Serum triglycerides level is independently associated with renal outcomes in patients with non-dialysis chronic kidney disease: Results from KNOW-CKD study

Unraveling the Connection between PCOS and renal Complications: Current insights and Future Directions

Polycystic ovary syndrome (PCOS) represents the most prevalent endocrine disorder among women of reproductive age, affecting approximately 5-18% of females worldwide. Characterized by irregular ovulation, hyperandrogenism, and polycystic ovaries, hyperandrogenism is the defining feature. Recent evidence highlights that, in addition to its notable reproductive and metabolic consequences, PCOS may also contribute to an elevated risk of renal complications. This increased risk is attributed to chronic low-grade inflammation, hormonal dysregulation, and disturbances in lipid metabolism inherent to the condition. However, the pathological mechanisms, clinical manifestations, and progression of secondary renal damage in this cohort remain insufficiently studied. This review consolidates current understanding of the relationship between PCOS and chronic kidney disease (CKD), aiming to clarify potential mechanisms by which PCOS may induce secondary renal dysfunction, encompassing both direct renal impairment and indirect damage mediated through systemic alterations. Furthermore, it advocates for comprehensive management strategies to mitigate renal risks in patients with PCOS, emphasizing the necessity of multidisciplinary approaches and further research to address these critical gaps.

Why protein-energy wasting leads to faster progression of chronic kidney disease

PURPOSE OF REVIEW

Protein-energy wasting (PEW) is increasingly more prevalent as chronic kidney disease (CKD) progresses to more advanced stages. There is a global recognition of the importance of preventing and mitigating PEW in the CKD population not on dialysis given the goal of extending dialysis-free time and delaying dialysis initiation and growing evidence of the clinical consequences of PEW which include the risk of death, hospitalization and clinical conditions such as infections. We reviewed the association of PEW and the malnutrition characteristics indicative of PEW on CKD progression.

RECENT FINDINGS

Studies show the association between low serum albumin levels, low BMI, and diets with inadequate dietary energy and protein intake and CKD progression. Limited studies suggest low muscle mass impacts CKD progression. Optimizing nutrition by dietary management, including a moderately low protein (0.6-0.8 g/kg/day) and plant-based (>50% of protein source, known as PLADO) diet and as needed with supplementation [e.g. during acute kidney injury (AKI) event] administrated orally, enterally, or parenterally are the basis for the prevention and treatment of PEW in CKD and delaying CKD progression. Furthermore, other therapeutic methods such as treating or avoiding comorbidities and AKI, ensuring appropriate exercise and incremental transition to dialysis treatment may help ameliorate and prevent PEW development in CKD patients.

SUMMARY

Using tailored precision nutrition approaches and nutritional supplementation with or without other beneficial strategies may help prevent and treat PEW and its consequent occurrence of CKD progression.

Association between the EHBP1 SNPs and dyslipidemia in the end-stage renal disease patients with dialysis in Chinese Han population

BACKGROUND

Lipid metabolism is influenced by mutations in the EH domain binding protein 1 gene (EHBP1). This study investigated the link between the EHBP1 single-nucleotide polymorphisms (SNPs) and dyslipidemia risks in maintenance dialysis patients with end-stage renal disease in Chinese Han population.

METHODS

A total of 539 patients were divided into dyslipidemia (379) and control (160) groups. The patients with dyslipidemia were divided into four subgroups: high low-density lipoprotein cholesterol, low high-density lipoprotein cholesterol (HDLC), high triglyceride (TG) and high total cholesterol groups. The genotype distributions of three EHBP1 SNPs (rs2710642, rs10496099 and rs1168816) were determined by high-throughput sequencing technology and were analyzed via generalized multifactor dimension reduction and binary logistic regression analysis.

RESULTS

The high-TG and control groups differed in terms of the genotype frequency of the rs2710642. One haplotype was detected in both the dyslipidemia and high-TG groups. The risk of dyslipidemia was 2.72-fold higher in participants with rs2710642GG compared with those of rs2710642AA and 2.62-fold higher compared with those with rs2710642AA + GA. Subjects who carried rs2710642GG had a 2.94 times greater risk of high TG levels than those who carried rs2710642AA and a 2.89 times greater risk than those who carried rs2710642AA + GA. Compared with those who carried rs2710642AA + GA, those who carried rs2710642GG were 2.53 times more likely to have low HDLC levels. The rs2710642-body mass index (BMI) (≥ 24 kg/m2) and rs11688816A-rs2710642G haplotype interactions increased the risk of dyslipidemia, and the rs2710642-BMI (≥ 24 kg/m2) interaction increased the risk of high TG levels. The rs10496099-rs2710642 and rs10496099-rs2710642-rs11688816 interactions increased the risk of low HDLC levels.

CONCLUSIONS

These results suggest that the EHBP1 rs2710642G and rs2710642GG and interactions with rs11688816A or BMI (≥ 24 kg/m2) were linked to higher dyslipidemia risks in end-stage renal disease patients in Chinese Han population.

Remnant cholesterol is an independent risk factor for the incidence of chronic kidney disease in newly-diagnosed type 2 diabetes: A nationwide population-based study

AIMS

To evaluate the impact of remnant cholesterol (remnant-C) on chronic kidney disease (CKD) incidence in newly-diagnosed type 2 diabetes.

METHODS

This retrospective cohort study used Korean National Health Insurance Service data on 212,836 patients with newly-diagnosed type 2 diabetes between 2009 and 2014. We conducted cox regression analysis to calculate hazard ratios (HRs) with 95% confidence intervals (CIs) for developing CKD according to remnant-C tertile.

RESULTS

During a median follow-up duration of 5.23 years, 6,850 CKD cases developed. In the fully adjusted model, HRs and 95 % CIs for incident CKD increased in the highest tertile of baseline remnant-C compared to the lowest (HR [95 % CI]; 1.234 [1.159-1.314]). This association was more prominent in patients with hypertension or low-income status (P for interaction < 0.05). Increased HRs in the highest tertile of remnant-C was sustained in type 2 diabetes patients within target range of conventional lipid profile such as low-density lipoprotein cholesterol (LDL-C) < 100 mg/dL and < 70 mg/dL (1.165 [1.041-1.304] and 1.308 [1.063-1.609]), high-density lipoprotein cholesterol (HDL-C) (1.243 [1.155-1.338]) and triglyceride (1.168 [1.076-1.268]), respectively.

CONCLUSIONS

In newly-diagnosed type 2 diabetes patients, higher remnant-C is independently associated with CKD incidence, even when conventional lipid values are well-controlled.

Dyslipidemia in Patients with Chronic Kidney Disease: An Updated Overview

Dyslipidemia is a potentially modifiable cardiovascular risk factor. Whereas the recommendations for the treatment target of dyslipidemia in the general population are being more and more rigorous, the 2013 Kidney Disease: Improving Global Outcomes clinical practice guideline for lipid management in chronic kidney disease (CKD) presented a relatively conservative approach with respect to the indication of lipid lowering therapy and therapeutic monitoring among the patients with CKD. This may be largely attributed to the lack of high-quality evidence derived from CKD population, among whom the overall feature of dyslipidemia is considerably distinctive to that of general population. In this review article, we cover the characteristic features of dyslipidemia and impact of dyslipidemia on cardiovascular outcomes in patients with CKD. We also review the current evidence on lipid lowering therapy to modify the risk of cardiovascular events in this population. We finally discuss the association between dyslipidemia and CKD progression and the potential strategy to delay the progression of CKD in relation to lipid lowering therapy.