Non-Insulin-Dependent Diabetes Mellitus and Hypertriglyceridemia Impair Lipoprotein Metabolism in Chronic Hemodialysis Patients

Abstract. Patients with diabetes mellitus undergoing chronic hemodialysis treatment have the worst outcome on dialysis due to an increased rate of cardiovascular complications. Nearly all patients present with dyslipidemia, a prominent vascular risk factor, probably responsible for the high rate of vascular injury. Since both uremia and diabetes predispose to hypertriglyceridemia, the present study was conducted to investigate the influence of diabetes mellitus and/or hypertriglyceridemia on lipoprotein metabolism in hemodialysis patients. LDL was isolated and characterized from hyper- and normotriglyceridemic diabetic and nondiabetic hemodialysis patients (n = 40; 10 in each group); also, LDL-receptor-dependent uptake and intracellular cholesterol metabolism were studied in HepG2 cells. In addition, scavenger-receptor-mediated uptake was examined in mouse peritoneal macrophages. LDL isolated from nondiabetic normotriglyceridemic hemodialysis patients exhibited impaired cellular uptake via the LDL receptor. Additionally, intracellular sterol synthesis was less inhibited and cholesterol esterification was reduced compared with LDL from healthy control subjects. Reduction of catabolic capacities was more marked in hemodialysis patients who were either diabetic or hypertriglyceridemic and even more pronounced in patients presenting with a combination of both diabetes and hypertriglyceridemia. Hypertriglyceridemic and diabetic patients showed reduced lipase activity and increased LDL oxidation. Furthermore, they accumulated a fraction of small, dense LDL, and LDL was predominantly taken up via the scavenger-receptor pathway in peritoneal macrophages. This study elucidates the distinct influence of diabetes and/or hypertriglyceridemia in hemodialysis patients on cellular LDL metabolism via specific and nonspecific metabolic pathways. Furthermore, it underscores the cumulative impact of these pathologic entities on impairment of lipoprotein metabolism and increase of cardiovascular risk.

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Assessment of Hyperglycemia, Hypoglycemia and Inter-Day Glucose Variability Using Continuous Glucose Monitoring among Diabetic Patients on Chronic Hemodialysis

Journal of Clinical Medicine ◽

10.3390/jcm10184116 ◽

2021 ◽

Vol 10 (18) ◽

pp. 4116

Author(s):

Maria Divani ◽

Panagiotis I. Georgianos ◽

Triantafyllos Didangelos ◽

Vassilios Liakopoulos ◽

Kali Makedou ◽

...

Keyword(s):

Continuous Glucose Monitoring ◽

Glycated Albumin ◽

Glucose Monitoring ◽

Area Under The Curve ◽

Glucose Variability ◽

Hemodialysis Patients ◽

Chronic Hemodialysis ◽

Diabetic Patients ◽

Lower Efficiency ◽

Target Glucose

Continuous glucose monitoring (CGM) facilitates the assessment of short-term glucose variability and identification of acute excursions of hyper- and hypo-glycemia. Among 37 diabetic hemodialysis patients who underwent 7-day CGM with the iPRO2 device (Medtronic Diabetes, Northridge, CA, USA), we explored the accuracy of glycated albumin (GA) and hemoglobin A1c (HbA1c) in assessing glycemic control, using CGM-derived metrics as the reference standard. In receiver operating characteristic (ROC) analysis, the area under the curve (AUC) in diagnosing a time in the target glucose range of 70–180 mg/dL (TIR70–180) in <50% of readings was higher for GA (AUC: 0.878; 95% confidence interval (CI): 0.728–0.962) as compared to HbA1c (AUC: 0.682; 95% CI: 0.508–0.825) (p < 0.01). The accuracy of GA (AUC: 0.939; 95% CI: 0.808–0.991) in detecting a time above the target glucose range > 250 mg/dL (TAR>250) in >10% of readings did not differ from that of HbA1c (AUC: 0.854; 95% CI: 0.699–0.948) (p = 0.16). GA (AUC: 0.712; 95% CI: 0.539–0.848) and HbA1c (AUC: 0.740; 95% CI: 0.570–0.870) had a similarly lower efficiency in detecting a time below target glucose range < 70 mg/dL (TBR<70) in >1% of readings (p = 0.71). Although the mean glucose levels were similar, the coefficient of variation of glucose recordings (39.2 ± 17.3% vs. 32.0 ± 7.8%, p < 0.001) and TBR<70 (median (range): 5.6% (0, 25.8) vs. 2.8% (0, 17.9)) were higher during the dialysis-on than during the dialysis-off day. In conclusion, the present study shows that among diabetic hemodialysis patients, GA had higher accuracy than HbA1c in detecting a 7-day CGM-derived TIR70–180 < 50%. However, both biomarkers provided an imprecise reflection of acute excursions of hypoglycemia and inter-day glucose variability.

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ERECTILE DYSFUNCTION

The Professional Medical Journal ◽

10.29309/tpmj/2016.23.03.1471 ◽

2016 ◽

Vol 23 (03) ◽

pp. 268-273

Author(s):

Ansari Muhammad Rafique ◽

Pooran Mal ◽

Jairamani Bhagwan Das ◽

Shafique-Ur-Rehman Memon ◽

Syed M Tahir ◽

...

Keyword(s):

Diabetes Mellitus ◽

Erectile Dysfunction ◽

Rural Areas ◽

Cross Sectional Study ◽

Hemodialysis Patients ◽

Maintenance Hemodialysis ◽

Diabetic Patients ◽

Cross Sectional ◽

Male Patients

Objectives: Erectile dysfunction (ED) is a very common and distressing healthproblem in chronic maintenance hemodialysis patients. There is no such data available fromSind province of Pakistan on this issue; we want to highlight the factors and prevalence oferectile dysfunction among hemodialysis patients in this part of our country. Study Design:This hospital based observational, cross-sectional study Setting: It was conducted at 04hemodialysis centers of Hyderabad city Perod: In 2014 Methods: The Study was conductedby using International Index of Erectile Dysfunction (IIEF-5) for determination of prevalence& severity of ED among these patients. Comparative analysis for frequency of ED was alsodone between urban & rural patients. Adapted Urdu version of IIEF-5 was used for those whocannot understand English pro forma. Results: There were total 62 male patients; all of themwere on maintenance hemodialysis for more than 6 months. Their ages were between 20 to59 years with mean 36±11. In this series of patients 80% (n=50) were < 50 years of age whilethe diabetic patients were 58% (n=36). The overall prevalence of ED observed in patients was88.7% (n=55) in our study. Severe ED was seen in 30 (48.4%) patients. The prevalence &severity of ED was significantly higher in diabetes mellitus and over 50 years of age. There washigher incidence of ED 94% observed in patients who are living in rural areas as compared tourban areas patients 82%. Conclusions: It has been concluded in this study that majority ofmale hemodialysis patients were suffering from ED problem. Diabetes mellitus and & > 50 yearsof age has the highest prevalence of ED. Erectile dysfunction is very common and distressinghealth related issue among hemodialysis patients and this should be addressed with routine

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Tinzaparin Provides Lower Lipid Profiles in Maintenance Hemodialysis Patients: A Cross-Sectional Observational Study

The Scientific World JOURNAL ◽

10.1155/2014/486781 ◽

2014 ◽

Vol 2014 ◽

pp. 1-9

Author(s):

Ming-Hsien Tsai ◽

Yu-Wei Fang ◽

Jyh-Gang Leu

Keyword(s):

Multivariate Analysis ◽

Total Cholesterol ◽

Univariate Analysis ◽

Serum Triglyceride ◽

Hemodialysis Patients ◽

Chronic Hemodialysis ◽

Maintenance Hemodialysis ◽

Diabetic Patients ◽

Significant Difference ◽

The Impact

As a low-molecular-weight heparin, tinzaparin has effectively been used as an anticoagulant during hemodialysis sessions. However, the impact of different heparin types on dyslipidemia is still controversial. In our study, 434 chronic hemodialysis patients were evaluated. The mean age was 65 ± 13. Forty-eight patients (11%) and 386 patients (89%) were in the tinzaparin and unfractionated heparin (UFH) groups, respectively. Triglyceride had significant difference between the two groups (P=0.001) but total cholesterol, HDL, or LDL did not. In the univariate analysis, the triglyceride level was significantly associated with tinzaparin use [β: −39.9, 95% confidence interval (CI): −76.7 to −3.0], and this association remained following the multivariate analysis (β: −40.8, 95% CI: −75.1 to −6.5). The difference in serum total cholesterol level between tinzaparin and UFH became significant (β: −13, 95% CI: −24.5 to −1.56) after adjustment in the multivariate analysis. Moreover, in a subgroup analysis, male diabetic patients showed lower serum triglyceride levels with the use of tinzaparin, while older, nondiabetic, male patients showed significant advantages in total cholesterol levels with the use of tinzaparin. Based on our findings, tinzaparin shows a significant association with a lower lipid profile in patients with chronic hemodialysis when compared to UFH.

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Relationship between Serum Butyrylcholinesterase Activity, Hypertriglyceridaemia and Insulin Sensitivity in Diabetes Mellitus

Clinical Science ◽

10.1042/cs0850077 ◽

1993 ◽

Vol 85 (1) ◽

pp. 77-81 ◽

Cited By ~ 49

Author(s):

C. A. Abbott ◽

M. I. MacKness ◽

S. Kumar ◽

A. O. Olukoga ◽

C. Gordon ◽

...

Keyword(s):

Diabetes Mellitus ◽

Type 2 Diabetes ◽

Insulin Sensitivity ◽

Lipoprotein Metabolism ◽

Diabetic Patients ◽

Control Subjects ◽

Triacylglycerol Concentration ◽

Butyrylcholinesterase Activity

1. The activity of serum butyrylcholinesterase (‘pseudocholinesterase’, EC3.1.1.8) was investigated in 56 patients with type 1 diabetes mellitus, 51 patients with type 2 diabetes mellitus and 101 healthy control subjects. 2. Butyrylcholinesterase activity was significantly elevated in both type 1 (8.10 ± 3.35 units/ml) and type 2 (7.22 ± 1.95 units/ml) diabetes compared with the control subjects (4.23 ± 1.89 units/ml) (P <0.001). 3. In the patients with type 1 and type 2 diabetes, serum butyrylcholinesterase activity was correlated with log serum fasting triacylglycerol concentration (r = 0.41 and r = 0.43, respectively, P <0.001). In the type 2 population serum butyrylcholinesterase activity was also correlated with insulin sensitivity (r = −0.51, P <0.001). 4. Serum butyrylcholinesterase activity was unrelated to age, gender, serum γ-glutamyltranspeptidase activity, body mass index, or treatment for diabetes in both the diabetic populations. 5. In 37 non-diabetic patients with butyrylcholinesterase deficiency serum triacylglycerol levels were in the normal range. 6. These results are consistent with the view that butyrylcholinesterase may have a role in the altered lipoprotein metabolism in hypertriglyceridaemia associated with insulin insensitivity or insulin deficiency in diabetes mellitus.

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A SURVIVAL OF PATIENTS IN MAINTENCE HEMODIALYSIS DEPENDING ON EXPRESSED ANAEMIA AND CHARACTER OF DEFEAT OF KIDNEY

Ukrainian Journal of Nephrology and Dialysis ◽

10.31450/ukrjnd.3(39).2013.05 ◽

2017 ◽

pp. 36-41

Author(s):

V. Savchuk

Keyword(s):

Diabetes Mellitus ◽

Hemodialysis Patients ◽

Mantel Test ◽

Rank Test ◽

Diabetic Patients ◽

Group Iii ◽

Hemoglobin Variability ◽

Group I ◽

Starting Point ◽

Patients With Diabetes

The aim of the present research was to study the survival of hemodialysis (HD) patients depending on of anemia and character of kidney damage, «hemoglobin variability” Materials and methods: We have conducted a retrospective study of 183 hemodialysis patients who were treated from 2009. to 2012. The starting point of observation was defined the first hemodialysis session. The patients were divided in accordance of hemoglobin (Hb) levels for 4 groups: the level of Hb <70 g/l (n=32) – group I, Hb 70–89 g/l (n=68) - group II, Hb 90-110 g/l (n=65) – group III, Hb≥110g/l (n=28) - IV group. Results. The cumulative survival of patients was 55% at the moment of the end of the study. The cumulative proportion surviving of patients with diabetes mellitus was significantly lower compared to non-diabetic patients – 18% and 57%, respectively. The survival of patients I & II groups was significantly lower than the patients of groups III & IV: 83.64% and 63.75% versus 31.7% and 29.28%, respectively (criteria Geha-Wilcoxon, Cox-Mantel test, Wilcoxon-Peto, F-criterion Cox log-rank test). The survival of patients with "stable hemoglobin" was significantly higher than in patients with "low of hemoglobin variability " and "high of hemoglobin variability"(р<0,005). Conclusions. Hb level and its variability had a significant effect on the survival of patients who are treated with hemodialysis. The survival of hemodialysis patients with diabetes mellitus was significantly lower than in non-diabetic kidney failure.

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Glycation Markers in the Geriatrics Patients

10.21203/rs.3.rs-448168/v1 ◽

2021 ◽

Author(s):

Aleksandra Kuzan ◽

Emilia Królewicz ◽

Irena Kustrzeba-Wójcicka ◽

Karolina Lindner ◽

Małgorzata Sobieszczańska

Keyword(s):

Diabetes Mellitus ◽

Geriatric Patients ◽

Scavenger Receptor ◽

Diagnostic Value ◽

High Density Lipoproteins ◽

Diabetic Patients ◽

Therapeutic Benefits ◽

Scavenger Receptor Class ◽

Free Amine ◽

Patients With Diabetes

Abstract Background: Medical care for geriatric patients is a great challenge, mainly due to overlapping various deficits relevant to physiologic ageing with numerous coexisting diseases, of which the most common are diabetes mellitus and atherosclerosis. In case of diabetes, glycation process is intensified, which accelerates atherosclerosis development and diabetic complications. Our goal was to investigate the relationship between the classical biochemical parameters of diabetes and atherosclerosis (fasting glucose, glycated hemoglobin (HbA1c), low and high density lipoproteins (LDL, HDL), triglycerides, etc.), as well as parameters which may indicate a nephropathy (creatinine, glomerular filtration rate – GFR), and the parameters strictly related to glycation. Methods: We analyzed the patients' serum concentration of fluorescent glycation products, concentration of soluble receptor for advanced glycation products (sRAGE), lipoprotein receptor-1 (LOX-1), galectin 3 (GAL3), scavenger receptor class A (SR-A) and scavenger receptor class B (SR-BI), as well as the level of lipid peroxidation and free amine content. Results: Among the identified correlations, the most interesting are the following : sRAGE with triglycerides (r = 0.47); sRAGE with SR-BI (r=0.47); SR-BI with LOX-1 (r=0.31), and SR-BI with HDL (r=-0.30). It has been shown that pentosidine and fluorescent AGEs as well as reactive free amine contents are significantly higher in elderly patients with ischemic heart disease. Fluorescent AGEs and pentosidine are also significantly higher in patients with arterial hypertension. The influence of diabetes therapy on parameters related to peroxidation and glycation was also analyzed. Malondialdehyde turned to be higher in patients with diabetes mellitus type 2 not treated with insulin or metformin than in those treated with both medications (p=0.052). GAL3 was found to be lower both in persons without diabetes and in diabetics treated with metformin (p=0.005). LOX1 was higher in diabetic patients not treated with metformin or insulin, and lowest in diabetics treated with both insulin and metformin, with the effect of metformin reducing LOX1 levels (p=0.039). Conclusions: Our results were the basis for a discussion about the diagnostic value in clinial practice of LOX-1 and GAL3 in geriatric patients with diabetes and also provide grounds for inferring the therapeutic benefits of insulin and metformin treatment.

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Effects of atrovastatin on concentrations of 3-hydroxy-3-methylglutaryl-coenzyme A- reductase (HMG-CoA-R), proprotein convertase subtilisin/kexin type 9 (PCSK9) and sortilin in patients with type 2 diabetes mellitus and pre-diabetics

Journal of Nephropathology ◽

10.34172/jnp.2021.05 ◽

2020 ◽

Vol 10 (1) ◽

pp. e05-e05

Author(s):

Ali Nosrati Andevari ◽

Soheila Moein ◽

Durdi Qujeq ◽

Zoleikha Moazezi ◽

Karimollah Hajian Tilaki

Keyword(s):

Diabetes Mellitus ◽

Coenzyme A ◽

Ldl Receptor ◽

Diabetic Group ◽

Control Group ◽

Diabetic Patients ◽

Healthy Individuals ◽

Proprotein Convertase ◽

Group I ◽

Coenzyme A Reductase

Introduction: Atorvastatin hinders cardiovascular disease by reducing cholesterol levels. Proprotein convertase subtilisin/kexin type 9 (PCSK9) enhances the secretion of insulin by binding to LDL receptor. Sortilin is committed in the transfer of intracellular proteins through the plasma membrane. Objectives: The purpose of this research was to determine the effect of atorvastatin consumption on alterations in the levels of 3-hydroxy-3-methylglutaryl-coenzyme A reductase (HMG-CoA-R), PCSK9 and sortilin in diabetic patients and pre-diabetics. Patients and Methods: This study was carried out on 80 individuals including normal subjects, diabetic patients and pre-diabetics. The participated individuals were divided as control group (i) (healthy individuals without diabetes mellitus), diabetic group receiving statin (ii), diabetic group not receiving statin (iii), pre-diabetic group receiving statin (iv) and pre-diabetic group not receiving statin (v). Levels of HMG-COA-R, PCSK9 and sortilin were determined by ELISA method. Results: In diabetics and pre-diabetics taking atorvastatin, the level of HMG-COA-R was not altered significantly compared to diabetics and pre-diabetics not taking atorvastatin, respectively (P> 0.05). The serum PCSK9 level in diabetics and pre-diabetics was significantly higher than the healthy individuals (P= 0.001). Additionally, the serum PCSK9 level in diabetics and pre-diabetics receiving atorvastatin was significantly higher than diabetics and pre-diabetics not receiving atorvastatin, respectively (P=0.001). The serum sortilin level in diabetics and pre-diabetics was significantly higher than the healthy individuals (P=0.001). In addition, the serum sortilin level in pre-diabetics receiving atorvastatin was significantly higher than pre-diabetics not receiving atorvastatin (P=0.001). Conclusion: Atorvastatin improved insulin secretion and sensitivity by increasing serum sortilin and PCSK9 levels. Thereby, it prevented the development of diabetes in diabetics and the progression of pre-diabetes to diabetes in pre-diabetics.

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A Clinical Review on Nutritional Requirements and Assessment for Type 2 Diabetes Mellitus with Chronic Renal Disease

Current Diabetes Reviews ◽

10.2174/1573399816666200211120402 ◽

2020 ◽

Vol 16 (9) ◽

pp. 922-930 ◽

Cited By ~ 1

Author(s):

Nourhan Khaled Hassan ◽

Syed Wasif Gillani ◽

Aisha Abubakr Kaoje ◽

Fatima Mufidah Fari ◽

Hisham Mohammed Elashmouny ◽

...

Keyword(s):

Diabetes Mellitus ◽

Type 2 Diabetes ◽

Type 2 Diabetes Mellitus ◽

Hemodialysis Patients ◽

Direct Result ◽

Cochrane Library ◽

Nutritional Requirements ◽

Diabetic Patients ◽

Dietary Requirements

Background: A significant correlation exists between type 2 diabetes mellitus (T2DM) and chronic kidney disease (CKD), where up to 40% of diabetic patients suffer from CKD as a direct result of diabetic complications. The management of diabetes in CKD patients can be challenging due to their need for disease-specific diets, as well as increased risks of complications due to malnutrition, which is why their dietary needs and nutritional requirements require attention to detail, and have to be assessed and tailored according to the patient’s needs. Objectives: This systematic review aimed to assess nutritional requirements for type 2 diabetes mellitus patients with chronic renal failure. Methods: In this review, 85 articles were screened, and 22 articles were then analyzed and selected as per the study criteria. PRISMA guidelines were used to select and screen the articles. Data search included a PubMed search using MeSH terms, and a literature review through the Cochrane library and the British Medical Journal. Results: The study highlighted the important nutrients and minerals needed to be maintained within a specified range in accordance with the patient’s needs and conditions. In addition, dietary restrictions must be set to prevent disease progression and deterioration. Dietary intake in hemodialysis patients must be carefully calculated based on their needs, with tight monitoring of their blood glucose. Protein intake in hemodialysis patients should be determined based on risk-to-benefit ratios. Conclusion: : Dietary requirements should be individualized based on the patient’s disease severity and progression. Assessment of the patient’s previous and current diet, as well as matching it with their dietary requirements and preferences is crucial.

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