidney cell types through in silico deconvolution in kidney single-nucleus RNA-sequencing and microdissected tubular epithelial cell proteomics datasets. Medication-specific transcriptomic responses following RYGB-FMRR were explored using a network pharmacology approach. Omic correlates of improvements in structural and ultrastructural indices of renal injury were defined using a molecular morphometric approach. Results RYGB-FMRR was superior to RYGB alone with respect to metabolic control, albuminuria, and histological and ultrastructural indices of glomerular injury. RYGB-FMRR reversed DKD-associated changes in mitochondrial morphology in the proximal tubule to a greater extent than RYGB. Attenuation of transcriptomic pathway level activation of pro-fibrotic responses was greater after RYGB-FMRR than RYGB. Fenofibrate was found to be the principal medication effector of gene expression changes following RYGB-FMRR, which led to the transcriptional induction of PPARα-regulated genes that are predominantly expressed in the proximal tubule and which regulate peroxisomal and mitochondrial fatty acid oxidation (FAO). After omics integration, expression of these FAO transcripts positively correlated with urinary levels of PPARα-regulated nicotinamide metabolites and negatively correlated with urinary tricarboxylic acid (TCA) cycle intermediates. Changes in FAO transcripts and nicotinamide and TCA cycle metabolites following RYGB-FMRR correlated strongly with improvements in glomerular and proximal tubular injury. Conclusions Integrative multi-omic analyses point to PPARα-stimulated FAO in the proximal tubule as a dominant effector of treatment response to combined surgical and medical therapy in experimental DKD. Synergism between RYGB and pharmacological stimulation of FAO represents a promising combinatorial approach to the treatment of DKD in the setting of obesity.
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Affiliation(s)
- William P. Martin
- Diabetes Complications Research Centre, School of Medicine, Conway Institute, University College Dublin, Dublin, Ireland
| | - Yeong H. D. Chuah
- Diabetes Complications Research Centre, School of Medicine, Conway Institute, University College Dublin, Dublin, Ireland
| | - Mahmoud Abdelaal
- Diabetes Complications Research Centre, School of Medicine, Conway Institute, University College Dublin, Dublin, Ireland
| | - Anders Pedersen
- Swedish NMR Centre, University of Gothenburg, Gothenburg, Sweden
| | - Daniel Malmodin
- Swedish NMR Centre, University of Gothenburg, Gothenburg, Sweden
| | - Sanna Abrahamsson
- Bioinformatics Core Facility, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Michaela Hutter
- Diabetes Complications Research Centre, School of Medicine, Conway Institute, University College Dublin, Dublin, Ireland
| | - Catherine Godson
- Diabetes Complications Research Centre, School of Medicine, Conway Institute, University College Dublin, Dublin, Ireland
| | - Eoin P. Brennan
- Diabetes Complications Research Centre, School of Medicine, Conway Institute, University College Dublin, Dublin, Ireland
| | - Lars Fändriks
- Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Carel W. le Roux
- Diabetes Complications Research Centre, School of Medicine, Conway Institute, University College Dublin, Dublin, Ireland
- Diabetes Research Group, Ulster University, Coleraine, United Kingdom
| | - Neil G. Docherty
- Diabetes Complications Research Centre, School of Medicine, Conway Institute, University College Dublin, Dublin, Ireland
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9
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Zhang Y, Gao W, Li B, Liu Y, Chen K, Wang A, Tang X, Yan L, Luo Z, Qin G, Chen L, Wan Q, Gao Z, Wang W, Ning G, Mu Y. The association between a body shape index and elevated urinary albumin-creatinine ratio in Chinese community adults. Front Endocrinol (Lausanne) 2022; 13:955241. [PMID: 35966103 PMCID: PMC9365939 DOI: 10.3389/fendo.2022.955241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2022] [Accepted: 06/27/2022] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Obesity, especially visceral obesity, seems to be one of the most decisive risk factors for chronic kidney disease. A Body Shape Index (ABSI) is an emerging body size measurement marker of visceral obesity. This study aimed to explore whether ABSI is associated with albuminuria in Chinese community adults. METHODS This cross-sectional study enrolled 40,726 participants aged 40 or older from seven provinces across China through a cluster random sampling method. ABSI was calculated by body mass index, waist circumference, and height. Increased albuminuria was defined as urinary albumin-creatinine ratio (UACR) ≥ 30 mg/g, indicating kidney injury. For ABSI, we divided it by quartile cutoff points and tried to determine the association between ABSI levels and UACR by multiple regression analysis. DAG (Directed Acyclic Graph) was plotted using literature and expert consensus to identify potential confounding factors. RESULTS The average age of subjects with elevated UACR was 61.43 ± 10.07, and 26% were men. The average age of subjects with normal UACR was 57.70 ± 9.02, and 30.5% were men. Multiple logistic regression analysis was conducted and demonstrated that the ABSI quartiles were related to elevated UACR positively (OR [95% CI] Q2 vs. Q1: 1.094 [1.004, 1.197]; OR [95% CI] Q3 vs. Q1: 1.126 [1.030, 1.231]; OR [95% CI] Q4 vs. Q1: 1.183 [1.080, 1.295], p for trend < 0.001) after adjustments for confounding factors. The stratified analysis further showed that with the mounting for ABSI levels, elevated UACR more easily occurred in the people characterized by the elderly, men, and hypertension. CONCLUSIONS In Chinese community adults, people with higher ABSI levels can be deemed as high-risk individuals with UACR elevation, and it will be beneficial for them to lose weight and significantly reduce visceral fat.
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Affiliation(s)
- Yue Zhang
- Medical School of Chinese People's Liberation Army, Beijing, China
- Department of Endocrinology, The First Clinical Medical Center of Chinese People’s Liberation Army General Hospital, Beijing, China
| | - Wenxing Gao
- Medical School of Chinese People's Liberation Army, Beijing, China
| | - Binqi Li
- Department of Endocrinology, The First Clinical Medical Center of Chinese People’s Liberation Army General Hospital, Beijing, China
- School of Medicine, Nankai University, Tianjin, China
| | - Yang Liu
- Department of Endocrinology, The First Clinical Medical Center of Chinese People’s Liberation Army General Hospital, Beijing, China
| | - Kang Chen
- Department of Endocrinology, The First Clinical Medical Center of Chinese People’s Liberation Army General Hospital, Beijing, China
| | - Anping Wang
- Department of Endocrinology, The First Clinical Medical Center of Chinese People’s Liberation Army General Hospital, Beijing, China
| | - Xulei Tang
- Department of Endocrinology, The First Hospital of Lanzhou University, Lanzhou, China
| | - Li Yan
- Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Zuojie Luo
- Department of Endocrinology, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Guijun Qin
- Department of Endocrinology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Lulu Chen
- Union Hospital, Tongji Medical College, Wuhan, China
| | - Qin Wan
- Department of Endocrinology, Affiliated Hospital of Luzhou Medical College, Luzhou, China
| | - Zhengnan Gao
- Department of Endocrinology, Dalian Municipal Central Hospital, Dalian, China
| | - Weiqing Wang
- Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Guang Ning
- Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yiming Mu
- Department of Endocrinology, The First Clinical Medical Center of Chinese People’s Liberation Army General Hospital, Beijing, China
- *Correspondence: Yiming Mu,
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10
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Zhou C, Peng Y, Jiang W, Yuan J, Zha Y. Comparison of novel visceral obesity indexes with traditional obesity measurements in predicting of metabolically unhealthy nonobese phenotype in hemodialysis patients. BMC Endocr Disord 2021; 21:244. [PMID: 34923974 PMCID: PMC8684649 DOI: 10.1186/s12902-021-00907-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 11/28/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Normal-weight maintenance hemodialysis (MHD) patients with abdominal obesity exhibited a more proatherogenic profile than overweight and obesity patients with abdominal obesity, highlighting the importance of early identification of metabolically unhealthy nonobese (MUNO) in this population. Visceral fat accumulation plays a crucial role in the development of MUNO. Lipid accumulation product (LAP), visceral adiposity index (VAI) have been proved as reliable visceral obesity markers. The Chinese visceral adiposity index (CVAI) and a body shape index (ABSI) are newly discovered indexes of visceral obesity and have been reported to be associated with multiple metabolic disorders. There are limited studies investigating the associations between different visceral obesity indices and risk of MUNO, especially in hemodialysis patients. Moreover, no general agreement has been reached to date regarding which of these obesity indices performs best in identifying MUNO. We aimed to investigate the prevalence of MUNO in MHD patients and compare the associations between different adiposity indices (CVAI, ABSI,VAI, LAP, body mass index (BMI), waist circumference (WC) and waist-to-hip ratio (WHtR)) with MUNO risk in this population. METHODS We conducted a multi-center cross-sectional study in Guizhou Province, Southwest China. 1302 nonobese adult MHD patients were included in our study. MUNO was defined as being nonobese and having the presence of > = 2 components of metabolic syndrome (MetS). Nonobese was defined as BMI less than 25 kg/m2. VAI, LAP, CVAI, ABSI, BMI, WC and WHtR were calculated. Logistic regression analyses and receiver operator curve (ROC) analyses were performed. Results 65.6% participants were metabolically unhealthy. The ROC curve analysis demonstrated that of the seven obesity indices tested, the VAI (AUC 0.84 for women and 0.79 for men) followed by LAP (AUC 0.78 for women and 0.72 for men) had the highest diagnostic accuracy for MUNO phenotype while ABSI exhibited the lowest AUC value for identifying MUNO phenotype CONCLUSIONS: Metabolically unhealthy is highly prevalent in nonobese MHD patients. VAI and LAP outperformed CVAI in discriminating MUNO in MHD patients. Though ABSI could be a weak predictor of MUNO, it is not better than WHtR, WC and BMI.
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Affiliation(s)
- Chaomin Zhou
- Renal Division, Department of Medicine, Guizhou Provincial People' s Hospital, Guizhou Provincial Institute of Nephritic and Urinary Disease, No. 83, Zhongshan Road, Guiyang, Guizhou, China.
| | - Yanzhe Peng
- Renal Division, Department of Medicine, Guizhou Provincial People' s Hospital, Guizhou Provincial Institute of Nephritic and Urinary Disease, No. 83, Zhongshan Road, Guiyang, Guizhou, China
| | - Wenyong Jiang
- Renal Division, The First People's Hospital of Guiyang, Guiyang, Guizhou, China
| | - Jing Yuan
- Renal Division, Department of Medicine, Guizhou Provincial People' s Hospital, Guizhou Provincial Institute of Nephritic and Urinary Disease, No. 83, Zhongshan Road, Guiyang, Guizhou, China
| | - Yan Zha
- Renal Division, Department of Medicine, Guizhou Provincial People' s Hospital, Guizhou Provincial Institute of Nephritic and Urinary Disease, No. 83, Zhongshan Road, Guiyang, Guizhou, China.
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11
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Ou YL, Lee MY, Lin IT, Wen WL, Hsu WH, Chen SC. Obesity-related indices are associated with albuminuria and advanced kidney disease in type 2 diabetes mellitus. Ren Fail 2021; 43:1250-1258. [PMID: 34461808 PMCID: PMC8409948 DOI: 10.1080/0886022x.2021.1969247] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Obesity is an important risk factor for the development of diseases including diabetes, hypertension, and cardiovascular disease. However, few reports have investigated the relationships between these obesity-related indices and diabetic nephropathy. The aim of this study was to evaluate associations between obesity-related markers with albuminuria and advanced kidney disease in patients with type 2 diabetes mellitus (DM). Obesity-related indices including body mass index (BMI), waist-to-hip ratio (WHR), waist-to-height ratio (WHtR), body roundness index (BRI), conicity index (CI), lipid accumulation product (LAP), visceral adiposity index (VAI), body adiposity index (BAI), abdominal volume index (AVI), body shape index (BSI), and triglyceride glucose (TyG) index were measured. Albuminuria was defined as a urine albumin/creatinine ratio of ≥30 mg/g. Advanced kidney disease was defined as an estimated glomerular filtration rate (eGFR) <30 ml/min/1.73 m2. A total of 1872 patients with type 2 DM (mean age 64.0 ± 11.3 years, 809 males and 1063 females) were enrolled. In multivariable analysis, 11 high obesity-related indices (BMI, WHR, WHtR, LAP, BRI, CI, VAI, BAI, AVI, ABSI, and TyG index) were significantly associated with albuminuria. In addition, high BMI, WHR, WHtR, LAP, BRI, CI, VAI, and AVI were significantly associated with eGFR <30 ml/min/1.73 m2. The results of this study showed that various obesity-related indices were significantly associated with albuminuria and advanced kidney disease in patients with type 2 DM. Screening may be considered in public health programs to recognize and take appropriate steps to prevent subsequent complications.
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Affiliation(s)
- Yu-Lun Ou
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Mei-Yueh Lee
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.,Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - I-Ting Lin
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Wei-Lun Wen
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Internal Medicine, Kaohsiung Municipal Siaogang Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Wei-Hao Hsu
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.,Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Szu-Chia Chen
- Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Internal Medicine, Kaohsiung Municipal Siaogang Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.,Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
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12
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Martin WP, Conroy C, Naicker SD, Cormican S, Griffin TP, Islam MN, McCole EM, McConnell I, Lamont J, FitzGerald P, Ferguson JP, Richardson C, Logue SE, Griffin MD. Multiplex Serum Biomarker Assays Improve Prediction of Renal and Mortality Outcomes in Chronic Kidney Disease. KIDNEY360 2021; 2:1225-1239. [PMID: 34849485 PMCID: PMC7612046 DOI: 10.34067/kid.0007552020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND We investigated the predictive value of 11 serum biomarkers for renal and mortality end points in people with CKD. METHODS Adults with CKD (n=139) were enrolled from outpatient clinics between February 2014 and November 2016. Biomarker quantification was performed using two multiplex arrays on a clinical-grade analyzer. Relationships between biomarkers and renal and mortality end points were investigated by random forests and Cox proportional hazards regression. RESULTS The cohort was 56% male. The mean age was 63 years and median (IQR) CKD-EPI eGFR was 33 (24-51) ml/min per BSA. A total of 56 (40%) people developed a composite end point defined as ≥40% decline in eGFR, doubling of serum creatinine, RRT, or death over median (IQR) follow-up of 5.4 (4.7-5.7) years. Prediction of the composite end point was better with random forests trained on serum biomarkers compared with clinical variables (area under the curve of 0.81 versus 0.78). The predictive performance of biomarkers was further enhanced when considered alongside clinical variables (area under the curve of 0.83 versus 0.81 for biomarkers alone). Patients (n=27, 19%) with high soluble TNF receptor-1 (≥3 ng/ml) and neutrophil gelatinase-associated lipocalin (≥156 ng/ml), coupled with low complement 3a des-arginine (<2368 ng/ml), almost universally (96%) developed the composite renal and mortality end point. C-reactive protein (adjusted hazard ratio, 1.4; 95% CI, 1.1 to 1.8), neutrophil gelatinase-associated lipocalin (adjusted hazard ratio, 2.8; 95% CI, 1.3 to 6.1) and complement 3a desarginine (adjusted hazard ratio, 0.6; 95% CI, 0.4 to 0.96) independently predicted time to the composite end point. CONCLUSIONS Outpatients with the triad of high soluble TNF receptor-1 and neutrophil gelatinase-associated lipocalin coupled with low complement 3a des-arginine had high adverse event rates over 5-year follow-up. Incorporation of serum biomarkers alongside clinical variables improved prediction of CKD progression and mortality. Our findings require confirmation in larger, more diverse patient cohorts.
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Affiliation(s)
- William P. Martin
- Diabetes Complications Research Centre, School of Medicine, Conway Institute, University College Dublin, Dublin, Ireland
| | - Chloe Conroy
- School of Medicine, University College Dublin, Dublin, Ireland
| | - Serika D. Naicker
- Regenerative Medicine Institute (REMEDI) at CÚRAM Centre for Research in Medical Devices, School of Medicine, National University of Ireland Galway, Galway, Ireland
| | - Sarah Cormican
- Regenerative Medicine Institute (REMEDI) at CÚRAM Centre for Research in Medical Devices, School of Medicine, National University of Ireland Galway, Galway, Ireland,Nephrology Services, Galway University Hospitals, Saolta University Health Care Group, Galway, Ireland
| | - Tomás P. Griffin
- Regenerative Medicine Institute (REMEDI) at CÚRAM Centre for Research in Medical Devices, School of Medicine, National University of Ireland Galway, Galway, Ireland,Centre for Diabetes, Endocrinology and Metabolism, Galway University Hospitals, Saolta University Health Care Group, Galway, Ireland
| | - Md Nahidul Islam
- Regenerative Medicine Institute (REMEDI) at CÚRAM Centre for Research in Medical Devices, School of Medicine, National University of Ireland Galway, Galway, Ireland
| | | | - Ivan McConnell
- Randox Laboratories Limited, Crumlin, Antrim, Northern Ireland
| | - John Lamont
- Randox Laboratories Limited, Crumlin, Antrim, Northern Ireland
| | | | - John P. Ferguson
- Health Research Board Clinical Research Facility, National University of Ireland Galway, Galway, Ireland
| | | | - Susan E. Logue
- Regenerative Medicine Institute (REMEDI) at CÚRAM Centre for Research in Medical Devices, School of Medicine, National University of Ireland Galway, Galway, Ireland
| | - Matthew D. Griffin
- Regenerative Medicine Institute (REMEDI) at CÚRAM Centre for Research in Medical Devices, School of Medicine, National University of Ireland Galway, Galway, Ireland,Nephrology Services, Galway University Hospitals, Saolta University Health Care Group, Galway, Ireland
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13
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Carvalho Silveira F, Martin WP, Maranga G, le Roux CW, Ren-Fielding CJ. The Impact of CKD on Perioperative Risk and Mortality after Bariatric Surgery. KIDNEY360 2020; 2:236-244. [PMID: 35373013 PMCID: PMC8740995 DOI: 10.34067/kid.0004832020] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Accepted: 12/10/2020] [Indexed: 02/04/2023]
Abstract
Background Twenty percent of patients with CKD in the United States have a body mass index (BMI) ≥35 kg/m2. Bariatric surgery reduces progression of CKD to ESKD, but the risk of perioperative complications remains a concern. Methods The 24-month data spanning 2017-2018 were obtained from the Metabolic and Bariatric Surgery Quality Improvement Program (MBSAQIP) database and analyzed. Surgical complications were assessed on the basis of the length of hospital stay, mortality, reoperation, readmission, surgical site infection (SSI), and worsening of kidney function during the first 30 days after surgery. Results The 277,948 patients who had primary bariatric procedures were 44±11.9 (mean ± SD) years old, 79.6% were women, and 71.2% were White. Mean BMI was 45.7±7.6 kg/m2. Compared with patients with an eGFR≥90 ml/min per BSA, those with stage 5 CKD/ESKD were 1.91 times more likely to be readmitted within 30 days of a bariatric procedure (95% CI, 1.37 to 2.67; P<0.001). Similarly, length of hospital stay beyond 2 days was 2.05-fold (95% CI, 1.64 to 2.56; P<0.001) higher and risk of deep incisional SSI was 6.92-fold (95% CI, 1.62 to 29.52; P=0.009) higher for those with stage 5 CKD/ESKD. Risk of early postoperative mortality increased with declining preoperative eGFR, such that patients with stage 3b CKD were 3.27 (95% CI, 1.82 to 5.89; P<0.001) times more likely to die compared with those with normal kidney function. However, absolute mortality rates remained relatively low at 0.53% in those with stage 3b CKD. Furthermore, absolute mortality rates were <0.5% in those with stages 4 and 5 CKD, and these advanced CKD stages were not independently associated with an increased risk of early postoperative mortality. Conclusions Increased severity of kidney disease was associated with increased complications after bariatric surgery. However, even for the population with advanced CKD, the absolute rates of postoperative complications were low. The mounting evidence for bariatric surgery as a renoprotective intervention in people with and without established kidney disease suggests that bariatric surgery should be considered a safe and effective option for patients with CKD.
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Affiliation(s)
| | - William P. Martin
- Diabetes Complications Research Centre, School of Medicine, Conway Institute of Biomolecular and Biomedical Research, University College Dublin, Belfield, Dublin 4, Ireland
| | - Gabrielle Maranga
- Department of Surgery, New York University School of Medicine, New York, New York
| | - Carel W. le Roux
- Diabetes Complications Research Centre, School of Medicine, Conway Institute of Biomolecular and Biomedical Research, University College Dublin, Belfield, Dublin 4, Ireland
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14
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Martin WP, le Roux CW, Docherty NG. Impact of Metabolic Surgery on Renal Injury in Pre-Clinical Models of Diabetic Kidney Disease. Nephron Clin Pract 2020; 145:585-594. [PMID: 33264793 DOI: 10.1159/000511790] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Accepted: 09/17/2020] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Surgical approaches to the treatment of obesity and type 2 diabetes, most notably the Roux-en-Y gastric bypass (RYGB) procedure, have been shown to be renoprotective, reducing the incidence of albuminuria and end-stage kidney disease over 15- to 20-year follow-up in patients with obesity. The tissue level effects of metabolic surgery on the diabetic kidney are not easily interrogated in clinical samples. However, elucidation of the cellular and molecular basis for the renoprotective effects of metabolic surgery is now emerging from a body of pre-clinical work in rodent models of diabetic kidney disease (DKD). SUMMARY Experimental metabolic surgery (RYGB, sleeve gastrectomy [SG], Roux-en-Y oesophagojejunostomy, and duodenojejunal bypass) exerts a pronounced albuminuria-lowering effect in rat models of DKD. Following RYGB in the Zucker diabetic fatty rat, glomerular histology is improved as demonstrated by reductions in podocyte stress, glomerulomegaly, and glomerulosclerosis. Glomerular ultrastructure improves after RYGB and after SG, manifested by quantifiable reductions in podocyte foot process effacement. The transcriptional programme underpinning these structural improvements has been characterized at the pathway level using RNA sequencing and is associated with a significant reduction in the activation of inflammatory and fibrotic responses. Key Messages: Experimental metabolic surgery reduces biochemical, histological, and molecular indices of DKD. These pre-clinical data support a growing interest in the potential utility of metabolic surgery as a therapeutic approach to slow renal functional decline in patients with obesity and DKD.
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Affiliation(s)
- William P Martin
- Diabetes Complications Research Centre, Conway Institute of Biomolecular and Biomedical Research, School of Medicine, University College Dublin, Dublin, Ireland,
| | - Carel W le Roux
- Diabetes Complications Research Centre, Conway Institute of Biomolecular and Biomedical Research, School of Medicine, University College Dublin, Dublin, Ireland.,Division of Investigative Science, Imperial College London, London, United Kingdom
| | - Neil G Docherty
- Diabetes Complications Research Centre, Conway Institute of Biomolecular and Biomedical Research, School of Medicine, University College Dublin, Dublin, Ireland
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15
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Martin WP, Bauer J, Coleman J, Dellatorre‐Teixeira L, Reeve JL, Twomey PJ, Docherty NG, O'Riordan A, Watson AJ, le Roux CW, Holian J. Obesity is common in chronic kidney disease and associates with greater antihypertensive usage and proteinuria: evidence from a cross-sectional study in a tertiary nephrology centre. Clin Obes 2020; 10:e12402. [PMID: 32845571 PMCID: PMC7685118 DOI: 10.1111/cob.12402] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 07/09/2020] [Accepted: 08/03/2020] [Indexed: 12/18/2022]
Abstract
Obesity is a treatable risk factor for chronic kidney disease progression. We audited the reporting of body-mass index in nephrology outpatient clinics to establish the characteristics of individuals with obesity in nephrology practice. Body-mass index, clinical information and biochemical measures were recorded for patients attending clinics between 3rd August, 2018 and 18th January, 2019. Inferential statistics and Pearson correlations were used to investigate relationships between body-mass index, type 2 diabetes, hypertension and proteinuria. Mean ± SD BMI was 28.6 ± 5.8 kg/m2 (n = 374). Overweight and obesity class 1 were more common in males (P = .02). Amongst n = 123 individuals with obesity and chronic kidney disease, mean ± SD age, n (%) female and median[IQR] eGFR were 64.1 ± 14.2 years, 52 (42.3%) and 29.0[20.5] mL/min/BSA, respectively. A positive correlation between increasing body-mass index and proteinuria was observed in such patients (r = 0.21, P = .03), which was stronger in males and those with CKD stages 4 and 5. Mean body-mass index was 2.3 kg/m2 higher in those treated with 4-5 versus 0-1 antihypertensives (P = .03). Amongst n = 59 patients with obesity, chronic kidney disease and type 2 diabetes, 2 (3.5%) and 0 (0%) were prescribed a GLP-1 receptor analogue and SGLT2-inhibitor, respectively. Our data provides a strong rationale not only for measuring body-mass index but also for acting on the information in nephrology practice, although prospective studies are required to guide treatment decisions in people with obesity and chronic kidney disease.
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Affiliation(s)
- William P. Martin
- Diabetes Complications Research CentreConway Institute of Biomolecular and Biomedical Research, School of Medicine, University College DublinDublinIreland
- Department of NephrologySt. Vincent's University HospitalDublinIreland
| | - Jessica Bauer
- Diabetes Complications Research CentreConway Institute of Biomolecular and Biomedical Research, School of Medicine, University College DublinDublinIreland
| | - John Coleman
- Department of NephrologySt. Vincent's University HospitalDublinIreland
| | - Ludmilla Dellatorre‐Teixeira
- Diabetes Complications Research CentreConway Institute of Biomolecular and Biomedical Research, School of Medicine, University College DublinDublinIreland
| | - Janice L.V. Reeve
- Department of Clinical ChemistrySt. Vincent's University HospitalDublinIreland
| | - Patrick J. Twomey
- Department of Clinical ChemistrySt. Vincent's University HospitalDublinIreland
| | - Neil G. Docherty
- Diabetes Complications Research CentreConway Institute of Biomolecular and Biomedical Research, School of Medicine, University College DublinDublinIreland
- Institute of Clinical Sciences, Sahlgrenska Academy, University of GothenburgGothenburgSweden
| | - Aisling O'Riordan
- Department of NephrologySt. Vincent's University HospitalDublinIreland
| | - Alan J. Watson
- Department of NephrologySt. Vincent's University HospitalDublinIreland
| | - Carel W. le Roux
- Diabetes Complications Research CentreConway Institute of Biomolecular and Biomedical Research, School of Medicine, University College DublinDublinIreland
- Institute of Clinical Sciences, Sahlgrenska Academy, University of GothenburgGothenburgSweden
- Division of Investigative ScienceImperial College LondonLondonUK
| | - John Holian
- Department of NephrologySt. Vincent's University HospitalDublinIreland
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Martin WP, le Roux CW. Can Metabolic Surgery Be Used to Improve Access to and Outcomes of Kidney Transplantation? Obesity (Silver Spring) 2020; 28:2259. [PMID: 33230960 PMCID: PMC7116467 DOI: 10.1002/oby.23052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 09/29/2020] [Indexed: 11/12/2022]
Affiliation(s)
- William P. Martin
- Diabetes Complications Research Centre, Conway Institute, School of Medicine, University College Dublin, Ireland
| | - Carel W. le Roux
- Diabetes Complications Research Centre, Conway Institute, School of Medicine, University College Dublin, Ireland
- Division of Investigative Science, Imperial College London, UK
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