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An impaired glomerular filtration rate (GFR) leads to end-stage renal disease and increases the risks of cardiovascular disease and death. Persons with type 1 diabetes are at high risk for kidney disease, but there are no interventions that have been proved to prevent impairment of the GFR in this population.
In the Diabetes Control and Complicatio...
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Context 1
... baseline to year 1 of the DCCT, the mean estimated GFR in the intensive-therapy group fell from 126.0 to 121.8 ml per minute per 1.73 m 2 , which was a decrease that was greater by 1.4 ml per minute per 1.73 m 2 than that in the conventional-therapy group (95% CI, 0.6 to 2.2; P<0.001) (Fig. 2, and Table S1 in the Supplementary Appendix). During the DCCT, the estimated GFR in the two treatments group declined in parallel after the first year. The overall mean estimated GFR was lower by 1.7 ml per minute per 1.73 m 2 in the intensive-therapy group than in the conventional-therapy ...
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Objective:
More than half of African Americans (AA) with a new diagnosis of diabetic ketoacidosis have clinical and metabolic features of type 2 diabetes during follow-up. This particular presentation of diabetes has been termed as ketosis-prone type 2 diabetes (KPDM) or atypical diabetes.
Methods:
We review the epidemiology, diagnosis, pathophy...
Background: Automated insulin management features of the MiniMed® 640G sensor-augmented pump system include suspension in response to predicted low sensor glucose (SG) values (“suspend before low”), suspension in response to existing low SG values (“suspend on low”), and automatic restarting of basal insulin delivery upon SG recovery. The effective...
Citations
... Oxidative stress is considered a common factor linking hyperglycemia with the complications of diabetes. Studies on experimental animal models of diabetes strongly implicate OS as a major determinant in the pathophysiology of DKD [30][31][32]. The kidney is an organ rich in oxidation reactions in the mitochondria since it requires a high energy demand to carry out its physiological functions, which makes it vulnerable to oxidative damage. ...
Diabetes mellitus (DM) is a metabolic disorder characterized by persistent hyperglycemia. This state may lead to an increase in oxidative stress, which contributes to the development of diabetes complications, including diabetic kidney disease. Potentilla indica is a traditional medicinal herb in Asia, employed in the treatment of several diseases, including DM. In this study, we investigated the antioxidant effect of the ethyl acetate extract of Potentilla indica both in vitro and on kidneys of streptozotocin-induced diabetic male rats. Firstly, phytochemicals were identified via UPLC-MS/MS, and their in vitro antioxidant capabilities were evaluated. Subsequently, male Wistar rats were assigned into four groups: normoglycemic control, diabetic control, normoglycemic treated with the extract, and diabetic treated with the extract. At the end of the treatment, fasting blood glucose (FBG) levels, creatinine, blood urea nitrogen (BUN), and uric acid were estimated. Furthermore, the kidneys were removed and utilized for the determination of mitochondrial reactive oxygen species (ROS) production, mitochondrial respiratory chain complex activities, mitochondrial lipid peroxidation, glutathione peroxidase (GSH-Px), superoxide dismutase (SOD), and catalase (CAT) activities. The in vitro findings showed that the major phytochemicals present in the extract were phenolic compounds, which exhibited a potent antioxidant activity. Moreover, the administration of the P. indica extract reduced creatinine and BUN levels, ROS production, and lipid peroxidation and improved mitochondrial respiratory chain complex activity and GSH-Px, SODk, and CAT activities when compared to the diabetic control group. In conclusion, our data suggest that the ethyl acetate extract of Potentilla indica possesses renoprotective effects by reducing oxidative stress on the kidneys of streptozotocin-induced diabetic male rats.
... This more intensive glycemic control has lasting beneficial effects on the development of microvascular complications including development of albuminuria and loss of eGFR. In the Diabetes Control and Complications Trial (DCCT), after the intensive glycemic control intervention ended and glycemic control worsened, the intervention group still had less microvascular complications over a decade later [72][73][74][75][76]. While more exposure to hyperglycemia does increase the risk of DKD, not all patients with poorly controlled diabetes develop DKD and not all patients with well-controlled diabetes are spared this complication. ...
Purpose of review:
Chronic kidney disease (CKD) is a common condition and a major cause of morbidity and mortality in adults, but children and adolescents are also at risk for early kidney injury and development of CKD. Obesity contributes both directly and indirectly to the development of CKD. The purpose of this review is to describe obesity-related kidney disease (ORKD) and diabetic kidney disease (DKD) and their impact in the pediatric population.
Recent findings:
Although obesity-related CKD in childhood and adolescence is uncommon, nascent kidney damage may magnify the lifetime risk of CKD. Glomerular hyperfiltration is an early phenotype of both ORKD and DKD and typically manifests prior to albuminuria and progressive decline in GFR. Novel treatments for obesity and type 2 diabetes exerting protective effects on the kidneys are being investigated for use in the pediatric population. It is important to understand the impact of obesity on the kidneys more fully in the pediatric population to help detect injury earlier and intervene prior to the onset of irreversible progression of disease and to guide future research in this area.
... no/slow kidney function decline) with odds of heart failure within 4 years from baseline kidney function decline was independent of the eGFR level reached at the end of follow-up, the association may also stem from rapid kidney function decline and HF sharing common etiological factors. In patients with diabetes, increased levels of blood pressure, dyslipidemia, and poor glycemic control have been independently associated with both the progression of renal damage and the development of HF [4,[28][29][30][31][32]. However, the association between rapid kidney function decline and HF observed in our study did not materially change after accounting for these shared factors. ...
Background:
Impaired kidney function and albuminuria are associated with increased risk of heart failure (HF) in patients with type 2 diabetes (T2D). We investigated whether rapid kidney function decline over time is an additional determinant of increased HF risk in patients with T2D, independent of baseline kidney function, albuminuria, and other HF predictors.
Methods:
Included in the study were 7,539 participants in the Action to Control Cardiovascular Risk in Diabetes (ACCORD) study with baseline urinary albumin-to-creatinine ratio (UACR) data, who had completed 4 years of follow-up and had ≥ 3 eGFR measurements during that period (median eGFR/year = 1.9, IQR 1.7-3.2). The association between rapid kidney function decline (eGFR loss ≥ 5 ml/min/1.73 m2/year) and odds of HF hospitalization or HF death during the first 4 years of follow-up was estimated by logistic regression. The improvement in risk discrimination provided by adding rapid kidney function decline to other HF risk factors was evaluated as the increment in the area under the Receiving Operating Characteristics curve (ROC AUC) and integrated discrimination improvement (IDI).
Results:
Over 4 years of follow-up, 1,573 participants (20.9%) experienced rapid kidney function decline and 255 (3.4%) experienced a HF event. Rapid kidney function decline was associated with a ~ 3.2-fold increase in HF odds (3.23, 95% CI, 2.51-4.16, p < 0.0001), independent of baseline CVD history. This estimate was not attenuated by adjustment for potential confounders, including eGFR and UACR at baseline as well as at censoring (3.74; 95% CI 2.63-5.31). Adding rapid kidney function decline during follow-up to other clinical predictors (WATCH-DM score, eGFR, and UACR at study entry and end of follow-up) improved HF risk classification (ROC AUC = + 0.02, p = 0.027; relative IDI = + 38%, p < 0.0001).
Conclusions:
In patients with T2D, rapid kidney function decline is associated with a marked increase in HF risk, independent of starting kidney function and/or albuminuria. These findings highlight the importance of serial eGFR measurements over time to improve HF risk estimation in T2D.
... This population started with a mean eGFR level of 126 mL/min. Over the 22-year duration of the study, an average decrease in eGFR of 1.2 and 1.56 mL/min per year was reported for the intensive therapy and conventional therapy groups, respectively [7]. The second reference population consists of an age-unadjusted cohort of 1,108 individuals with T1D who received islet transplantation alone and were followed by the CITR. ...
... Hyperglycemia greatly affects the occurence and deterioration of DN. therefore, strict glycemic control from the early stages is important to prevent and treat MAU [12]. Triglycerides (TG), high lowdensity lipoprotein cholesterol (HDL-C) and low-density lipoprotein cholesterol (LDL-C) levels due to hyperglycemia were predictors of vascular complications and associated with MAU[11] [13]. ...
... [48-53 mmol/mol]) can reduce the risk of DKD (41)(42)(43)(44). The earlier the initiation of antihyperglycemic therapy, the greater the prognosis benefits (45). In our study, with HbA 1c increased by 1% (11 mmol/mol), the risk for DKD increased by 17%. ...
... Poor glycemic control drives the development and progression of DKD, and studies in T1DM have demonstrated that good metabolic control prevents and delays the progression of DKD [15]. Good metabolic control prevents hyperfiltration, which is believed to be a risk factor for CKD progression [16][17][18][19]. ...
The diabetes epidemic and the increasing number of patients with diabetic chronic vascular complications poses a significant challenge to health care providers. Diabetic kidney disease is a serious diabetes-mediated chronic vascular complication and represents a significant burden for both patients and society in general. Diabetic kidney disease not only represents the major cause of end stage renal disease but is also paralleled by an increase in cardiovascular morbidity and mortality. Any interventions to delay the development and progression of diabetic kidney disease are important to reduce the associated cardiovascular burden. In this review we will discuss five therapeutic tools for the prevention and treatment of diabetic kidney disease: drugs inhibiting the renin-angiotensin-aldosterone system, statins, the more recently recognized sodium-glucose co-transporter-2 inhibitors, glucagon-like peptide 1 agonists, and a novel non-steroidal selective mineralocorticoid receptor antagonist.
... Cornerstones of CKD management in diabetic patients include strict glycemic control to prevent CKD onset and early progression, and RAAS blockade, glucagon-like peptide-1 (GLP-1) receptor analogues, SGLT-2 inhibitors to prevent progression of overt CKD. Multiple trials have demonstrated decreased rates of CKD with lower HgbA1c targets, including a 22-year follow up of the Diabetes Control and Complications (DCCT) trial that showed 50% reduction of CKD incidence in the intensive glucose control group.75,76 However, other trials involving type 2 diabetes failed to demonstrate improved kidney outcomes with stricter control of HgbA1c and instead showed increased mortality and risk of hypoglycemia. ...
Chronic kidney disease (CKD) and its downstream complications (i.e., cardiovascular) are a major source of morbidity worldwide. Additionally, deaths due to CKD or CKD-attributable cardiovascular disease account for a sizeable proportion of global mortality. However, the advent of new pharmacotherapies, diagnostic tools, and global initiatives are directing greater attention to kidney health in the public health agenda, including the implementation of effective strategies that 1) prevent kidney disease, 2) provide early CKD detection, and 3) ameliorate CKD progression and its related complications. In this Review, we discuss major risk factors for incident CKD and CKD progression categorized across cardiovascular (i.e., hypertension, dyslipidemia, cardiorenal syndrome), endocrine (i.e., diabetes mellitus, hypothyroidism, testosterone), lifestyle (i.e., obesity, dietary factors, smoking), and genetic/environmental (i.e. CKDu/Mesoamerican nephropathy, APOL1, herbal nephropathy) domains, as well as scope, mechanistic underpinnings, and management.
... [48-53 mmol/mol]) can reduce the risk of DKD (41)(42)(43)(44). The earlier the initiation of antihyperglycemic therapy, the greater the prognosis benefits (45). In our study, with HbA 1c increased by 1% (11 mmol/mol), the risk for DKD increased by 17%. ...
Background and purpose:
Image-defined sarcopenia is linked to increased mortality among patients with cancer. Nevertheless, its effect on patients with nasopharyngeal carcinoma (NPC) is incompletely established. This study's aim was to investigate the prognostic significance of MRI-defined sarcopenia on the survival of patients undergoing concurrent chemoradiotherapy (CCRT) ± inducing chemotherapy (IC) for NPC treatment.
Methods:
1,307 patients with stage II-IVa NPC were included in this retrospective study. Sarcopenia was defined using skeletal muscle index (SMI) determined through baseline MRI at the C3 level. The association of sarcopenia with overall survival (OS) and progression-free survival (PFS) was assessed by Cox regression models using 1:1 propensity score matching (PSM) analysis. We also conducted a stratification analysis using BMI and treatment strategies.
Results:
Sarcopenia was an independent risk factor for both OS and PFS (all P < 0.05). However, BMI was not substantially linked to OS and PFS (all P > 0.05). Sarcopenic patients showed lower rates of OS (HR = 2.00, 95% CI: 1.54-2.60, P < 0.001) and PFS (HR = 1.67, 95% CI: 1.35-2.07, P < 0.001) in contrast with nonsarcopenic patients. According to stratification analysis, being overweight was linked to a protective effect in nonsarcopenic patients only. Sarcopenic patients showed similar OS and PFS regardless of the treatment modality.
Conclusions:
Sarcopenia is underrecognized in NPC patients. Measurement of sarcopenia using routine MRI scans in NPC patients provided significant prognostic information, outperforming BMI. Patients with sarcopenia failed to benefit from an additional IC regimen.
... [48-53 mmol/mol]) can reduce the risk of DKD (41)(42)(43)(44). The earlier the initiation of antihyperglycemic therapy, the greater the prognosis benefits (45). In our study, with HbA 1c increased by 1% (11 mmol/mol), the risk for DKD increased by 17%. ...
Objectives: The association between platelet status and hepatocellular carcinoma (HCC) prognoses remains controversial. Herein, we aimed to clarify the prognostic value of multiple platelet-related biomarkers, including platelet count, platelet/lymphocyte ratio (PLR), aspartate aminotransferase to platelet ratio index (APRI), and alkaline phosphatase-to-platelet count ratio index (APPRI) in HCC with microvascular invasion (MVI) after curative resection or liver transplantation.
Materials and methods: A retrospective review of 169 patients with solitary HCC and MVI who underwent resection or liver transplantation between January 2015 and December 2018 was conducted. Preoperative clinical, laboratory, pathologic, and imaging data were collected and analyzed. Overall survival (OS) and disease-free survival (DFS) were defined as the clinical endpoints. Univariate and multivariate Cox proportional hazards regression analyses were conducted to investigate potential predictors of DFS and OS.
Results: Multivariate Cox regression analyses revealed that maximum tumor diameter, poor cell differentiation, and APPRI were independent predictors of DFS; while poor cell differentiation, APRI, APPRI, prothrombin time, and alpha-fetoprotein were independent prognostic factors for OS. The 1-, 3-, and 5-year DFS rates were 66.90%, 48.40%, and 37.40% for patients with APPRI ≤0.74 and 40.40%, 24.20%,and 24.20% for patients with APPRI>0.74. The corresponding rates of OS over 1, 3, and 5 years were 92.40%, 88.10% and 77.70%, and 72.30%, 38.20%, and 19.10%, respectively. The DFS and OS rates of patients whose APPRI was more than 0.74 were substantially lower than those of patients whose APPRI was less than or equal to 0.74 (p = 0.002 and p < 0.001, respectively).
Conclusion: Elevated preoperative APPRI is a noninvasive, simple, and easily assessable parameter linked to poor prognosis in individuals with single HCC and MVI after resection or liver transplantation.
