Hypoadiponectinemia is associated with aortic stiffness in nondialysis diabetic patients with stage 3–5 chronic kidney disease

Vascular ◽  
2021 ◽  
pp. 170853812110076
Author(s):  
Ssu-Chin Lin ◽  
Tsung-Jui Wu ◽  
Du-An Wu ◽  
Bang-Gee Hsu
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Aortic Stiffness ◽  
Diabetic Kidney Disease ◽  
Applanation Tonometry ◽  
Serum Adiponectin ◽  
Control Group ◽  
Multivariable Logistic Regression Analysis ◽  
Diabetic Patients ◽  
Diabetic Kidney

Objectives Albuminuria and serum adiponectin levels are factors that have been associated with the development of cardiovascular disease in patients with diabetes mellitus. Here we investigated the relationship between serum adiponectin levels and aortic stiffness in nondialysis diabetic kidney disease patients with stage 3–5 chronic kidney disease. Methods Fasting blood samples were obtained from 80 nondialysis diabetic kidney disease patients with stage 3–5 chronic kidney disease. Carotid-femoral pulse wave velocity (cfPWV) was measured using applanation tonometry; cfPWV values of >10 m/s were defined as aortic stiffness. Serum adiponectin levels were determined by enzyme immunoassay. Results Forty-two patients (52.5%) with nondialysis diabetic kidney disease were diagnosed with aortic stiffness. The patients in this group were older ( p =  0.011), had higher systolic blood pressure ( p =  0.002) and urine albumin-to-creatinine ratios ( p =  0.013), included fewer females ( p =  0.024), and had lower serum adiponectin ( p =  0.001) levels than those in the control group. Multivariable logistic regression analysis revealed that serum adiponectin was independently associated with aortic stiffness (odds ratio = 0.930, 95% confidence interval: 0.884–0.978, p =  0.005) and also positively correlated with cfPWV values by multivariable linear regression ( β = –0.309, p =  0.002) in nondialysis diabetic kidney disease patients. Conclusions The results suggested that serum adiponectin levels could be used to predict aortic stiffness in nondialysis diabetic kidney disease patients with stage 3–5 chronic kidney disease.

scholarly journals Prevalence and risk factors of diabetic kidney disease in north eastern Nigeria

2021 ◽  
Vol 3 (2) ◽  
Author(s):  
Ijuptil Chiroma ◽  
Mohammad Maina Sulaiman ◽  
Bilkisu Mohammed Mubi ◽  
Akilahyel Auta Ndahi ◽  
Ahidiyu Anaryu Mamza ◽  
...  
Keyword(s):  
Risk Factors ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Diabetic Kidney Disease ◽  
Stage Iv ◽  
Diabetic Patients ◽  
Diabetic Kidney ◽  
North Eastern ◽  
Male Sex ◽  
Stage Renal Disease

Diabetic Kidney Disease (DKD) is a leading cause of chronic kidney disease and end stage renal disease. In northeastern Nigeria the epidemiology and risk factors have not been fully studied. This study aimed at evaluating the prevalence and risk factors of DKD in Maiduguri, north eastern Nigeria. The study population consisted of adult diabetic patients recruited consecutively at the diabetic clinic of University of Maiduguri Teaching Hospital Maiduguri. Socio-demographic variables including age, sex, weight, BMI, as well as laboratory parameters, were obtained from each patient. Glomerular filtration rate was derived from CKD-EPI formula using serum creatinine. Two hundred and sixty-one diabetic patients were recruited. The prevalence of DKD among them was 42.9%. Classification based on eGFRshowed that 35(13.4%) patients had hyperfiltration; 48 (18.4%) stage I; 66 (25.3%) stage II; 68 (26.1%) stage III; 36 (13.8%) stage IV; 8 (3.1%) stage V. One hundred and seventeen (44.8%) had proteinuria. Low eGFR <60ml/1.73M2 was associated with age >50 years (r=1.039, p=0.011); male sex (r=-0.899, p=0.008); hyperuricaemia (r=1.010, p=0.000); low PCV (r=1.276, p=0.000); HbA1C (r=1.127, p=0.030); proteinuria (r=2.011, p=0.004).This study has shown that chronic kidney disease is common among diabetic patients in northeastern Nigeria. Age, male sex, hyperuricaemia, low PCV, high HbA1C levels and proteinuria were found to be associated with development of DKD.

scholarly journals First, Do No Harm: Critical Appraisal of Protein Restriction for Diabetic Kidney Disease

Diabetology ◽  
2021 ◽  
Vol 2 (2) ◽  
pp. 51-64
Author(s):  
Satoru Yamada
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Diabetic Kidney Disease ◽  
Protein Diet ◽  
Historical Background ◽  
Diabetic Patients ◽  
Protective Effects ◽  
Diabetic Kidney ◽  
Low Protein ◽  
Protein Diets

Low-protein diets have been recommended as diet therapy for the management of chronic kidney disease; however, its effect on chronic kidney disease has not been scientifically proven. Although several studies have reported significantly more favorable results with low-protein diet than with normal-protein diet, the renal protective effects of low-protein diets are still unclear in diabetic patients with chronic kidney disease. Moreover, some studies have reported that extremely low-protein diets may increase the risk of mortality. Thus, this paper describes the effectiveness and safety of low-protein diets for patients with diabetic kidney disease by reviewing the historical background of different low-protein diets that were critically examined in several studies.

scholarly journals XOR - Possible Correlations with Oxidative Stress and Inflammation Markers in the Context of Diabetic Kidney Disease

2019 ◽  
Vol 70 (4) ◽  
pp. 1396-1398 ◽  
Author(s):  
Alexandra Totan ◽  
Andra-Elena Balcangiu-Stroescu ◽  
Marina Melescanu Imre ◽  
Daniela Miricescu ◽  
Daniela Balan ◽  
...  
Keyword(s):  
Oxidative Stress ◽  
Kidney Disease ◽  
Diabetic Kidney Disease ◽  
Microvascular Complications ◽  
Serum Levels ◽  
Control Group ◽  
Diabetic Patients ◽  
Inflammation Markers ◽  
Diabetic Kidney ◽  
Diabetic Microvascular Complications

Xanthine oxidoreductase (XOR) activity plays an important role as a pivotal source of reactive oxygen species. The aim of our study was to investigate possible correlations of XOR serum levels with oxidative stress (total antioxidant capacity - TAC, anti-oxidative stress responsive 1 antibody - OXSR1) and inflammation markers (interleukin 6 - IL-6), in 20 hemodialysis diabetic patients. The present study included the hemodialysis diabetic patients group (10 males and 10 females) and the control group (20 healthy volunteers). For serum XOR (ng/mL), TAC (U/mL) and OXSR1 (ng/ml) measurements we have used the ELISA technique. Serum IL6 (pg/mL) was performed using an automatic immunoassay system (Immulite 1000, Siemens- Germany). Comparing the two groups, our results revealed significantly increased serum levels for XOR (6.2�1.5 / 3.9�1.1); OXSR1 (11.3�2.9 / 6.2�2.1) and IL6 (7.0�1.2 / 5.0�0.4). Patients� serum levels of TAC were significantly decreased compared with the control group values (25.2�3.9 / 33.5�2.8). It becomes more and more obvious that oxidative stress is an important element initiating diabetic microvascular complications, including diabetic kidney disease. Our results suggested that XOR should be regarded as an important target in the attempt to reduce oxidative stress in the context of diabetic kidney disease.

scholarly journals Normoalbuminuric chronic kidney disease in diabetes

2018 ◽  
Vol 90 (10) ◽  
pp. 94-98
Author(s):  
V V Klimontov ◽  
A I Korbut
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Diabetic Kidney Disease ◽  
Interstitial Fibrosis ◽  
Treatment Options ◽  
Practical Importance ◽  
Future Research ◽  
Diabetic Patients ◽  
Tubular Damage ◽  
Diabetic Kidney

Urinary albumin excretion (UAE) is widely used in clinical practice as indicator of diabetic kidney disease. According to the classical concept of the natural course of diabetic nephropathy, an increase in UAE usually precedes a decline in renal function. Meanwhile, a growing body of evidences indicates a high prevalence of normoalbuminuric chronic kidney disease (NA-CKD) in diabetic subjects, especially among patients with type 2 diabetes. An increase in NA-CKD prevalence can be results of improved glucose, blood pressure, and lipid control, widespread use of renin-angiotensin system blockers, and smoking cessation. It was shown that NA-CKD is more prevalent among women and is associated with arterial hypertension and coronary artery disease. The renal structure in subjects with NA-CKD is more heterogeneous when compared to patients with increased albuminuria, wherein interstitial changes and arteriolosclerosis could be the principal morphological findings, while signs of glomerulopathy may be absent. The prognostic value of NA-CKD needs to be clarified. It was shown that NA-CKD increases the risk of myocardial infarction, stroke and cardiovascular death in patients with diabetes. The search for alternative diagnostic markers for detecting of diabetic kidney disease in the absence of albuminuria, is of practical importance. The evaluations of the markers of tubular damage and interstitial fibrosis, as well as proteomic approaches, are considered as perspective diagnostic and prognostic options in NA-CKD. The study of pathogenesis, pathology, clinical course of NA-CKD in diabetic patients, as well as the development of more specific diagnostic and treatment options is a challenge for future research.

539-P: The Trend of Diabetic Kidney Disease with Low eGFR and Absence of Albuminuria in Type 2 Diabetic Patients in Japan from 1996-2015

Diabetes ◽  
2019 ◽  
Vol 68 (Supplement 1) ◽  
pp. 539-P
Author(s):  
YOSHINORI KAKUTANI ◽  
MASANORI EMOTO ◽  
KATSUHITO MORI ◽  
YUKO YAMAZAKI ◽  
AKINOBU OCHI ◽  
...  
Keyword(s):  
Kidney Disease ◽  
Diabetic Kidney Disease ◽  
Diabetic Patients ◽  
Type 2 Diabetic Patients ◽  
Diabetic Kidney ◽  
Type 2 Diabetic

scholarly journals Mineralocorticoid receptor antagonists for nephroprotection and cardioprotection in patients with diabetes mellitus and chronic kidney disease

2021 ◽  
Author(s):  
Alberto Ortiz ◽  
Charles J Ferro ◽  
Olga Balafa ◽  
Michel Burnier ◽  
Robert Ekart ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Kidney Failure ◽  
Mineralocorticoid Receptor ◽  
Diabetic Kidney Disease ◽  
Renin Angiotensin System ◽  
Cardiovascular Death ◽  
Mineralocorticoid Receptor Antagonists ◽  
Receptor Antagonists ◽  
Diabetic Kidney

Abstract Diabetic kidney disease develops in about 40% of patients with diabetes and is the commonest cause of chronic kidney disease worldwide. Patients with chronic kidney disease, especially those with diabetes mellitus, are at high risk of both developing kidney failure and cardiovascular death. The use of renin-angiotensin system blockers to reduce the incidence of kidney failure in patients with diabetic kidney disease dates back to studies that are now 20 or more years old. During the last few years sodium-glucose co-transporter-2 inhibitors have shown beneficial renal effects in randomized trials. However, even in response to combined treatment with renin-angiotensin system blockers and sodium-glucose co-transporter-2 inhibitors, the renal residual risk remains high with kidney failure only deferred, but not avoided. The risk of cardiovascular death also remains high even with optimal current treatment. Steroidal mineralocorticoid receptor antagonists reduce albuminuria and surrogate markers of cardiovascular disease in patients already on optimal therapy. However, their use has been curtailed by the significant risk of hyperkalaemia. In The FInerenone in reducing kiDnEy faiLure and dIsease prOgression in Diabetic Kidney Disease (FIDELIO-DKD) study comparing the actions of the non-steroidal mineralocorticoid receptor antagonist finerenone with placebo, finerenone reduced the progression of diabetic kidney disease and the incidence of cardiovascular events with a relatively safe adverse event profile. This document presents in detail the available evidence on the cardioprotective and nephroprotective effects of mineralocorticoid receptor antagonists, analyses the potential mechanisms involved and discusses their potential future place in the treatment of patients with diabetic chronic kidney disease.

MO580HYPOPROTEIC DIET SUPPLEMENTED WITH KETOANALOGUES IN PATIENTS WITH ADVANCED DIABETIC KIDNEY DISEASE – EFFECTS ON MINERAL BONE DISORDERS

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Liliana Garneata ◽  
Carmen-Antonia Mocanu ◽  
Tudor Petrisor Simionescu ◽  
Andreea Elena Mocanu ◽  
Gabriel Mircescu
Keyword(s):  
Kidney Disease ◽  
Diabetic Kidney Disease ◽  
Serum Levels ◽  
Protein Diet ◽  
Low Protein Diet ◽  
Diabetic Patients ◽  
Bone Disorders ◽  
Diabetic Kidney ◽  
Low Protein ◽  
Ckd Stage

Abstract Background and Aims Dietary protein restriction is rediscussed as mainstay approach in advanced Chronic Kidney Disease (CKD), both in diabetics and non-diabetics to defer renal replacement therapy (RRT), mainly by better metabolic control; improvements in mineral bone disorders (MBD) were also suggested, but less studied in Diabetic Kidney Disease (DKD). An unicentric prospective interventional trial aimed to assess the effects of ketoanalogue-supplemented low protein diet (sLPD) on proteinuria and CKD progression (data already presented). The parameters of MBD were also evaluated. Method Adult diabetic patients (452) with stable CKD stage 4+, proteinuria&gt;3g/g creatininuria and SGA A were enrolled in a run-in phase (3 mo), with LPD (0.6g/kg dry ideal bw). Those who proved adherent (92, 64% males, median age 55.7 yrs, 65% on insulin) received sLPD (Ketosteril®, 1 tablet/10kg) for 12mo. Monitoring and treatment followed the Best Practice Guidelines. The primary endpoint was proteinuria during intervention as compared to pre-enrolment. Serum levels of calcium, phosphates and iPTH were considered to assess MBD. Nutrition, inflammation (SGA, BMI, serum albumin, CRP) and compliance were safety parameters. Results In patients with advanced DKD and severe proteinuria, sLPD was associated with a 69 (63; 82) % reduction in proteinuria (data presented). Significant amelioration in MBD was noted: serum levels of calcium and phosphates were significantly ameliorated at the end of the study as compared to enrolment - 4.3 (4.2-4.9) vs 3.2 (3.1-3.5) mg/dL and 5.4 (4.9-6.1) vs 8.2 (7.8-8.9) mg/dL, respectively. Serum iPTH significantly decreased: 185 (168-212) vs 375 (354-585) pg/mL. The need for calcium supplementation decreased: 6.5 (6.0-6.7) vs 7.0 (6.8-7.3) g/day. Vitamin D was required by only 35% vs 65% of patients. Nutritional status was preserved and dietary compliance was very good throughout the study. Conclusion In patients with advanced DKD ketoanalogue supplemented low protein diet seems to be effective and safe as part of MBD management.

scholarly journals Histopathological evaluation of kidney disease in patients with diabetes mellitus

2021 ◽  
Vol 8 (2) ◽  
pp. 112-119
Author(s):  
Juju Raj Shrestha ◽  
Kashyap Dahal ◽  
Anil Baral ◽  
Rajani Hada
Keyword(s):  
Diabetes Mellitus ◽  
Diabetic Retinopathy ◽  
Kidney Disease ◽  
Diabetic Kidney Disease ◽  
Diabetic Patients ◽  
Rapid Rise ◽  
Class Iii ◽  
Diabetic Kidney ◽  
Duration Of Diabetes

Introduction: Non diabetic kidney disease (NDKD), a treatable condition, is common in diabetic patients with atypical clinical presentations. Present study aimed to find out histopathological diagnosis of kidney disease in type 2 Diabetes mellitus with such presentations. Method: This was a hospital based cross sectional study conducted in Nephrology department, Bir hospital, Nepal from Aug 2019 to January 2021. Total 29 diabetic patients with atypical presentations, rapid rise of proteinuria alone (n=5), with microscopic hematuria (n=6), with impaired renal function (n=8) and rapid rise of creatinine with (n=8) or without (n=2) microscopic hematuria were included. The baseline information was recorded and kidney biopsy was performed. Result: The mean age of patients was 52.6±10.4 y and 22(75.9%) were male. Diabetic retinopathy (DR) was absent in 24(82.8%) patients. Presence of NDKD alone was in 6(20.7%) and superimposed on diabetic kidney disease (DKD) in 10(34.5%) with total NDKD in 16(55.2%) and isolated DKD in 13(44.8%) patients. Non diabetic kidney disease were glomerulonephritis 12(75%) with membranous nephropathy 4(25%) and IgA nephropathy 4(25%) patients. The significant difference between NDKD and isolated DKD was only the duration of diabetes < 5 y in 8(61.5%) of isolated DKD and ≥5 y in 13(81.2%) patients with NDKD (p=0.018). Diabetic retinopathy was absent in 6(100%) patients with isolated NDKD, 8(80%) of class III and 5(62.5%) of class IV DKD. Conclusion: Glomerulonephritis is the commonest NDKD in type 2 DM with atypical presentation and advance DKD (Class III & IV) is present even in absence of diabetic retinopathy and short duration of diabetes.

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