scholarly journals Change in renal hemodynamics after renal denervation in diabetic patients with resistant hypertension and chronic kidney disease

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
M Manukyan ◽  
A Falkovskaya ◽  
V Mordovin ◽  
S Pekarskiy ◽  
I Zyubanova ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Serum Creatinine ◽  
Resistant Hypertension ◽  
Renal Denervation ◽  
Therapeutic Option ◽  
Renal Hemodynamics ◽  
Diabetic Patients ◽  
Type 2 Dm

Abstract Background There are very few data on the initial features of hemodynamics and its changes after renal denervation (RDN) in patients with resistant hypertension (RHTN) and type 2 diabetes mellitus (DM), depending on the presence of chronic kidney disease (CKD), and the mechanisms of this effect require further study. Purpose To assess the features of renal hemodynamics and its change after RDN in patients with RHTN with type 2 DM, depending on the presence or absence of CKD. Methods In the study were included 38 patients with RHTN with type 2 DM (mean age 60.6±8.1 years, 14 men, 24-hour systolic / diastolic blood pressure (24-hr SBP/DBP) 160.9±16.5 / 82.2±11.3 mm Hg, mean HbA1c 7.87±1.62%), of which CKD occurred in 18 pts. (eGFR – 47.1 ml/min/1.73 m2), and 20 pts. without CKD (eGFR – 80.3 ml/min/1.73m2). All patients underwent baseline office and 24-hr BP measurement with calculation DBP/SBP ratio (D/S ratio), Doppler ultrasonography, serum creatinine, estimated glomerular filtration rate (eGFR) (CKD-EPI formula), urinary albumin excretion (UAE). The six-month follow-up period was completed by 14 patients in the group with CKD and 18 patients without CKD. Results At baseline, patients with CKD compared with those without CKD had higher pulse BP (82.2±10.0 versus 75.6±15.9, p=0.061), renal resistive indices (RRI) (0.78±0.06 versus 0.69±0.05, p=0.001 in the main renal arteries (RA); 0.73±0.07 versus 0, 63±0.06, p=0.001 in segmental RA) and significantly lower level of D/S ratio (0.49±0.06 versus 0.53±0.06, p=0.040). At the same time, the frequency of increased RRI (>0.70) in the CKD group was almost 14 times higher than in those without CKD (73% and 5.3%, respectively, p<0.001).After RDN, patients with CKD showed a significant decrease in SBP (−10.7 mm Hg, p=0.008) and an insignificant decrease in DBP (−3.9 mm Hg, p=0.118). In group without CKD, on the contrary, there was an insignificant decrease in SBP (−7.6 mm Hg, p=0.102) and a significant decrease in DBP (−5.5 mm Hg, p=0.030). The D/S ratio tended to increase in the group of CKD patients (p=0.08), whereas these indicators did not change significantly in the group without CKD. Additionally, there were a positive dynamics of RRI (decrease >0.05) in patients with CKD, the frequency of which was almost 4 times higher than that in persons without CKD (43% and 11%, respectively, p=0.049). Moreover, a decrease in RRI correlated with an increase in the D / S ratio of both the main RA (R = 0.50; p=0.005) and in segmental RA (R = 0.40; p=0.028). There were no significant changes in UAE and serum creatinine in both groups. Conclusions Thus, CKD in patients with RHTN with type 2 DM is characterized by a significant increase in renal vascular resistance, while RDN in this patients, in contrast to patients without CKD, can be an effective therapeutic option not only for BP reduction, but also for improvement of renal hemodynamics. FUNDunding Acknowledgement Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Russian Foundation for Basic Research

Frequency of Chronic Kidney Disease in Type 2 Diabetic Patients Presenting with Diabetic Foot Ulcer

2020 ◽  
Author(s):  
Ghazala Usman
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Diabetic Foot ◽  
Foot Ulcer ◽  
Diabetic Foot Ulcer ◽  
P Value ◽  
Diabetic Patients ◽  
Type 2 Dm ◽  
Significant Difference

Background: Recent evidence states that about a quarter of all diabetic patients will experience an ulcer on foot at some point in their lifetime and 15-25% of these will require foot amputation. In the present study, we aimed to evaluate the incidence of chronic kidney disease (CKD) in Type 2 diabetes mellitus (T2DM) patients presenting with Diabetic foot ulcer. Methods: The present study was carried out at Jinnah Postgraduate Medical Center (JPMC), Sindh from February-August 2017. Over 100 Type 2 - DM patients, aged between 35-60 years who presented with diabetic foot ulcer took part in this study. Data was collected and documented in pre-approved pro-forma, subsequently, entered and analyzed via SPSS version 19. Chi-square was applied to test any significant difference between the categories with a p-value of ≤0.05 considered as significant. Results: The mean serum creatinine (mg/dl) value was reported to be 1.17 ± 0.45. Frequency of CKD in Type 2 - DM patients presenting with diabetic foot ulcer was 31%. Male gender was affected more from CKD. Frequency distribution of chronic kidney disease among duration of DM groups 10-15 years = 35.5% and >15 years = 64.5%. The characteristics of HbA1c (g/dl) of study population was 8.34 ± 0.59. Conclusion: Occurrence of CKD in Type 2 - DM patients presenting with diabetic foot ulcer was much higher as compared to national and international studies. Therefore, special attention should be given on regular screening of diabetic patients with a complaint of a foot ulcer.

scholarly journals Guidelines adherence in the prevention and management of chronic kidney disease in patients with diabetes mellitus on the background of recent European recommendations – a registry-based analysis

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Peter Bramlage ◽  
Stefanie Lanzinger ◽  
Sascha R. Tittel ◽  
Eva Hess ◽  
Simon Fahrner ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Chronic Kidney Disease ◽  
Clinical Practice ◽  
Kidney Disease ◽  
Analysis Data ◽  
Disease Diagnosis ◽  
Diabetic Patients ◽  
European Society Of Cardiology

Abstract Background Recent European Society of Cardiology (ESC)/European Association for the Study of Diabetes (EASD) guidelines provide recommendations for detecting and treating chronic kidney disease (CKD) in diabetic patients. We compared clinical practice with guidelines to determine areas for improvement. Methods German database analysis of 675,628 patients with type 1 or type 2 diabetes, with 134,395 included in this analysis. Data were compared with ESC/EASD recommendations. Results This analysis included 17,649 and 116,747 patients with type 1 and type 2 diabetes, respectively. The analysis showed that 44.1 and 49.1 % patients with type 1 and type 2 diabetes, respectively, were annually screened for CKD. Despite anti-diabetic treatment, only 27.2 % patients with type 1 and 43.5 % patients with type 2 achieved a target HbA1c of < 7.0 %. Use of sodium-glucose transport protein 2 inhibitors (1.5 % type 1/8.7 % type 2 diabetes) and glucagon-like peptide-1 receptor agonists (0.6 % type 1/5.2 % type 2 diabetes) was limited. Hypertension was controlled according to guidelines in 41.1 and 67.7 % patients aged 18–65 years with type 1 and 2 diabetes, respectively, (62.4 vs. 68.4 % in patients > 65 years). Renin angiotensin aldosterone inhibitors were used in 24.0 and 40.9 % patients with type 1 diabetes (micro- vs. macroalbuminuria) and 39.9 and 47.7 %, respectively, in type 2 diabetes. Conclusions Data indicate there is room for improvement in caring for diabetic patients with respect to renal disease diagnosis and treatment. While specific and potentially clinically justified reasons for non-compliance exist, the data may serve well for a critical appraisal of clinical practice decisions.

scholarly journals Carotid Intima-Media Thickness and Visit-to-Visit HbA1c Variability Predict Progression of Chronic Kidney Disease in Type 2 Diabetic Patients with Preserved Kidney Function

2016 ◽  
Vol 2016 ◽  
pp. 1-6 ◽  
Author(s):  
Akiko Takenouchi ◽  
Ayaka Tsuboi ◽  
Miki Kurata ◽  
Keisuke Fukuo ◽  
Tsutomu Kazumi
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Kidney Function ◽  
Subclinical Atherosclerosis ◽  
Intima Media Thickness ◽  
Glycemic Variability ◽  
Carotid Intima Media Thickness ◽  
Diabetic Patients ◽  
Type 2 Diabetic Patients

Background/Aims. Subclinical atherosclerosis and long-term glycemic variability have been reported to predict incident chronic kidney disease (CKD) in the general population. However, these associations have not been investigated in patients with type 2 diabetes with preserved kidney function.Methods. We prospectively followed up 162 patients with type 2 diabetes (mean age, 62.3 years; 53.6% men) and assessed whether carotid intima-media thickness (IMT) measured by B-mode ultrasound and visit-to-visit HbA1c variability are associated with deterioration of CKD (incident CKD defined as estimated GFR [eGFR] < 60 mL/min/1.73 m2and progression of CKD stages) over a median follow-up of 6.0 years. At baseline, 25 patients (15.4%) had CKD. Cox proportional hazards regression models were used for identifying associated factors of CKD deterioration.Results.Estimated GFR decreased from75.8±16.3to67.4±18.2 mL/min/1.73 m2(p<0.01). Of 162 patients, 32 developed CKD and 8 made a progression of CKD stages. Multivariate Cox regression analysis revealed that carotid IMT (HR: 4.0, 95% CI: 1.1–14.226.7, andp=0.03) and coefficient of variation of HbA1c (HR: 1.12, 95%: 1.04–1.21, andp=0.003) were predictors of deterioration of CKD independently of age, mean HbA1c, urinary albumin/creatinine ratio, baseline eGFR, uric acid, and leucocyte count.Conclusions.Subclinical atherosclerosis and long-term glycemic variability predict deterioration of chronic kidney disease (as defined by incident or worsening CKD) in type 2 diabetic patients with preserved kidney function.

P0775A RETROSPECTIVE OBSERVATIONAL COHORT STUDY TO ASSESS THE PREVALENCE OF CHRONIC KIDNEY DISEASE AMONG TYPE 2 DIABETES MELLITUS PATIENTS IN ONTARIO, CANADA

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Wally Rapattoni ◽  
David Zante ◽  
Sha Kang ◽  
Ali Tehrani ◽  
Varun Myageri ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Chronic Kidney Disease ◽  
Cohort Study ◽  
Kidney Disease ◽  
Serum Creatinine ◽  
Real World ◽  
Burden Of Illness ◽  
Total Prevalence ◽  
Capture Recapture

Abstract Background and Aims The CREDENCE trial with canagliflozin demonstrated definitive evidence of renal benefits to slow the progression of end stage renal disease (ESRD) in type 2 diabetes (T2D) patients with chronic kidney disease (CKD). This real-world study was undertaken to better understand the prevalence of CKD among T2D patients in Ontario using the CREDENCE trial criteria. Ontario is the largest province, accounting for 38.8% of Canada’s population in 20191. Patients were identified in the following cohorts: T2D-CKD, T2D-CKD+cardiovascular disease (CVD), T2D-CKD+stroke, and T2D-CKD+CVD or stroke. Method This population-based retrospective cohort study was conducted in partnership with IQVIA and the Institute for Clinical Evaluative Sciences (ICES). The ICES data repository contains publicly funded administrative health service records for the Ontario population eligible for universal health coverage since 1986. Patients’ eligibility for this study was aligned with enrolment criteria in the CREDENCE trial. Patients were ≥30 years of age at index and were identified as having both T2D and CKD. Diabetes patients were identified using the validated Ontario Diabetes Database (ODD), patients &lt;19 years of age when first diagnosed with diabetes were excluded due to suspected type 1 diabetes (T1D). Additionally, patients with a T1D diagnosis at any time-point were excluded. CKD patients were identified through diagnosis/billing codes or estimated glomerular filtration rate(eGFR)&lt;90 ml/min/1.73ml2 derived from serum creatinine laboratory values. Diagnosis/billing codes are expected to have poor sensitivity2,3 when used as the sole method to identify CKD. To account for anticipated missing information in each dataset, the capture-recapture method was used to obtain a more accurate estimate for the total prevalence. Capture-recapture accounts for incomplete ascertainment of administrative datasets by using the overlap between the datasets to derive an estimate of the total population4,5 (Figure 1). This method was used in Manitoba to estimate the total CKD population, using administrative and laboratory datasets4. Therefore, each cohort (T2D-CKD, T2D-CKD+CVD, T2D-CKD+stroke, and T2D-CKD+CVD or stroke) has utilized each of the following four methods to identify CKD patients: diagnosis/billing codes, eGFR, diagnosis/billing codes or eGFR, and capture-recapture method. Yearly point prevalence of CKD among T2D patients is reported for the five fiscal years (FY) between 2011/12 and 2015/16. Results The prevalence of T2D patients ≥30 years of age in Ontario has increased from 959,850 in FY2011/12 to 1,169,759 in FY2015/16 (Figure 2). The prevalence of CKD among T2D patients ≥30 years of age in Ontario has increased across all methods from FY2011/12 to FY2015/16: from 21% to 28% based on diagnosis/billing codes, 47% to 63% based on eGFR, 55% to 70% based on diagnosis/billing codes or eGFR, and 76% to 84% based on capture-recapture. Similarly, prevalence of T2D-CKD+CVD, T2D-CKD+stroke, and T2D-CKD+CVD or stroke has increased in most cases (Figure 3). Conclusion CKD is a common comorbidity amongst T2D patients ≥30 years of age. The study provides estimates of the prevalence of CKD in four cohorts of T2D patients with defined co-morbidities and shows that the use of diagnosis/billing codes alone may underestimate the prevalence of CKD in T2D patients. Furthermore, this real-world analysis highlights a significant, increasing prevalence of CKD among T2D patients ≥30 years of age in Ontario with all methods. On-going research aims to assess the burden of illness of patients with both T2D and CKD who are incident to T2D-related outcomes (CKD or CVD related death, kidney transplant, kidney dialysis, doubling of serum creatinine).

305 TRANSCATHETER RENAL DENERVATION IN PATIENTS WITH CHRONIC KIDNEY DISEASE AND RESISTANT HYPERTENSION

2012 ◽  
Vol 30 ◽  
pp. e90
Author(s):  
Marcio Kiuchi ◽  
George Maia ◽  
Jocemir Lugon ◽  
Maria Angela Carreira ◽  
Tetsuaki Kiuchi ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Resistant Hypertension ◽  
Renal Denervation

scholarly journals Effects of renal denervation with a standard irrigated cardiac ablation catheter on blood pressure and renal function in patients with chronic kidney disease and resistant hypertension

2013 ◽  
Vol 34 (28) ◽  
pp. 2114-2121 ◽  
Author(s):  
Márcio Galindo Kiuchi ◽  
George Luiz Marques Maia ◽  
Maria Angela Magalhães de Queiroz Carreira ◽  
Tetsuaki Kiuchi ◽  
Shaojie Chen ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Chronic Kidney Disease ◽  
Renal Function ◽  
Kidney Disease ◽  
Resistant Hypertension ◽  
Renal Denervation ◽  
Ablation Catheter ◽  
Cardiac Ablation

scholarly journals The Effect of Renal Dysfunction on Circulating Sclerostin Level in Patients with Type 2 Diabetes

2014 ◽  
Vol 2014 ◽  
pp. 1-5 ◽  
Author(s):  
Se Hwa Kim ◽  
Soo Young Yoon ◽  
Sung-Kil Lim ◽  
Yumie Rhee
Keyword(s):  
Type 2 Diabetes ◽  
Chronic Kidney Disease ◽  
Renal Function ◽  
Kidney Disease ◽  
Renal Dysfunction ◽  
Diabetic Patients ◽  
Type 2 Diabetic Patients ◽  
Cross Sectional ◽  
Sclerostin Level

Objective. Sclerostin is a Wnt inhibitor produced specifically by osteocytes. However, it is not currently clear whether renal dysfunction has an effect on circulating sclerostin level in patients with type 2 diabetes. The aim of the study was to evaluate this relationship. Design and Patients. We conducted a cross-sectional observational study of 302 type 2 diabetic patients with or without chronic kidney disease. Serum sclerostin level was analyzed by ELISA, and renal function was assessed by estimated glomerular filtration rate (eGFR) using chronic kidney disease epidemiology collaboration (CKD-EPI) equation. Results. There was a strong correlation between sclerostin level with renal function presented as serum creatinine (r=0.745, P<0.001) and eGFR (r=-0.590, P<0.001). Serum sclerostin level was significantly higher in patients with CKD-G3 stage than those with CKD-G1/2 stages after adjusting for age, sex, and BMI (P=0.011). Patients with CKD-G4/5 stages had dramatically increased level of circulating sclerostin. Multiple regression analyses found that age, sex, and eGFR were independent determining factors for circulating sclerostin level. Conclusion. Our data showed that serum sclerostin levels start to increase in diabetic patients with CKD-G3 stage. Further studies are needed to establish the potential role of elevated sclerostin in diabetic patients with CKD.

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