scholarly journals Efficacy and durability of multifactorial intervention on mortality and MACEs: a randomized clinical trial in type-2 diabetic kidney disease

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Ferdinando Carlo Sasso ◽  
Pia Clara Pafundi ◽  
Vittorio Simeon ◽  
Luca De Nicola ◽  
Paolo Chiodini ◽  
...  
Keyword(s):  
Risk Factors ◽  
Clinical Trial ◽  
Cardiovascular Risk ◽  
Kidney Disease ◽  
Primary Endpoint ◽  
Diabetic Kidney Disease ◽  
Multifactorial Intervention ◽  
Diabetic Kidney

Abstract Background Multiple modifiable risk factors for late complications in patients with diabetic kidney disease (DKD), including hyperglycemia, hypertension and dyslipidemia, increase the risk of a poor outcome. DKD is associated with a very high cardiovascular risk, which requires simultaneous treatment of these risk factors by implementing an intensified multifactorial treatment approach. However, the efficacy of a multifactorial intervention on major fatal/non-fatal cardiovascular events (MACEs) in DKD patients has been poorly investigated. Methods Nephropathy in Diabetes type 2 (NID-2) study is a multicentre, cluster-randomized, open-label clinical trial enrolling 395 DKD patients with albuminuria, diabetic retinopathy (DR) and negative history of CV events in 14 Italian diabetology clinics. Centres were randomly assigned to either Standard-of-Care (SoC) (n = 188) or multifactorial intensive therapy (MT, n = 207) of main cardiovascular risk factors (blood pressure < 130/80 mmHg, glycated haemoglobin < 7%, LDL, HDL and total cholesterol < 100 mg/dL, > 40/50 mg/dL for men/women and < 175 mg/dL, respectively). Primary endpoint was MACEs occurrence by end of follow-up phase. Secondary endpoints included single components of primary endpoint and all-cause death. Results At the end of intervention period (median 3.84 and 3.40 years in MT and SoC group, respectively), targets achievement was significantly higher in MT. During 13.0 years (IQR 12.4–13.3) of follow-up, 262 MACEs were recorded (116 in MT vs. 146 in SoC). The adjusted Cox shared-frailty model demonstrated 53% lower risk of MACEs in MT arm (adjusted HR 0.47, 95%CI 0.30–0.74, P = 0.001). Similarly, all-cause death risk was 47% lower (adjusted HR 0.53, 95%CI 0.29–0.93, P = 0.027). Conclusion MT induces a remarkable benefit on the risk of MACEs and mortality in high-risk DKD patients. Clinical Trial Registration ClinicalTrials.gov number, NCT00535925. https://clinicaltrials.gov/ct2/show/NCT00535925

scholarly journals Association Between Classical and Emerging Risk Factors for Diabetic Kidney Disease and Albuminuria in a Cohort of Type 2 Diabetes Mellitus Patients

2021 ◽  
Vol 18 (3) ◽  
pp. 17-25
Author(s):  
Stoiţă Marcel ◽  
Popa Amorin Remus
Keyword(s):  
Diabetes Mellitus ◽  
Risk Factors ◽  
Blood Pressure ◽  
Type 2 Diabetes ◽  
Type 2 Diabetes Mellitus ◽  
Kidney Disease ◽  
Diabetic Kidney Disease ◽  
Significant Positive Association ◽  
Diabetic Kidney

Abstract The presence of albuminuria in patients with type 2 diabetes mellitus is a marker of endothelial dysfunction and also one of the criteria for diagnosing diabetic kidney disease. The present study aimed to identify associations between cardiovascular risk factors and renal albumin excretion in a group of 218 patients with type 2 diabetes mellitus. HbA1c values, systolic blood pressure, diastolic blood pressure were statistically significantly higher in patients with microalbuinuria or macroalbuminuria compared to patients with normoalbuminuria (p <0.01). We identified a statistically significant positive association between uric acid values and albuminuria, respectively 25- (OH)2 vitamin D3 deficiency and microalbuminuria (p <0.01).

AI-based prediction model for the risk of diabetic kidney disease in patients with type 2 diabetes mellitus

2021 ◽  
Author(s):  
Ning Zhang ◽  
Rui Fan ◽  
Jing Ke ◽  
Qinghua Cui ◽  
Dong ZHAO
Keyword(s):  
Risk Factors ◽  
Type 2 Diabetes ◽  
Kidney Disease ◽  
Prediction Model ◽  
Diabetic Kidney Disease ◽  
Feature Selection Method ◽  
Training Set ◽  
Test Set ◽  
Diabetic Kidney

Abstract BackgroundMicroalbuminuria is the main characteristic of Diabetic kidney disease (DKD), but it fluctuates greatly under the influence of blood glucose. Our aim was to establish some common clinical variables which could be easily collected to predict the risk of DKD in patients with type 2 diabetes. Methods and resultsWe build an artificial intelligence (AI) model to quantitively predict the risk of DKD based on the biomedical parameters from 1239 patients. An information entropy-based feature selection method was applied to screen out the risk factors of DKD. The dataset was divided with 4/5 into the training set and 1/5 into the test set. By using the selected risk factors, 5-fold cross-validation is applied to train the prediction model and it finally got AUC of 0.72 and 0.71 in the training set and test set respectively. In addition, we provide a method of calculating risk factors’ contribution for individuals to provide personalized guidance for treatment. We set up web-based application available on http://www.cuilab.cn/dkd for self-check and early warning. ConclusionsWe establish a feasible prediction model for DKD and suggest the degree of risk contribution of each indicator for each individual, which has certain clinical significance for early intervention and prevention.

scholarly journals Cohort profile: the Singapore diabetic cohort study

BMJ Open ◽  
2020 ◽  
Vol 10 (5) ◽  
pp. e036443 ◽  
Author(s):  
Miyang Luo ◽  
Linda Wei Lin Tan ◽  
Xueling Sim ◽  
Milly Khiam Hoon Ng ◽  
Rob Van Dam ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Kidney Disease ◽  
Diabetic Kidney Disease ◽  
Sample Collection ◽  
Data Set ◽  
Diabetic Kidney ◽  
New Biomarkers ◽  
Rich Data

PurposeThe diabetic cohort (DC) was set up to study the determinants of complications in individuals with type 2 diabetes and examine the role of genetic, physiological and lifestyle factors in the development of complications in these individuals.ParticipantsA total of 14 033 adult participants with type 2 diabetes were recruited from multiple public sector polyclinics and hospital outpatient clinics in Singapore between November 2004 and November 2010. The first round of follow-up was conducted for 4131 participants between 2012 and 2016; the second round of follow-up started in 2016 and is expected to end in 2021. A questionnaire survey, physical assessments, blood and urine sample collection were conducted at recruitment and each follow-up visit. The data set also includes genetic data and linkage to medical and administrative records for recruited participants.Findings to dateData from the cohort have been used to identify determinants of diabetes and related complications. The longitudinal data of medical records have been used to analyse diabetes control over time and its related outcomes. The cohort has also contributed to the identification of genetic loci associated with type 2 diabetes and diabetic kidney disease in collaboration with other large cohort studies. About 25 scientific papers based on the DC data have been published up to May 2019.Future plansThe rich data in DC can be used for various types of research to study disease-related complications in patients with type 2 diabetes. We plan to further investigate disease progression and new biomarkers for common diabetic complications, including diabetic kidney disease and diabetic neuropathy.

scholarly journals Faktor Risiko Penyakit Ginjal Kronik Diabetes (PGK-DM) pada Diabetes Mellitus Tipe-2 (Studi di RSUD DR Soedarso Kota Pontianak Provinsi Kalimantan Barat)

2018 ◽  
Vol 3 (2) ◽  
pp. 101
Author(s):  
Sulistio Rini ◽  
Suharyo Hadisaputro ◽  
Lestariningsih Lestariningsih ◽  
Heri Nugroho ◽  
Selamat Budijitno
Keyword(s):  
Diabetes Mellitus ◽  
Risk Factors ◽  
Type 2 Diabetes ◽  
Type 2 Diabetes Mellitus ◽  
Kidney Disease ◽  
Family Support ◽  
Diabetic Kidney Disease ◽  
Diabetic Kidney ◽  
Sugar Levels

Background: Prevalence of type-2 diabetes mellitus have increased significantly. The increasing number of people with diabetes has a major impact on the development of chronic diabetic kidney disease. The research was aimed to clarify several risk factors of chronic diabetic kidney disease on type-2 diabetes mellitus (CDK-DM).Method: The research was based on case control study design. The number of respondents was 140 respondents consisting 70 cases and 70 controls that met the criteria of inclusion and exclusion. The cases were patients with type-2 chronic diabetic kidney disease stadium 2-5. The controls were patients with type-2 chronic diabetic kidney disease with blood sugar levels ≥ 200 mg / dL. The data were then analyzed using logistic regression.Results: The result shows that risk factors of chronic diabetic kidney disease in type-2 diabetes mellitus are diabetes in family (OR = 6,732; 95% CI = 2,623- 17,276), high blood pressure (OR = 6,760; 95% CI = 2,190- 20,867), lack of physical activities (OR = 4,367 95% CI = 1,823-10,462) and lack of family support (OR = 4,203; 95% CI = 1,437-12,295). The probability of chronic diabetic kidney disease occurrence in type-2 diabetes mellitus when four risk factors exist are 96,71%.Conclusion: The host factors have important role of chronic diabetic kidney disease in type 2 diabetes mellitus . The factors proven to be risk factors for occurrence of chronic diabetic kidney disease in type 2 diabetes mellitus were diabetic in the family, Hipertension, poor physical exercise and family Support. 

scholarly journals The Aggressive Diabetic Kidney Disease in Youth-Onset Type 2 Diabetes: Pathogenetic Mechanisms and Potential Therapies

Medicina ◽  
2021 ◽  
Vol 57 (9) ◽  
pp. 868
Author(s):  
Michela Amatruda ◽  
Guido Gembillo ◽  
Alfio Edoardo Giuffrida ◽  
Domenico Santoro ◽  
Giovanni Conti
Keyword(s):  
Diabetes Mellitus ◽  
Risk Factors ◽  
Type 2 Diabetes ◽  
Kidney Disease ◽  
Diabetic Kidney Disease ◽  
The United States ◽  
Diabetic Kidney ◽  
Onset Type ◽  
Hereditary Component

Youth-onset Type 2 Diabetes Mellitus (T2DM) represents a major burden worldwide. In the last decades, the prevalence of T2DM became higher than that of Type 1 Diabetes Mellitus (T1DM), helped by the increasing rate of childhood obesity. The highest prevalence rates of youth-onset T2DM are recorded in China (520 cases/100,000) and in the United States (212 cases/100,000), and the numbers are still increasing. T2DM young people present a strong hereditary component, often unmasked by social and environmental risk factors. These patients are affected by multiple coexisting risk factors, including obesity, hyperglycemia, dyslipidemia, insulin resistance, hypertension, and inflammation. Juvenile T2DM nephropathy occurs earlier in life compared to T1DM-related nephropathy in children or T2DM-related nephropathy in adult. Diabetic kidney disease (DKD) is T2DM major long term microvascular complication. This review summarizes the main mechanisms involved in the pathogenesis of the DKD in young population and the recent evolution of treatment, in order to reduce the risk of DKD progression.

scholarly journals Novel Cardiovascular Risk Factors in Patients with Diabetic Kidney Disease

2021 ◽  
Vol 22 (20) ◽  
pp. 11196
Author(s):  
Christodoula Kourtidou ◽  
Maria Stangou ◽  
Smaragdi Marinaki ◽  
Konstantinos Tziomalos
Keyword(s):  
Risk Factors ◽  
Cardiovascular Risk ◽  
Kidney Disease ◽  
Risk Stratification ◽  
Cardiovascular Risk Factors ◽  
Cardiovascular Events ◽  
Diabetic Kidney Disease ◽  
Fibroblast Growth Factor 23 ◽  
Diabetic Kidney ◽  
Increased Risk

Patients with diabetic kidney disease (DKD) are at very high risk for cardiovascular events. Only part of this increased risk can be attributed to the presence of diabetes mellitus (DM) and to other DM-related comorbidities, including hypertension and obesity. The identification of novel risk factors that underpin the association between DKD and cardiovascular disease (CVD) is essential for risk stratification, for individualization of treatment and for identification of novel treatment targets.In the present review, we summarize the current knowledge regarding the role of emerging cardiovascular risk markers in patients with DKD. Among these biomarkers, fibroblast growth factor-23 and copeptin were studied more extensively and consistently predicted cardiovascular events in this population. Therefore, it might be useful to incorporate them in risk stratification strategies in patients with DKD to identify those who would possibly benefit from more aggressive management of cardiovascular risk factors.

scholarly journals Effects of Mesenchymal Stem Cells Therapy on Cardiovascular Risk Factors in Experimental Diabetic Kidney Disease

2020 ◽  
Vol 7 ◽  
pp. 205435812095742
Author(s):  
Einas Nagib Hussein ◽  
Gehane M. Hamed ◽  
Ansam A. Seif ◽  
Mona A. Ahmed ◽  
Fatma Abd Elkarim Abu Zahra
Keyword(s):  
Risk Factors ◽  
Blood Pressure ◽  
Stem Cells ◽  
Mesenchymal Stem Cells ◽  
Cardiovascular Risk ◽  
Blood Glucose ◽  
Kidney Disease ◽  
Diabetic Kidney Disease ◽  
Atherogenic Index ◽  
Diabetic Kidney

Background: Diabetic kidney disease (DKD) is a progressive kidney disease and a leading cause of end-stage renal disease (ESRD). Diabetic kidney disease has been strongly associated with increased risk of cardiovascular morbidity and mortality. Despite their susceptibility to cardiovascular diseases (CVDs), patients with DKD are less likely to receive appropriate cardiovascular risk modification as they are generally excluded from major cardiovascular trials. Awareness of vulnerability of these patients necessitates investigating potential interventions that would lessen their risk of adverse outcomes. Objectives: This study aimed to explore the effect of bone marrow–derived mesenchymal stem cells (MSCs) in modulating cardiovascular risk factors that develop with the progression of DKD. Methods: A total of 60 adult female albino rats were allocated into 3 groups: control group, untreated DKD group, and mesenchymal stem cells–treated diabetic kidney disease (MSCs-DKD) group. Blood pressure, blood glucose level, lipid profile, and atherogenic index were used to assess cardiovascular risk. All rats were killed and subjected to in vitro aortic reactivity studies 8 weeks after induction of diabetes. The MSCs-DKD rats received a single intravenous injection of MSCs 4 weeks after diabetes induction. Results: Mesenchymal stem cells injection significantly decreased blood pressure, atherogenic index, and blood glucose compared with untreated rats. The MSCs-DKD aorta also exhibited significant enhancement of vascular reactivity parameters despite absence of improvement in kidney function. These findings conformed to tracked MSCs, which were found residing in aortic and pancreatic tissues and absent in kidneys. Conclusions: Mesenchymal stem cells hold hope of improving cardiovascular risk and mortality in patients with DKD, particularly those deteriorating to ESRD.

scholarly journals Multifactorial intervention has a significant effect on diabetic kidney disease in patients with type 2 diabetes

2021 ◽  
Vol 99 (1) ◽  
pp. 256-266
Author(s):  
Kohjiro Ueki ◽  
Takayoshi Sasako ◽  
Yukiko Okazaki ◽  
Kana Miyake ◽  
Masaomi Nangaku ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Kidney Disease ◽  
Diabetic Kidney Disease ◽  
Multifactorial Intervention ◽  
Diabetic Kidney
Sign in / Sign up

Export Citation Format

Share Document