scholarly journals Association of unhealthy dietary behaviors with renal function decline in patients with diabetes

2020 ◽  
Vol 8 (1) ◽  
pp. e000743
Author(s):  
Cheng-Wei Lin ◽  
I-Wen Chen ◽  
Ying-Tzu Lin ◽  
Hsin-Yun Chen ◽  
Shih-Yuan Hung
Keyword(s):  
Renal Function ◽  
Low Density Lipoprotein ◽  
Density Lipoprotein ◽  
Dietary Behaviors ◽  
Chang Gung Memorial Hospital ◽  
Renal Function Decline ◽  
Renal Outcomes ◽  
Patients With Diabetes ◽  
Item List ◽  
Egfr Decline

ObjectiveBalanced nutrition is important for patients with diabetes, and nutrition might well influence diabetes-related complications, although there is limited evidence for this supposition at present. Consequently, we investigate the association between dietary behaviors and renal function decline among patients with diabetes.Research design and methodsFrom 2011 to 2013, a total of 2797 patients with type 2 diabetes participated in the Diabetes Shared Care Program at Chang Gung Memorial Hospital. All received nutritional consulting by dieticians and an eight-item list of unhealthy dietary behaviors, which included the excessive intake of carbohydrates, fats, protein, fruit, pickled foods, dessert and alcohol, as well as inadequate dietary vegetable. Estimated glomerular filtration rate (eGFR) decline ≥40% was defined as a surrogate end point for kidney damage. Independent dietary risk factors predicting poor renal outcomes were assessed.ResultsStable mean glycated hemoglobin (A1c) (7.78% to 7.75%, p=0.151), improved cholesterol (174.04 to 170.13 mg/dL, p<0.001) and low-density lipoprotein (104.19 to 98.07 mg/dL, p<0.001) were found in patients throughout 2 years of therapy. However, significant eGFR decline was noted (94.20 to 88.08 mL/min/1.73 m2, p<0.001). A total of 125 subjects had eGFR decline ≥40% and 2672 had stable renal progression.In regression analysis, 625 stable renal patients (selected via propensity score matching) and 125 subjects with eGFR decline ≥40% demonstrated excessive pickled foods to be predictive of poor renal outcomes (OR 1.861, 95% CI 1.230 to 2.814, p=0.003).ConclusionsOur study suggests that excessive pickled foods deteriorate renal function more than other unhealthy dietary behaviors in patients with diabetes.

scholarly journals Oxidized LDL Modifies the Association between Proteinuria and Deterioration of Kidney Function in Proteinuric Diabetic Kidney Disease

Life ◽  
2021 ◽  
Vol 11 (6) ◽  
pp. 504
Author(s):  
Stefanos Roumeliotis ◽  
Panagiotis I. Georgianos ◽  
Athanasios Roumeliotis ◽  
Theodoros Eleftheriadis ◽  
Aikaterini Stamou ◽  
...  
Keyword(s):  
Kidney Disease ◽  
Kidney Function ◽  
Diabetic Kidney Disease ◽  
Oxidized Ldl ◽  
Low Density Lipoprotein ◽  
Density Lipoprotein ◽  
Secondary Outcome ◽  
Diabetic Kidney ◽  
Egfr Decline ◽  
Over Time

Proteinuria is characterized by low accuracy for predicting onset and development of diabetic kidney disease (DKD) because it is not directly associated with molecular changes that promote DKD, but is a result of kidney damage. Oxidized low-density lipoprotein (ox-LDL) reflects oxidative stress and endothelial dysfunction, both underlying the development of proteinuria and loss of kidney function in DKD. We aimed to investigate whether ox-LDL modifies the association between proteinuria and progression of DKD in a cohort of 91 patients with proteinuric DKD and diabetic retinopathy, followed for 10 years. The primary endpoint was a combined kidney outcome of eGFR decline ≥30% or progression to end-stage kidney disease. After the end of the study, we considered the percentage change of eGFR over time as our secondary outcome. Proteinuria was associated with both outcomes, and ox-LDL amplified the magnitude of this link (p < 0.0001 for primary and p < 0.0001 for secondary outcome, respectively). After adjustment for duration of diabetes, history of cardiovascular disease and serum albumin, ox-LDL remained a significant effect modifier of the association between proteinuria and eGFR decline over time (p = 0.04). Our study shows that in proteinuric DKD, circulating ox-LDL levels amplified the magnitude of the association between proteinuria and progression of DKD.

scholarly journals Effect of a Multidisciplinary-Assisted Resident Diabetes Clinic on Resident Knowledge and Patient Outcomes

2013 ◽  
Vol 5 (1) ◽  
pp. 145-149 ◽  
Author(s):  
Margaret C. Lo ◽  
Morganna Freeman ◽  
M. Cecilia Lansang
Keyword(s):  
Patient Outcomes ◽  
Large Scale ◽  
Low Density Lipoprotein ◽  
Density Lipoprotein ◽  
Patient Specific ◽  
Team Approach ◽  
Diabetes Knowledge ◽  
Diabetes Clinic ◽  
Practice Behavior ◽  
Patients With Diabetes

Abstract Background Despite the rising prevalence of diabetes, there is a paucity of diabetes curricula in residency training. The multidisciplinary diabetes team approach is underused in residency education. Objective To assess the feasibility of an innovative multidisciplinary resident diabetes clinic (MRDC) in enhancing (1) resident diabetes knowledge via a Diabetes Awareness Questionnaire, and (2) subsequent process and patient outcomes in patients with diabetes via a Diabetes Practice Behavior Checklist. Methods From October 2008 to February 2010, 14 internal medicine residents managed patients with uncontrolled diabetes in a weekly half-day MRDC for 1 month (total 4–5 half-day sessions/resident), with a collaborative team of internists, diabetes educators, an endocrinologist, and a pharmacist. The curriculum included didactic sessions, required readings, and patient-specific case discussions. A 20-question Diabetes Awareness Questionnaire was administered to each resident prerotation and postrotation. Records of 47 patients with diabetes in the residents' own continuity clinics (not the MRDC) were audited 6 months before and after the MRDC for Diabetes Practice Behavior Checklist measures (glycated hemoglobin, blood pressure, low-density lipoprotein cholesterol, retinal referral, foot exam, microalbumin screen). Pre-MRDC and post-MRDC data were compared via paired t test. Results The MRDC residents exhibited a modest increase in mean (SD) scores on the Diabetes Awareness Questionnaire (before, 8.2 [2.8]; after, 10.9 [2.8]; P  =  .02) and a modest mean (SD) performance increase in overall process outcomes from the Diabetes Practice Behavior Checklist (before, 74% [18%]; after, 84% [18%]; P  =  .004). No improvements occurred in patient outcomes. Conclusions Multidisciplinary diabetes teaching may be useful in fostering certain resident knowledge and performance measures but may not alter clinical outcomes. Further large-scale, longitudinal studies are needed to understand the effect of our curriculum on residents' diabetes knowledge and future practice behavior.

scholarly journals Comparison of the Effects of Denosumab and Alendronate on Cardiovascular and Renal Outcomes in Osteoporotic Patients

2019 ◽  
Vol 8 (7) ◽  
pp. 932 ◽  
Author(s):  
Tsuen-Wei Hsu ◽  
Chien-Ning Hsu ◽  
Shih-Wei Wang ◽  
Chiang-Chi Huang ◽  
Lung-Chih Li
Keyword(s):  
Renal Function ◽  
Kidney Injury ◽  
Protective Effects ◽  
Medical Organization ◽  
Renal Function Decline ◽  
Renal Outcomes ◽  
Increased Risk ◽  
Significant Difference ◽  
Myocardial Infraction ◽  
Cox Proportional Hazard Regression

A correlation between impaired bone metabolism, chronic kidney disease, and cardiovascular diseases (CVD) has been suggested. This study aimed to compare the effects of denosumab and alendronate, two anti-resorptive agents, on cardiovascular and renal outcomes in osteoporotic patients. Propensity score-matched cohort study comparing denosumab to alendronate users between January 2005 and December 2017 was conducted from a large medical organization in Taiwan. Risks of CVD development and renal function decline were estimated using Cox proportional hazard regression. A total 2523 patients were recruited in each group. No significant difference in cardiovascular events was found between the two groups over a 5-year study period. Stratified analysis results showed that denosumab was likely to exert protective effects against composite CVD in patients with medication possession rate ≥60% (adjusted hazard ratio (AHR), 0.74; p = 0.0493) and myocardial infraction (AHR, 0.42; p = 0.0415). Denosumab was associated with increased risk of renal function decline in male patients (AHR, 1.78; p = 0.0132), patients with renal insufficiency (AHR, 1.5; p = 0.0132), and patients with acute kidney injury during the study period (AHR, 1.53; p = 0.0154). Conclusively, denosumab may exert cardiovascular benefits in patients with good adherence but may have renal disadvantages in certain conditions and thus must be used with caution.

scholarly journals Sex Differences in the Renal Function Decline of Patients with Type 2 Diabetes

2016 ◽  
Vol 2016 ◽  
pp. 1-8 ◽  
Author(s):  
Ayami Kajiwara ◽  
Ayana Kita ◽  
Junji Saruwatari ◽  
Hiroko Miyazaki ◽  
Yuki Kawata ◽  
...  
Keyword(s):  
Risk Factors ◽  
Renal Function ◽  
Sex Differences ◽  
Renal Dysfunction ◽  
Ldl Cholesterol ◽  
Early Stage ◽  
Interactive Effects ◽  
Renal Function Decline ◽  
Egfr Decline

Aims. We aimed to investigate the sex differences in the renal function decline among patients with type 2 diabetic mellitus (T2DM), focusing on the differences in the risk factors at early stage of renal dysfunction.Methods. A clinic-based retrospective longitudinal study (follow-up duration:8.1±1.4years) was conducted to assess the sex differences in the annual estimated glomerular filtration rate (eGFR) change in 344 (247 male and 97 female) Japanese T2DM patients. The sex differences in the risk factors of annual eGFR decline were subjected to linear regression analyses.Results. The mean annual eGFR change was-3.5±2.7%/year in females and-2.0±2.2%/year in males (P<0.001). Baseline retinopathy and proteinuria were significantly associated with a larger eGFR decline, irrespective of sex, while HbA1c and LDL-cholesterol levels were significantly associated with an eGFR decline in females only. Interactive effects were observed between sex and the HbA1c, LDL-cholesterol, retinopathy, or proteinuria levels on the annual eGFR decline.Conclusions. The increased susceptibility to poor metabolic control seemed to contribute to a higher risk of renal dysfunction in females with T2DM. Our study highlights the importance of aggressive therapeutic intervention to improve metabolic profiles at early stage, especially in females.

scholarly journals Subanalysis of the OZIRKA study: efficacy of Ozalex (rosuvastatin) in patients with diabetes mellitus

HYPERTENSION ◽  
2021 ◽  
Vol 14 (2) ◽  
pp. 30-38
Author(s):  
Yu.M. Sirenko ◽  
O.O. Torbas ◽  
S.M. Kushnir
Keyword(s):  
Diabetes Mellitus ◽  
Total Cholesterol ◽  
Low Density Lipoprotein ◽  
Density Lipoprotein ◽  
Final Analysis ◽  
High Density Lipoproteins ◽  
Open Population ◽  
Lipid Metabolism Disorders ◽  
Patients With Diabetes

Background. Diabetes mellitus (DM) remains one of the most important cardiovascular risk factors significantly worsening the prognosis in patients with hypertension and dyslipidemia. The leading role among drugs for the treatment of such patients belongs to statins with their powerful influence on the development and progression of atherosclerosis and its complications. We used the OZIRKA study database and performed additional subanalysis to study the effects of rosuvastatin in patients with diabetes and dyslipidemia. Purpose: to study the effect of Ozalex (rosuvastatin) on lipid and cholesterol levels in patients with lipid metabolism disorders and hypercholesterolemia and DM. Materials and methods. It was a prospective open population study. The recruitment of patients was conducted from March to December 2019. The analysis of the study data was conducted from June to November 2020. Results. A total of 20,000 patients from all over Ukraine were included in the study. The full follow-up period was completed by 18,100 patients, of whom 17,530 had all the necessary data, they were included in the final analysis. The mean follow-up period was 2.2 months. Approximately 13 % of patients included in the study had DM type 2. We observed a significant reduction in total cholesterol, low-density lipoprotein (LDL) and triglyceride levels in patients with diabetes. In addition, there was a tendency to an increase in the level of high-density lipoproteins in this group of patients. In general, it can be noted that there was a significant improvement in lipid profile in patients with diabetes: the level of total cholesterol decreased by 28 %, LDL cholesterol — by 34 %, triglycerides — by 24 %. Administration of rosuvastatin did not impair glucose control in any way in the group of patients with DM; moreover, even in the group of people without DM, there was no negative effect of rosuvastatin on fasting glucose level. Conclusions. In general, we can recommend Ozalex in a dose of 10 to 20 mg as an optimal start of statin therapy at the stage of primary care for patients with DM.

scholarly journals No Correlation between Serum Progranulin Levels and Severity of Diabetic Retinopathy in Chinese People with Type 2 Diabetes and Normal or Mildly Impaired Renal Function

2020 ◽  
Author(s):  
haiyan cheng ◽  
lan xu ◽  
ruifang bu ◽  
cheng jiang ◽  
lijun yao ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Renal Function ◽  
Diabetic Retinopathy ◽  
Low Density Lipoprotein ◽  
Density Lipoprotein ◽  
Chinese Patients ◽  
Enzyme Linked Immunosorbent Assay ◽  
Renal Elimination ◽  
Significant Difference

Abstract Background: Progranulin (PGRN), a novel pro-inflammatory adipokine, was reported to be related to the development and progression of diabetic retinopathy(DR). However, recently PGRN was established as a renal function-dependent protein, but no data regarding PGRN and DR excluded the influence of decreased renal elimination. This study aimed to investigate the correlation between serum PGRN and DR excluding the effect of deteriorating renal function.Methods: 338 subjects with estimated glomerular filtration rate (eGFR) ≥ 60 ml/min/1.73m2 were divided into four groups of normal controls (NC)(n=76), simple diabetes mellitus (SDM)(n=195) , nonproliferative diabetic retinopathy (NPDR)(n=41), and proliferative diabetic retinopathy (PDR)(n=26). Serum PGRN was quantified by enzyme-linked immunosorbent assay, and further analyses of serum PGRN in different groups were conducted. Results: There was no significant difference of serum PGRN between NC, SDM, NPDR, and PDR groups (P>0.05). Serum PGRN in all subjects negatively and significantly correlated with eGFR (r=-0.144, P<0.05), triglycerides and glucose (TyG) index (r=-0.127, P<0.05), and triglyceride (TG) (r=-0.132, P<0.05), while positively and significantly correlated with low-density lipoprotein cholesterol (LDL-C) (r=0.140, P<0.05). Multivariate stepwise regression analysis indicated only LDL-C (β=1.030, P<0.05) was independently associated with serum PGRN. Conclusions: We demonstrated that serum PGRN levels did not correlate with severity of DR in Chinese patients with type 2 diabetes and eGFR ≥ 60ml/min/1.73m2, but positively and independently correlated with LDL-C.

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