1
|
Tang X, Han YP, Chai YH, Gong HJ, Xu H, Patel I, Qiao YS, Zhang JY, Cardoso MA, Zhou JB. Association of kidney function and brain health: A systematic review and meta-analysis of cohort studies. Ageing Res Rev 2022; 82:101762. [PMID: 36374833 DOI: 10.1016/j.arr.2022.101762] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2022] [Revised: 10/07/2022] [Accepted: 10/14/2022] [Indexed: 01/31/2023]
Abstract
OBJECTIVE This study aimed to evaluate the bidirectional association between the kidney dysfunction and the brain health, including structural and functional abnormalities. DESIGN Systematic review and meta-analysis with network meta-analysis for outcomes with different estimated glomerular filtration rate (eGFR) ranges. DATA SOURCES PubMed, Embase database, Cochrane library and Web of Science (up to Dec. 2021). ELIGIBILITY CRITERIA FOR SELECTING STUDIES Longitudinal studies that provided evidence of the impact of kidney function estimated from eGFR and urine albumin-to-creatinine ratio (UACR) or chronic kidney disease (CKD) on structural and functional brain abnormalities, and those that provided evidence of the opposite relationship. Studies with study population mean age under 18 years old were excluded. MAIN OUTCOME MEASURES Two independent reviewers screened the included studies, extracted the data, and assessed the risk of bias. We performed a random-effects meta-analysis and a network meta-analysis for outcomes with compatible data. We assessed the risk of bias using the Newcastle-Ottawa Quality Assessment Scale criteria (NOS). Subgroup and sensitivity analyses were conducted to explore heterogeneity in the meta-analyses. Inconsistency analyses using the node-splitting method were performed to confirm the results of network meta-analysis. RESULTS A total of 53 studies with 3037,357 participants were included in the current systematic review. Among these, 16 provided evidence of structural brain abnormalities, and 38 provided evidence of cognitive impairment and dementia. Analysis of evidence of categorical kidney function showed a positive association between kidney dysfunction and cerebral small vessel disease (cSVD) (relative risk (RR) 1.77, 95% confidence interval (CI) 1.40-2.24, I2 = 0.0%), but such results were not found in the analyses of evidence where the kidney function was measured as a continuous variable. Meanwhile, analysis of 28 prior longitudinal studies with 194 compatible sets of data showed that the worse kidney function as categorical variables was related to a greater risk of global brain cognitive disorder (RR 1.28, 95% CI 1.20-1.36, I2 = 82.5%). CONCLUSIONS In this systematic review and meta-analysis, we found a positive association between CKD and functional brain disorders. However, the relationship between the kidney dysfunction and structural abnormalities in the brain remains controversial. As for the opposite relationship, structural brain abnormalities, especially cerebral microbleeds and silent infarction, but not functional brain abnormalities, are associated with worse renal function. In addition, a higher UACR, but not a lower eGFR, was associated with a higher risk of Alzheimer's disease and vascular dementia.
Collapse
Affiliation(s)
- Xingyao Tang
- Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Yi-Peng Han
- Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Yin-He Chai
- Department of Endocrinology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Hong-Jian Gong
- Department of Endocrinology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Hui Xu
- Department of Endocrinology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Ikramulhaq Patel
- Department of Endocrinology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Yu-Shun Qiao
- Department of Endocrinology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Jin-Yan Zhang
- Department of Endocrinology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Marly Augusto Cardoso
- Department of Nutrition, School of Public Health, University of Sao Paulo, Sao Paulo, Brazil
| | - Jian-Bo Zhou
- Beijing Tongren Hospital, Capital Medical University, Beijing, China; Department of Endocrinology, Beijing Tongren Hospital, Capital Medical University, Beijing, China.
| |
Collapse
|
2
|
Moazzeni SS, Arani RH, Hasheminia M, Tohidi M, Azizi F, Hadaegh F. High Incidence of Chronic Kidney Disease among Iranian Diabetic Adults: Using CKD-EPI and MDRD Equations for Estimated Glomerular Filtration Rate. Diabetes Metab J 2021; 45:684-697. [PMID: 33715338 PMCID: PMC8497933 DOI: 10.4093/dmj.2020.0109] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 09/27/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND To investigate the population based incidence rate of chronic kidney disease (CKD) and its potential risk factors among Iranian diabetic adults during over 14 years of follow-up. METHODS Two different equations (Chronic Kidney Disease Epidemiology Collaboration [CKD-EPI] and Modification of Diet in Renal Disease [MDRD]) were applied for the calculating the estimated glomerular filtration rate (eGFR). Among a total of 1,374 diabetic Tehranian adults, 797 and 680 individuals were eligible for CKD-EPI and MDRD analyses, respectively. CKD was defined as eGFR lower than 60 mL/min/1.73 m2. Multivariable Cox proportional hazard models were used to estimate the hazard ratios (HRs) and 95% confidence intervals (CI) for all potential risk factors. RESULTS The incidence rates (95% CI) of CKD per 1,000 person-years were 43.84 (39.49 to 48.66) and 55.80 (50.29 to 61.91) based on CKD-EPI and MDRD equations, respectively. Being older, a history of cardiovascular disease, and having lower levels of eGFR were significant risk factors in both equations. Moreover, in CKD-EPI, using glucose-lowering medications and hypertension, and in MDRD, female sex and fasting plasma glucose ≥10 mmol/L were also independent risk factors. Regarding the discrimination index, CKD-EPI equation showed a higher range of C-index for the predicted probability of incident CKD in the full-adjusted model, compared to MDRD equation (0.75 [0.72 to 0.77] vs. 0.69 [0.66 to 0.72]). CONCLUSION We found an incidence rate of more than 4%/year for CKD development among our Iranian diabetic population. Compared to MDRD, it can be suggested that CKD-EPI equation can be a better choice to use for prediction models of incident CKD among the Iranian diabetic populations.
Collapse
Affiliation(s)
- Seyyed Saeed Moazzeni
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Reyhane Hizomi Arani
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mitra Hasheminia
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Maryam Tohidi
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Fereidoun Azizi
- Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Farzad Hadaegh
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Corresponding author: Farzad Hadaegh https://orcid.org/0000-0002-8935-2744 Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, No. 24, Parvaneh Street, Velenjak, Tehran 19395-4763, Iran E-mail:
| |
Collapse
|
3
|
Venkat P, Zacharek A, Landschoot-Ward J, Wang F, Culmone L, Chen Z, Chopp M, Chen J. Exosomes derived from bone marrow mesenchymal stem cells harvested from type two diabetes rats promotes neurorestorative effects after stroke in type two diabetes rats. Exp Neurol 2020; 334:113456. [PMID: 32889008 DOI: 10.1016/j.expneurol.2020.113456] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 07/08/2020] [Accepted: 08/30/2020] [Indexed: 12/26/2022]
Abstract
BACKGROUND AND PURPOSE Diabetes elevates the risk of stroke, promotes inflammation, and exacerbates vascular and white matter damage post stroke, thereby hindering long term functional recovery. Here, we investigated the neurorestorative effects and the underlying therapeutic mechanisms of treatment of stroke in type 2 diabetic rats (T2DM) using exosomes harvested from bone marrow stromal cells obtained from T2DM rats (T2DM-MSC-Exo). METHODS T2DM was induced in adult male Wistar rats using a combination of high fat diet and Streptozotocin. Rats were subjected to transient 2 h middle cerebral artery occlusion (MCAo) and 3 days later randomized to one of the following treatment groups: 1) phosphate-buffered-saline (PBS, i.v), 2) T2DM-MSC-Exo, (3 × 1011, i.v), 3) T2DM-MSC-Exo with miR-9 over expression (miR9+/+-T2DM-MSC-Exo, 3 × 1011, i.v) or 4) MSC-Exo derived from normoglycemic rats (Nor-MSC-Exo) (3 × 1011, i.v). T2DM sham control group is included as reference. Rats were sacrificed 28 days after MCAo. RESULTS T2DM-MSC-Exo treatment does not alter blood glucose, lipid levels, or lesion volume, but significantly improves neurological function and attenuates post-stroke weight loss compared to PBS treated as well as Nor-MSC-Exo treated T2DM-stroke rats. Compared to PBS treatment, T2DM-MSC-Exo treatment of T2DM-stroke rats significantly 1) increases tight junction protein ZO-1 and improves blood brain barrier (BBB) integrity; 2) promotes white matter remodeling indicated by increased axon and myelin density, and increases oligodendrocytes and oligodendrocyte progenitor cell numbers in the ischemic border zone as well as increases primary cortical neuronal axonal outgrowth; 3) decreases activated microglia, M1 macrophages, and inflammatory factors MMP-9 (matrix mettaloproteinase-9) and MCP-1 (monocyte chemoattractant protein-1) expression in the ischemic brain; and 4) decreases miR-9 expression in serum, and increases miR-9 target ABCA1 (ATP-binding cassette transporter 1) and IGFR1 (Insulin-like growth factor 1 receptor) expression in the brain. MiR9+/+-T2DM-MSC-Exo treatment significantly increases serum miR-9 expression compared to PBS treated and T2DM-MSC-Exo treated T2DM stroke rats. Treatment of T2DM stroke with miR9+/+-T2DM-MSC-Exo fails to improve functional outcome and attenuates T2DM-MSC-Exo treatment induced white matter remodeling and anti-inflammatory effects in T2DM stroke rats. CONCLUSIONS T2DM-MSC-Exo treatment for stroke in T2DM rats promotes neurorestorative effects and improves functional outcome. Down regulation of miR-9 expression and increasing its target ABCA1 pathway may contribute partially to T2DM-MSC-Exo treatment induced white matter remodeling and anti-inflammatory responses.
Collapse
|
4
|
Yeh YC, Chao A, Lee CY, Lee CT, Yeh CC, Liu CM, Tsai MK. An observational study of microcirculation in dialysis patients and kidney transplant recipients. Eur J Clin Invest 2017; 47:630-637. [PMID: 28683162 DOI: 10.1111/eci.12784] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2017] [Accepted: 07/04/2017] [Indexed: 12/15/2022]
Abstract
BACKGROUND Microcirculatory dysfunction contributes to acute and chronic kidney diseases. To the best of our knowledge, no study has compared differences in microcirculation among healthy volunteers, dialysis patients and kidney transplant recipients. MATERIALS AND METHODS Sublingual microcirculation was examined using sidestream dark field imaging and was compared among 90 healthy volunteers, 40 dialysis patients and 40 kidney transplant recipients. The gender effect on microcirculation and the correlations among the microcirculation parameters, age, body mass index, heart rate and blood pressure were analysed. RESULTS Total small vessel density, perfused small vessel density and the proportion of perfused small vessels were lower in the dialysis patients than in the healthy volunteers and kidney transplant recipients [total small vessel density; healthy volunteers vs. dialysis patients vs. kidney transplant recipients, 25·2 (2·3) vs. 22·8 (2·6) vs. 24·2 (2·9) mm/mm2 , P < 0·001]. Systolic blood pressure showed a weak negative correlation with the microvascular flow index scores in the healthy volunteers. By contrast, systolic blood pressure, diastolic blood pressure and mean arterial pressure showed weak positive correlations with proportion of perfused small vessels and the microvascular flow index scores in the dialysis patients. CONCLUSIONS Microcirculatory dysfunction is noted in dialysis patients, and this alteration is ameliorated in KT recipients. The positive correlation between blood pressure and microcirculation in dialysis patients suggests that additional studies should investigate the optimal goal of blood pressure management for dialysis patients.
Collapse
Affiliation(s)
- Yu Chang Yeh
- Department of Anesthesiology, National Taiwan University Hospital, Taipei, Taiwan
| | - Anne Chao
- Department of Anesthesiology, National Taiwan University Hospital, Taipei, Taiwan
| | - Chih-Yuan Lee
- Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan
| | - Chen-Tse Lee
- Department of Anesthesiology, National Taiwan University Hospital, Taipei, Taiwan
| | - Chi-Chuan Yeh
- Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan
| | - Chih-Min Liu
- Department of Anesthesiology, National Taiwan University Hospital, Taipei, Taiwan
| | - Meng-Kun Tsai
- Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan
| |
Collapse
|
5
|
Koye DN, Shaw JE, Reid CM, Atkins RC, Reutens AT, Magliano DJ. Incidence of chronic kidney disease among people with diabetes: a systematic review of observational studies. Diabet Med 2017; 34:887-901. [PMID: 28164387 DOI: 10.1111/dme.13324] [Citation(s) in RCA: 71] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/31/2017] [Indexed: 12/26/2022]
Abstract
AIMS The aim was to systematically review published articles that reported the incidence of chronic kidney disease among people with diabetes. METHODS A systematic literature search was performed using MEDLINE, Embase and CINAHL databases. The titles and abstracts of all publications identified by the search were reviewed and 10 047 studies were retrieved. RESULTS A total of 71 studies from 30 different countries with sample sizes ranging from 505 to 211 132 met the inclusion criteria. The annual incidence of microalbuminuria and albuminuria ranged from 1.3% to 3.8% for Type 1 diabetes. For Type 2 diabetes and studies combining both diabetes types, the range was from 3.8% to 12.7%, with four of six studies reporting annual rates between 7.4% and 8.6%. In studies reporting the incidence of eGFR < 60 ml/min/1.73 m2 using the Modification of Diet on Renal Disease (MDRD) equation, apart from one study which reported an annual incidence of 8.9%, the annual incidence ranged from 1.9% to 4.3%. The annual incidence of end-stage renal disease ranged from 0.04% to 1.8%. CONCLUSIONS The annual incidence of microalbuminuria and albuminuria is ~ 2-3% in Type 1 diabetes, and ~ 8% in Type 2 diabetes or mixed diabetes type. The incidence of developing eGFR < 60 ml/min/1.73 m2 is ~ 2-4% per year. Despite the wide variation in methods and study design, within a particular category of kidney disease, there was only modest variation in incidence rates. These findings may be useful in clinical settings to help understand the risk of developing kidney disease among those with diabetes.
Collapse
Affiliation(s)
- D N Koye
- Department of Clinical Diabetes and Epidemiology, Baker IDI 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
| | - J E Shaw
- Department of Clinical Diabetes and Epidemiology, Baker IDI Heart and Diabetes Institute, Melbourne, Australia
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| | - C M Reid
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
- School of Public Health, Curtin University, Perth, Australia
| | - R C Atkins
- Department of Clinical Diabetes and Epidemiology, Baker IDI Heart and Diabetes Institute, Melbourne, Australia
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| | - A T Reutens
- Department of Clinical Diabetes and Epidemiology, Baker IDI Heart and Diabetes Institute, Melbourne, Australia
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| | - D J Magliano
- Department of Clinical Diabetes and Epidemiology, Baker IDI Heart and Diabetes Institute, Melbourne, Australia
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| |
Collapse
|
6
|
Shima H, Mori T, Ooi M, Sonoda M, Shoji T, Ishimura E, Okamura M, Ishizaka N, Inaba M. Silent Cerebral Microbleeds and Longitudinal Risk of Renal and Cardiovascular Events in Patients with CKD. Clin J Am Soc Nephrol 2016; 11:1557-1565. [PMID: 27354659 PMCID: PMC5012493 DOI: 10.2215/cjn.13481215] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2015] [Accepted: 05/06/2016] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND OBJECTIVES In the general population, the presence of cerebral microbleeds on T2*-weighted magnetic resonance imaging has been reported to be a predictor of future stroke. Patients with CKD have a high prevalence of microbleeds and are at higher risk of ESRD as well as cardiovascular disease, including stroke. Because endothelial dysfunction is the common pathophysiology among microbleeds, CKD, and cardiovascular disease, we hypothesized that the presence of microbleeds would be an important predictor of composite outcome, including both cardiovascular disease and renal events, in those with CKD. DESIGN, SETTINGS, PARTICIPANTS, & MEASUREMENTS This was a prospective cohort study of 404 patients with CKD who underwent T2*-weighted magnetic resonance imaging for this study between January of 2008 and January of 2011. The primary outcome was composite of cardiovascular and renal outcomes. Cardiovascular outcomes included cardiovascular death, the new onset of myocardial infarction, coronary revascularization, stroke, and amputation/revascularization because of peripheral artery disease. Renal outcomes included doubling of the serum creatinine level and development of ESRD requiring dialysis or transplantation. RESULTS At baseline, microbleeds were present in 83 (20.5%) patients. During the follow-up median period of 2.3 years, 124 of the 404 patients experienced the composite outcome. The presence of microbleeds was associated with higher risk for the composite outcome in an unadjusted Cox model, and it remained significant after adjustment for age, sex, diabetes, and systolic BP (hazard ratio [HR], 2.58; 95% confidence interval [95% CI], 1.68 to 3.46 for composite outcome; hazard ratio, 2.41; 95% CI, 1.55 to 3.77 for renal outcome; hazard ratio, 3.46; 95% CI, 1.62 to 7.43 for cardiovascular disease outcome). CONCLUSIONS In patients with CKD, the presence of microbleeds is a novel and independent predictor of both renal and cardiovascular disease end points.
Collapse
Affiliation(s)
- Hideaki Shima
- Division of Nephrology, Department of Internal Medicine and
| | - Tatsuhiko Mori
- Division of Nephrology, Department of Internal Medicine and
| | - Masayuki Ooi
- Division of Nephrology, Department of Internal Medicine and
| | - Mika Sonoda
- Departments of Endocrinology, Metabolism and Molecular Medicine
| | | | - Eiji Ishimura
- Nephrology, Osaka City University Graduate School of Medicine, Osaka, Japan; and
| | - Mikio Okamura
- Division of Nephrology, Ohno Memorial Hospital, Osaka, Japan
| | - Nobukazu Ishizaka
- Division of Cardiology, Department of Internal Medicine, Osaka Medical College, Takatsuki, Japan
| | - Masaaki Inaba
- Departments of Endocrinology, Metabolism and Molecular Medicine
| |
Collapse
|
7
|
Kurella Tamura M, Yaffe K, Hsu CY, Yang J, Sozio S, Fischer M, Chen J, Ojo A, DeLuca J, Xie D, Vittinghoff E, Go AS. Cognitive Impairment and Progression of CKD. Am J Kidney Dis 2016; 68:77-83. [PMID: 26972681 DOI: 10.1053/j.ajkd.2016.01.026] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2015] [Accepted: 01/31/2016] [Indexed: 11/11/2022]
Abstract
BACKGROUND Cognitive impairment is common among patients with chronic kidney disease (CKD); however, its prognostic significance is unclear. We assessed the independent association between cognitive impairment and CKD progression in adults with mild to moderate CKD. STUDY DESIGN Prospective cohort. SETTING & PARTICIPANTS Adults with CKD participating in the CRIC (Chronic Renal Insufficiency Cohort) Study. Mean age of the sample was 57.7±11.0 years and mean estimated glomerular filtration rate (eGFR) was 45.0±16.9mL/min/1.73m(2). PREDICTOR Cognitive function was assessed with the Modified Mini-Mental State Examination at study entry. A subset of participants 55 years and older underwent 5 additional cognitive tests assessing different domains. Cognitive impairment was defined as a score > 1 SD below the mean score on each test. Covariates included demographics, kidney function, comorbid conditions, and medications. OUTCOMES Incident end-stage renal disease (ESRD) and incident ESRD or 50% decline in baseline eGFR. RESULTS In 3,883 CRIC participants, 524 (13.5%) had cognitive impairment at baseline. During a median 6.1 years of follow-up, 813 developed ESRD and 1,062 developed ESRD or a ≥50% reduction in eGFR. There was no significant association between cognitive impairment and risk for ESRD (HR, 1.07; 95% CI, 0.87-1.30) or the composite of ESRD or 50% reduction in eGFR (HR, 1.06; 95% CI, 0.89-1.27). Similarly, there was no association between cognitive impairment and the joint outcome of death, ESRD, or 50% reduction in eGFR (HR, 1.06; 95% CI, 0.91-1.23). Among CRIC participants who underwent additional cognitive testing, we found no consistent association between impairment in specific cognitive domains and risk for CKD progression in adjusted analyses. LIMITATIONS Unmeasured potential confounders, single measure of cognition for younger participants. CONCLUSIONS Among adults with CKD, cognitive impairment is not associated with excess risk for CKD progression after accounting for traditional risk factors.
Collapse
Affiliation(s)
- Manjula Kurella Tamura
- VA Palo Alto Geriatric Research and Education Clinical Center; Division of Nephrology, Stanford University School of Medicine; Palo Alto, CA.
| | - Kristine Yaffe
- Department of Psychiatry, University of California San Francisco, San Francisco, CA; Department of Neurology, University of California San Francisco, San Francisco, CA; Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA
| | - Chi-Yuan Hsu
- Division of Nephrology, Department of Medicine, University of California San Francisco, San Francisco, CA; Division of Research, Kaiser Permanente Northern California; Oakland, CA
| | - Jingrong Yang
- Division of Research, Kaiser Permanente Northern California; Oakland, CA
| | - Stephen Sozio
- Division of Nephrology, Johns Hopkins University School of Medicine and Welch Center for Prevention, Epidemiology, and Clinical Research; Baltimore, MD
| | - Michael Fischer
- Center of Innovation for Complex Chronic Healthcare, Jesse Brown VAMC and Edward Hines, Jr VA, Chicago, IL; University of Illinois Hospital and Health Sciences System, Chicago, IL
| | - Jing Chen
- Tulane University School of Medicine; New Orleans, LA
| | - Akinlolu Ojo
- Department of Medicine, University of Michigan; Ann Arbor, MI
| | | | - Dawei Xie
- Division of Nephrology, Department of Medicine, University of California San Francisco, San Francisco, CA; Department of Biostatistics and Epidemiology, Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania; Philadelphia, PA
| | - Eric Vittinghoff
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA
| | - Alan S Go
- Division of Research, Kaiser Permanente Northern California; Oakland, CA
| | | |
Collapse
|
8
|
Shirazian S, Grant C, Rambhujun V, Sharma R, Patel R, Islam S, Mattana J. A pilot trial to examine the association between circulating endothelial cell levels and vascular injury in patients with diabetes and chronic kidney disease. F1000Res 2016; 5:292. [PMID: 27303625 PMCID: PMC4892336 DOI: 10.12688/f1000research.8005.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/02/2016] [Indexed: 01/13/2023] Open
Abstract
Objective While albuminuria is a marker for progressive chronic kidney disease (CKD) in patients with type 2 diabetes (T2DM), both albuminuric and normoalbuminuric patients appear prone to vascular injury. This pilot study examines the association between circulating endothelial cell (CEC) levels and vascular injury in patients with T2DM and CKD. Methods In this cross-sectional study, eligible adult patients had T2DM, and stage 3 CKD (estimated glomerular filtration rate between 30 and 60 mL/min/1.73m
2). CEC levels were tested by Janssen Diagnostics, LLC using an immuno-magnetic bead-based assay. CEC levels were compared to levels in a previously tested normal population. Correlations between CEC levels and other vascular injury markers (urine albumin, von-Willebrand factor antigen, hs-CRP, uric acid) were performed. Results Patients included 40 adults of which nineteen were normoalbuminuric. Mean CEC levels (38.7, SD 38.1 cells) were significantly higher than the normal population (M = 21±18 cells, p<0.001; N = 249), including in the normoalbuminuric subgroup (M = 42.9±42.5 cells, p<0.001). CEC levels were significantly correlated with uric acid levels (r=0.33, p=0.039). Conclusions CEC levels in patients with T2DM and CKD, both albuminuric and normoalbuminuric, are significantly higher than a normal population, suggesting the presence of vascular injury in both groups. Future studies are needed to evaluate the role of CECs as a biomarker to predict outcomes in normoalbuminuric patients with CKD.
Collapse
Affiliation(s)
- Shayan Shirazian
- Division of Nephrology, Department of Medicine, Winthrop University Hospital, Mineola, NY, USA
| | - Candace Grant
- Division of Nephrology, Department of Medicine, Winthrop University Hospital, Mineola, NY, USA
| | - Vikash Rambhujun
- Division of Nephrology, Department of Medicine, Winthrop University Hospital, Mineola, NY, USA
| | - Ritika Sharma
- Division of Nephrology, Department of Medicine, Winthrop University Hospital, Mineola, NY, USA
| | - Ronak Patel
- Division of Nephrology, Department of Medicine, Winthrop University Hospital, Mineola, NY, USA
| | - Shahidul Islam
- Winthrop Research Institute, Winthrop University Hospital, Mineola, NY, USA
| | - Joseph Mattana
- Division of Nephrology, Department of Medicine, Winthrop University Hospital, Mineola, NY, USA
| |
Collapse
|
9
|
Schlett CL, Bertheau RC, Kauczor HU, Weckbach S. [Prognostic value of cardiovascular MRI in diabetics]. Radiologe 2015; 55:299-307. [PMID: 25711144 DOI: 10.1007/s00117-014-2719-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
CLINICAL/METHODICAL ISSUE Despite an increased cardiovascular risk in patients with diabetes mellitus they are a heterogeneous population with very different individual manifestation of diseases; therefore, a profound stratification is recommended. STANDARD METHODS Clinical examinations and blood biomarkers are typically used in diabetic patients to determine the risk for developing cardio-cerebrovascular events. METHODICAL INNOVATIONS Cardiac as well as whole-body magnetic resonance imaging (MRI) including cardiovascular sequences are established methods for clinical diagnostics. Their significance in predicting the outcome and the corresponding risk stratification for patients with diabetes is becoming increasingly more important based on recent study results. PERFORMANCE Late gadolinium enhancement (LGE) in cardiac MRI detects silent myocardial ischemia in up to 30% of diabetic patients, which is associated with a hazard ratio of 3-6 for cardiovascular events. Regional left ventricular wall motion abnormalities and decreased ejection fraction also have a prognostic value in diabetics. Based on whole-body MRI, the vessel score as well as carotid artery stenosis have been evaluated as additional predictors for cardio-cerebrovascular events. ACHIEVEMENTS The MRI-based predictors have independent and incremental prognostic value beyond traditional risk stratification for cardio-cerebrovascular events; however, only the comprehensive assessment of whole-body MRI including angiography allows the identification of patients who remain free of cardio-cerebrovascular events over a period of 6 years. PRACTICAL RECOMMENDATIONS Cardiac MRI, particularly the detection of LGE, can be recommended for risk stratification of patients with diabetes mellitus. The clinical relevance of the added prognostic value of whole-body MRI needs to be clarified in further studies.
Collapse
|
10
|
Bertheau RC, Bamberg F, Lochner E, Findeisen HM, Parhofer KG, Kauczor H, Schoenberg SO, Weckbach S, Schlett CL. Whole-Body MR Imaging Including Angiography: Predicting Recurrent Events in Diabetics. Eur Radiol 2016; 26:1420-30. [DOI: 10.1007/s00330-015-3936-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2015] [Revised: 06/02/2015] [Accepted: 07/20/2015] [Indexed: 01/15/2023]
|
11
|
Petrica L, Vlad A, Gluhovschi G, Gadalean F, Dumitrascu V, Vlad D, Popescu R, Velciov S, Gluhovschi C, Bob F, Ursoniu S, Petrica M, Jianu DC. Glycated peptides are associated with the variability of endothelial dysfunction in the cerebral vessels and the kidney in type 2 diabetes mellitus patients: a cross-sectional study. J Diabetes Complications 2015; 29:230-7. [PMID: 25511877 DOI: 10.1016/j.jdiacomp.2014.11.014] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2014] [Revised: 11/23/2014] [Accepted: 11/25/2014] [Indexed: 11/19/2022]
Abstract
BACKGROUND Diabetic atherosclerosis and microangiopathy parallel diabetic nephropathy. The aim of our study was to evaluate the pattern of endothelial dysfunction in two vascular territories, the kidney and the brain, both affected by diabetic vasculopathic complications. The endothelial variability was evaluated in relation to advanced glycation end-products modified peptides. METHODS Seventy patients with type 2 diabetes mellitus and 11 healthy subjects were assessed concerning urine albumin: creatinine ratio, plasma and urinary advanced glycation end-products, plasma asymmetric dimethyl-arginine, serum cystatin C, intima-media thickness in the common carotid arteries, the pulsatility index, the resistance index in the internal carotid arteries and the middle cerebral arteries, the cerebrovascular reactivity through the breath-holding test. RESULTS The breath-holding index correlated with asymmetric dimethyl-arginine (R²=0.151; p<0.001), plasma advanced glycation end-products (R²=0.173; p<0.001), C-reactive protein (R²=0.587; p<0.001), duration of diabetes mellitus (R²=0.146; p=0.001), cystatin C (R²=0.220; p<0.001), estimated glomerular filtration rate (R²=0.237; p=0.001). Urine albumin: creatinine ratio correlated with urinary advanced glycation end-products (R²=0.257; p<0.001), but not with asymmetric dimethyl-arginine (R²=0.029; p=0.147). CONCLUSIONS In type 2 diabetic patients endothelial dysfunction in the cerebral vessels appears to be dissociated from glomerular endothelial dysfunction in early diabetic nephropathy. Advanced glycation end-products could impact both the cerebral vessels and the glomerular endothelium.
Collapse
MESH Headings
- Aged
- Albuminuria/etiology
- Arginine/analogs & derivatives
- Arginine/blood
- Biomarkers/blood
- Biomarkers/urine
- Breath Holding
- Cohort Studies
- Cross-Sectional Studies
- Diabetes Mellitus, Type 2/complications
- Diabetic Angiopathies/blood
- Diabetic Angiopathies/metabolism
- Diabetic Angiopathies/physiopathology
- Diabetic Angiopathies/urine
- Diabetic Nephropathies/blood
- Diabetic Nephropathies/metabolism
- Diabetic Nephropathies/physiopathology
- Diabetic Nephropathies/urine
- Endothelium, Vascular/metabolism
- Endothelium, Vascular/physiopathology
- Female
- Glomerular Filtration Rate
- Glycation End Products, Advanced/blood
- Glycation End Products, Advanced/metabolism
- Glycation End Products, Advanced/urine
- Humans
- Kidney/blood supply
- Kidney/metabolism
- Kidney/physiopathology
- Male
- Middle Aged
- Outpatient Clinics, Hospital
- Romania
- Severity of Illness Index
- Vasculitis, Central Nervous System/complications
- Vasculitis, Central Nervous System/metabolism
- Vasculitis, Central Nervous System/physiopathology
- Vasculitis, Central Nervous System/urine
Collapse
Affiliation(s)
- Ligia Petrica
- "Victor Babes" University of Medicine and Pharmacy, Timisoara, Romania; Department of Nephrology, County Emergency Hospital, Timisoara, Romania.
| | - Adrian Vlad
- "Victor Babes" University of Medicine and Pharmacy, Timisoara, Romania; Department of Diabetes and Metabolic Diseases, County Emergency Hospital, Timisoara, Romania.
| | - Gheorghe Gluhovschi
- "Victor Babes" University of Medicine and Pharmacy, Timisoara, Romania; Department of Nephrology, County Emergency Hospital, Timisoara, Romania.
| | - Florica Gadalean
- "Victor Babes" University of Medicine and Pharmacy, Timisoara, Romania; Department of Nephrology, County Emergency Hospital, Timisoara, Romania.
| | - Victor Dumitrascu
- "Victor Babes" University of Medicine and Pharmacy, Timisoara, Romania; Department of Pharmacology, County Emergency Hospital, Clinical Laboratory, Timisoara, Romania.
| | - Daliborca Vlad
- "Victor Babes" University of Medicine and Pharmacy, Timisoara, Romania; Department of Pharmacology, County Emergency Hospital, Clinical Laboratory, Timisoara, Romania.
| | - Roxana Popescu
- "Victor Babes" University of Medicine and Pharmacy, Timisoara, Romania; Clinical Laboratory, Department of Cellular Biology, County Emergency Hospital, Timisoara, Romania.
| | - Silvia Velciov
- "Victor Babes" University of Medicine and Pharmacy, Timisoara, Romania; Department of Nephrology, County Emergency Hospital, Timisoara, Romania.
| | - Cristina Gluhovschi
- "Victor Babes" University of Medicine and Pharmacy, Timisoara, Romania; Department of Nephrology, County Emergency Hospital, Timisoara, Romania.
| | - Flaviu Bob
- "Victor Babes" University of Medicine and Pharmacy, Timisoara, Romania; Department of Nephrology, County Emergency Hospital, Timisoara, Romania.
| | - Sorin Ursoniu
- "Victor Babes" University of Medicine and Pharmacy, Timisoara, Romania; Department of Public Health Medicine, "Victor Babes" University of Medicine and Pharmacy, Timisoara, Romania.
| | - Maxim Petrica
- Department of Neurology, County Emergency Hospital, Timisoara, Romania.
| | - Dragos Catalin Jianu
- "Victor Babes" University of Medicine and Pharmacy, Timisoara, Romania; Department of Neurology, County Emergency Hospital, Timisoara, Romania.
| |
Collapse
|
12
|
Toyoda G, Bokura H, Mitaki S, Onoda K, Oguro H, Nagai A, Yamaguchi S. Association of mild kidney dysfunction with silent brain lesions in neurologically normal subjects. Cerebrovasc Dis Extra 2015; 5:22-7. [PMID: 25873927 PMCID: PMC4376920 DOI: 10.1159/000373916] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2014] [Accepted: 01/07/2015] [Indexed: 11/25/2022] Open
Abstract
Background Chronic kidney disease (CKD) has been closely associated with stroke. Although a large number of studies reported the relationship between CKD and different types of asymptomatic brain lesions, few comprehensive analyses have been performed for all types of silent brain lesions. Methods We performed a cross-sectional study involving 1,937 neurologically normal subjects (mean age 59.4 years). Mild CKD was defined as an estimated glomerular filtration rate between 30 and 60 ml/min/1.73 m2 or positive proteinuria. Results The prevalence of mild CKD was 8.7%. Univariate analysis revealed an association between CKD and all silent brain lesions, including silent brain infarction, periventricular hyperintensity, subcortical white matter lesion, and microbleeds, in addition to hypertension and diabetes mellitus after adjusting for age and sex. In binary logistic regression analysis, the presence of CKD was a significant risk factor for all types of silent brain lesions, independent of other risk factors. Conclusions These results suggest that mild CKD is independently associated with all types of silent brain lesions, even in neurologically normal subjects.
Collapse
Affiliation(s)
- Genya Toyoda
- Department of Neurology, Shimane Prefectural Central Hospital, Izumo, Japan
| | - Hirokazu Bokura
- Department of Neurology, Shimane Prefectural Central Hospital, Izumo, Japan
| | - Shingo Mitaki
- Department of Neurology, Shimane University, Izumo, Japan
| | - Keiichi Onoda
- Department of Neurology, Shimane University, Izumo, Japan
| | - Hiroaki Oguro
- Department of Neurology, Shimane University, Izumo, Japan
| | - Atsushi Nagai
- Department of Laboratory Medicine, Faculty of Medicine, Shimane University, Izumo, Japan
| | | |
Collapse
|
13
|
Makin SDJ, Cook FAB, Dennis MS, Wardlaw JM. Cerebral small vessel disease and renal function: systematic review and meta-analysis. Cerebrovasc Dis 2014; 39:39-52. [PMID: 25547195 PMCID: PMC4335630 DOI: 10.1159/000369777] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2014] [Accepted: 11/10/2014] [Indexed: 11/23/2022] Open
Abstract
Background The small vessel disease (SVD) that appears in the brain may be part of a multisystem disorder affecting other vascular beds such as the kidney and retina. Because renal failure is associated with both stroke and white matter hyperintensities we hypothesised that small vessel (lacunar) stroke would be more strongly associated with renal failure than cortical stroke. Therefore, we performed a systematic review and meta-analysis to establish first if lacunar stroke was associated with the renal function, and second, if cerebral small vessel disease seen on the MRI of patients without stroke was more common in patients with renal failure. Methods We searched Medline and EMBASE for studies in adults with cerebral SVD (lacunar stroke or white matter hyper intensities (WMH) on Magnetic Resonance Imaging (MRI)), in which renal function was assessed (estimated glomerular filtration rate (eGFR) or proteinuria). We extracted data on SVD diagnosis, renal function, demographics and comorbidities. We performed two meta-analyses: first, we calculated the odds of renal impairment in lacunar (small vessel) ischaemic stroke compared to other ischaemic stroke subtypes (non-small vessel disease); and second, we calculated the odds of renal impairment in non-stroke individuals with WMH on MRI compared to individuals without WMH. We then performed a sensitivity analysis by excluding studies with certain characteristics and repeating the meta-analysis calculation. Results After screening 11,001 potentially suitable titles, we included 37 papers reporting 32 studies of 20,379 subjects: 15 of stroke patients and 17 of SVD features in non-stroke patients. To diagnose lacunar stroke, 13/15 of the studies used risk factor-based classification (none used diffusion-weighted MRI). 394/1,119 (35%) of patients with lacunar stroke had renal impairment compared with 1,443/4,217 (34%) of patients with non-lacunar stroke, OR 0.88, (95% CI 0.6-1.30). In individuals without stroke the presence of SVD was associated with an increased risk of renal impairment (whether proteinuria or reduced eGFR) OR 2.33 (95% CI 1.80-3.01), when compared to those without SVD. After adjustment for age and hypertension, 15/21 studies still reported a significant association between renal impairment and SVD. Conclusion We found no specific association between renal impairment and lacunar stroke, but we did find that in individuals who had not had a stroke, having more SVD features on imaging was associated with a worse renal function, which remained significant after controlling for hypertension. However, this finding does not exclude a powerful co-associate effect of age or vascular risk factor exposure. Future research should subtype lacunar stroke sensitively and control for major risk factors.
Collapse
Affiliation(s)
- Stephen D J Makin
- Clinical Research Fellow, Neuroimaging Sciences, University of Edinburgh, Edinburgh, UK
| | | | | | | |
Collapse
|
14
|
Macisaac RJ, Ekinci EI, Jerums G. Markers of and risk factors for the development and progression of diabetic kidney disease. Am J Kidney Dis 2014; 63:S39-62. [PMID: 24461729 DOI: 10.1053/j.ajkd.2013.10.048] [Citation(s) in RCA: 206] [Impact Index Per Article: 20.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2013] [Accepted: 10/08/2013] [Indexed: 12/12/2022]
Abstract
Diabetic kidney disease (DKD) occurs in 25%-40% of patients with diabetes. Given the dual problems of a significant risk of progression from DKD to end-stage renal disease (ESRD) and increased cardiovascular morbidity and mortality, it is important to identify patients at risk of DKD and ESRD and initiate protective renal and cardiovascular therapies. The importance of preventive therapy is emphasized further by worldwide increases in the incidence of diabetes. This review summarizes the evidence regarding the prognostic value and benefits of targeting established and novel risk markers for DKD development and progression. Family history of DKD, smoking history, and glycemic, blood pressure, and plasma lipid level control are established factors for identifying people at greatest risk of DKD development and progression. Absolute albumin excretion rate (AER) and glomerular filtration rate (GFR) measurements also are important, although AER categorization generally lacks the necessary specificity and sensitivity, and estimates of declining GFR are compromised by methodological limitations for GFRs in the normal-to-high range. Emerging risk markers for progressive loss of kidney function include markers of oxidation and inflammation, profibrotic cytokines, uric acid, advanced glycation end products, functional and structural markers of vascular dysfunction, kidney structural changes, and tubular biomarkers. Among these, the most promising are serum uric acid and soluble tumor necrosis factor receptor (type 1 and type 2) levels, especially in relation to GFR changes. At present, these can only be considered as risk markers because they only identify an individual at increased risk of progressive DKD and not necessarily related to the causal pathway promoting kidney damage. Further work is needed to establish whether modulating these factors improves the prognosis in DKD. Although change in urinary peptidome levels also is a promising marker, there currently is neither a clinical assay nor adequate studies defining its prognostic value. Until these or other novel markers become available for clinical use, predictive accuracy often may be increased with greater attention to established markers.
Collapse
Affiliation(s)
- Richard J Macisaac
- Department of Endocrinology & Diabetes, St Vincent's Hospital Melbourne, Victoria, Australia; University of Melbourne, Victoria, Australia.
| | - Elif I Ekinci
- University of Melbourne, Victoria, Australia; Endocrine Centre & Department of Medicine, Austin Health, Darwin, Australia; Menzies School of Health Research, Darwin, Australia
| | - George Jerums
- University of Melbourne, Victoria, Australia; Endocrine Centre & Department of Medicine, Austin Health, Darwin, Australia
| |
Collapse
|
15
|
López-Revuelta K, Galdo PP, Stanescu R, Parejo L, Guerrero C, Pérez-Fernández E. Silent diabetic nephropathy. World J Nephrol 2014; 3:6-15. [PMID: 24527402 PMCID: PMC3920222 DOI: 10.5527/wjn.v3.i1.6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2013] [Revised: 09/04/2013] [Accepted: 11/03/2013] [Indexed: 02/06/2023] Open
Abstract
AIM: To examine the risk of renal events in patients with biopsy-proven diabetic nephropathy (DN) and its possible associated factors.
METHODS: Clinical and histological data of 60 patients diagnosed with diabetic nephropathy were retrospectively collected. Patients with evidence or suspicion of other nephropathies were excluded from the study. The final event was defined as renal replacement therapy (RRT) initiation or progression of chronic kidney disease (CKD), according to the KDIGO 2012 definition of a decrease in CKD category and a decrease in GFR of 25% or more.
RESULTS: A total of 45 patients with a follow-up of at least 3 mo were included. Most of the patients presented type 2 DM, with a mean age of 58.3 years old. The time of evolution of DM was 9.6 ± 7.8 years, although in 13 patients, it was less than 5 years. A total of 62% of patients reached the final event in a median period of 3.4 years (95%CI: 2.1-4.7), with 21 of them requiring dialysis. The factors that were independently associated with renal survival were estimated glomerular filtration rate (eGFR) at the time of biopsy, cardiovascular disease (CVD) history and HbA1c less than 7%. Therefore, for each 10 mL/min per 1.73 m2 reduction in eGFR, we obtained a DN progression risk of HR = 2 (1.3-3.0) (P = 0.001); patients with CVD were at greater risk for DN progression (HR = 2.8, 1.1-7.1, P = 0.032), and CKD patients with HbA1c < 7% demonstrated greater renal risk than patients with HbA1c ≥ 7%, with an HR of 2.9 (1.0-8.4) (P = 0.054).
CONCLUSION: A past history of CVD is a risk factor for DN progression. Levels of HbA1c less than 7% could favor an eGFR decrease in these patients.
Collapse
|
16
|
|
17
|
Kelly KJ, Zhang J, Han L, Wang M, Zhang S, Dominguez JH. Intravenous renal cell transplantation with SAA1-positive cells prevents the progression of chronic renal failure in rats with ischemic-diabetic nephropathy. Am J Physiol Renal Physiol 2013; 305:F1804-12. [PMID: 24133118 DOI: 10.1152/ajprenal.00097.2013] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Diabetic nephropathy, the most common cause of progressive chronic renal failure and end-stage renal disease, has now reached global proportions. The only means to rescue diabetic patients on dialysis is renal transplantation, a very effective therapy but severely limited by the availability of donor kidneys. Hence, we tested the role of intravenous renal cell transplantation (IRCT) on obese/diabetic Zucker/SHHF F1 hybrid (ZS) female rats with severe ischemic and diabetic nephropathy. Renal ischemia was produced by bilateral renal clamping of the renal arteries at 10 wk of age, and IRCT with genetically modified normal ZS male tubular cells was given intravenously at 15 and 20 wk of age. Rats were euthanized at 34 wk of age. IRCT with cells expressing serum amyloid A had strong and long-lasting beneficial effects on renal function and structure, including tubules and glomeruli. However, donor cells were found engrafted only in renal tubules 14 wk after the second infusion. The results indicate that IRCT with serum amyloid A-positive cells is effective in preventing the progression of chronic kidney disease in rats with diabetic and ischemic nephropathy.
Collapse
Affiliation(s)
- Katherine J Kelly
- Veterans Affairs Medical Center, N111, 1481 W. 10th St., Indianapolis, IN 46202.
| | | | | | | | | | | |
Collapse
|
18
|
Shimizu M, Furuichi K, Yokoyama H, Toyama T, Iwata Y, Sakai N, Kaneko S, Wada T. Kidney lesions in diabetic patients with normoalbuminuric renal insufficiency. Clin Exp Nephrol 2014; 18:305-12. [DOI: 10.1007/s10157-013-0870-0] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2013] [Accepted: 09/09/2013] [Indexed: 01/06/2023]
|
19
|
Hsu TW, Kuo KL, Hung SC, Huang PH, Chen JW, Tarng DC. Progression of kidney disease in non-diabetic patients with coronary artery disease: predictive role of circulating matrix metalloproteinase-2, -3, and -9. PLoS One 2013; 8:e70132. [PMID: 23922934 PMCID: PMC3724836 DOI: 10.1371/journal.pone.0070132] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2013] [Accepted: 06/16/2013] [Indexed: 12/03/2022] Open
Abstract
Background Circulating matrix metalloproteinase (MMP)-2, -3 and -9 are well recognized in predicting cardiovascular outcome in coronary artery disease (CAD), but their risks for chronic kidney disease (CKD) are lacking. Therefore, the present study aimed to investigate whether circulating MMP levels could independently predict future kidney disease progression in non-diabetic CAD patients. Methods The prospective study enrolled 251 non-diabetic subjects referred for coronary angiography, containing normal coronary artery (n = 30) and CAD with insignificant (n = 95) and significant (n = 126) stenosis. Estimated glomerular filtration rate (eGFR) was calculated using the CKD-EPI formula. eGFR decline rate was calculated and the primary endpoint was a decline in eGFR over 25% from baseline. Results The eGFR decline rate (ml/min/1.73 m2 per year) in patients with CAD (1.22 [−1.27, 1.05]) was greater than that in those with normal coronary artery (0.21 [−2.63, 0.47], P<0.01). The circulating MMP-2, -3 and -9 were independently associated with faster eGFR decline among CAD patients. The mean follow-up period was 8.5±2.4 years, and 39 patients reached the primary endpoint. In multivariate Cox regression model, the adjusted hazard ratios of MMP-2 ≥861 ng/mL, MMP-3 ≥227 ng/mL and MMP-9 ≥49 ng/mL for predicting CKD progression were 2.47 (95% CI, 1.21 to 5.07), 2.15 (1.12 to 4.18), and 4.71 (2.14 to 10.4), respectively. While added to a model of conventional risk factors and baseline eGFR, MMP-2, -3 and -9 further significantly improved the model predictability for CKD progression (c statistic, 0.817). In the sensitivity analyses, the results were similar no matter if we changed the endpoints of a decline of >20% in eGFR from baseline or final eGFR < 60 mL/min/1.73 m2. Conclusion Circulating MMP-2, -3 and -9 are independently associated with kidney disease progression in non-diabetic CAD patients and add incremental predictive power to conventional risk factors.
Collapse
Affiliation(s)
- Ta-Wei Hsu
- Division of Nephrology, National Yang-Ming University Hospital, Yilan, Taiwan
| | - Ko-Lin Kuo
- Division of Nephrology, Buddhist Tzu Chi Hospital Taipei Branch, Taipei, Taiwan
| | - Szu-Chun Hung
- Division of Nephrology, Buddhist Tzu Chi Hospital Taipei Branch, Taipei, Taiwan
| | - Po-Hsun Huang
- Division of Cardiology, Taipei Veterans General Hospital, Taipei, Taiwan
- Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Jaw-Wen Chen
- Division of Cardiology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Der-Cherng Tarng
- Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan
- Division of Nephrology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- Department and Institute of Physiology, National Yang-Ming University, Taipei, Taiwan
- * E-mail:
| |
Collapse
|
20
|
Abstract
Diabetes and hypertension often coexist and their coexistence substantially promote cardiovascular disease (CVD) and chronic kidney disease. Control of blood pressure to a level of 140/90 mm Hg in people with diabetes can prevent or at least delay CVD and chronic kidney disease.. In the past many society treatment guidelines have stressed tight blood pressure control (=< 130/80) for people with diabetes. But recommendations for such tight blood pressure control have not been supported by recent large randomized control trials, especially in in elderly. Here we review the recent literature regarding the benefits of blood pressure control in elderly patients with diabetics. We further focus on evidence for specific levels of blood pressure treatment goals, in this population subset..
Collapse
|
21
|
Chade AR, Stewart N. Angiogenic cytokines in renovascular disease: do they have potential for therapeutic use? J Am Soc Hypertens 2013; 7:180-90. [PMID: 23428409 PMCID: PMC3605220 DOI: 10.1016/j.jash.2013.01.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/03/2013] [Accepted: 01/11/2013] [Indexed: 10/27/2022]
Abstract
Experimental and clinical studies suggest that the damage of the renal microvascular function and architecture may participate in the early steps of renal injury in chronic renal disease, irrespective of the cause. This supporting evidence has provided the impetus to targeting the renal microvasculature as an attempt to interfere with the progressive nature of the disease process. Chronic renovascular disease is often associated with renal microvascular dysfunction, damage, loss, and defective renal angiogenesis associated with progressive renal dysfunction and damage. It is possible that damage of the renal microvasculature in renovascular disease constitutes an initiating event for renal injury and contributes towards progressive and later on irreversible renal injury. Recent studies have suggested that protection of the renal microcirculation can slow or halt the progression of renal injury in this disease. This brief review will focus on the therapeutic potential and feasibility of using angiogenic cytokines to protect the kidney microvasculature in chronic renovascular disease. There is limited but provocative evidence showing that stimulation of vascular proliferation and repair using vascular endothelial growth factor or hepatocyte growth factor can slow the progression of renal damage, stabilize renal function, and protect the renal parenchyma. Such interventions may potentially constitute a sole strategy to preserve renal function and/or a co-adjuvant tool to improve the success of current therapeutic approaches in renovascular disease.
Collapse
Affiliation(s)
- Alejandro R Chade
- Department of Physiology and Biophysics, University of Mississippi Medical Center, Jackson, MS 39216-4505, USA.
| | | |
Collapse
|
22
|
Abstract
Renal failure in type 2 diabetes has been termed "a medical catastrophe of worldwide dimension". In 2001, we found in our unit that 49% of incident patients requiring maintenance hemodialysis had diabetes (i.e. 98/million population/year), 6% of whom had type 1 and most (94%) had type 2 diabetes, i.e. more than the than reported frequency in Germany (approximately 35% of incident patients). The frequency is underestimated because hyperglycemia is often lost in the preterminal phase when diabetic patients lose weight and fasting hyperglycemia.
Collapse
MESH Headings
- Blood Pressure/drug effects
- Diabetes Mellitus, Type 1/complications
- Diabetes Mellitus, Type 1/psychology
- Diabetes Mellitus, Type 1/therapy
- Diabetes Mellitus, Type 2/complications
- Diabetes Mellitus, Type 2/psychology
- Diabetes Mellitus, Type 2/therapy
- Diabetic Nephropathies/diagnosis
- Diabetic Nephropathies/etiology
- Diabetic Nephropathies/physiopathology
- Diabetic Nephropathies/therapy
- Disease Progression
- Dyslipidemias/drug therapy
- Dyslipidemias/etiology
- Glomerular Filtration Rate/drug effects
- Humans
- Hyperglycemia/drug therapy
- Hyperglycemia/etiology
- Kidney/drug effects
- Kidney/pathology
- Kidney/physiopathology
- Kidney Failure, Chronic/etiology
- Kidney Failure, Chronic/physiopathology
- Kidney Failure, Chronic/prevention & control
- Medication Therapy Management
- Outcome Assessment, Health Care
- Proteinuria/etiology
- Proteinuria/physiopathology
- Renin-Angiotensin System/drug effects
- Risk Reduction Behavior
Collapse
Affiliation(s)
- Eberhard Ritz
- University of Heidelberg, Nierenzentrum, Im Neuenheimer Feld 162, Heidelberg 69120, Germany.
| |
Collapse
|
23
|
Araki SI, Nishio Y, Araki A, Umegaki H, Sakurai T, Iimuro S, Ohashi Y, Uzu T, Maegawa H, Kashiwagi A, Ito H. Factors associated with progression of diabetic nephropathy in Japanese elderly patients with type 2 diabetes: Sub-analysis of the Japanese Elderly Diabetes Intervention Trial. Geriatr Gerontol Int 2012; 12 Suppl 1:127-33. [DOI: 10.1111/j.1447-0594.2011.00820.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
24
|
Uzu T, Kida Y, Yamauchi A, Kume S, Isshiki K, Araki SI, Koya D, Haneda M, Kashiwagi A, Maegawa H, Kikkawa R. The effects of blood pressure control levels on the renoprotection of type 2 diabetic patients without overt proteinuria. ACTA ACUST UNITED AC 2012; 6:124-31. [DOI: 10.1016/j.jash.2011.11.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2011] [Revised: 11/04/2011] [Accepted: 11/08/2011] [Indexed: 01/13/2023]
|
25
|
Nakao K, Uzu T, Araki S, Kume S, Deji N, Chin‐Kanasaki M, Araki H, Isshiki K, Sugimoto T, Kawai H, Nishio Y, Kashiwagi A, Maegawa H. Arterial stiffness and renal impairment in non-proteinuric type 2 diabetic patients. J Diabetes Investig 2012; 3:86-91. [PMID: 24843550 PMCID: PMC4014937 DOI: 10.1111/j.2040-1124.2011.00146.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
UNLABELLED Aims/Introduction: Although increases in urinary protein excretion generally precede a decline in the glomerular filtration rate, non-proteinuric renal impairment is common in patients with diabetes. In the present study, we examined the relationship between indices of arterial stiffness and renal function in type 2 diabetic patients without proteinuria. METHODS Blood sampling, 24-h urine collection, brachial-ankle pulse wave velocity, and 24-h ambulatory blood pressure monitoring were performed in type 2 diabetic patients without overt proteinuria. The ambulatory arterial stiffness index was calculated as (1 - the regression slope of diastolic/systolic ambulatory blood pressure). Estimated glomerular filtration rate (eGFR)was calculated using the simplified prediction equation proposed by the Japanese Society of Nephrology. RESULTS Of 213 non-proteinuric patients with type 2 diabetes, 60 (28.2%) had a reduced eGFR (<60 mL/min per 1.73 m(2)). Although the urinary albumin excretion rate was significantly correlated with the eGFR, 34 of 152 patients with normoalbuminuria (22.4%) had a reduced eGFR. The eGFR was significantly and negatively correlated with the ambulatory arterial stiffness index and brachial-ankle pulse wave velocity, but not with 24-h pulse pressure. Multivariate analysis revealed that increased age and increased urinary albumin excretion were independently associated with decreased eGFR. In addition, the ambulatory arterial stiffness index, but not brachial-ankle pulse wave velocity, were found to be independently and significantly associated with eGFR. CONCLUSIONS Ambulatory arterial stiffness index is a marker for increased risk of renal failure in non-proteinuric patients with type 2 diabetes. (J Diabetes Invest, doi: 10.1111/j.2040-1124.2011.00146.x, 2012).
Collapse
Affiliation(s)
- Keiko Nakao
- Department of Medicine, Shiga University of Medical Science, Otsu, Shiga, Japan
| | - Takashi Uzu
- Department of Medicine, Shiga University of Medical Science, Otsu, Shiga, Japan
| | - Shin‐ichi Araki
- Department of Medicine, Shiga University of Medical Science, Otsu, Shiga, Japan
| | - Shinji Kume
- Department of Medicine, Shiga University of Medical Science, Otsu, Shiga, Japan
| | - Naoko Deji
- Department of Medicine, Shiga University of Medical Science, Otsu, Shiga, Japan
| | | | - Hisazumi Araki
- Department of Medicine, Shiga University of Medical Science, Otsu, Shiga, Japan
| | - Keiji Isshiki
- Department of Medicine, Shiga University of Medical Science, Otsu, Shiga, Japan
| | - Toshiro Sugimoto
- Department of Medicine, Shiga University of Medical Science, Otsu, Shiga, Japan
| | - Hiromichi Kawai
- Department of Medicine, Shiga University of Medical Science, Otsu, Shiga, Japan
| | - Yoshihiko Nishio
- Department of Medicine, Shiga University of Medical Science, Otsu, Shiga, Japan
| | - Atsunori Kashiwagi
- Department of Medicine, Shiga University of Medical Science, Otsu, Shiga, Japan
| | - Hiroshi Maegawa
- Department of Medicine, Shiga University of Medical Science, Otsu, Shiga, Japan
| |
Collapse
|
26
|
Abstract
Vascular endothelial growth factor (VEGF) plays a central role in angiogenesis. A number of studies have focused on its role in health and disease and discussed the possibility of VEGF as both a therapeutic tool and target based on its specific actions on vascular proliferation and cell survival. On one side, anti-VEGF therapies are at the fore-front of treatment of many solid tumors, but blockade of VEGF carries collateral effects such as hypertension and renal damage largely due to abnormalities in the microvasculature. On the other hand, recent clinical and experimental evidence has shown the feasibility of using VEGF administration to protect ischemic tissues such as the myocardium or the kidney via stimulation of microvascular proliferation and repair. In this commentary, we discuss the possibility and potential mechanisms of using intra-renal administration of VEGF to preserve the renal microcirculation and, consequently, decrease progressive renal injury in chronic renovascular disease. Targeted administration of VEGF may constitute a novel stand-alone or co-adjuvant intervention with the potential to become a part of a comprehensive plan to protect renal function.
Collapse
Affiliation(s)
- Alejandro R. Chade
- The Department of Physiology and Biophysics, Center for Excellence in Cardiovascular-Renal Research2500 North State Street, Jackson, MS, 39216-4505
- The Department of Medicine, University of Mississippi Medical Center2500 North State Street, Jackson, MS, 39216-4505
| |
Collapse
|
27
|
Affiliation(s)
- E Ritz
- Department of Internal Medicine, Division Nephrology, Ruperto Carola University of Heidelberg, Germany
| | | |
Collapse
|
28
|
Chou CC, Lien LM, Chen WH, Wu MS, Lin SM, Chiu HC, Chiou HY, Bai CH. Adults with late stage 3 chronic kidney disease are at high risk for prevalent silent brain infarction: a population-based study. Stroke 2011; 42:2120-5. [PMID: 21700935 DOI: 10.1161/strokeaha.110.597930] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE The close relationship between stroke and chronic kidney disease (CKD) has been well-documented. However, few studies have focused on silent brain infarction (SBI) in CKD. We investigated the prevalence of SBI in different stages of CKD. METHODS We included 1312 participants aged 30 to 93 years who came from either a random sample of residents or from a group of physically examined subjects in the same community. Basic information, clinical evaluations, laboratory tests, and MRI images were assessed. Subjects were divided into groups 1, 2, 3a, and 3b, corresponding to the estimated glomerular filtration rate (eGFR) levels of ≥ 90.0, 60.0 to 89.9, 45.0 to 59.9, and 30.0 to 44.9 mL/min/1.73 m². RESULTS The crude prevalence was 4.7%: 2.6% (20 of 759 subjects) in group 1; 6.3% (32 of 506) in group 2; 12.9% (4 of 31) in group 3a; and 37.5% (6 of 16) in group 3b (P<0.001). Additionally, SBI also correlated with age, male sex, hypertension, diabetes, moderate carotid plaque, higher blood pressures, obesity, and levels of triglyceride, high-density lipoprotein cholesterol, high-sensitivity C-reactive protein, and uric acid (all P<0.05). The effects for SBI risk in each eGFR group versus group 1 did not increase except for group 3b (OR, 9.34; P<0.001). CONCLUSIONS A close association exists between SBI and eGFR. We have found a significant increase in prevalence of SBI when eGFR is between 30.0 and 44.9 mL/min/1.73 m². Adults with late stage 3 CKD are at high risk for prevalent SBI.
Collapse
Affiliation(s)
- Chia-Chi Chou
- Division of Nephrology, Chang Gung Memorial Hospital, Keelung, Taiwan
| | | | | | | | | | | | | | | |
Collapse
|
29
|
Afsar B, Elsurer R, Covic A, Johnson RJ, Kanbay M. Relationship between uric acid and subtle cognitive dysfunction in chronic kidney disease. Am J Nephrol 2011; 34:49-54. [PMID: 21659739 DOI: 10.1159/000329097] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2011] [Accepted: 05/04/2011] [Indexed: 02/04/2023]
Abstract
BACKGROUND Elevated serum uric acid has been associated with cognitive dysfunction and vascular cognitive impairment in the elderly. Serum uric acid is also commonly elevated in chronic kidney disease (CKD), but its relationship with cognitive function in these patients has not been addressed. METHODS Subjects with CKD (defined as eGFR <60/ml/min/1.73 m(2)) were evaluated for cognitive dysfunction using the validated Standardized Mini-Mental State Examination (SMMSE). Individuals with dementia, depression or other psychiatric disorders were excluded, as were subjects on uric acid-lowering therapy or with serious illnesses such as severe anemia or active or ongoing cardiovascular or cerebrovascular disease. RESULTS 247 subjects were enrolled. SMMSE scores showed stepwise deterioration with increasing quartile of serum uric acid (26.4; 26.1; 25.5; 25.3, score range 20-30, p = 0.019). Post-hoc analysis demonstrated that there was no linear trend and only groups 1 and 4 were different with respect to SMMSE scores (p = 0.025). Stepwise multivariate linear regression revealed that age, educational status, presence of cerebrovascular disease, and serum uric acid were independently related to SMMSE scores. CONCLUSION Serum uric acid levels are independently and inversely associated with mild cognitive dysfunction in subjects with CKD.
Collapse
Affiliation(s)
- Baris Afsar
- Division of Nephrology, Department of Medicine, Zonguldak State Hospital, Zonguldak, Turkey
| | | | | | | | | |
Collapse
|
30
|
Affiliation(s)
- Eberhard Ritz
- Department of Internal Medicine, Nierenzentrum, Im Neuenheimer Feld, Heidelberg, Germany.
| |
Collapse
|
31
|
Miyazawa I, Araki SI, Obata T, Yoshizaki T, Morino K, Kadota A, Ugi S, Kawai H, Uzu T, Nishio Y, Koya D, Haneda M, Kashiwagi A, Maegawa H. Association between serum soluble TNFα receptors and renal dysfunction in type 2 diabetic patients without proteinuria. Diabetes Res Clin Pract 2011; 92:174-80. [PMID: 21288590 DOI: 10.1016/j.diabres.2011.01.008] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2010] [Revised: 12/28/2010] [Accepted: 01/10/2011] [Indexed: 10/18/2022]
Abstract
AIM The aim of our study was to investigate whether serum levels of soluble tumor necrosis factor α receptor (sTNFR) 1 and 2 are markers for renal dysfunction in type 2 diabetic patients without overt proteinuria. METHODS Japanese type 2 diabetic patients without overt proteinuria (n = 168) enrolled in the prospective observational follow-up study in 2001 were retrospectively analyzed. At baseline, the serum levels of sTNFR1 and sTNFR2 were measured by sandwich ELISA. The associations between these markers and change in estimated glomerular filtration rate (eGFR) after 5 years were evaluated. RESULTS The levels of sTNFR1 and sTNFR2 closely correlated. At baseline, sTNFR1 and sTNFR2 associated inversely with eGFR. After 5 years, patients with high level of both sTNFR1 and sTNFR2 showed a greater decline in eGFR (-13.8 ± 15.5% versus -8.5 ± 11.8%, P = 0.027) and a 4-fold higher risk for a GFR decline of ≥ 25% than those with high level of only one receptor or low level of both receptors. These associations were enhanced in diabetic women. CONCLUSIONS The higher levels of sTNFR1 and sTNFR2 were associated with a greater decline in eGFR in type 2 diabetic patients without proteinuria, especially in diabetic women.
Collapse
Affiliation(s)
- Itsuko Miyazawa
- Department of Medicine, Shiga University of Medical Science, Seta, Otsu, Shiga 520-2192, Japan
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
32
|
Wolf G, Busch M, Müller N, Müller UA. Association between socioeconomic status and renal function in a population of German patients with diabetic nephropathy treated at a tertiary centre. Nephrol Dial Transplant 2011; 26:4017-23. [PMID: 21493815 DOI: 10.1093/ndt/gfr185] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Diabetic nephropathy is the most common disease leading to end-stage renal disease (ESRD) in many countries including Germany. Some previous studies, mainly from the US, suggest that low socioeconomic status (SES) may increase the risk of ESRD. No data are available whether the SES influences the development of diabetic nephropathy in patients with diabetes mellitus in Germany. METHODS This cross-sectional study was performed on patients treated at a large university outpatient department for endocrinology and metabolic diseases. A total of 174 patients with type 1 and 651 patients with type 2 diabetes and chronic preterminal diabetic nephropathy were studied [mainly chronic kidney disease (CKD) Stages 2 and 3]. Only very few CKD Stage 5 patients were included. Patients with acute kidney injury or abnormal urinary sediment were excluded. Patients were asked about their social status using a questionnaire. Social status was determined by three components: education, highest professional position achieved and household net income. Each component was assessed by a score with 1 to 7 points to generate a total score with a minimum of 3 up to maximum of 21 points. Smoking habits were also assessed by questionnaire. HbA1c, systolic and diastolic blood pressure and body mass index from the last observation were recorded. Estimated glomerular filtration rate (eGFR) was calculated according to the modified equation 7 MDRD formula. Patients were grouped into the CKD stages according to eGFR and presence of albuminuria. Multivariate analysis was used for data analysis. RESULTS Patients were grouped in tertiles according to their social status (Tertile 1: 307, Tertile 2: 269, Tertile 3: 269 patients). The majority of type 1 (50.9%) and type 2 (64.9%) patients were in CKD Stages 2 and 3. Multivariate analysis revealed that SES is an independent predictor of renal function in all patients as well as in type 2 diabetic patients with diabetic nephropathy. This relationship was independent of smoking behaviour, duration of diabetes and HbA1c values. There was no association between renal function and SES in type 1 diabetic patients, but a type 2 error caused by low patient number cannot be excluded. Furthermore, no significant association between SES and albuminuria (defined ≥20 mg/L) existed. There was no significant difference in the number of visits to the clinic in regard to SES excluding referral bias. CONCLUSIONS A lower SES was associated with the presence of diabetic nephropathy in patients with type 2 diabetes in a German population. The causes for this association are likely multiple.
Collapse
Affiliation(s)
- Gunter Wolf
- Department of Internal Medicine III, University of Jena, Jena, Germany.
| | | | | | | |
Collapse
|
33
|
Ritz E. Drug of choice in the management of hypertension in diabetes and diabetic nephropathy: angiotensin-converting enzyme inhibitors. J Clin Hypertens (Greenwich) 2011; 13:285-9. [PMID: 21466627 DOI: 10.1111/j.1751-7176.2011.00448.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Hypertension is common in patients with diabetes mellitus and is a main cause of renal and cardiovascular complications. There has been recent controversy on what should be considered the optimal blood pressure goal and the optimal antihypertensive agent. It has become apparent that one blood pressure does not fit all in diabetic patients. Major confounders are preexisting cardiovascular disease and presence or absence of proteinuric kidney disease. In proteinuric diabetic nephropathy, renin-angiotensin system blockade is clearly indicated, but monotherapy is practically always insufficient to achieve target blood pressure values.
Collapse
Affiliation(s)
- Eberhard Ritz
- Division of Nephrology, Department of Internal Medicine, Nierenzentrum, Heidelberg, Germany.
| |
Collapse
|
34
|
Mogi M, Horiuchi M. Clinical Interaction between Brain and Kidney in Small Vessel Disease. Cardiol Res Pract 2011; 2011:306189. [PMID: 21274446 PMCID: PMC3025374 DOI: 10.4061/2011/306189] [Citation(s) in RCA: 110] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2010] [Revised: 11/29/2010] [Accepted: 12/20/2010] [Indexed: 11/20/2022] Open
Abstract
Patients with chronic kidney disease (CKD) are well known to have a higher prevalence of cardiovascular disease from epidemiological studies. Recently, CKD has also been shown to be related to neurological disorders, not only ischemic brain injury but also cognitive impairment. This cerebrorenal connection is considered to involve small vessel disease in both the kidney and brain, based on their hemodynamic similarities. Clinical studies suggest that markers for CKD such as estimated glomerular filtration rate (eGFR), proteinuria, and albuminuria may be helpful to predict brain small vessel disease, white matter lesions (WMLs), silent brain ischemia (SBI), and microhemorrhages. Recently, changes in the vascular system of the brain have been shown to contribute to the onset and progression of cognitive impairment, not only vascular dementia but also Alzheimer's disease. Patients with CKD are also reported to have higher risk of impaired cognitive function in the future compared with non-CKD subjects. These results indicate that CKD markers may be helpful to predict the future risk of neuronal disease.
Collapse
Affiliation(s)
- Masaki Mogi
- Department of Molecular Cardiovascular Biology and Pharmacology, Graduate School of Medicine, Ehime University, Tohon, Ehime 791-0295, Japan
| | | |
Collapse
|
35
|
Giang LM, Weiner DE, Agganis BT, Scott T, Sorensen EP, Tighiouart H, Sarnak MJ. Cognitive function and dialysis adequacy: no clear relationship. Am J Nephrol 2010; 33:33-8. [PMID: 21150193 DOI: 10.1159/000322611] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/08/2010] [Indexed: 12/17/2022]
Abstract
BACKGROUND/AIMS Cognitive impairment is common in hemodialysis patients and may be impacted by multiple patient and treatment characteristics. The impact of dialysis dose on cognitive function remains uncertain, particularly in the current era of increased dialysis dose and flux. METHODS We explored the cross-sectional relationship between dialysis adequacy and cognitive function in a cohort of maintenance hemodialysis patients. Adequacy was defined as the average of the 3 most proximate single pool Kt/V assessments. A detailed neurocognitive battery was administered during the 1st hour of dialysis. Multivariable linear regression models were adjusted for age, sex, education, race and other clinical and demographic characteristics. RESULTS Among 273 patients who underwent cognitive testing, the mean (SD) age was 63 (17) years and the median dialysis duration was 13 months, 47% were woman, 22% were African American, and 48% had diabetes. The mean (SD) Kt/V was 1.51 (0.24). In univariate, parsimonious and multivariable models, there were no significant relationships between decreased cognitive function and lower Kt/V. CONCLUSION In contrast to several older studies, there is no association between lower Kt/V and worse cognitive performance in the current era of increased dialysis dose. Future studies should address the longitudinal relationship between adequacy of dialysis and cognitive function to confirm these findings.
Collapse
|
36
|
Abstract
Cognitive impairment, including dementia, is a common but poorly recognized problem among patients with end-stage renal disease (ESRD), affecting 16-38% of patients. Dementia is associated with high risks of death, dialysis withdrawal, hospitalization, and disability among patients with ESRD; thus, recognizing and effectively managing cognitive impairment may improve clinical care. Dementia screening strategies should take into account patient factors, the time available, the timing of assessments relative to dialysis treatments, and the implications of a positive screen for subsequent management (for example, transplantation). Additional diagnostic testing in patients with cognitive impairment, including neuroimaging, is largely based on the clinical evaluation. There is limited data on the efficacy and safety of pharmacotherapy for dementia in the setting of ESRD; therefore, decisions about the use of these medications should be individualized. Management of behavioral symptoms, evaluation of patient safety, and advance care planning are important components of dementia management. Prevention strategies targeting vascular risk factor modification, and physical and cognitive activity have shown promise in the general population and may be reasonably extrapolated to the ESRD population. Modification of ESRD-associated factors such as anemia and dialysis dose or frequency require further study before they can be recommended for treatment or prevention of cognitive impairment.
Collapse
|
37
|
Bouchi R, Babazono T, Yoshida N, Nyumura I, Toya K, Hayashi T, Hanai K, Tanaka N, Ishii A, Iwamoto Y. Silent cerebral infarction is associated with the development and progression of nephropathy in patients with type 2 diabetes. Hypertens Res 2010; 33:1000-3. [PMID: 20613763 DOI: 10.1038/hr.2010.122] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Chronic kidney disease (CKD) is an important risk factor for cardiovascular disease in patients with diabetes. The relationship between renal manifestations of CKD (albuminuria and decreased glomerular filtration rate) and silent cerebral infarction (SCI) has attracted attention; however, most studies examined the effects of components of CKD on prevalence of SCI. We sought to assess the relationship between SCI and the development and progression of nephropathy in type 2 diabetic patients. We studied 366 type 2 diabetic patients with normoalbuminuria (urinary albumin-to-creatinine ratio [ACR] <30 mg g(-1), N=246) or microalbuminuria (ACR=30-299 mg g(-1), N=120). SCI was defined by cranial MRI. The primary end point was progression from normo- to microalbuminuria or from micro- to macroalbuminuria. The cumulative incidence of the primary end point was estimated using the Kaplan-Meier method. Risk estimates for reaching the end point were calculated using Cox proportional hazard model analyses. During a median follow-up period of 3.9 years, 23 normoalbuminuric and 24 microalbuminuric patients reached the primary end point. Patients with SCI (N=171) had a greater incidence of reaching the end point than those without SCI (N=195, P=0.020 by the log-rank test), with a hazard ratio of 2.02 (95% confidence interval=1.09-3.72, P=0.025) in the multivariate Cox regression model. Although the common pathogenesis of SCI and albuminuria in diabetic patients is still unclear, SCI may be a predictor of progression of nephropathy in type 2 diabetic patients.
Collapse
Affiliation(s)
- Ryotaro Bouchi
- Division of Nephrology and Hypertension, Department of Medicine, Diabetes Center, Tokyo Women's Medical University School of Medicine, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, Japan
| | | | | | | | | | | | | | | | | | | |
Collapse
|
38
|
Ireland R. Cerebral microvascular disease independently predicts renal failure in patients with type 2 diabetes. Nat Rev Nephrol 2010; 6:250. [DOI: 10.1038/nrneph.2010.50] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
|