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Kim NH, Seo MH, Jung JH, Han KD, Kim MK, Kim NH. 2023 Diabetic Kidney Disease Fact Sheet in Korea. Diabetes Metab J 2024; 48:463-472. [PMID: 38499437 PMCID: PMC11140395 DOI: 10.4093/dmj.2023.0310] [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: 07/30/2023] [Accepted: 01/26/2024] [Indexed: 03/20/2024] Open
Abstract
BACKGRUOUND To investigate the prevalence, incidence, comorbidities, and management status of diabetic kidney disease (DKD) and diabetes-related end-stage kidney disease (ESKD) in South Korea. METHODS We used the Korea National Health and Nutrition Examination Survey data (2019 to 2021, n=2,665) for the evaluation of prevalence, comorbidities, control rate of glycemia and comorbidities in DKD, and the Korean Health Insurance Service-customized database (2008 to 2019, n=3,950,857) for the evaluation of trends in the incidence and prevalence rate of diabetes-related ESKD, renin-angiotensin system (RAS) blockers and sodium glucose cotransporter 2 (SGLT2) inhibitors use for DKD, and the risk of atherosclerotic cardiovascular disease (ASCVD) and mortality according to DKD stages. DKD was defined as albuminuria or low estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m2 in patients with diabetes mellitus. RESULTS The prevalence of DKD was 25.4% (albuminuria, 22.0%; low eGFR, 6.73%) in patients with diabetes mellitus aged ≥30 years. Patients with DKD had a higher rate of comorbidities, including hypertension, dyslipidemia, and central obesity; however, their control rates were lower than those without DKD. Prescription rate of SGLT2 inhibitors with reduced eGFR increased steadily, reaching 5.94% in 2019. Approximately 70% of DKD patients were treated with RAS blockers. The prevalence rate of diabetesrelated ESKD has been steadily increasing, with a higher rate in older adults. ASCVD and mortality were significantly associated with an in increase in DKD stage. CONCLUSION DKD is prevalent among Korean patients with diabetes and is an independent risk factor for cardiovascular morbidity and mortality, which requiring intensive management of diabetes and comorbidities. The prevalence of diabetes-related ESKD has been increasing, especially in the older adults, during past decade.
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Affiliation(s)
- Nam Hoon Kim
- Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Mi-Hae Seo
- Department of Internal Medicine, Soonchunhyang University Gumi Hospital, Soonchunhyang University College of Medicine, Gumi, Korea
| | - Jin Hyung Jung
- Samsung Biomedical Research Institute, Sungkyunkwan University School of Medicine, Suwon, Korea
| | - Kyung Do Han
- Department of Statistics and Actuarial Science, Soongsil University, Seoul, Korea
| | - Mi Kyung Kim
- Department of Internal Medicine, Keimyung University School of Medicine, Daegu, Korea
| | - Nan Hee Kim
- Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
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Ding Z, Wu X, Liu C, Ying R, Zhang Y, Zhang S, Zhang Q, Hu H, Dai F. Associations between dietary patterns and renal impairment in individuals with diabetes: a cross-sectional study. J Hum Nutr Diet 2024; 37:193-202. [PMID: 37795524 DOI: 10.1111/jhn.13245] [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: 06/15/2023] [Accepted: 09/13/2023] [Indexed: 10/06/2023]
Abstract
BACKGROUND A variety of chronic diseases are affected by diet. To our knowledge, few studies have investigated the relationship between dietary patterns and renal impairment in individuals with diabetes within an Asian population. This study aimed to assess the relationship between renal impairment and dietary patterns in individuals with diabetes within a Chinese population. METHODS In this cross-sectional survey, we analysed data on 1522 participants with diabetes aged 18 years or older who took part in the China National Diabetic Chronic Complications Study. We utilised the Chinese Diabetes Complications Questionnaire, including the semiquantitative food frequency questionnaire (SQFFQ). We identified three dietary patterns using factor analysis: Chinese traditional, healthy and plant-based dietary patterns, and these dietary patterns were used to classify participants into four groups based on the quartiles of their scores. A decrease in the estimated glomerular filtration rate (eGFR; <60 mL/min/1.73 m2 ) and an increase in the albumin-to-creatinine ratio (ACR; ≥3 mg/mmol) were used as indicators of renal impairment. Binary logistic regression models were used to estimate the odds ratio (OR) of the highest quartile (Q4: high intake levels of each dietary pattern) for renal impairment compared to the lowest quartile (Q1: low intake levels of each dietary pattern). RESULTS Among the 1522 participants, there was a 5.5% prevalence of low eGFR, with prevalence rates of 5.2% in men and 5.9% in women, yet the prevalence of albuminuria was as high as 47.9%. After adjusting for confounders, participants in Q4 of the plant-based dietary pattern had a smaller OR for renal impairment than those in Q1. CONCLUSIONS Our findings demonstrated that a plant-based dietary pattern is associated with a reduced risk of renal impairment in a population with diabetes.
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Affiliation(s)
- Ziling Ding
- Department of Endocrinology, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Xingzhe Wu
- Department of Endocrinology, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Chao Liu
- Department of Endocrinology, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Ruixue Ying
- Department of Endocrinology, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Yi Zhang
- Department of Endocrinology, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, Hefei, Anhui, China
| | - Shiqi Zhang
- Department of Endocrinology, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Qiu Zhang
- Department of Endocrinology, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Honglin Hu
- Department of Endocrinology, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Fang Dai
- Department of Endocrinology, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
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Etana Tola D, Bayissa ZB, Desissa TA, Solbana LK, Tesfaye AH, Eba BF. Determinants of diabetic nephropathy among adult diabetic patients on follow-up at public hospitals in Addis Ababa, Ethiopia: A case-control study. SAGE Open Med 2024; 12:20503121231218890. [PMID: 38222310 PMCID: PMC10787527 DOI: 10.1177/20503121231218890] [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: 05/29/2023] [Accepted: 11/14/2023] [Indexed: 01/16/2024] Open
Abstract
Background Diabetic nephropathy is defined as patients with diabetes mellitus who have persistent proteinuria for at least three consecutive measurements per year, a high blood creatinine level (>130 mol/l), or a decrease in glomerular filtration rate (<60 ml/min). Limited studies were done in Ethiopia on determinants of diabetic nephropathy among diabetic patients. Therefore, this study aimed to identify determinants of nephropathy among adult diabetic patients on follow-up at public hospitals in Addis Ababa, Ethiopia, 2022. Methods A hospital-based unmatched case-control study design was conducted from 6 September to 9 November 2022, among diabetic patients on follow-up at public health hospitals in Addis Ababa. Using consecutive sampling techniques, a total of 442 (353 controls and 89 cases) were recruited, with a control-to-case ratio of 4:1. The data were collected using a structured and interview-administered questionnaire and variables like high-density lipoprotein, low-density lipoprotein, Glycated hemoglobin, and type of diabetes were extracted from the medical records of the patients using a checklist. The collected data were entered into Epidata 3.1 and analyzed by STATA version 15.0. Variables with a p-value < 0.25 in the bivariable logistic regression were selected for the final model. In multivariable logistic regression model fitting, variables with a p-value < 0.05 with 95% CI adjusted odds ratio have declared statistically significant risk factors of diabetic nephropathy. Results In this study, out of 442 study participants, 334 controls and 89 cases were included in the analysis, with a response rate of 94.6% and 100%, respectively. The majority of the study participants were 92.13% of cases and 84.13% of controls; 7.87% of cases, and 15.87% of controls were type 2 diabetes mellitus. Age 65 and above years old (AOR: 2.42; 95% CI: 1.28, 4.57); Smoking cigarette (AOR: 2.22; 95% CI: 1.18, 4.16); Non-adherent to diet (AOR: 2.11; 95% CI: 1.15, 3.84); Drinking alcohols (AOR: 1.95; 95% CI: 1.07, 3.52); Duration with diabetes more than 10 years (AOR: 3.39; 95% CI: 1.76, 6.54); Poor glycemic control (AOR: 2.19; 95% CI: 1.23, 4.28); and Low-density lipoprotein (AOR: 2.97; 95% CI: 1.69, 5.28) were found to be statistically significant risk factors of nephropathy among diabetic patients. Conclusion This study found that old age, smoking cigarettes, non-adherence to diet, duration of diabetes, alcohol drinking, Glycated hemoglobin A1C, and high low-density lipoprotein were risk factors for nephropathy. Hence, continuous health education on lifestyle modifications and diabetic-related complications in each follow-up visit via front-line health professionals are very essential to avert the problem.
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Affiliation(s)
- Diriba Etana Tola
- Department of Midwifery, College of Health Science, Assosa University, Assosa, Ethiopia
| | - Zenebu Begna Bayissa
- Department of Public Health, College of Health Science and Medicine, Ambo University, Ambo, Ethiopia
| | - Tamene Abera Desissa
- Department of Public Health, College of Health Science and Medicine, Ambo University, Ambo, Ethiopia
| | - Lencho Kajela Solbana
- Department of Nursing, College of Health Science, Assosa University, Assosa, Ethiopia
| | - Azeb Haile Tesfaye
- Department of Nursing, College of Health Science, Assosa University, Assosa, Ethiopia
| | - Bikila Fufa Eba
- Department of General Medicine, School of Medicine, St. Petros’ Referral Hospital, Addis Ababa, Ethiopia
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Kim DH, Hyun YY, Cha JJ, Lee S, Lee HK, Choi JW, Kim SH, Han SY, Park CW, Lee EY, Cha DR, Kim SG, Lim CS, Park SH. Kidney Health Plan 2033 in Korea: bridging the gap between the present and the future. Kidney Res Clin Pract 2024; 43:8-19. [PMID: 38311359 PMCID: PMC10846987 DOI: 10.23876/j.krcp.23.232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 11/02/2023] [Accepted: 11/09/2023] [Indexed: 02/08/2024] Open
Abstract
In response to the increase in the prevalence of chronic kidney disease (CKD) in Korea, the growth of patients requiring renal replacement therapy and the subsequent increase in medical costs, the rapid expansion of patients with end-stage kidney disease (ESKD), and the decrease in patients receiving home therapy, including peritoneal dialysis, the Korean Society of Nephrology has proclaimed the new policy, Kidney Health Plan 2033 (KHP 2033). KHP 2033 would serve as a milestone to bridge the current issues to a future solution by directing the prevention and progression of CKD and ESKD, particularly diabetic kidney disease, and increasing the proportion of home therapy, thereby reducing the socioeconomic burden of kidney disease and improving the quality of life. Here, we provide the background for the necessity of KHP 2033, as well as the contents of KHP 2033, and enlighten the Korean Society of Nephrology's future goals. Together with patients, healthcare providers, academic societies, and national policymakers, we need to move forward with goal-oriented drive and leadership to achieve these goals.
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Affiliation(s)
- Do Hyoung Kim
- Department of Internal Medicine, Hallym University Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Republic of Korea
| | - Young Youl Hyun
- Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jin Joo Cha
- Department of Internal Medicine, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Republic of Korea
| | - Sua Lee
- Department of Internal Medicine, Daejeon Eulji Medical Center, Eulji University, Daejeon, Republic of Korea
| | - Hyun Kyung Lee
- Department of Pediatrics, Kangwon National University Hospital, Chuncheon, Republic of Korea
| | - Jong Wook Choi
- Department of Internal Medicine, Konkuk University School of Medicine, Chungju, Republic of Korea
| | - Su-Hyun Kim
- Department of Internal Medicine, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Republic of Korea
| | - Sang Youb Han
- Department of Internal Medicine, Inje University Ilsan Paik Hospital, Goyang, Republic of Korea
| | - Cheol Whee Park
- Division of Nephrology, Department of Internal Medicine, The Catholic University of Korea, Seoul St. Mary’s Hospital, Seoul, Republic of Korea
| | - Eun Young Lee
- Department of Internal Medicine, Soonchunhyang University Cheonan Hospital, Cheonan, Republic of Korea
| | - Dae Ryong Cha
- Department of Internal Medicine, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Republic of Korea
| | - Sung Gyun Kim
- Department of Internal Medicine, Hallym University Sacred Heart Hospital, Anyang, Republic of Korea
| | - Chun Soo Lim
- Department of Internal Medicine, SMG–SNU Boramae Medical Center, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Sun-Hee Park
- Division of Nephrology, Department of Internal Medicine, Kyungpook National University Hospital, Kyungpook National University School of Medicine, Daegu, Republic of Korea
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Bae ES, Hur JY, Jang HS, Kim JS, Kang HS. Risk Factors of Microalbuminuria among Patients with Type 2 Diabetes Mellitus in Korea: A Cross-Sectional Study Based on 2019-2020 Korea National Health and Nutrition Examination Survey Data. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:4169. [PMID: 36901179 PMCID: PMC10002237 DOI: 10.3390/ijerph20054169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Revised: 02/19/2023] [Accepted: 02/23/2023] [Indexed: 06/18/2023]
Abstract
Diabetes mellitus is a chronic disease with high economic and social burdens. This study aimed to determine the risk factors of microalbuminuria among patients with type 2 diabetes mellitus. Microalbuminuria is predictive of early-stage renal complications and subsequent progression to renal dysfunction. We collected data on type 2 diabetes patients who participated in the 2019-2020 Korea National Health and Nutrition Examination Survey. The risk factors for microalbuminuria among patients with type 2 diabetes were analyzed using logistic regression. As a result, the odds ratios were 1.036 (95% confidence interval (CI) = 1.019-1.053, p < 0.001) for systolic blood pressure, 0.966 (95% CI = 0.941-0.989, p = 0.007) for high-density lipoprotein cholesterol level, 1.008 (95% CI = 1.002-1.014, p = 0.015) for fasting blood sugar level, and 0.855 (95% CI = 0.729-0.998, p = 0.043) for hemoglobin level. A significant strength of this study is the identification of low hemoglobin level (i.e., anemia) as a risk factor for microalbuminuria in patients with type 2 diabetes. This finding implies that the early detection and management of microalbuminuria can prevent the development of diabetic nephropathy.
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Affiliation(s)
- Eun Sook Bae
- Good Aein Medical Care Hospital, Busan 47889, Republic of Korea
| | - Jung Yi Hur
- Department of Nursing, Saekyung University, Yeongwol-gun 26239, Gangwon-do, Republic of Korea
| | - Hyung Soon Jang
- Department of Nursing, Saekyung University, Yeongwol-gun 26239, Gangwon-do, Republic of Korea
| | - Jeong Suk Kim
- Department of Nursing, Saekyung University, Yeongwol-gun 26239, Gangwon-do, Republic of Korea
| | - Hye Seung Kang
- Department of Nursing, Saekyung University, Yeongwol-gun 26239, Gangwon-do, Republic of Korea
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Gurmu MZ, Genet S, Gizaw ST, Feyisa TO, Gnanasekaran N. Neutrophil-lymphocyte ratio as an inflammatory biomarker of diabetic nephropathy among type 2 diabetes mellitus patients: A comparative cross-sectional study. SAGE Open Med 2022; 10:20503121221140231. [PMID: 36505969 PMCID: PMC9729998 DOI: 10.1177/20503121221140231] [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: 08/17/2022] [Accepted: 11/03/2022] [Indexed: 12/12/2022] Open
Abstract
Objective This study aimed to determine the neutrophil-lymphocyte ratio (NLR) as an inflammatory biomarker among type 2 diabetes mellitus (T2DM) patients with diabetic nephropathy (DN). Methods A comparative cross-sectional study design was conducted on 199 T2DM patients attending Bole 17 Health Center, Addis Ababa, Ethiopia. The urine albumin test was done by the MICRAL-II test strip. Fasting blood sugar was measured by a glucometer. Complete blood count was analyzed using an automated hematology analyzer (HUMAN GmbH, Wiesbaden, Hesse, Germany). The student's t-test, a chi-square test, and Pearson correlation were applied to analyze the data. Results Out of the 199 diabetes mellitus patients, 45 (22.6%) and 154 (77.4%) were found with DN and without DN, respectively. Interestingly, the mean NLR value (2.66 ± 0.49) was found significantly higher in diabetic patients with DN compared to the mean NLR (1.65 ± 0.20) in diabetes patients without DN (p < 0.0001). The NLR showed positive significant correlation with variables such as age (r = 0.162, p = 0.023), duration of disease (r = 0.52, p < 0.0001), absolute neutrophil count (r = 0.712, p < 0.0001), total white blood cell count (r = 0.162, p = 0.022), systolic blood pressure (r = 0.338, p < 0.0001), and diastolic blood pressure (r = 0.731, p < 0.0001). On the other hand, negatively significant correlation was found between NLR and absolute lymphocyte count (r = -0.770, p < 0.000). Conclusion The NLR was significantly increased in T2DM patients with DN, suggesting that inflammation and endothelial dysfunction could be an integral part of the pathogenesis of DN, and therefore, this ratio may be considered as a predictor and a prognostic biomarker of DN.
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Affiliation(s)
- Mesfin Zewude Gurmu
- Department of Biomedical Science, College of Health Sciences, Arsi University, Asela, Ethiopia
| | - Solomon Genet
- Department of Medical Biochemistry, Addis Ababa University, College of Health Sciences, Addis Ababa, Ethiopia,Solomon Genet, Associate Professor of Medical Biochemistry, Department of Medical Biochemistry, Addis Ababa University, College of Health Sciences, Addis Ababa, Ethiopia.
| | - Solomon Tebeje Gizaw
- Department of Medical Biochemistry, Addis Ababa University, College of Health Sciences, Addis Ababa, Ethiopia
| | - Teka Obsa Feyisa
- Department of Medical Biochemistry, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Netasan Gnanasekaran
- Department of Medical Biochemistry, Addis Ababa University, College of Health Sciences, Addis Ababa, Ethiopia
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Zhang X, Wang Y, Yang Z, Chen X, Zhang J, Wang X, Jin X, Wu L, Xing X, Yang W, Zhang B. Development and assessment of diabetic nephropathy prediction model using hub genes identified by weighted correlation network analysis. Aging (Albany NY) 2022; 14:8095-8109. [PMID: 36242604 PMCID: PMC9596198 DOI: 10.18632/aging.204340] [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: 06/09/2022] [Accepted: 09/23/2022] [Indexed: 11/25/2022]
Abstract
Diabetic nephropathy (DN) is one microvascular complication of diabetes. About 30% of diabetic patients can develop DN, which is closely related to the high incidence and mortality of heart diseases, and then develop end-stage renal diseases. Therefore, early detection and screening of high-risk patients with DN is important. Herein, we explored the differences of serum transcriptomics between DN and non-DN in type II diabetes mellitus (T2DM) patients. We obtained 110 target genes using weighted correlation network analysis. Gene Ontology enrichment analysis indicates these target genes are mainly related to membrane adhesion, alpha-amino acid biosynthesis, metabolism, and binding, terminus, inhibitory synapse, clathrinid-sculpted vesicle, kinase activity, hormone binding, receptor activity, and transporter activity. Kyoto Encyclopedia of Genes and Genomes analysis indicates the process of DN in diabetic patients can involve synaptic vesicle cycle, cysteine and methionine metabolism, N-Glycan biosynthesis, osteoclast differentiation, and cAMP signaling pathway. Next, we detected the expression levels of hub genes in a retrospective cohort. Then, we developed a risk score tool included in the prediction model for early DN in T2DM patients. The prediction model was well applied into clinical practice, as confirmed by internal validation and several other methods. A novel DN risk model with relatively high prediction accuracy was established based on clinical characteristics and hub genes of serum detection. The estimated risk score can help clinicians develop individualized intervention programs for DN in T2DM. External validation data are required before individualized intervention measures.
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Affiliation(s)
- Xuelian Zhang
- Department of Endocrinology, China-Japan Friendship Hospital, Beijing 100029, People's Republic of China
| | - Yao Wang
- Department of Endocrinology, China-Japan Friendship Hospital, Beijing 100029, People's Republic of China
| | - Zhaojun Yang
- Department of Endocrinology, China-Japan Friendship Hospital, Beijing 100029, People's Republic of China
| | - Xiaoping Chen
- Department of Endocrinology, China-Japan Friendship Hospital, Beijing 100029, People's Republic of China
| | - Jinping Zhang
- Department of Endocrinology, China-Japan Friendship Hospital, Beijing 100029, People's Republic of China
| | - Xin Wang
- Department of Endocrinology, China-Japan Friendship Hospital, Beijing 100029, People's Republic of China
| | - Xian Jin
- Department of Endocrinology, China-Japan Friendship Hospital, Beijing 100029, People's Republic of China
| | - Lili Wu
- Department of Endocrinology, China-Japan Friendship Hospital, Beijing 100029, People's Republic of China
| | - Xiaoyan Xing
- Department of Endocrinology, China-Japan Friendship Hospital, Beijing 100029, People's Republic of China
| | - Wenying Yang
- Department of Endocrinology, China-Japan Friendship Hospital, Beijing 100029, People's Republic of China
| | - Bo Zhang
- Department of Endocrinology, China-Japan Friendship Hospital, Beijing 100029, People's Republic of China
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Kim NH, Kim NH. Renoprotective Mechanism of Sodium-Glucose Cotransporter 2 Inhibitors: Focusing on Renal Hemodynamics. Diabetes Metab J 2022; 46:543-551. [PMID: 35929172 PMCID: PMC9353563 DOI: 10.4093/dmj.2022.0209] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2022] [Accepted: 07/20/2022] [Indexed: 11/08/2022] Open
Abstract
Diabetic kidney disease (DKD) is a prevalent renal complication of diabetes mellitus that ultimately develops into end-stage kidney disease (ESKD) when not managed appropriately. Substantial risk of ESKD remains even with intensive management of hyperglycemia and risk factors of DKD and timely use of renin-angiotensin-aldosterone inhibitors. Sodium-glucose cotransporter 2 (SGLT2) inhibitors reduce hyperglycemia primarily by inhibiting glucose and sodium reabsorption in the renal proximal tubule. Currently, their effects expand to prevent or delay cardiovascular and renal adverse events, even in those without diabetes. In dedicated renal outcome trials, SGLT2 inhibitors significantly reduced the risk of composite renal adverse events, including the development of ESKD or renal replacement therapy, which led to the positioning of SGLT2 inhibitors as the mainstay of chronic kidney disease management. Multiple mechanisms of action of SGLT2 inhibitors, including hemodynamic, metabolic, and anti-inflammatory effects, have been proposed. Restoration of tubuloglomerular feedback is a plausible explanation for the alteration in renal hemodynamics induced by SGLT2 inhibition and for the associated renal benefit. This review discusses the clinical rationale and mechanism related to the protection SGLT2 inhibitors exert on the kidney, focusing on renal hemodynamic effects.
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Affiliation(s)
- Nam Hoon Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Nan Hee Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
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Yang J, Jiang S. Development and Validation of a Model That Predicts the Risk of Diabetic Nephropathy in Type 2 Diabetes Mellitus Patients: A Cross-Sectional Study. Int J Gen Med 2022; 15:5089-5101. [PMID: 35645579 PMCID: PMC9130557 DOI: 10.2147/ijgm.s363474] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 05/12/2022] [Indexed: 12/19/2022] Open
Abstract
Purpose To develop a nomogram model that predicts the risk of diabetic nephropathy (DN) incidence in type 2 diabetes mellitus (T2DM) patients. Methods We collect information from electronic medical record systems. The data were split into a training set (n=521) containing 73.8% of patients and a validation set (n=185) holding the remaining 26.2% of patients based on the date of data collection. Stepwise and multivariable logistic regression analyses were used to screen out DN risk factors. A predictive model including selected risk factors was developed by logistic regression analysis. The results of binary logistic regression are presented through forest plots and nomogram. Lastly, the c-index, calibration plots, and receiver operating characteristic (ROC) curves were used to assess the accuracy of the nomogram in internal and external validation. The clinical benefit of the model was evaluated by decision curve analysis. Results Predictors included serum creatinine (Scr), hypertension, glycosylated hemoglobin A1c (HbA1c), blood urea nitrogen (BUN), body mass index (BMI), triglycerides (TG), and Diabetic peripheral neuropathy (DPN). Harrell’s C-indexes were 0.773 (95% CI:0.726–0.821) and 0.758 (95% CI:0.679–0.837) in the training and validation sets, respectively. Decision curve analysis (DCA) demonstrated that the novel nomogram was clinically valuable. Conclusion Our simple nomogram with seven factors may help clinicians predict the risk of DN incidence in patients with T2DM.
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Affiliation(s)
- Jing Yang
- State Key Laboratory of Pathogenesis, Prevention and Treatment of High Incidence Diseases in Central Asia; Department of Endocrinology, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, 830017, People’s Republic of China
| | - Sheng Jiang
- State Key Laboratory of Pathogenesis, Prevention and Treatment of High Incidence Diseases in Central Asia; Department of Endocrinology, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, 830017, People’s Republic of China
- Correspondence: Sheng Jiang, Email
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Jung J, Park WY, Kim YJ, Kim M, Choe M, Jin K, Seo JH, Ha E. 3-Hydroxybutyrate Ameliorates the Progression of Diabetic Nephropathy. Antioxidants (Basel) 2022; 11:antiox11020381. [PMID: 35204263 PMCID: PMC8868458 DOI: 10.3390/antiox11020381] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 02/07/2022] [Accepted: 02/10/2022] [Indexed: 02/04/2023] Open
Abstract
Studies report beneficial effects of 3-hydroxybutyrate (3-OHB) on the treatment of type 2 diabetes and obesity, but the effects of 3-OHB on diabetic nephropathy have not been elucidated. This study was designed to investigate the efficacy and mechanism of 3-OHB against progression of diabetic nephropathy (DN). Mice (db/db) were fed normal chow, high-fat, or ketogenic diets (KD) containing precursors of 3-OHB. Hyperglycemia was determined based on random glucose level (≥250 mg/dL). Fasting blood glucose and body weights were measured once a week. Twenty four-hour urine albumin to creatinine ratio was determined 5 weeks after the differential diet. Energy expenditure was measured 9 weeks after the differential diet. Body weights were significantly lower in the KD group than those in other groups, but no significant differences in fasting blood glucose levels among three groups were observed. Urine albumin to creatinine ratio and serum blood urea nitrogen (BUN) to creatinine ratio in the KD group were significantly lower than in other groups. Histologic and quantitative analysis of mesangial area suggested that KD delayed the progression of DN phenotype in db/db mice. Metabolic cage analysis also revealed that KD increased energy expenditure in db/db mice. In vitro studies with proximal tubular cells revealed that 3-OHB stimulated autophagic flux. 3-OHB increased LC3 I to LC3 II ratio, phosphorylation of AMPK, beclin, p62 degradation, and NRF2 expression. Moreover, we found that 3-OHB attenuated high glucose-induced reactive oxygen species (ROS) levels in proximal tubular cells. In vivo study also confirmed increased LC3 and decreased ROS levels in the kidney of KD mice. In summary, this study shows in both in vivo and in vitro models that 3-OHB delays the progression of DN by augmenting autophagy and inhibiting oxidative stress.
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Affiliation(s)
- Jeeyoun Jung
- Clinical Medicine Division, Korea Institute of Oriental Medicine, Daejeon 34054, Korea;
| | - Woo Yeong Park
- Department of Internal Medicine, Keimyung University School of Medicine, Daegu 42601, Korea;
| | - Yun Jin Kim
- Department of Biochemistry, Keimyung University School of Medicine, Daegu 42601, Korea; (Y.J.K.); (M.K.)
| | - Mikyung Kim
- Department of Biochemistry, Keimyung University School of Medicine, Daegu 42601, Korea; (Y.J.K.); (M.K.)
| | - Misun Choe
- Department of Pathology, Keimyung University School of Medicine, Daegu 42601, Korea;
| | - Kyubok Jin
- Department of Internal Medicine, Keimyung University School of Medicine, Daegu 42601, Korea;
- Correspondence: (K.J.); (J.H.S.); (E.H.)
| | - Ji Hae Seo
- Department of Biochemistry, Keimyung University School of Medicine, Daegu 42601, Korea; (Y.J.K.); (M.K.)
- Correspondence: (K.J.); (J.H.S.); (E.H.)
| | - Eunyoung Ha
- Department of Biochemistry, Keimyung University School of Medicine, Daegu 42601, Korea; (Y.J.K.); (M.K.)
- Correspondence: (K.J.); (J.H.S.); (E.H.)
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11
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Protective effects of klotho on palmitate-induced podocyte injury in diabetic nephropathy. PLoS One 2021; 16:e0250666. [PMID: 33891667 PMCID: PMC8064606 DOI: 10.1371/journal.pone.0250666] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Accepted: 04/08/2021] [Indexed: 11/19/2022] Open
Abstract
The anti-aging gene, klotho, has been identified as a multi-functional humoral factor and is implicated in multiple biological processes. However, the effects of klotho on podocyte injury in diabetic nephropathy are poorly understood. Thus, the current study aims to investigate the renoprotective effects of klotho against podocyte injury in diabetic nephropathy. We examined lipid accumulation and klotho expression in the kidneys of diabetic patients and animals. We stimulated cultured mouse podocytes with palmitate to induce lipotoxicity-mediated podocyte injury with or without recombinant klotho. Klotho level was decreased in podocytes of lipid-accumulated obese diabetic kidneys and palmitate-treated mouse podocytes. Palmitate-treated podocytes showed increased apoptosis, intracellular ROS, ER stress, inflammation, and fibrosis, and these were significantly attenuated by klotho administration. Klotho treatment restored palmitate-induced downregulation of the antioxidant molecules, Nrf2, Keap1, and SOD1. Klotho inhibited the phosphorylation of FOXO3a, promoted its nuclear translocation, and then upregulated MnSOD expression. In addition, klotho administration attenuated palmitate-induced cytoskeleton changes, decreased nephrin expression, and increased TRPC6 expression, eventually improving podocyte albumin permeability. These results suggest that klotho administration prevents palmitate-induced functional and morphological podocyte injuries, and this may indicate that klotho is a potential therapeutic agent for the treatment of podocyte injury in obese diabetic nephropathy.
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12
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Kim J, Lee S, Hwang E, Ryu KS, Jeong H, Lee JW, Hwangbo Y, Choi KS, Cha HS. Limitations of Deep Learning Attention Mechanisms in Clinical Research: Empirical Case Study Based on the Korean Diabetic Disease Setting. J Med Internet Res 2020; 22:e18418. [PMID: 33325832 PMCID: PMC7773508 DOI: 10.2196/18418] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 09/13/2020] [Accepted: 11/11/2020] [Indexed: 12/03/2022] Open
Abstract
Background Despite excellent prediction performance, noninterpretability has undermined the value of applying deep-learning algorithms in clinical practice. To overcome this limitation, attention mechanism has been introduced to clinical research as an explanatory modeling method. However, potential limitations of using this attractive method have not been clarified to clinical researchers. Furthermore, there has been a lack of introductory information explaining attention mechanisms to clinical researchers. Objective The aim of this study was to introduce the basic concepts and design approaches of attention mechanisms. In addition, we aimed to empirically assess the potential limitations of current attention mechanisms in terms of prediction and interpretability performance. Methods First, the basic concepts and several key considerations regarding attention mechanisms were identified. Second, four approaches to attention mechanisms were suggested according to a two-dimensional framework based on the degrees of freedom and uncertainty awareness. Third, the prediction performance, probability reliability, concentration of variable importance, consistency of attention results, and generalizability of attention results to conventional statistics were assessed in the diabetic classification modeling setting. Fourth, the potential limitations of attention mechanisms were considered. Results Prediction performance was very high for all models. Probability reliability was high in models with uncertainty awareness. Variable importance was concentrated in several variables when uncertainty awareness was not considered. The consistency of attention results was high when uncertainty awareness was considered. The generalizability of attention results to conventional statistics was poor regardless of the modeling approach. Conclusions The attention mechanism is an attractive technique with potential to be very promising in the future. However, it may not yet be desirable to rely on this method to assess variable importance in clinical settings. Therefore, along with theoretical studies enhancing attention mechanisms, more empirical studies investigating potential limitations should be encouraged.
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Affiliation(s)
- Junetae Kim
- Graduate School of Cancer Science and Policy, National Cancer Center, Goyang-si, Gyeonggi-do, Republic of Korea.,Cancer Data Center, National Cancer Control Institute, National Cancer Center, Goyang-si, Gyeonggi-do, Republic of Korea.,Healthcare AI Team, Healthcare Platform Center, National Cancer Center, Goyang-si, Gyeonggi-do, Republic of Korea
| | - Sangwon Lee
- Cancer Data Center, National Cancer Control Institute, National Cancer Center, Goyang-si, Gyeonggi-do, Republic of Korea
| | - Eugene Hwang
- School of Management Engineering, Korea Advanced Institute of Science and Technology, Seoul, Republic of Korea
| | - Kwang Sun Ryu
- Cancer Data Center, National Cancer Control Institute, National Cancer Center, Goyang-si, Gyeonggi-do, Republic of Korea
| | - Hanseok Jeong
- Graduate School of Cancer Science and Policy, National Cancer Center, Goyang-si, Gyeonggi-do, Republic of Korea
| | - Jae Wook Lee
- Division of Nephrology, Department of Internal Medicine, National Cancer Center, Goyang-si, Gyeonggi-do, Republic of Korea
| | - Yul Hwangbo
- Healthcare AI Team, Healthcare Platform Center, National Cancer Center, Goyang-si, Gyeonggi-do, Republic of Korea.,Division of Endocrinology, Department of Internal Medicine, National Cancer Center, Goyang-si, Gyeonggi-do, Republic of Korea
| | - Kui Son Choi
- Graduate School of Cancer Science and Policy, National Cancer Center, Goyang-si, Gyeonggi-do, Republic of Korea.,Cancer Data Center, National Cancer Control Institute, National Cancer Center, Goyang-si, Gyeonggi-do, Republic of Korea
| | - Hyo Soung Cha
- Graduate School of Cancer Science and Policy, National Cancer Center, Goyang-si, Gyeonggi-do, Republic of Korea.,Cancer Data Center, National Cancer Control Institute, National Cancer Center, Goyang-si, Gyeonggi-do, Republic of Korea
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13
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Dawood AA, Kamel MA, Omar TA, Agaba AAM. Study of serum pentraxin 3 level in patients with diabetic nephropathy. THE EGYPTIAN JOURNAL OF INTERNAL MEDICINE 2020. [DOI: 10.1186/s43162-020-00002-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Pentraxin 3 (PTX3), a member of a superfamily of conserved proteins called pentraxins. PTX3 and C-reactive protein (CRP) are members of this family and play an important role in the innate immune system. PTX3 is classified as a long pentraxin, while CRP is a short pentraxin. PTX3 is reported to be a vascular inflammatory marker providing prognostic information of vasculopathy, such as diabetic nephropathy (DN). The purpose of this study is to evaluate the association between serum PTX3 concentrations and the development and/or progression of DN. A total number of 66 patients with type 2 diabetes mellitus (T2DM) and 22 healthy subjects were enrolled in this study. Patients with T2DM were divided, according to the levels of urinary albumin/creatinine ratio (UACR), into three groups: normoalbuminuric, microalbuminuric, and macroalbuminuric groups. Serum PTX3 and high-sensitivity C-reactive protein (hs-CRP) concentrations were determined using ELISA kits.
Results
Serum PTX3 and hs-CRP concentrations were significantly higher in patients with T2DM compared with the controls. Furthermore, serum PTX3 concentrations were significantly higher in macroalbuminuric patients than in microalbuminuric patients (P < 0.001) and also were significantly higher in microalbuminuric patients than in normoalbuminuric patients (P < 0.001). However, there were no significant differences between controls and T2DM patients with normoalbuminuria regarding serum PTX3 concentrations (P > 0.05). Moreover, like PTX3, hs-CRP concentrations were higher in microalbuminuric patients than in normoalbuminuric patients (P < 0.05), and also, there were no significant differences between controls and T2DM patients with normoalbuminuria regarding hs-CRP concentrations (P > 0.05). But, unlike PTX3, there were no significant differences between macroalbuminuric and microalbuminuric patients regarding hs-CRP concentrations (P > 0.05).
Conclusions
Serum PTX3 is positively associated with DN development and progression, and may be a more accurate predictor of DN development than hs-CRP as it can discriminate between macroalbuminuric and microalbuminuric DN patients, while hs-CRP cannot.
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14
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Lee J. Did Sejong the Great have ankylosing spondylitis? The oldest documented case of ankylosing spondylitis. Int J Rheum Dis 2020; 24:203-206. [PMID: 33159423 DOI: 10.1111/1756-185x.14025] [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: 08/10/2020] [Revised: 10/22/2020] [Accepted: 10/22/2020] [Indexed: 10/23/2022]
Abstract
AIM Sejong the Great (May 7, 1397-March 30, 1450), a king during Korea's Choson Dynasty, is the most respected historical figure in South Korean society, and consequently, many studies have been conducted on his achievements and the disease he suffered. The dominant trend of scholarship claims that Sejong suffered from diabetic retinopathy. However, this interpretation has not been medically verified. The present analysis aimed to demonstrate that Sejong's is the oldest documented case of ankylosing spondylitis. METHODS The Annals of the Choson Dynasty (hereafter, The Annals) are daily records of the king. The Annals were recorded for 472 years (1392-1865) and contain 49 646 667 Chinese characters. Records in The Annals on Sejong span 1418-1450; the present study author reviewed these records. RESULTS Sejong's medical records are mentioned 40 times in the source text. The king first experienced musculoskeletal pain in his knee at the age of 22 years. Sejong's knee pain is mentioned 3 times, and his back pain, which he described as "stiff and immobile", is mentioned 6 times. He complained most frequently of ocular symptoms described as "prickly or tingling," which are mentioned 12 times. CONCLUSIONS Based on the analysis of official documentation, the author argues that there is a high probability that Sejong suffered from ankylosing spondylitis, making this the oldest officially documented case of the disease.
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Affiliation(s)
- JiHwan Lee
- Department of Orthopedic Surgery, Konkuk University School of Medicine, Seoul, Korea
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15
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Ahn HS, Kim JH, Jeong H, Yu J, Yeom J, Song SH, Kim SS, Kim IJ, Kim K. Differential Urinary Proteome Analysis for Predicting Prognosis in Type 2 Diabetes Patients with and without Renal Dysfunction. Int J Mol Sci 2020; 21:ijms21124236. [PMID: 32545899 PMCID: PMC7352871 DOI: 10.3390/ijms21124236] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 06/05/2020] [Accepted: 06/12/2020] [Indexed: 12/28/2022] Open
Abstract
Renal dysfunction, a major complication of type 2 diabetes, can be predicted from estimated glomerular filtration rate (eGFR) and protein markers such as albumin concentration. Urinary protein biomarkers may be used to monitor or predict patient status. Urine samples were selected from patients enrolled in the retrospective diabetic kidney disease (DKD) study, including 35 with good and 19 with poor prognosis. After removal of albumin and immunoglobulin, the remaining proteins were reduced, alkylated, digested, and analyzed qualitatively and quantitatively with a nano LC-MS platform. Each protein was identified, and its concentration normalized to that of creatinine. A prognostic model of DKD was formulated based on the adjusted quantities of each protein in the two groups. Of 1296 proteins identified in the 54 urine samples, 66 were differentially abundant in the two groups (area under the curve (AUC): p-value < 0.05), but none showed significantly better performance than albumin. To improve the predictive power by multivariate analysis, five proteins (ACP2, CTSA, GM2A, MUC1, and SPARCL1) were selected as significant by an AUC-based random forest method. The application of two classifiers—support vector machine and random forest—showed that the multivariate model performed better than univariate analysis of mucin-1 (AUC: 0.935 vs. 0.791) and albumin (AUC: 1.0 vs. 0.722). The urinary proteome can reflect kidney function directly and can predict the prognosis of patients with chronic kidney dysfunction. Classification based on five urinary proteins may better predict the prognosis of DKD patients than urinary albumin concentration or eGFR.
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Affiliation(s)
- Hee-Sung Ahn
- Asan Institute for Life Sciences, Asan Medical Center, Seoul 05505, Korea; (H.-S.A.); (J.Y.)
| | - Jong Ho Kim
- Department of Internal Medicine and Biomedical Research Institute, Pusan National University Hospital, Busan 49241, Korea; (J.H.K.); (S.H.S.); (S.S.K.)
| | - Hwangkyo Jeong
- Department of Biomedical Sciences, University of Ulsan College of Medicine, Seoul 05505, Korea;
| | - Jiyoung Yu
- Asan Institute for Life Sciences, Asan Medical Center, Seoul 05505, Korea; (H.-S.A.); (J.Y.)
| | - Jeonghun Yeom
- Convergence Medicine Research Center, Asan Institute for Life Sciences, Seoul 05505, Korea;
| | - Sang Heon Song
- Department of Internal Medicine and Biomedical Research Institute, Pusan National University Hospital, Busan 49241, Korea; (J.H.K.); (S.H.S.); (S.S.K.)
| | - Sang Soo Kim
- Department of Internal Medicine and Biomedical Research Institute, Pusan National University Hospital, Busan 49241, Korea; (J.H.K.); (S.H.S.); (S.S.K.)
| | - In Joo Kim
- Department of Internal Medicine and Biomedical Research Institute, Pusan National University Hospital, Busan 49241, Korea; (J.H.K.); (S.H.S.); (S.S.K.)
- Correspondence: (I.J.K.); (K.K.); Tel.: +82-51-240-7224 (I.J.K.); +82-2-1688-7575 (K.K.)
| | - Kyunggon Kim
- Asan Institute for Life Sciences, Asan Medical Center, Seoul 05505, Korea; (H.-S.A.); (J.Y.)
- Department of Biomedical Sciences, University of Ulsan College of Medicine, Seoul 05505, Korea;
- Clinical Proteomics Core Laboratory, Convergence Medicine Research Center, Asan Medical Center, Seoul 05505, Korea
- Bio-Medical Institute of Technology, Asan Medical Center, Seoul 05505, Korea
- Correspondence: (I.J.K.); (K.K.); Tel.: +82-51-240-7224 (I.J.K.); +82-2-1688-7575 (K.K.)
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16
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Hu Y, Shi R, Mo R, Hu F. Nomogram for the prediction of diabetic nephropathy risk among patients with type 2 diabetes mellitus based on a questionnaire and biochemical indicators: a retrospective study. Aging (Albany NY) 2020; 12:10317-10336. [PMID: 32484786 PMCID: PMC7346021 DOI: 10.18632/aging.103259] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Accepted: 05/01/2020] [Indexed: 12/29/2022]
Abstract
Purpose: Develop a diabetic nephropathy incidence risk nomogram in a Chinese population with type 2 diabetes mellitus. Results: Predictors included systolic blood pressure, diastolic blood pressure, fasting blood glucose, glycosylated hemoglobin A1c, total triglycerides, serum creatinine, blood urea nitrogen and body mass index. The model displayed medium predictive power with a C-index of 0.744 and an area under curve of 0.744. Internal verification of C-index reached 0.737. The decision curve analysis showed the risk threshold was 20%. The value of net reclassification improvement and integrated discrimination improvement were 0.131, 0.05, and that the nomogram could be applied in clinical practice. Conclusion: Diabetic nephropathy incidence risk nomogram incorporating 8 features is useful to predict diabetic nephropathy incidence risk in type 2 diabetes mellitus patients. Methods: Questionnaires, physical examinations and biochemical tests were performed on 3489 T2DM patients in six communities in Shanghai. LASSO regression was used to optimize feature selection by running cyclic coordinate descent. Logistic regression analysis was applied to build a prediction model incorporating the selected features. The C-index, calibration plot, curve analysis, forest plot, net reclassification improvement, integrated discrimination improvement and internal validation were used to validate the discrimination, calibration and clinical usefulness of the model.
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Affiliation(s)
- Yuhong Hu
- School of Public Health, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Rong Shi
- School of Public Health, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Ruohui Mo
- School of Public Health, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Fan Hu
- School of Public Health, Shanghai University of Traditional Chinese Medicine, Shanghai, China
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17
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Urine E-cadherin: A Marker for Early Detection of Kidney Injury in Diabetic Patients. J Clin Med 2020; 9:jcm9030639. [PMID: 32121033 PMCID: PMC7141221 DOI: 10.3390/jcm9030639] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Revised: 02/11/2020] [Accepted: 02/24/2020] [Indexed: 12/17/2022] Open
Abstract
Diabetic nephropathy (DN) is the main reason for end-stage renal disease. Microalbuminuria as the non-invasive available diagnosis marker lacks specificity and gives high false positive rates. To identify and validate biomarkers for DN, we used in the present study urine samples from four patient groups: diabetes without nephropathy, diabetes with microalbuminuria, diabetes with macroalbuminuria and proteinuria without diabetes. For the longitudinal validation, we recruited 563 diabetic patients and collected 1363 urine samples with the clinical data during a follow-up of 6 years. Comparative urinary proteomics identified four proteins Apolipoprotein A-I (APOA1), Beta-2-microglobulin (B2M), E-cadherin (CDH1) and Lithostathine-1-alpha (REG1A), which differentiated with high statistical strength (p < 0.05) between DN patients and the other groups. Label-free mass spectrometric quantification of the candidates confirmed the discriminatory value of E-cadherin and Lithostathine-1-alpha (p < 0.05). Immunological validation highlighted E-cadherin as the only marker able to differentiate significantly between the different DN stages with an area under the curve (AUC) of 0.85 (95%-CI: [0.72, 0.97]). The analysis of the samples from the longitudinal study confirmed the prognostic value of E-cadherin, the critical increase in urinary E-cadherin level was measured 20 ± 12.5 months before the onset of microalbuminuria and correlated significantly (p < 0.05) with the glomerular filtration rate measured by estimated glomerular filtration rate (eGFR).
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18
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Lou J, Jing L, Yang H, Qin F, Long W, Shi R. Risk factors for diabetic nephropathy complications in community patients with type 2 diabetes mellitus in Shanghai: Logistic regression and classification tree model analysis. Int J Health Plann Manage 2019; 34:1013-1024. [PMID: 31368138 DOI: 10.1002/hpm.2871] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND The prevalence of type 2 diabetes mellitus (T2DM) in China was 11.6% in 2010. Chronic complications are the main diabetes-related cause of death and disability, accounting for more than 80% of the cost of diabetes treatment. Diabetic nephropathy (DN) is a common microvascular complication and is the second leading cause of end-stage renal failure in China. OBJECTIVE We aimed to analyse the DN status among community-based T2DM patients and to explore risk factors for T2DM with DN. METHODS This study was conducted in six communities of Shanghai. We administered a questionnaire, physical examination, and biochemical tests to 5078 patients with T2DM. Logistic regression and the classification tree model were used to analyse risk factors for T2DM with DN. RESULTS In total, 1937 patients were diagnosed with DN (prevalence 38.4%). The logistic regression model indicated that course of disease more than 15 years, body mass index (BMI) greater than 24 kg/m2 , haemoglobin A1c (HbA1c) greater than 7.5%, fasting blood glucose (FBG) greater than 11.0 mmol/L, total cholesterol (TC), and high-density lipoprotein (HDL)-C control failure, hypertension, and diabetic retinopathy were risk factors for T2DM with DN (P < .05). The classification tree model identified seven risk factors (HbA1c, FBG, hypertension, postprandial blood glucose, BMI, triacylglycerol, and HDL), of which, HbA1c (cut-off point 7.45%), hypertension, and FBG showed the strongest association. CONCLUSION This suggests that screening for DN based on HbA1c, FBG, and hypertension should be more extensively promoted by the government on a community level, more attention should be focused on patients' health management, and that patients should be educated on self-management.
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Affiliation(s)
- Jieqiong Lou
- Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Limei Jing
- School of Public Health, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Hui Yang
- School of Public Health, Shanghai Jiao Tong University, Shanghai, China
| | - Fei Qin
- School of Public Health, Shanghai Jiao Tong University, Shanghai, China
| | - Wen Long
- Department of School Hygiene, Huangpu District Center for Disease Control and Prevention, Shanghai, China
| | - Rong Shi
- School of Public Health, Shanghai University of Traditional Chinese Medicine, Shanghai, China.,School of Public Health, Shanghai Jiao Tong University, Shanghai, China
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19
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Hwang YC, Kim SW, Hur KY, Cha BS, Kim IJ, Park TS, Baik SH, Yoon KH, Lee KW, Lee IK, Lee MK. Predictive Factors for Efficacy of AST-120 Treatment in Diabetic Nephropathy: a Prospective Single-Arm, Open-Label, Multi-Center Study. J Korean Med Sci 2019; 34:e117. [PMID: 31001934 PMCID: PMC6473095 DOI: 10.3346/jkms.2019.34.e117] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Accepted: 04/01/2019] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Removal of uremic toxins such as indoxyl sulfate by AST-120 is known to improve renal function and delay the initiation of dialysis in patients with advanced chronic kidney disease. However, it is unclear whether the addition of AST-120 to conventional treatments is effective in delaying the progression of renal dysfunction in patients with diabetic nephropathy. METHODS A total of 100 patients with type 2 diabetes and renal dysfunction (serum creatinine levels ranging from 1.5 to 3.0 mg/dL) were recruited from eight centers in Korea and treated with AST-120 (6 g/day) for 24 weeks. The primary endpoint was improvement in renal function measured as the gradient of the reciprocal serum creatinine level (1/sCr) over time (i.e., the ratio of 1/sCr time slope for post- to pre-AST-120 therapy). A response was defined as a ratio change of the regression coefficient of 1/sCr ≤ 0.90. RESULTS Renal function improved in 80.3% of patients (61/76) after 24 weeks of AST-120 treatment. There were no differences between responder and non-responder groups in baseline characteristics except for diastolic blood pressure (73.5 ± 9.5 mmHg in the responder group vs. 79.3 ± 11.1 mmHg in the non-responder group; P = 0.046). Serum lipid peroxidation level decreased significantly in the responder group (from 2.25 ± 0.56 μol/L to 1.91 ± 0.72 μol/L; P = 0.002) but not in the non-responder group. CONCLUSION The addition of AST-120 to conventional treatments may delay the progression of renal dysfunction in diabetic nephropathy. The antioxidant effect of AST-120 might contribute to improvement in renal function.
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Affiliation(s)
- You Cheol Hwang
- Division of Endocrinology and Metabolism, Department of Medicine, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, Seoul, Korea
| | - Se Won Kim
- Division of Endocrinology and Metabolism, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Kyu Yeon Hur
- Division of Endocrinology and Metabolism, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Bong Soo Cha
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - In Joo Kim
- Department of Internal Medicine, Pusan National University School of Medicine, Busan, Korea
| | - Tae Sun Park
- Department of Internal Medicine, Chonbuk National University Hospital, Jeonju, Korea
| | - Sei Hyun Baik
- Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Kun Ho Yoon
- Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Kwan Woo Lee
- Department of Internal Medicine, Ajou University Hospital, Ajou University School of Medicine, Suwon, Korea
| | - In Kyu Lee
- Department of Internal Medicine, Kyungpook National University School of Medicine, Daegu, Korea
| | - Moon Kyu Lee
- Division of Endocrinology and Metabolism, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
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20
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Wang Y, Zhang R, Zhang J, Liu F. MicroRNA-326-3p ameliorates high glucose and ox-LDL-IC- induced fibrotic injury in renal mesangial cells by targeting FcγRIII. Nephrology (Carlton) 2019; 23:1031-1038. [PMID: 28921768 DOI: 10.1111/nep.13168] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/11/2017] [Indexed: 02/05/2023]
Abstract
AIM The aim of the present study was to identify the regulatory relationship between miR-326-3p and FcγRIII, and to explore the involvement of miR-326-3p/FcγRIII/TGF-β/Smad signalling pathway in fibrotic injury, which was induced by the high glucose (HG) and oxidized low density lipoprotein immune complex (ox-LDL-IC) in mouse glomerular mesangial cells (GMCs). METHODS Dual-luciferase reporter system and real time PCR (RT-PCR) were used to identify FcγRIII as a target gene of miR-326-3p. Lentiviral transduction was used to construct different expression of miR-326-3p in GMCs, which were divided into three groups: miR-326-3p mimics group (miR-326-3p group), miR-326-3p inhibitor group (miR-326-3p-inhibit group) and scramble control group (control group). Then, each group was stimulated by normal glucose (NG), HG, ox-LDL-IC and HG + ox-LDL-IC, respectively. RT-PCR and western blot were used to measure the expressions of Col-I, CTGF, α-SMA, TGF-β, Smad2/3 and pSmad2/3. RESULTS FcγRIII was regulated negatively by miR-326-3p in GMCs under the condition of HG and ox-LDL-IC, which implied FcγRIII as a target gene of miR-326-3p. Furthermore, compared with normal glucose group, the expressions of Col-I, CTGF, α-SMA, TGF-β and pSmad2/3 were higher under the condition of HG, ox-LDL-IC and HG + ox-LDL-IC (P < 0.05). In particular, miR-326-3p-inhibit groups exhibited the most significant increase (P < 0.05), while miR-326-3p could attenuate the increase (P < 0.05). CONCLUSION FcγRIII was identified as a target gene of miR-326-3p. MiR-326-3p/FcγRIII/TGF-β/Smad signaling pathway was investigated to be involved in the pathophysiology of renal fibrosis of DKD.
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Affiliation(s)
- Yiting Wang
- Division of Nephrology, West China Hospital of Sichuan University, Chengdu, China
| | - Rui Zhang
- Division of Nephrology, West China Hospital of Sichuan University, Chengdu, China
| | - Junlin Zhang
- Division of Nephrology, West China Hospital of Sichuan University, Chengdu, China
| | - Fang Liu
- Division of Nephrology, West China Hospital of Sichuan University, Chengdu, China
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21
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Liao D, Ma L, Liu J, Fu P. Cigarette smoking as a risk factor for diabetic nephropathy: A systematic review and meta-analysis of prospective cohort studies. PLoS One 2019; 14:e0210213. [PMID: 30716100 PMCID: PMC6361430 DOI: 10.1371/journal.pone.0210213] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Accepted: 12/17/2018] [Indexed: 02/05/2023] Open
Abstract
Background Observational studies suggested that tobacco smoking was associated with diabetic nephropathy (DN). However, the results were conflicting and inconsistent. In the study, we performed a meta-analysis to assess the relationship between tobacco smoking and the development of DN. Materials and methods We searched in PubMed, Embase, Web of Science and the Cochrane Library (CENTRAL) from database inception until Mar 8, 2018, and updated our search on May 1, 2018. We screened the reference lists of the retrieved articles. Only original prospective cohort studies which have investigated the association between smoking and DN incidence or its progression were included. Pooled HRs and 95% confidence intervals (CIs) were calculated using a random effects model. Results A total of 9 prospective cohort studies were identified, including more than 203337 participants. Compared with those of no smoking, smoking participants increased the risk of developing DN (HR = 1.07, 95% CI: 1.01–1.13, P = 0.01). The subgroup analysis showed that the current and total smoking may increase the risk of DN, but these results did not reach statistical significance (current: HR = 1.69, 95% CI = 0.79–3.64, p = 0.17; total: HR = 1.17, 95% CI = 0.97–1.41, p = 0.10), whereas former smoking significantly increased the risk of DN (HR = 1.04, 95% CI = 1.03–1.05, p<0.001). Compared with no-smokers, smokers showed an elevated risk of developing DN (HR = 1.05; 95% CI, 1.00–1.11, P = 0.05). In patients with T2DM, those who smoked were at an increased risk of developing DN, as compared to those who had never smoked (HR = 1.05; 95% CI, 1.00–1.11, P = 0.05). However, compared to no smoking, smoking did not increase the risk of DN development in patients with T2DM (HR = 1.15; 95% CI, 0.9–1.47, P = 0.25). Univariate and multivariate meta-regression did not find any confounding factors. No publication bias was found in the meta-analysis. Conclusions The present study highlighted that smoking was an independent risk factor for DN, especially in patients with T1DM. This is the first meta-analysis of prospective cohort studies to discuss the relationship between smoking and DN.
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Affiliation(s)
- Dan Liao
- Kidney Research Lab, Division of Nephrology, National Clinical Research Center for Geriatrics, West China Hospital of Sichuan University, Chengdu, China
- Division of Nephrology, Mianyang Central Hospital, Mianyang, China
| | - Liang Ma
- Kidney Research Lab, Division of Nephrology, National Clinical Research Center for Geriatrics, West China Hospital of Sichuan University, Chengdu, China
- * E-mail: (LM); (PF)
| | - Jing Liu
- Kidney Research Lab, Division of Nephrology, National Clinical Research Center for Geriatrics, West China Hospital of Sichuan University, Chengdu, China
| | - Ping Fu
- Kidney Research Lab, Division of Nephrology, National Clinical Research Center for Geriatrics, West China Hospital of Sichuan University, Chengdu, China
- * E-mail: (LM); (PF)
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22
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Doghish AS, Bassyouni AA, Mahfouz MH, Abd El-Aziz HG, Zakaria RY. Plasma endoglin in Type2 diabetic patients with nephropathy. Diabetes Metab Syndr 2019; 13:764-768. [PMID: 30641803 DOI: 10.1016/j.dsx.2018.11.058] [Citation(s) in RCA: 63] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Accepted: 11/30/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND Diabetic nephropathy may be a common complication of diabetes mellitus. Endoglin is glycoprotein located on cell surfaces of endothelial cells and is part of the transforming growth factor beta (TGF- β) receptor. Endoglin expression is enhanced in endothelial cells during injury and inflammation. The aim of this study was to estimate the plasma level of soluble endoglin (sEng) in type 2 diabetic patients (with and without nephropathy). Also to explore its availability as marker for disease progression. METHODS In this study, sixty eight patients with type 2 diabetes mellitus (T2DM) were included; the patients were sub-grouped to normoalbuminuria without nephropathy and moderately increased albuminuria (microalbuminuria) with nephropathy groups with 13 individuals as control group. Plasma soluble endoglin level was determined using ELISA technique. Fasting plasma glucose (FPG), glycated haemoglobin (HbA1c), lipid profile, and creatinine were determined using colorimetric assay, whereas glomerular filtration rate (GFR) was calculated. RESULTS The plasma level of sEng of both normoalbuminuria group 1 and microalbuminuria group 2 were significantly higher when compared to control group. While, the plasma level of sEng in microalbuminuria group 2 was nonsignificant lower when compared to normoalbuminuria group 1. Also, there was a significant positive association between plasma level of sEng and HbA1c, HDL-C and urinary albumin concentration in normoalbuminuria group. CONCLUSION Plasma level of soluble Endoglin is markedly increase prior to alteration in endothelial function, and increases to lesser extent with the developing of diabetic nephropathy which indicated disease progression and development of vascular abnormalities.
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Affiliation(s)
- Ahmed S Doghish
- Biochemistry Department, Faculty of Pharmacy, Al-Azhar University, Nasr City, 13465, Cairo, Egypt; Biochemistry Department, Faculty of Pharmacy, Badr University in Cairo, Cairo, Egypt.
| | - Atef A Bassyouni
- National Institute of Diabetes and Endocrinology (NIDE), Cairo, Egypt
| | - Mohamed H Mahfouz
- National Institute of Diabetes and Endocrinology (NIDE), Cairo, Egypt
| | - Heba G Abd El-Aziz
- Biochemistry Department, Faculty of Pharmacy, Al-Azhar University, Nasr City, 13465, Cairo, Egypt
| | - Rania Y Zakaria
- Biochemistry Department, Faculty of Pharmacy, Al-Azhar University, Nasr City, 13465, Cairo, Egypt
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23
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Baik SY, Kim H, Yang SJ, Kim TM, Lee SH, Cho JH, Lee H, Yim HW, Yoon KH, Kim HS. Long-term effects of various types of 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors on changes in glomerular filtration rate in Korea. Front Med 2018; 13:713-722. [PMID: 30483915 DOI: 10.1007/s11684-018-0661-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Accepted: 06/15/2018] [Indexed: 11/24/2022]
Abstract
Few long-term follow-up studies have compared the changes in renal function according to the type of statin used in Korea. We compared the long-term effects of statin intensity and type on the changes in the glomerular filtration rate (GFR). We extracted data of patients who took statin for the first time. We analyzed whether or not different statins affect the changes in GFR at 3 months after baseline and 4 years after. We included 3678 patients and analyzed the changes in GFR. The GFR decreased by 3.2% ± 0.4% on average 4 years after the first statin prescription, indicating statistically significant deterioration (from 83.5 ± 0.4 mL/min/1.73 m2 to 79.9 0.4 mL/min/1.73 m2, P < 0.001). When comparing the GFR among different statins, significant differences were observed between atorvastatin and fluvastatin (-5.3% ± 0.7% vs. 1.2% ± 2.2%, P < 0.05) and between atorvastatin and simvastatin (-5.3% ± 0.7% vs. -0.7% ± 0.8%, P < 0.05). In pitavastatin (odds ratio [OR]= 0.64, 95% confidence interval [CI]= 0.46-0.87, P < 0.005) and simvastatin (OR = 0.69, 95% CI = 0.53-0.91, P < 0.008), the GFR rate that decreased by < 60 mL/min/1.73 m2 was significantly lower than that of atorvastatin. Regarding long-term statin intake, GFR changed with the type of statin. This work is the first in Korea to compare each statin in terms of changes in the GFR after the statin prescription.
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Affiliation(s)
- Seo Yeon Baik
- Department of Medical Informatics, College of Medicine, The Catholic University of Korea, Seoul, 06591, Republic of Korea
| | - Hyunah Kim
- College of Pharmacy, Sookmyung Women's University, Seoul, 04310, Republic of Korea
| | - So Jung Yang
- Department of Medical Informatics, College of Medicine, The Catholic University of Korea, Seoul, 06591, Republic of Korea
| | - Tong Min Kim
- Department of Medical Informatics, College of Medicine, The Catholic University of Korea, Seoul, 06591, Republic of Korea
| | - Seung-Hwan Lee
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, 06591, Republic of Korea
| | - Jae Hyoung Cho
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, 06591, Republic of Korea
| | - Hyunyong Lee
- Clinical Research Coordinating Center, Catholic Medical Center, The Catholic University of Korea, Seoul, 06591, Republic of Korea
| | - Hyeon Woo Yim
- Department of Preventive Medicine, College of Medicine, The Catholic University of Korea, Seoul, 06591, Republic of Korea
| | - Kun-Ho Yoon
- Department of Medical Informatics, College of Medicine, The Catholic University of Korea, Seoul, 06591, Republic of Korea.,Division of Endocrinology and Metabolism, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, 06591, Republic of Korea
| | - Hun-Sung Kim
- Department of Medical Informatics, College of Medicine, The Catholic University of Korea, Seoul, 06591, Republic of Korea. .,Division of Endocrinology and Metabolism, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, 06591, Republic of Korea.
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24
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Won JC, Lee JH, Kim JH, Kang ES, Won KC, Kim DJ, Lee MK. Diabetes Fact Sheet in Korea, 2016: An Appraisal of Current Status. Diabetes Metab J 2018; 42:415-424. [PMID: 30113146 PMCID: PMC6202557 DOI: 10.4093/dmj.2018.0017] [Citation(s) in RCA: 77] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Accepted: 05/02/2018] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND This report presents the recent prevalence and comorbidities related to diabetes in Korea by analyzing the nationally representative data. METHODS Using data from the Korea National Health and Nutrition Examination Survey for 2013 to 2014, the percentages and the total number of subjects over the age of 30 years with diabetes and prediabetes were estimated and applied to the National Population Census in 2014. Diagnosis of diabetes was based on fasting plasma glucose (≥126 mg/dL), current taking of antidiabetic medication, history of previous diabetes, or glycosylated hemoglobin (HbA1c) ≥6.5%. Impaired fasting glucose (IFG) was defined by fasting plasma glucose in the range of 100 to 125 mg/dL among those without diabetes. RESULTS About 4.8 million (13.7%) Korean adults (≥30 years old) had diabetes, and about 8.3 million (24.8%) Korean adults had IFG. However, 29.3% of the subjects with diabetes are not aware of their condition. Of the subjects with diabetes, 48.6% and 54.7% were obese and hypertensive, respectively, and 31.6% had hypercholesterolemia. Although most subjects with diabetes (89.1%) were under medical treatment, and mostly being treated with oral hypoglycemic agents (80.2%), 10.8% have remained untreated. With respect to overall glycemic control, 43.5% reached the target of HbA1c <7%, whereas 23.3% reached the target when the standard was set to HbA1c <6.5%, according to the Korean Diabetes Association guideline. CONCLUSION Diabetes is a major public health threat in Korea, but a significant proportion of adults were not controlling their illness. We need comprehensive approaches to overcome the upcoming diabetes-related disease burden in Korea.
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Affiliation(s)
- Jong Chul Won
- Department of Internal Medicine, Cardiovascular and Metabolic Disease Center, Inje University Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea
| | - Jae Hyuk Lee
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Myongji Hospital, Goyang, Korea
| | - Jae Hyeon Kim
- Division of Endocrinology and Metabolism, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Eun Seok Kang
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Kyu Chang Won
- Department of Internal Medicine, Yeungnam University College of Medicine, Daegu, Korea
| | - Dae Jung Kim
- Department of Endocrinology and Metabolism, Ajou University School of Medicine, Suwon, Korea.
| | - Moon Kyu Lee
- Division of Endocrinology and Metabolism, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
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25
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Correlation of vascular endothelial function and coagulation factors with renal function and inflammatory factors in patients with diabetic nephropathy. Exp Ther Med 2018; 16:4167-4171. [PMID: 30402157 PMCID: PMC6200961 DOI: 10.3892/etm.2018.6718] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Accepted: 08/30/2018] [Indexed: 11/16/2022] Open
Abstract
Correlation of vascular endothelial function and coagulation factors with renal function and inflammatory factors in patients with diabetic nephropathy was analyzed. A total of 86 patients diagnosed with diabetes mellitus (DM) and admitted to the 89th Hospital of the People's Liberation Army (Weifang, China) from March 2014 to May 2017 were selected. Among them, 38 patients complicated with nephropathy were divided into the observation group and 48 patients without nephropathy into the control group. The general data of patients were collected, and the relevant biochemical indexes, vascular endothelial function, coagulation factors and renal function indicators and the levels of inflammatory factors were determined. In the observation group, the duration of DM was longer than that in the control group, and the levels of glycated hemoglobin (HbA1c), fasting plasma glucose (FPG) and fasting insulin (FINS), level of fibrinogen (FIB) were higher than those in the control group (p<0.05). Homocysteine (Hcy) and brachial artery blood flow in the observation group were higher than those in the control group. The levels of nitric oxide (NO) and flow-mediated dilation (FMD) were lower than those in the control group (p<0.05). Activated partial thromboplastin time (APTT) in the observation group was shorter than that in the control group (p<0.05). The levels of cystatin-C (Cys-C), serum creatinine (SCr), urea and β2-microglobulin, levels of C-reactive protein (CRP), tumor necrosis factor-α (TNF-α) and interleukin-6 (IL-6) in peripheral serum in the observation group were greatly higher than those in the control group (p<0.05). It was concluded via the correlation analysis of vascular endothelial function and coagulation factor with renal function and inflammatory factors that SCr and CRP were negatively correlated with NO, and SCr and CRP were positively correlated with FIB. Serum inflammatory factors, coagulation function and vascular endothelial function are closely related to diabetic nephropathy, which are good reference indexes for the assessment of diabetic nephropathy.
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26
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Liu W, Yu J, Yan Q, Wang L, Li N, Xiong W. Meta-analysis of the benefit of sitagliptin treatment in patients with type 2 diabetes complicated with incipient nephropathy. Exp Ther Med 2018; 16:2545-2553. [PMID: 30210604 PMCID: PMC6122566 DOI: 10.3892/etm.2018.6449] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Accepted: 07/02/2018] [Indexed: 12/14/2022] Open
Abstract
The purpose of this meta-analysis was to evaluate the evidence of the clinical efficacy and safety of sitagliptin in diabetic patients with incipient nephropathy. PubMed, Ovid, Cochrane library, Chinese National Knowledge Infrastructure, and Wanfang databases were searched in September 2017 to identify randomized controlled trials (RCTs) of sitagliptin in diabetic patients with incipient nephropathy. Study selection, data extraction and study quality assessment were performed independently by two investigators, while disagreements were resolved by a third reviewer. The treatment effect was estimated by calculating the mean difference (MD) or standard mean difference (SMD). Heterogeneity was assessed with the χ2 and I2 tests. Additionally, risk of bias graphs and summaries were used to assess the quality of the included trials. Thirteen RCTs were included in this review; their results suggested that sitagliptin has obvious advantages in lowering the 24-hour urinary albumin excretion [MD, -25.71; 95% confidence interval (CI), -30.75 to -20.66; P<0.00001], serum cystatin C (MD, -0.59; 95% CI, -0.64 to -0.54; P<0.00001), inflammation (MD, -0.81; 95% CI, -1.20 to -0.42; P<0.0001), and total cholesterol (MD, -0.13; 95% CI, -0.22 to -0.03; P=0.009). However, sitagliptin did not appear to influence serum creatinine, fasting blood glucose, postprandial blood glucose, glycosylated hemoglobin A1c, or triglyceride levels, although these results may have been influenced by biases in the included trials. The most common adverse effects of sitagliptin were gastrointestinal tract reaction and hypoglycemia, although these symptoms resolved quickly. Sitagliptin appears to be effective in reducing proteinuria, ameliorating renal function, and producing an anti-inflammatory effect in patients with early-stage diabetic nephropathy. The present analysis provides important guidance for the clinical application of sitagliptin.
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Affiliation(s)
- Wei Liu
- The First Clinical Medical College, Nanjing University of Chinese Medicine, Nanjing, Jiangsu 210023, P.R. China
| | - Jiangyi Yu
- The First Clinical Medical College, Nanjing University of Chinese Medicine, Nanjing, Jiangsu 210023, P.R. China.,Department of Endocrinology and Metabolism, Jiangsu Province Hospital of Traditional Chinese Medicine, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, Jiangsu 210023, P.R. China
| | - Qianhua Yan
- Department of Endocrinology and Metabolism, Jiangsu Province Hospital of Traditional Chinese Medicine, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, Jiangsu 210023, P.R. China
| | - Lijuan Wang
- Department of Endocrinology and Metabolism, Jiangsu Province Hospital of Traditional Chinese Medicine, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, Jiangsu 210023, P.R. China
| | - Nan Li
- The First Clinical Medical College, Nanjing University of Chinese Medicine, Nanjing, Jiangsu 210023, P.R. China
| | - Wei Xiong
- The First Clinical Medical College, Nanjing University of Chinese Medicine, Nanjing, Jiangsu 210023, P.R. China
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27
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Huh JH, Lee M, Park SY, Kim JH, Lee BW. Glycated Albumin Is a More Useful Glycation Index than HbA1c for Reflecting Renal Tubulopathy in Subjects with Early Diabetic Kidney Disease. Diabetes Metab J 2018; 42:215-223. [PMID: 29885104 PMCID: PMC6015965 DOI: 10.4093/dmj.2017.0091] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Accepted: 02/05/2018] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND The aim of this study was to investigate which glycemic parameters better reflect urinary N-acetyl-β-D-glucosaminidase (uNAG) abnormality, a marker for renal tubulopathy, in subjects with type 2 diabetes mellitus (T2DM) subjects with normoalbuminuria and a normal estimated glomerular filtration rate (eGFR). METHODS We classified 1,061 participants with T2DM into two groups according to uNAG level-normal vs. high (>5.8 U/g creatinine)-and measured their biochemical parameters. RESULTS Subjects with high uNAG level had significantly higher levels of fasting and stimulated glucose, glycated albumin (GA), and glycosylated hemoglobin (HbA1c) and lower levels of homeostasis model assessment of β-cell compared with subjects with normal uNAG level. Multiple linear regression analyses showed that uNAG was significantly associated with GA (standardized β coefficient [β]=0.213, P=0.016), but not with HbA1c (β=?0.137, P=0.096) or stimulated glucose (β=0.095, P=0.140) after adjusting confounding factors. In receiver operating characteristic analysis, the value of the area under the curve (AUC) for renal tubular injury of GA was significantly higher (AUC=0.634; 95% confidence interval [CI], 0.646 to 0.899) than those for HbA1c (AUC=0.598; 95% CI, 0.553 to 0.640), stimulated glucose (AUC=0.594; 95% CI, 0.552 to 0.636), or fasting glucose (AUC=0.558; 95% CI, 0.515 to 0.600). The optimal GA cutoff point for renal tubular damage was 17.55% (sensitivity 59%, specificity 62%). CONCLUSION GA is a more useful glycation index than HbA1c for reflecting renal tubulopathy in subjects with T2DM with normoalbuminuria and normal eGFR.
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Affiliation(s)
- Ji Hye Huh
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Minyoung Lee
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - So Young Park
- Division of Endocrinology and Metabolism, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jae Hyeon Kim
- Division of Endocrinology and Metabolism, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
| | - Byung Wan Lee
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.
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28
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Han K, Park JB. Evaluation of the association between the number of natural teeth and anemia among Korean adults using nationally representative data. J Periodontol 2018; 89:1184-1192. [PMID: 29624683 DOI: 10.1002/jper.17-0440] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Revised: 01/22/2018] [Accepted: 01/30/2018] [Indexed: 11/06/2022]
Abstract
BACKGROUND Anemia as a chronic disease is defined as anemia occurring in chronic infections with inflammatory conditions. The purpose of this study is to assess the association between the number of natural teeth and anemia using nationally representative data. METHODS This study involved a cross-sectional analysis using data from the Korean National Health and Nutrition Examination Survey from 2010 to 2012. A total of 16,875 respondents aged > 19 years without missing values were included in this study. The association between the number of natural teeth and anemia was evaluated by multivariable logistic regression analyses after adjusting for age, sex, body mass index, smoking habits, drinking habits, exercise levels, income levels, education levels, vitamin D levels, diabetes, toothbrushing frequency, energy intake, and percentage of fat in total energy intake among Korean adults. RESULTS There was a significant decrease in prevalence of anemia and a significant increase in hemoglobin levels in participants with more natural teeth (P < 0.05). Adjusted odds ratios and their 95% confidence intervals for anemia in participants with numbers of natural teeth of < 15, 15 to 19, 20 to 24, or 24 to 28 were 1 (reference), 0.856(0.591 to 1.24), 0.659(0.5 to 0.868), and 0.607(0.463 to 0.797), respectively, with adjustment for confounding factors (P < 0.05). CONCLUSION The number of natural teeth is negatively associated with anemia in Korean adults, and the number of natural teeth may be considered an independent risk indicator of anemia.
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Affiliation(s)
- Kyungdo Han
- Department of Biostatistics, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jun-Beom Park
- Department of Periodontics, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
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29
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Koye DN, Magliano DJ, Nelson RG, Pavkov ME. The Global Epidemiology of Diabetes and Kidney Disease. Adv Chronic Kidney Dis 2018; 25:121-132. [PMID: 29580576 PMCID: PMC11000253 DOI: 10.1053/j.ackd.2017.10.011] [Citation(s) in RCA: 278] [Impact Index Per Article: 46.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Revised: 10/17/2017] [Accepted: 10/23/2017] [Indexed: 12/21/2022]
Abstract
The prevalence of diabetes is increasing worldwide, with the greatest increases occurring in low- and middle-income countries. In most developed countries, type 2 diabetes is presently the leading cause of end-stage renal disease and also contributes substantially to cardiovascular disease. In countries with weaker economies type 2 diabetes is rapidly replacing communicable diseases as a leading cause of kidney disease and is increasingly competing for scarce health care resources. Here, we present a narrative review of the prevalence and incidence of diabetes-related kidney disease worldwide. Mortality among those with diabetes and kidney disease will also be explored. Given the high morbidity and mortality associated with chronic kidney disease, we will also examine the level of awareness of this disease among people who have it.
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Affiliation(s)
- Digsu N Koye
- Department of Clinical Diabetes and Epidemiology, Baker Heart and Diabetes Institute, Melbourne, Australia; Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia; Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia; Chronic Kidney Disease Section, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Phoenix, AZ; and Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, GA
| | - Dianna J Magliano
- Department of Clinical Diabetes and Epidemiology, Baker Heart and Diabetes Institute, Melbourne, Australia; Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia; Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia; Chronic Kidney Disease Section, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Phoenix, AZ; and Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, GA
| | - Robert G Nelson
- Department of Clinical Diabetes and Epidemiology, Baker Heart and Diabetes Institute, Melbourne, Australia; Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia; Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia; Chronic Kidney Disease Section, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Phoenix, AZ; and Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, GA
| | - Meda E Pavkov
- Department of Clinical Diabetes and Epidemiology, Baker Heart and Diabetes Institute, Melbourne, Australia; Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia; Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia; Chronic Kidney Disease Section, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Phoenix, AZ; and Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, GA.
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30
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Xu H, Suo J, Lian J. Cigarette smoking and risk of albuminuria in patients with type 2 diabetes: a systematic review and meta-analysis of observational studies. Int Urol Nephrol 2018; 50:911-922. [PMID: 29476432 DOI: 10.1007/s11255-018-1825-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2017] [Accepted: 02/13/2018] [Indexed: 12/14/2022]
Abstract
BACKGROUND The aim of this study was to assess the effects of smoking on albuminuria risk in adults with type 2 diabetes mellitus (T2DM). METHODS A literature search was conducted using MEDLINE, EMBASE, and China National Knowledge Infrastructure from the established date to October 2017. Summary relative risks (SRR) and 95% confidence intervals (CI) were computed utilizing a random effect inverse variance method. RESULTS This meta-analysis included a total of 19 relevant observational studies (four prospective cohort, seven case-control, and eight cross-sectional studies), reporting 105,031 participants and 23,366 albuminuria events. Compared with never-smokers with T2DM, the SRRs of albuminuria were 1.43 (95% CIs 1.27-1.61) for ever-smokers, 2.61 (95% CIs 1.86-3.64) for current smokers, and 1.86 (95% CIs 1.37-2.52) for former smokers. Considerable heterogeneity was observed among these studies, and study design was a significant modifier for this association. There were significantly elevated risk associations for microalbuminuria (SRRs = 1.24, 95% CIs 1.05-1.46) and for macroalbuminuria (SRRs = 1.65, 95% CIs 1.03-2.66), respectively. CONCLUSIONS Our systematic review and meta-analysis indicates that cigarette smoking might be a potential factor for the development of albuminuria in adults with T2DM. Future studies are required to investigate the association between smoking cessation and intensity and incident albuminuria in adults with T2DM.
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Affiliation(s)
- Haili Xu
- Department of Nursing, The First Affiliated Hospital, Zhengzhou University, Zhengzhou, Henan Province, People's Republic of China
| | - Jinliu Suo
- Department of Urology Surgery, The First Affiliated Hospital, Zhengzhou University, 1 Jianshe Dong Road, Zhengzhou, 450052, Henan Province, People's Republic of China
| | - Jing Lian
- Department of Urology Surgery, The First Affiliated Hospital, Zhengzhou University, 1 Jianshe Dong Road, Zhengzhou, 450052, Henan Province, People's Republic of China.
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Song SJ, Han K, Lee SS, Park JB. Association between the number of natural teeth and diabetic retinopathy among type 2 diabetes mellitus: The Korea national health and nutrition examination survey. Medicine (Baltimore) 2017; 96:e8694. [PMID: 29381952 PMCID: PMC5708951 DOI: 10.1097/md.0000000000008694] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
The aim of this study was to investigate the relationship between the number of teeth and diabetic retinopathy among Korean population.This was a retrospective analysis using data of total 45,811 individuals who participated in the Korea National Health and Nutrition Examination Survey (KNHANES) 2008 to 2012. Among these, 2593 (5.7%) participants were identified as having type 2 diabetes mellitus. After excluding participants without ophthalmic evaluation or other variables, 2078 (80%) participants were included. Demographic factors including dental status were analyzed and compared between participants with and without diabetic retinopathy.Among the 2078 type 2 diabetes, 358 (17.2%) had diabetic retinopathy. Type 2 diabetes with fewer teeth were more likely to have diabetic retinopathy (P < .001). Multivariate analysis showed that type 2 diabetes with < 20 teeth had an 8.7-fold risk of having vision-threatening diabetic retinopathy when compared with type 2 diabetes with ≥28 teeth (95% confidence interval: 2.69-28.3) after adjusting for age, sex, body mass index, smoking, drinking, exercise, hypertension, diabetes mellitus duration, and glycated hemoglobin level.The number of teeth was found to be an independent risk factor for diabetic retinopathy. Thus, a comprehensive approach of dentists and ophthalmologists is needed to minimize the complications of diabetes mellitus. Whether the teeth number reflects microvascular changes of the retina among type 2 diabetes warrants further investigation.
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Affiliation(s)
- Su Jeong Song
- Department of Ophthalmology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine
| | - Kyungdo Han
- Department of Biostatistics, College of Medicine, The Catholic University of Korea, Seoul
| | - Seong-su Lee
- Department of Internal Medicine, Division of Endocrinology and Metabolism, College of Medicine, The Catholic University of Korea, Bucheon-si Gyeonggi-do
| | - Jun-Beom Park
- Department of Periodontics, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
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Smoking and the risk of diabetic nephropathy in patients with type 1 and type 2 diabetes: a meta-analysis of observational studies. Oncotarget 2017; 8:93209-93218. [PMID: 29190990 PMCID: PMC5696256 DOI: 10.18632/oncotarget.21478] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Accepted: 09/21/2017] [Indexed: 12/21/2022] Open
Abstract
Background Conflicting evidence exists for observational studies on whether tobacco smoking is a risk factor for diabetic nephropathy (DN) in patients with type 1 (T1DM) and type 2 diabetes mellitus (T2DM). In this meta-analysis, we aimed to assess the effects of tobacco smoking on the development of DN. Materials and Methods We searched MEDLINE and EMBASE databases from their inception to March 31st, 2017 for cross-sectional, case-control, and prospective cohort studies. We screened reference lists of retrieved articles. Summary relative risks (SRRs) and 95% confidence intervals (CIs) were calculated using a random-effects model. Results A total of nineteen observational studies (1 case-control, 8 cross-sectional and 10 prospective cohort studies) were identified, involving more than 78,000 participants and a total of 17,832 DN cases. Compared with never-smokers, there was an augmented SRR (95% CI) of DN in ever-smokers in patients with T1DM (1.31 [1.06–1.62]; P = 0.006) and T2DM (1.44 [1.24–1.67]; P < 0.001), respectively. In patients with T1DM, the SRR (95% CI) was 1.25 (0.86–1.83) for microalbuminuria only, 1.27 (1.10–1.48) for macroalbuminuria only, and 1.06 (0.97–1.15) for end-stage renal disease (ESRD). In patients with T2DM, the SRR (95% CI) associated with ever smoking was 1.46 (0.94–2.26) for microalbuminuria only, 1.72 (1.04–2.84) for macroalbuminuria only, and 1.10 (0.36–3.33) for ESRD. Conclusions Our meta-analysis suggests evidence for cigarette smoking as an independent risk factor for the development of DN in patients with both T1DM and T2DM.
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Ahn KH, Kim SS, Kim WJ, Kim JH, Nam YJ, Park SB, Jeon YK, Kim BH, Kim IJ, Kim YK. Low serum bilirubin level predicts the development of chronic kidney disease in patients with type 2 diabetes mellitus. Korean J Intern Med 2017; 32:875-882. [PMID: 28560862 PMCID: PMC5583441 DOI: 10.3904/kjim.2015.153] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2015] [Revised: 10/08/2015] [Accepted: 05/17/2016] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND/AIMS We evaluated whether serum bilirubin levels can predict the development of chronic kidney disease (CKD) in patients with type 2 diabetes mellitus (T2DM). METHODS This was a retrospective observational longitudinal study of patients presenting at the Pusan National University Hospital. A total of 349 patients with T2DM and preserved kidney function (estimated glomerular filtration rate ≥ 60 mL/min/1.73 m2) were enrolled. The main outcome was the development of CKD stage 3 or greater. The patients were divided into four groups according to the quartiles of the total serum bilirubin levels at baseline. RESULTS The group with the lowest range of total serum bilirubin level (Q1) showed the highest cumulative incidence of CKD stage 3 or greater than that of the other lower quartiles (Q1 vs. Q4; hazard ratio [HR], 6.75; 95% confidence interval [CI], 1.54 to 29.47; p = 0.011). In multivariate analysis, the risk of developing CKD stage 3 or greater was higher in the second lowest quartile of the serum bilirubin level than that in the highest quartile of the serum bilirubin level (Q2 vs. Q4; HR, 9.36; 95% CI, 1.33 to 65.73; p = 0.024). In the normoalbuminuria subgroup (n = 236), multivariate analysis showed that the risk of developing CKD stage 3 or greater was higher in the lowest quartile of the serum bilirubin level than that in the highest quartile of the serum bilirubin level (Q1 vs. Q4; HR, 7.36; 95% CI, 1.24 to 35.82; p = 0.019). CONCLUSIONS Serum bilirubin might be an early clinical marker for predicting the progression of CKD in patients with T2DM and preserved renal function.
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Affiliation(s)
- Kang Hee Ahn
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Pusan National University Hospital, Busan, Korea
| | - Sang Soo Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Pusan National University Hospital, Busan, Korea
- Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Won Jin Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Pusan National University Hospital, Busan, Korea
| | - Jong Ho Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Pusan National University Hospital, Busan, Korea
| | - Yun Jeong Nam
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Pusan National University Hospital, Busan, Korea
| | - Su Bin Park
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Pusan National University Hospital, Busan, Korea
| | - Yun Kyung Jeon
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Pusan National University Hospital, Busan, Korea
| | - Bo Hyun Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Pusan National University Hospital, Busan, Korea
| | - In Joo Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Pusan National University Hospital, Busan, Korea
- Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
- Correspondence to In Joo Kim, M.D. Department of Internal Medicine, Pusan National University Hospital, 179 Gudeok-ro, Seo-gu, Busan 49241, Korea Tel: +82-51-240-7224 Fax: +82-51-254-3127 E-mail:
| | - Yong Ki Kim
- Kim Yong Ki Internal Medicine Clinic, Busan, Korea
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Kim MK. Treatment of diabetic kidney disease: current and future targets. Korean J Intern Med 2017; 32:622-630. [PMID: 28704915 PMCID: PMC5511942 DOI: 10.3904/kjim.2016.219] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2016] [Accepted: 06/14/2017] [Indexed: 12/19/2022] Open
Abstract
Diabetic kidney disease (DKD) is a leading cause of end-stage renal disease in Korea and worldwide, and is a risk factor for the development of cardiovascular complications. The conventional treatments for DKD are control of blood glucose and blood pressure levels by inhibiting the renin-angiotensin system. However, the prevalence of DKD continues to increase and additional therapies are required to prevent or ameliorate the condition. Many drugs have been, or are being, developed to target the molecular mechanisms in play in DKD. This review focuses on DVD treatment, considering current and emerging therapeutic targets and the clinical trial-based evidence.
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Affiliation(s)
- Mi-Kyung Kim
- Correspondence to Mi-Kyung Kim, M.D. Division of Endocrinology and Metabolism, Department of Internal Medicine, Keimyung University School of Medicine, 56 Dalseong-ro, Jung-gu, Daegu 41931, Korea Tel: +82-53-250-7486 Fax: +82-53-250-7982 E-mail:
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Han E, Kim G, Lee JY, Lee YH, Kim BS, Lee BW, Cha BS, Kang ES. Comparison between Atorvastatin and Rosuvastatin in Renal Function Decline among Patients with Diabetes. Endocrinol Metab (Seoul) 2017; 32:274-280. [PMID: 28685516 PMCID: PMC5503873 DOI: 10.3803/enm.2017.32.2.274] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Revised: 03/13/2017] [Accepted: 04/21/2017] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Although the beneficial effects of statin treatment in dyslipidemia and atherosclerosis have been well studied, there is limited information regarding the renal effects of statins in diabetic nephropathy. We aimed to investigate whether, and which, statins affected renal function in Asian patients with diabetes. METHODS We enrolled 484 patients with diabetes who received statin treatment for more than 12 months. We included patients treated with moderate-intensity dose statin treatment (atorvastatin 10 to 20 mg/day or rosuvastatin 5 to 10 mg/day). The primary outcome was a change in estimated glomerular filtration rate (eGFR) during the 12-month statin treatment, and rapid renal decline was defined as a >3% reduction in eGFR in a 1-year period. RESULTS In both statin treatment groups, patients showed improved serum lipid levels and significantly reduced eGFRs (from 80.3 to 78.8 mL/min/1.73 m² for atorvastatin [P=0.012], from 79.1 to 76.1 mL/min/1.73 m² for rosuvastatin [P=0.001]). A more rapid eGFR decline was observed in the rosuvastatin group than in the atorvastatin group (48.7% vs. 38.6%, P=0.029). Multiple logistic regression analyses demonstrated more rapid renal function loss in the rosuvastatin group than in the atorvastatin group after adjustment for other confounding factors (odds ratio, 1.60; 95% confidence interval, 1.06 to 2.42). CONCLUSION These results suggest that a moderate-intensity dose of atorvastatin has fewer detrimental effects on renal function than that of rosuvastatin.
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Affiliation(s)
- Eugene Han
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
- Diabetes Center, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
- Graduate School, Yonsei University College of Medicine, Seoul, Korea
| | - Gyuri Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
- Diabetes Center, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Ji Yeon Lee
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
- Diabetes Center, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
- Graduate School, Yonsei University College of Medicine, Seoul, Korea
| | - Yong Ho Lee
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
- Diabetes Center, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
- Graduate School, Yonsei University College of Medicine, Seoul, Korea
- Institute of Endocrine Research, Yonsei University College of Medicine, Seoul, Korea
| | - Beom Seok Kim
- Graduate School, Yonsei University College of Medicine, Seoul, Korea
- Division of Nephrology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Byung Wan Lee
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
- Diabetes Center, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
- Graduate School, Yonsei University College of Medicine, Seoul, Korea
- Institute of Endocrine Research, Yonsei University College of Medicine, Seoul, Korea
| | - Bong Soo Cha
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
- Diabetes Center, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
- Graduate School, Yonsei University College of Medicine, Seoul, Korea
- Institute of Endocrine Research, Yonsei University College of Medicine, Seoul, Korea
| | - Eun Seok Kang
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
- Diabetes Center, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
- Graduate School, Yonsei University College of Medicine, Seoul, Korea
- Institute of Endocrine Research, Yonsei University College of Medicine, Seoul, Korea.
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Park SB, Kim SS, Kim IJ, Nam YJ, Ahn KH, Kim JH, Jeon YK, Kim BH, Song SH, Kwak IS, Lee EK, Kim YK. Variability in glycated albumin levels predicts the progression of diabetic nephropathy. J Diabetes Complications 2017; 31:1041-1046. [PMID: 28396158 DOI: 10.1016/j.jdiacomp.2017.01.014] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Revised: 01/19/2017] [Accepted: 01/21/2017] [Indexed: 12/18/2022]
Abstract
AIM The present study was performed to assess variability in glycated albumin (GA) using a coefficient of variation (CV) to predict the progression of diabetic nephropathy in type 2 diabetic patients, independently of HbA1c and other conventional risk factors. METHODS The present study consecutively enrolled 369 patients with type 2 diabetes mellitus from outpatient clinic. During the follow-up period, GA and HbA1c levels were measured repeatedly (≥5 times), and the CV of GA (GA-CV) was calculated for each patient. The patients were divided into two subgroups: Group 1, a MEAN-HbA1c value <7.2% (55mmol/mol); Group 2, a MEAN-HbA1c value ≥7.2% (55mmol/mol). The primary outcome was the renal composite outcome (RCO), which was based on the progression rates of chronic kidney disease and albuminuria and renal death. RESULTS The median follow-up period was 33months. The RCO was developed in 109 patients (29.5%). In Group 1, the third highest and highest quartile groups for GA-CV had higher cumulative incidences of the RCO than those of the lowest quartile group (Q4 vs. Q1: HR=5.43, P=0.007, Q3 vs. Q1: HR=5.16, P=0.009). After adjusting for HbA1c levels and other risk factors, the GA-CV remained significantly associated with the development of the RCO. However, Group 2 did not exhibit any significant differences in terms of the cumulative incidence of the RCO among the four GA-CV quartile groups. CONCLUSIONS The present findings suggest that variability in GA may be a better predictor of the progression of diabetic nephropathy in type 2 diabetic patients regardless of HbA1c.
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Affiliation(s)
- Su Bin Park
- Department of Internal Medicine, Pusan National University Hospital, Busan, Republic of Korea
| | - Sang Soo Kim
- Department of Internal Medicine, Pusan National University Hospital, Busan, Republic of Korea; Biomedical Research Institute, Pusan National University Hospital, Busan, Republic of Korea
| | - In Joo Kim
- Department of Internal Medicine, Pusan National University Hospital, Busan, Republic of Korea; Biomedical Research Institute, Pusan National University Hospital, Busan, Republic of Korea.
| | - Yoon Jeong Nam
- Department of Internal Medicine, Pusan National University Hospital, Busan, Republic of Korea
| | - Kang Hee Ahn
- Department of Internal Medicine, Pusan National University Hospital, Busan, Republic of Korea
| | - Jong Ho Kim
- Department of Internal Medicine, Pusan National University Hospital, Busan, Republic of Korea; Biomedical Research Institute, Pusan National University Hospital, Busan, Republic of Korea
| | - Yun Kyung Jeon
- Department of Internal Medicine, Pusan National University Hospital, Busan, Republic of Korea; Biomedical Research Institute, Pusan National University Hospital, Busan, Republic of Korea
| | - Bo Hyun Kim
- Department of Internal Medicine, Pusan National University Hospital, Busan, Republic of Korea; Biomedical Research Institute, Pusan National University Hospital, Busan, Republic of Korea
| | - Sang Heon Song
- Department of Internal Medicine, Pusan National University Hospital, Busan, Republic of Korea; Biomedical Research Institute, Pusan National University Hospital, Busan, Republic of Korea
| | - Ihm Soo Kwak
- Department of Internal Medicine, Pusan National University Hospital, Busan, Republic of Korea; Biomedical Research Institute, Pusan National University Hospital, Busan, Republic of Korea
| | | | - Yong Ki Kim
- Kim Yong Ki Internal Medicine Clinic, Busan, Republic of Korea
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Hintsa S, Dube L, Abay M, Angesom T, Workicho A. Determinants of diabetic nephropathy in Ayder Referral Hospital, Northern Ethiopia: A case-control study. PLoS One 2017; 12:e0173566. [PMID: 28403160 PMCID: PMC5389619 DOI: 10.1371/journal.pone.0173566] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Accepted: 02/23/2017] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Diabetic nephropathy is the most serious complication of diabetes which leads to end-stage renal failure and other complication of diabetes mellitus. Determinants of Diabetic nephropathy are not consistent in different studies and associated factors to chronic complications of diabetes are not specific and there are limited studies specific to diabetic nephropathy. Thus, the aim of this study is to identify determinants of diabetic nephropathy in Ayder Referral Hospital, Northern Ethiopia. METHODS A case-control study was conducted from February 14 to May 8 2016. Diabetic patients who developed nephropathy in the last two years were the cases and diabetic patients free of nephropathy were controls. Cases and controls were identified detailed review of the chronic care follow up chart. Then simple random sampling was used to select sample of 420 (with control to case ratio of 4:1) resulting in 84 cases and 336 controls. Record review and interviewer administered questionnaire were used to collect data. Data was coded and entered in to Epi-Data version 3.1 and then exported to STATA 12 for analysis. Variables with P-values< 0.25 in Bivariate logistic regression were selected for multiple logistic regressions to determine independent determinants of diabetic nephropathy. OR was calculated with 95% CI to show strength of association. RESULT The mean age (±Standard deviation) for the cases and the controls were 52(SD: ±1.34) and 42.4(SD: ±0.8) respectively. In multiple logistic regressions age of patient (AOR: 1.037 95%CI: 1.01-1.064), duration of diabetes after diagnosis (AOR for one year increase: 1.09 95%CI: 1.036-1.15), not-adhered to blood glucose measurement at home (AOR: 6.81 95%CI: 1.15-40.24), having Systolic Hypertension (AOR;2.13 (1.002-4.51), poor glycemic control (AOR;2.71 95%CI: (1.49-4.95), being overweight(AOR;2.7(1.47-4.96) were the independent predictors of diabetic nephropathy. CONCLUSION In the light of these findings, targeted interventions should be designed at the follow up clinic to address the risk of developing diabetic nephropathy among the risk groups.
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Affiliation(s)
- Solomon Hintsa
- Department of Public Health College of Health Sciences, Aksum University ksum, Ethiopia
| | - Lamessa Dube
- Department of Epidemiology, College of Health Sciences, Jimma University Jimma, Ethiopia
| | - Mebrahtu Abay
- Department of Public Health College of Health Sciences, Aksum University ksum, Ethiopia
| | - Teklit Angesom
- Department of Public Health College of Health Sciences, Aksum University ksum, Ethiopia
| | - Abdulhalik Workicho
- Department of Epidemiology, College of Health Sciences, Jimma University Jimma, Ethiopia
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Song SJ, Lee SS, Han K, Park JB. Periodontitis is associated with diabetic retinopathy in non-obese adults. Endocrine 2017; 56:82-89. [PMID: 28032209 DOI: 10.1007/s12020-016-1215-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2016] [Accepted: 12/19/2016] [Indexed: 01/09/2023]
Abstract
PURPOSE Patients with diabetes retinopathy appear to show increased susceptibility to periodontal disease. This study was performed to assess the relationship between periodontitis and the prevalence of diabetic retinopathy in a large probability sample of the Korean population. A subgroup analysis was performed using body mass index <25 kg/m2 as the criterion to evaluate the effect of obesity on this relationship. METHODS This study is based on data from the Korean National Health and Nutrition Examination Survey of the Korean population, conducted between 2008 and 2010. The presence of diabetic retinopathy in relation to demographic variables and anthropometric characteristics of the participants is presented as means with their standard errors. The presence of periodontitis and presence of retinopathy categorized by body mass index (<25 and ≥25 kg/m2) were evaluated. Multiple logistic regression analyses were used to assess the associations between periodontitis and diabetic retinopathy after adjustment with variables, including age, sex, smoking, drinking, exercise, hypertension, metabolic syndrome, HbA1c, and duration of diabetes mellitus. RESULTS There was a statistically significant increase in the prevalence of periodontitis in individuals who had proliferative diabetic retinopathy. The odds ratios [95% confidence intervals] of prevalence of diabetic retinopathy were 1.193 [0.757-1.881] for the whole population after adjustments with confounding factors. Subgroup analysis after adjustments with confounding factors showed that the odds ratios [95% confidence intervals] of prevalence were 2.206 [1.114-4.366] and 0.588 [0.326-1.061] among participants with body mass index <25 kg/m2 and body mass index 37 ≥25 kg/m2, respectively. CONCLUSIONS The diabetic retinopathy was positively associated with the presence of periodontitis in non-obese diabetic Korean adults after adjustment with confounding variables. Our findings suggest that when a periodontist finds the presence of periodontitis in non-obese diabetic patients, timely evaluation of the patient's ophthalmic evaluation should be 44 recommended.
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Affiliation(s)
- Su Jeong Song
- Department of Ophthalmology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Seong-Su Lee
- Department of Internal Medicine, Division of Endocrinology and Metabolism, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Kyungdo Han
- Department of Biostatistics, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jun-Beom Park
- Department of Periodontics, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
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Jeong YJ, Kim H, Baik SJ, Kim TM, Yang SJ, Lee SH, Cho JH, Lee H, Yim HW, Choi IY, Yoon KH, Kim HS. Analysis and comparison of the cost-effectiveness of statins according to the baseline low-density lipoprotein cholesterol level in Korea. J Clin Pharm Ther 2017; 42:292-300. [PMID: 28251662 DOI: 10.1111/jcpt.12512] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2016] [Accepted: 02/02/2017] [Indexed: 01/01/2023]
Abstract
WHAT IS KNOWN AND OBJECTIVE There are a few Korean studies on the economics of statins based on reduction in low-density lipoprotein cholesterol (LDL-C) data from other countries. This study aimed to analyse and compare the cost-effectiveness of statins according to the baseline LDL-C level in Korea. METHODS Between January 2009 and December 2015, the data of patients who were prescribed statins for the first time were extracted from electronic medical records. We performed a cost-effectiveness analysis (CEA) based on the LDL-C reduction rate (CEA-RR) and target achievement rate. RESULTS AND DISCUSSION Among high-intensity statins, the CEA-RR value of rosuvastatin (20 mg) was significantly lower than that of atorvastatin (40 mg) at all baseline LDL-C levels, except levels of 160-189 mg/dL. Additionally, at baseline LDL-C levels of 130-159 mg/dL, the CEA-RR value of rosuvastatin (20 mg) was three times lower than that of atorvastatin (40 mg) (9·1 ± 2·5 $/% vs. 31·7 ± 15·0 $/%, P < 0·001). Among moderate-to-low-intensity statins, rosuvastatin (5 mg) showed the lowest CEA-RR value (4·0 ± 0·6 $/%), and the value significantly increased for pitavastatin (2 mg) (8·0 ± 0·6 $/%), atorvastatin (10 mg) (9·5 ± 0·5 $/%), simvastatin (10·8 ± 1·1 $/%) and pravastatin (40 mg) (11·5 ± 0·9 $/%) in order (P < 0·0001). On changing from atorvastatin (10 mg) to atorvastatin (20 mg), the additional yearly cost was 16·0 and additional CEA-RR value was 2·74 $/%. On the other hand, on changing from atorvastatin (10 mg) to rosuvastatin (10 mg), the additional yearly cost was -16·3 and additional CEA-RR value was -1·8 $/%. WHAT IS NEW AND CONCLUSION We successfully compared the cost-effectiveness of statins according to the baseline LDL-C level in Korea. It is expected that our findings will help clinical decision-making with regard to statin prescription, and this will help reduce national medical expenditure.
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Affiliation(s)
- Y J Jeong
- Department of Medical Informatics, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - H Kim
- College of Pharmacy, Sookmyung Women's University, Seoul, Korea
| | - S J Baik
- Department of Medical Informatics, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - T M Kim
- Department of Medical Informatics, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - S J Yang
- Department of Medical Informatics, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - S-H Lee
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - J-H Cho
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - H Lee
- Clinical Research Coordinating Center, Catholic Medical Center, The Catholic University of Korea, Seoul, Korea
| | - H W Yim
- Department of Preventive Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - I Y Choi
- Department of Medical Informatics, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - K-H Yoon
- Department of Medical Informatics, College of Medicine, The Catholic University of Korea, Seoul, Korea.,Division of Endocrinology and Metabolism, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - H-S Kim
- Department of Medical Informatics, College of Medicine, The Catholic University of Korea, Seoul, Korea.,Division of Endocrinology and Metabolism, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
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Kim H, Yoo TH, Choi KH, Oh KH, Lee J, Kim SW, Kim TH, Sung S, Han SH. Baseline Cardiovascular Characteristics of Adult Patients with Chronic Kidney Disease from the KoreaN Cohort Study for Outcomes in Patients With Chronic Kidney Disease (KNOW-CKD). J Korean Med Sci 2017; 32:231-239. [PMID: 28049233 PMCID: PMC5219988 DOI: 10.3346/jkms.2017.32.2.231] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2016] [Accepted: 11/11/2016] [Indexed: 01/17/2023] Open
Abstract
Cardiovascular disease (CVD) is the most common cause of death in patients with chronic kidney disease (CKD). We report the baseline cardiovascular characteristics of 2,238 participants by using the data of the KoreaN Cohort Study for Outcomes in Patients With Chronic Kidney Disease (KNOW-CKD) study. The cohort comprises 5 subcohorts according to the cause of CKD: glomerulonephritis (GN), diabetic nephropathy (DN), hypertensive nephropathy (HTN), polycystic kidney disease (PKD), and unclassified. The average estimated glomerular filtration rate (eGFR) was 50.5 ± 30.3 mL/min⁻¹/1.73 m⁻² and lowest in the DN subcohort. The overall prevalence of previous CVD was 14.4% in all patients, and was highest in the DN followed by that in the HTN subcohort. The DN subcohort had more adverse cardiovascular risk profiles (higher systolic blood pressure [SBP], and higher levels of cardiac troponin T, left ventricular mass index [LVMI], coronary calcium score, and brachial-ankle pulse wave velocity [baPWV]) than the other subcohorts. The HTN subcohort exhibited less severe cardiovascular risk profiles than the DN subcohort, but had more severe cardiovascular risk features than the GN and PKD subcohorts. All these cardiovascular risk profiles were inversely correlated with eGFR. In conclusion, this study shows that the KNOW-CKD cohort exhibits high cardiovascular burden, as other CKD cohorts in previous studies. Among the subcohorts, the DN subcohort had the highest risk for CVD. The ongoing long-term follow-up study up to 10 years will further delineate cardiovascular characteristics and outcomes of each subcohort exposed to different risk profiles.
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Affiliation(s)
- Hyoungnae Kim
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Tae Hyun Yoo
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Kyu Hun Choi
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Kook Hwan Oh
- Department of Internal Medicine, Seoul National University, Seoul, Korea
| | - Joongyub Lee
- Medical Research Collaborating Center, Seoul National University Hospital and Seoul National University College of Medicine, Seoul, Korea
| | - Soo Wan Kim
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Tae Hee Kim
- Department of Internal Medicine, Inje University, Pusan Paik Hospital, Busan, Korea
| | - Suah Sung
- Department of Internal Medicine, Eulji Medical Center, Eulji University, Seoul, Korea
| | - Seung Hyeok Han
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.
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Song IS, Han K, Ryu JJ, Park JB. Association between underweight and tooth loss among Korean adults. Sci Rep 2017; 7:41524. [PMID: 28128349 PMCID: PMC5288795 DOI: 10.1038/srep41524] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Accepted: 12/21/2016] [Indexed: 12/23/2022] Open
Abstract
There is growing interest in the relationship between body mass index and oral health. Previous study showed that being underweight was significantly associated with having lower masticatory performance. This study was performed to assess the relationship between an underweight body mass index lower than 18.5 and the number of natural teeth using nationally representative data. Initially, a total of 25,534 individuals were candidates in the Korean National Health and Nutrition Examination Survey. The analysis in this study was confined to 17,870 subjects who were 19 years or older and without missing values for outcome variables. Body mass index and number of natural teeth were evaluated. Multiple regression analysis was used to evaluate the risk of tooth loss in relation to body mass index. Adjusted odds ratios and their 95% confidence intervals for chewing discomfort in individuals who were underweight, normal, overweight, obese, and extremely obese were 1.712(1.156–2.535), 1.111(0.939–1.315), 1(reference), 0.949(0.798–1.128), and 1.172(0.807–1.700), respectively, after adjustment. The association between underweight and tooth loss was proven by multiple logistic regression analyses after adjusting for confounding factors. Underweight may be considered a potential risk indicator for tooth loss in Korean adults.
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Affiliation(s)
- In-Seok Song
- Department of Oral and Maxillofacial Surgery, Korea University Anam Hospital, Seoul, Republic of Korea
| | - Kyungdo Han
- Department of Biostatistics, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jae-Jun Ryu
- Department of Prosthodontics, Korea University Anam Hospital, Seoul, Republic of Korea
| | - Jun-Beom Park
- Department of Periodontics, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
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Xue R, Gui D, Zheng L, Zhai R, Wang F, Wang N. Mechanistic Insight and Management of Diabetic Nephropathy: Recent Progress and Future Perspective. J Diabetes Res 2017; 2017:1839809. [PMID: 28386567 PMCID: PMC5366800 DOI: 10.1155/2017/1839809] [Citation(s) in RCA: 90] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2016] [Accepted: 02/16/2017] [Indexed: 12/14/2022] Open
Abstract
Diabetic nephropathy (DN) is the most serious microvascular complication of diabetes and the largest single cause of end-stage renal disease (ESRD) in many developed countries. DN is also associated with an increased cardiovascular mortality. It occurs as a result of interaction between both genetic and environmental factors. Hyperglycemia, hypertension, and genetic predisposition are the major risk factors. However, the exact mechanisms of DN are unclear. Despite the benefits derived from strict control of glucose and blood pressure, as well as inhibition of renin-angiotensin-aldosterone system, many patients continue to enter into ESRD. Thus, there is urgent need for improving mechanistic understanding of DN and then developing new and effective therapeutic approaches to delay the progression of DN. This review focuses on recent progress and future perspective about mechanistic insight and management of DN. Some preclinical relevant studies are highlighted and new perspectives of traditional Chinese medicine (TCM) for delaying DN progression are discussed in detail. These findings strengthen the therapeutic rationale for TCM in the treatment of DN and also provide new insights into the development of novel drugs for the prevention of DN. However, feasibility and safety of these therapeutic approaches and the clinical applicability of TCM in human DN need to be further investigated.
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Affiliation(s)
- Rui Xue
- Department of Nephrology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Dingkun Gui
- Department of Nephrology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Liyang Zheng
- Department of Nephrology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Ruonan Zhai
- Department of Nephrology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Feng Wang
- Department of Nephrology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
- *Feng Wang: and
| | - Niansong Wang
- Department of Nephrology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
- *Niansong Wang:
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Kim JH, Kim SS, Kim IJ, Kim BH, Park JY, Lee CW, Suk JH, Shin SH, Son SP, Kim MC, Ahn JH, Lee KJ, Kwon MJ, Lee SH, Park JH. Arterial Stiffness Is More Associated with Albuminuria than Decreased Glomerular Filtration Rate in Patients with Type 2 Diabetes Mellitus: The REBOUND Study. J Diabetes Res 2017; 2017:7047909. [PMID: 28951879 PMCID: PMC5603750 DOI: 10.1155/2017/7047909] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2016] [Revised: 04/17/2017] [Accepted: 05/18/2017] [Indexed: 11/17/2022] Open
Abstract
AIM The aim of this study was to evaluate the association between arterial stiffness and albuminuria and glomerular filtration rate (GFR) in patients with type 2 diabetes mellitus. METHODS This multicenter cohort study analyzed 2613 patients with type 2 diabetes. Brachial-ankle pulse wave velocity (baPWV) was used as a noninvasive marker of arterial stiffness. Additionally, the patients were categorized into four groups according to their albumin-to-creatinine ratio (ACR, normoalbuminuria versus albuminuria) and estimated GFR (eGFR, <60 mL/min/1.73 m2 versus ≥60 mL/min/1.73 m2). RESULTS A univariate analysis revealed that maximal baPWV was significantly associated with both the ACR (r = 0.297, P < 0.001) and eGFR (r = -0.220, P < 0.001). A multivariate analysis adjusted for significant clinical variables and eGFR showed that baPWV remained significantly correlated with the ACR (r = 0.150, P < 0.001). Also, baPWV was correlated positively with the ACR in patients with an eGFR ≥ 60 mL/min/1.73 m2 (r = 0.146, P < 0.001). However, baPWV was not correlated with eGFR after adjustment for significant clinical variables. CONCLUSIONS The present findings indicate that arterial stiffness is more associated with albuminuria than a decrease in GFR in patients with type 2 diabetes mellitus.
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Affiliation(s)
- Jong Ho Kim
- Department of Internal Medicine, Pusan National University Hospital, Busan, Republic of Korea
| | - Sang Soo Kim
- Department of Internal Medicine, Pusan National University Hospital, Busan, Republic of Korea
- *Sang Soo Kim: and
| | - In Joo Kim
- Department of Internal Medicine, Pusan National University Hospital, Busan, Republic of Korea
- *In Joo Kim:
| | - Bo Hyun Kim
- Department of Internal Medicine, Pusan National University Hospital, Busan, Republic of Korea
| | - Ja Young Park
- Department of Internal Medicine, Busan St. Mary's Medical Center, Busan, Republic of Korea
| | - Chang Won Lee
- Department of Internal Medicine, Busan St. Mary's Medical Center, Busan, Republic of Korea
| | - Ji Hye Suk
- Department of Internal Medicine, Woori Medical Clinic, Busan, Republic of Korea
| | - Sun Hae Shin
- Department of Internal Medicine, Bongseng Memorial Hospital, Busan, Republic of Korea
| | - Sung Pyo Son
- Department of Internal Medicine, Bongseng Memorial Hospital, Busan, Republic of Korea
| | - Min Chul Kim
- Department of Internal Medicine, Ilsin Christian Hospital, Busan, Republic of Korea
| | - Jun Hyeob Ahn
- Department of Internal Medicine, Good Moonhwa Hospital, Busan, Republic of Korea
| | - Kwang Jae Lee
- Department of Internal Medicine, Daedong Hospital, Busan, Republic of Korea
| | - Min Jung Kwon
- Department of Internal Medicine, College of Medicine, Pusan Paik Hospital, Inje University, Busan, Republic of Korea
| | - Soon Hee Lee
- Department of Internal Medicine, College of Medicine, Pusan Paik Hospital, Inje University, Busan, Republic of Korea
| | - Jeong Hyun Park
- Department of Internal Medicine, College of Medicine, Pusan Paik Hospital, Inje University, Busan, Republic of Korea
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Kim JH, Oh SY, Kim EH, Lee MJ, Jeon YK, Kim BH, Kim JM, Kim YK, Kim SS, Kim IJ. Addition of nonalbumin proteinuria to albuminuria improves prediction of type 2 diabetic nephropathy progression. Diabetol Metab Syndr 2017; 9:68. [PMID: 28912839 PMCID: PMC5588678 DOI: 10.1186/s13098-017-0267-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Accepted: 08/31/2017] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Albuminuria is generally accepted as a sensitive marker of diabetic nephropathy but has limitations in predicting its progression. The aim of this study was to evaluate the use of nonalbumin proteinuria in addition to albuminuria for predicting the progression of type 2 diabetic nephropathy. METHODS In this retrospective observational study, the urine albumin-to-creatinine ratio (ACR) and the nonalbumin protein-to-creatinine ratio (NAPCR) were measured in 325 patients with type 2 diabetes and estimated glomerular filtration rates (eGFR) ≥30 mL/min/1.73 m2. The patients were divided into four groups based on the cutoff points for the urinary ACR (30 mg/g) and NAPCR (120 mg/g). The renal outcomes were chronic kidney disease (CKD) progression and accelerated eGFR decline. RESULTS During the 4.3-year follow-up period, 25 (7.7%) patients showed CKD progression and 69 (21.2%) patients showed accelerated eGFR decline. After adjusting for nine clinical parameters, the group with a NAPCR greater than 120 mg/g exhibited higher cumulative incidences of CKD progression (hazard ratio 6.84; P = 0.001) and accelerated eGFR decline (hazard ratio 1.95; P = 0.011) than the group with a NAPCR < 120 mg/g. In patients with normoalbuminuria, the group with NAPCR levels greater than 120 mg/g also exhibited a higher cumulative incidence than that with NAPCR levels <120 mg/g of CKD progression (hazard ratio 21.82; P = 0.005). The addition of NAPCR to ACR improved the model fit for CKD progression and accelerated eGFR decline. CONCLUSION Nonalbumin proteinuria showed additional value over and above that of albuminuria for predicting the progression of CKD in patients with type 2 diabetes.
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Affiliation(s)
- Jong Ho Kim
- Department of Internal Medicine, Pusan National University Hospital, Busan, South Korea
- Biomedical Research Institute, Pusan National University Hospital, Busan, South Korea
| | - Seo Young Oh
- Department of Internal Medicine, Pusan National University Hospital, Busan, South Korea
- Biomedical Research Institute, Pusan National University Hospital, Busan, South Korea
| | - Eun Heui Kim
- Department of Internal Medicine, Pusan National University Hospital, Busan, South Korea
- Biomedical Research Institute, Pusan National University Hospital, Busan, South Korea
| | - Min Jin Lee
- Department of Internal Medicine, Pusan National University Hospital, Busan, South Korea
- Biomedical Research Institute, Pusan National University Hospital, Busan, South Korea
| | - Yun Kyung Jeon
- Department of Internal Medicine, Pusan National University Hospital, Busan, South Korea
- Biomedical Research Institute, Pusan National University Hospital, Busan, South Korea
| | - Bo Hyun Kim
- Department of Internal Medicine, Pusan National University Hospital, Busan, South Korea
- Biomedical Research Institute, Pusan National University Hospital, Busan, South Korea
| | - Jin Mi Kim
- Department of Biostatistics, Pusan National University Hospital, Busan, South Korea
| | - Yong Ki Kim
- Kim Yong Ki Internal Medicine Clinic, Busan, South Korea
| | - Sang Soo Kim
- Department of Internal Medicine, Pusan National University Hospital, Busan, South Korea
- Biomedical Research Institute, Pusan National University Hospital, Busan, South Korea
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Pusan National University Hospital, 179 Gudeok-Ro, Seo-Gu, Busan, 602-739 South Korea
| | - In Joo Kim
- Department of Internal Medicine, Pusan National University Hospital, Busan, South Korea
- Biomedical Research Institute, Pusan National University Hospital, Busan, South Korea
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Pusan National University Hospital, 179 Gudeok-Ro, Seo-Gu, Busan, 602-739 South Korea
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Factors Influencing Intention to Receive Examination of Diabetes Complications. Asian Nurs Res (Korean Soc Nurs Sci) 2016; 10:289-294. [DOI: 10.1016/j.anr.2016.10.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2016] [Revised: 09/16/2016] [Accepted: 10/09/2016] [Indexed: 11/18/2022] Open
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Tanaka M, Itoh H. Nonalbuminuric Renal Insufficiency: Can It Be a Novel Category of Diabetic Nephropathy? Endocrinol Metab (Seoul) 2016; 31:533-534. [PMID: 28029024 PMCID: PMC5195829 DOI: 10.3803/enm.2016.31.4.533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Affiliation(s)
- Masami Tanaka
- Division of Endocrinology, Metabolism, and Nephrology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan.
| | - Hiroshi Itoh
- Division of Endocrinology, Metabolism, and Nephrology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
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Abstract
The purpose of the present study was to investigate the association between the number of natural teeth and measures of kidney dysfunction, such as urinary albumin/creatinine ratio (ACR) and estimated glomerular filtration (eGFR) rate, using nationally representative data.The data used were from the Korea National Health and Nutrition Examination Survey with cross-sectional design, which was conducted between 2011 and 2012; the sample analyzed in this study consisted of a total of 10,388 respondents, each of whom was 19 years or older and had no missing outcome variables. The association between the number of natural teeth and kidney function was assessed by multiple logistic regression and model was adjusted for age, sex, waist conference, smoking, drinking, exercise, education, income, frequency of tooth brushing per day, diabetes, metabolic syndrome, urinary ACR, and eGFR.The mean age, body mass index, and waist circumference were significantly higher among those with lower kidney function (urinary ACR ≥30 mg/g and eGFR <60 mL/min/1.73m). Urinary ACR and eGFR were associated with loss of natural teeth. As urinary ACR increased, the number of natural teeth decreased accordingly. Conversely, the number of natural teeth increased with an increase in eGFR.This study showed that the number of natural teeth is inversely associated with the presence of kidney disease. Severity of tooth loss may be considered an independent risk indicator for kidney disease among Koreans. More epidemiological studies are warranted to investigate the role of tooth loss in kidney disease, to confirm this relationship and to test possible underlying mechanisms.
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Affiliation(s)
- Hye Min Choi
- Department of Internal Medicine, Seonam University Myongji Hospital, Goyang, Gyeonggi-do
| | | | | | - Jun-Beom Park
- Department of Periodontics, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
- Correspondence: Jun-Beom Park, Department of Periodontics, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul 06591, Republic of Korea (e-mail: )
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Kim SS, Song SH, Kim IJ, Lee EY, Lee SM, Chung CH, Kwak IS, Lee EK, Kim YK. Decreased plasma α-Klotho predict progression of nephropathy with type 2 diabetic patients. J Diabetes Complications 2016; 30:887-92. [PMID: 27037042 DOI: 10.1016/j.jdiacomp.2016.03.006] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2015] [Revised: 03/04/2016] [Accepted: 03/09/2016] [Indexed: 01/07/2023]
Abstract
AIM The potential role of soluble α-klotho in diabetic kidney disease has not yet been evaluated. The aim of this study was to evaluate the association of plasma and/or urine α-klotho with the progression of type 2 diabetic nephropathy. METHODS The baseline values of plasma and urine α-klotho were measured in 147 patients with type 2 diabetes mellitus with an estimated glomerular filtration rate (eGFR) of ≥60mL/min/1.73m(2). In this prospective observational study, a total of 109 type 2 diabetic patients were followed up for 34months (8-50 months). RESULTS Plasma α-klotho, but not urine α-klotho, was negatively correlated with the decline of eGFR (r=-0.304, P=0.001; r=0.042, P=0.068, respectively). After adjusting for several clinical parameters, baseline eGFR and urine ACR, plasma α-klotho was significantly associated with the decline of eGFR (r=-0.219, P=0.008). In the normoalbuminuria group (n=63), the plasma α-klotho remained significantly associated with a decline in eGFR (r=0.324, P=0.004) in the final model. CONCLUSIONS It is suggested that plasma α-klotho may be an early biomarker for predicting renal impairment in type 2 diabetic patients. The disappearance of a compensatory increase of plasma α-klotho might be a predictive marker for the progression of type 2 diabetic nephropathy.
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Affiliation(s)
- Sang Soo Kim
- Department of Internal Medicine, Pusan National University Hospital, Busan, Korea; Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Sang Heon Song
- Department of Internal Medicine, Pusan National University Hospital, Busan, Korea; Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
| | - In Joo Kim
- Department of Internal Medicine, Pusan National University Hospital, Busan, Korea; Biomedical Research Institute, Pusan National University Hospital, Busan, Korea.
| | - Eun Young Lee
- Department of Internal Medicine, Soonchunhyang University Cheonan Hospital, Cheonan, Korea.
| | - Su Mi Lee
- Department of Internal Medicine, Dong-A University Hospital, Busan, Korea
| | - Choon Hee Chung
- Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Ihm Soo Kwak
- Department of Internal Medicine, Pusan National University Hospital, Busan, Korea
| | | | - Yong Ki Kim
- Kim Yong Ki Internal Medicine Clinic, Busan, Korea
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Kim SS, Kim JH, Kim IJ. Current Challenges in Diabetic Nephropathy: Early Diagnosis and Ways to Improve Outcomes. Endocrinol Metab (Seoul) 2016; 31:245-53. [PMID: 27246284 PMCID: PMC4923408 DOI: 10.3803/enm.2016.31.2.245] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Revised: 05/04/2016] [Accepted: 05/13/2016] [Indexed: 12/29/2022] Open
Abstract
Diabetes is often associated with chronic kidney disease (CKD) and is the primary cause of kidney failure in half of patients who receive dialysis therapy. Given the increasing prevalence of diabetes and its high morbidity and mortality, diabetic nephropathy is a serious drawback in individual patients and a tremendous socioeconomic burden on society. Despite growing concern for the management of diabetic nephropathy, the prevalence of CKD with diabetes is the same today as it was 20 years ago. The current strategy to manage diabetic nephropathy, including the control of hyperglycemia, dyslipidemia, and blood pressure and the wide-spread use of renin-angiotensin-aldosterone system inhibitors, is well established to be beneficial in the early stages of diabetic nephropathy. However, the effects are uncertain in patients with relatively progressed CKD. Therefore, early diagnosis or risk verification is extremely important in order to reduce the individual and socioeconomic burdens associated with diabetic nephropathy by providing appropriate management to prevent the development and progression of this condition. This review focuses on recent research and guidelines regarding risk assessment, advances in medical treatment, and challenges of and future treatments for diabetic nephropathy.
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Affiliation(s)
- Sang Soo Kim
- Department of Internal Medicine and Biomedical Research Institute, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea
| | - Jong Ho Kim
- Department of Internal Medicine and Biomedical Research Institute, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea
| | - In Joo Kim
- Department of Internal Medicine and Biomedical Research Institute, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea.
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