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Scurt FG, Menne JJ, Korda A, Haller H, Chatzikyrkou C. Effect of gender on transition of normo- to microalbuminuria under angiotensin receptor blocker therapy in diabetes. J Diabetes 2020; 12:856-859. [PMID: 32755046 DOI: 10.1111/1753-0407.13102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 07/24/2020] [Accepted: 07/31/2020] [Indexed: 11/30/2022] Open
Abstract
Highlights In normoalbuminuric diabetic patients at low cardiovascular risk, the risk of transition from normo- to microalbuminuria is lower in women, despite the nonprotective effects of the angiotensin receptor blocker olmesartan. Additional methods of assessment of albuminuria in clinical studies (eg, measurements of albumin and creatinine excretion rate) should be implemented or the actually accepted higher urine albumin creatinine ratio (UACR) cutoff values for microalbuminuria in women reconsidered.
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Affiliation(s)
- Florian G Scurt
- Clinic of Nephrology, Hypertension, Diabetes and Endocrinology, Health Campus Immunology, Infectiology and Inflammation, Otto-von Guericke University, Magdeburg, Germany
| | - Jan J Menne
- Nephrology Section, Hannover Medical School, Hannover, Germany
- Clinic of Nephrology, Angiology and Rheumatology, KRH Klinikum Siloah, Hannover, Germany
| | - Alexandra Korda
- LVR-Klinikum Düsseldorf, Heinrich, Heine, University Düsseldorf, Düsseldorf, Germany
| | - Hermann Haller
- Nephrology Section, Hannover Medical School, Hannover, Germany
| | - Christos Chatzikyrkou
- Clinic of Nephrology, Hypertension, Diabetes and Endocrinology, Health Campus Immunology, Infectiology and Inflammation, Otto-von Guericke University, Magdeburg, Germany
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Anderson AH, Xie D, Wang X, Baudier RL, Orlandi P, Appel LJ, Dember LM, He J, Kusek JW, Lash JP, Navaneethan SD, Ojo A, Rahman M, Roy J, Scialla JJ, Sondheimer JH, Steigerwalt SP, Wilson FP, Wolf M, Feldman HI. Novel Risk Factors for Progression of Diabetic and Nondiabetic CKD: Findings From the Chronic Renal Insufficiency Cohort (CRIC) Study. Am J Kidney Dis 2020; 77:56-73.e1. [PMID: 32866540 DOI: 10.1053/j.ajkd.2020.07.011] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Accepted: 07/06/2020] [Indexed: 12/31/2022]
Abstract
RATIONALE & OBJECTIVE Identification of novel risk factors for chronic kidney disease (CKD) progression may inform mechanistic investigations and improve identification of high-risk subgroups. The current study aimed to characterize CKD progression across levels of numerous risk factors and identify independent risk factors for CKD progression among those with and without diabetes. STUDY DESIGN The Chronic Renal Insufficiency Cohort (CRIC) Study is a prospective cohort study of adults with CKD conducted at 7 US clinical centers. SETTING & PARTICIPANTS Participants (N=3,379) had up to 12.3 years of follow-up; 47% had diabetes. PREDICTORS 30 risk factors for CKD progression across sociodemographic, behavioral, clinical, and biochemical domains at baseline. OUTCOMES Study outcomes were estimated glomerular filtration rate (eGFR) slope and the composite of halving of eGFR or initiation of kidney replacement therapy. ANALYTICAL APPROACH Stepwise selection of independent risk factors was performed stratified by diabetes status using linear mixed-effects and Cox proportional hazards models. RESULTS Among those without and with diabetes, respectively, mean eGFR slope was-1.4±3.3 and-2.7±4.7mL/min/1.73m2 per year. Among participants with diabetes, multivariable-adjusted hazard of the composite outcome was approximately 2-fold or greater with higher levels of the inflammatory chemokine CXCL12, the cardiac marker N-terminal pro-B-type natriuretic peptide (NT-proBNP), and the kidney injury marker urinary neutrophil gelatinase-associated lipocalin (NGAL). Among those without diabetes, low serum bicarbonate and higher high-sensitivity troponin T, NT-proBNP, and urinary NGAL levels were all significantly associated with a 1.5-fold or greater rate of the composite outcome. LIMITATIONS The observational study design precludes causal inference. CONCLUSIONS Strong associations for cardiac markers, plasma CXCL12, and urinary NGAL are comparable to that of systolic blood pressure≥140mm Hg, a well-established risk factor for CKD progression. This warrants further investigation into the potential mechanisms that these markers indicate and opportunities to use them to improve risk stratification.
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Affiliation(s)
- Amanda H Anderson
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA; Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA.
| | - Dawei Xie
- Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Xue Wang
- Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Robin L Baudier
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA
| | - Paula Orlandi
- Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Lawrence J Appel
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, MD
| | - Laura M Dember
- Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA; Renal, Electrolyte, and Hypertension Division, Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Jiang He
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA
| | - John W Kusek
- Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - James P Lash
- Division of Nephrology, Department of Medicine, University of Illinois at Chicago College of Medicine, Chicago, IL
| | - Sankar D Navaneethan
- Section of Nephrology, Department of Medicine, Baylor University College of Medicine, Houston, TX
| | - Akinlolu Ojo
- University of Kansas School of Medicine, Kansas City, KS
| | - Mahboob Rahman
- Division of Nephrology and Hypertension, Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, OH
| | - Jason Roy
- Department of Biostatistics and Epidemiology, Rutgers School of Public Health, Piscataway, NJ
| | - Julia J Scialla
- Division of Nephrology, Department of Medicine, and Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC; Department of Medicine, University of Virginia School of Medicine, Charlottesville, VA; Department of Public Health Sciences, University of Virginia School of Medicine, Charlottesville, VA
| | - James H Sondheimer
- Division of Nephrology and Hypertension, Wayne State University School of Medicine, Detroit
| | - Susan P Steigerwalt
- Division of Nephrology, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI
| | - F Perry Wilson
- Program of Applied Translational Research, Department of Medicine, Yale University School of Medicine, New Haven, CT
| | - Myles Wolf
- Division of Nephrology, Department of Medicine, and Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC
| | - Harold I Feldman
- Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA; Renal, Electrolyte, and Hypertension Division, Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA; Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
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Hayashi Y. Detection of Lower Albuminuria Levels and Early Development of Diabetic Kidney Disease Using an Artificial Intelligence-Based Rule Extraction Approach. Diagnostics (Basel) 2019; 9:E133. [PMID: 31569548 PMCID: PMC6963949 DOI: 10.3390/diagnostics9040133] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Revised: 09/21/2019] [Accepted: 09/27/2019] [Indexed: 12/22/2022] Open
Abstract
The aim of the present study was to determine the lowest cut-off value for albuminuria levels, which can be used to detect diabetic kidney disease (DKD) using the urinary albumin-to-creatinine ratio (UACR). National Health and Nutrition Examination Survey (NHANES) data for US adults were used, and participants were classified as having diabetes or prediabetes based on a self-report and physiological measures. The study dataset comprised 942 diabetes and 524 prediabetes samples. This study clarified the significance of the lower albuminuria (UACR) levels, which can detect DKD, using an artificial intelligence-based rule extraction approach. The diagnostic rules (15 concrete rules) for both samples were extracted using a recursive-rule eXtraction (Re-RX) algorithm with continuous attributes (continuous Re-RX) to discriminate between prediabetes and diabetes datasets. Continuous Re-RX showed high test accuracy (77.56%) and a large area under the receiver operating characteristics curve (75%), which derived the two cut-off values (6.1 mg/g Cr and 71.00 mg/g Cr) for the lower albuminuria level in the UACR to detect early development of DKD. The early cut-off values for normoalbuminuria (NA) and microalbuminuria (MA) will be determined to help detect CKD and DKD, and to detect diabetes before MA develop and to prevent diabetic complications.
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Affiliation(s)
- Yoichi Hayashi
- Department of Computer Science, Meiji University, 1-1-1 Higashimita, Tama-ku, Kawasaki 214-8571, Japan.
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Modafferi S, Ries M, Calabrese V, Schmitt CP, Nawroth P, Kopf S, Peters V. Clinical Trials on Diabetic Nephropathy: A Cross-Sectional Analysis. Diabetes Ther 2019; 10:229-243. [PMID: 30617943 PMCID: PMC6349284 DOI: 10.1007/s13300-018-0551-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Indexed: 12/11/2022] Open
Abstract
INTRODUCTION Treatment options and decisions are often based on the results of clinical trials. We have evaluated the public availability of results from completed, registered phase III clinical trials on diabetic nephropathy and current treatment options. METHODS This was a cross-sectional analysis in which STrengthening the Reporting of OBservational studies in Epidemiology criteria were applied for design and analysis. In June 2017, 34 completed phase III clinical trials on diabetic nephropathy in the ClinicalTrials. gov registry were identified and matched to publications in the ClinicalTrials.gov registry and to those in the PubMed and Google Scholar databases. If no publication was identified, the principal investigator was contacted. The ratio of published and non-published studies was calculated. Various parameters, including study design, drugs, and comparators provided, were analyzed. RESULTS Drugs/supplements belonged to 26 different categories of medications, with the main ones being angiotensin-converting enzyme inhibitors, angiotensin-II receptors blockers, and dipeptidyl-peptidase-4-inhibitors. Among the trials completed before 2016 (n = 32), 22 (69%) were published, and ten (31%) remained unpublished. Thus, data on 11 different interventions and more than 1000 patients remained undisclosed. Mean time to publication was 26.5 months, which is longer than the time constrictions imposed by the U.S. Food and Drug Administration Amendments Act. Most trials only showed weak effects on micro- and macroalbuminuria, with an absolute risk reduction of 1.0 and 0.3%, respectively, and the number needed to treat varied between 91 and 333, without any relevant effect on end-stage-renal disease by intensive glucose-lowering treatment. Comparison of the results, however, was difficult since study design, interventions, and the renal outcome parameters vary greatly between the studies. CONCLUSION Despite the financial and human resources involved and the relevance for therapeutic guidelines and clinical decisions, about one-third of phase III clinical trials on diabetic nephropathy remain unpublished. Interventions used in published trials showed a low efficacy on renal outcome. FUNDING Deutsche Forschungsgemeinschaft (DFG): SFB 1118.
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Affiliation(s)
- Sergio Modafferi
- Center for Pediatric and Adolescent Medicine, University of Heidelberg, Heidelberg, Germany
- Department of Biomedical and Biotechnological Sciences, School of Medicine, University of Catania, Catania, Italy
| | - Markus Ries
- Center for Pediatric and Adolescent Medicine, University of Heidelberg, Heidelberg, Germany
| | - Vittorio Calabrese
- Department of Biomedical and Biotechnological Sciences, School of Medicine, University of Catania, Catania, Italy
| | - Claus P Schmitt
- Center for Pediatric and Adolescent Medicine, University of Heidelberg, Heidelberg, Germany
| | - Peter Nawroth
- Department of Endocrinology, Diabetology and Clinical Chemistry, University Hospital Heidelberg, University Heidelberg, Heidelberg, Germany
- Deutsches Zentrum für Diabetesforschung e.V. (DZD), Neuherberg, Germany
- Joint Heidelberg-IDC Translational Diabetes Program, Institute for Diabetes and Cancer, Helmholtz Zentrum, Neuherberg, Germany
| | - Stefan Kopf
- Department of Endocrinology, Diabetology and Clinical Chemistry, University Hospital Heidelberg, University Heidelberg, Heidelberg, Germany
- Deutsches Zentrum für Diabetesforschung e.V. (DZD), Neuherberg, Germany
| | - Verena Peters
- Center for Pediatric and Adolescent Medicine, University of Heidelberg, Heidelberg, Germany.
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Wang S, Wen X, Han X, Wang Y, Shen M, Fan S, Zhuang J, Xu W, Zhang Z, Shan Q, Li M, Hu B, Sun C, Wu D, Lu J, Zheng Y. Retracted
: MicroRNA‐30d preserves pancreatic islet β‐cell function through negative regulation of the JNK signaling pathway via SOCS3 in mice with streptozotocin‐induced diabetes mellitus. J Cell Physiol 2018; 233:7343-7355. [DOI: 10.1002/jcp.26569] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Accepted: 02/27/2018] [Indexed: 12/17/2022]
Affiliation(s)
- Shan Wang
- Key Laboratory for Biotechnology on Medicinal Plants of Jiangsu Province, School of Life ScienceJiangsu Normal UniversityXuzhouP.R. China
- College of Health SciencesJiangsu Normal UniversityXuzhouP.R. China
| | - Xin Wen
- Key Laboratory for Biotechnology on Medicinal Plants of Jiangsu Province, School of Life ScienceJiangsu Normal UniversityXuzhouP.R. China
- College of Health SciencesJiangsu Normal UniversityXuzhouP.R. China
| | - Xin‐Rui Han
- Key Laboratory for Biotechnology on Medicinal Plants of Jiangsu Province, School of Life ScienceJiangsu Normal UniversityXuzhouP.R. China
- College of Health SciencesJiangsu Normal UniversityXuzhouP.R. China
| | - Yong‐Jian Wang
- Key Laboratory for Biotechnology on Medicinal Plants of Jiangsu Province, School of Life ScienceJiangsu Normal UniversityXuzhouP.R. China
- College of Health SciencesJiangsu Normal UniversityXuzhouP.R. China
| | - Min Shen
- Key Laboratory for Biotechnology on Medicinal Plants of Jiangsu Province, School of Life ScienceJiangsu Normal UniversityXuzhouP.R. China
- College of Health SciencesJiangsu Normal UniversityXuzhouP.R. China
| | - Shao‐Hua Fan
- Key Laboratory for Biotechnology on Medicinal Plants of Jiangsu Province, School of Life ScienceJiangsu Normal UniversityXuzhouP.R. China
- College of Health SciencesJiangsu Normal UniversityXuzhouP.R. China
| | - Juan Zhuang
- Key Laboratory for Biotechnology on Medicinal Plants of Jiangsu Province, School of Life ScienceJiangsu Normal UniversityXuzhouP.R. China
- School of Environment Science and Spatial InformaticsChina University of Mining and TechnologyXuzhouP.R. China
- Jiangsu Key Laboratory for Eco‐Agricultural Biotechnology around Hongze Lake, School of Life SciencesHuaiyin Normal UniversityHuaianP.R. China
| | - Wei Xu
- Department of Endocrinology, Xuzhou Central HospitalThe Affiliated XuZhou Hospital of Medical College of Southeast UniversityXuzhouP.R. China
- Xuzhou Institute of Medical SciencesXuzhou Institute of DiabetesXuzhouP.R. China
| | - Zi‐Feng Zhang
- Key Laboratory for Biotechnology on Medicinal Plants of Jiangsu Province, School of Life ScienceJiangsu Normal UniversityXuzhouP.R. China
- College of Health SciencesJiangsu Normal UniversityXuzhouP.R. China
| | - Qun Shan
- Key Laboratory for Biotechnology on Medicinal Plants of Jiangsu Province, School of Life ScienceJiangsu Normal UniversityXuzhouP.R. China
- College of Health SciencesJiangsu Normal UniversityXuzhouP.R. China
| | - Meng‐Qiu Li
- Key Laboratory for Biotechnology on Medicinal Plants of Jiangsu Province, School of Life ScienceJiangsu Normal UniversityXuzhouP.R. China
- College of Health SciencesJiangsu Normal UniversityXuzhouP.R. China
| | - Bin Hu
- Key Laboratory for Biotechnology on Medicinal Plants of Jiangsu Province, School of Life ScienceJiangsu Normal UniversityXuzhouP.R. China
- College of Health SciencesJiangsu Normal UniversityXuzhouP.R. China
| | - Chun‐Hui Sun
- Key Laboratory for Biotechnology on Medicinal Plants of Jiangsu Province, School of Life ScienceJiangsu Normal UniversityXuzhouP.R. China
- College of Health SciencesJiangsu Normal UniversityXuzhouP.R. China
| | - Dong‐Mei Wu
- Key Laboratory for Biotechnology on Medicinal Plants of Jiangsu Province, School of Life ScienceJiangsu Normal UniversityXuzhouP.R. China
- College of Health SciencesJiangsu Normal UniversityXuzhouP.R. China
| | - Jun Lu
- Key Laboratory for Biotechnology on Medicinal Plants of Jiangsu Province, School of Life ScienceJiangsu Normal UniversityXuzhouP.R. China
- College of Health SciencesJiangsu Normal UniversityXuzhouP.R. China
| | - Yuan‐Lin Zheng
- Key Laboratory for Biotechnology on Medicinal Plants of Jiangsu Province, School of Life ScienceJiangsu Normal UniversityXuzhouP.R. China
- College of Health SciencesJiangsu Normal UniversityXuzhouP.R. China
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Ferrario CM, Mullick AE. Renin angiotensin aldosterone inhibition in the treatment of cardiovascular disease. Pharmacol Res 2017; 125:57-71. [PMID: 28571891 PMCID: PMC5648016 DOI: 10.1016/j.phrs.2017.05.020] [Citation(s) in RCA: 79] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2017] [Revised: 05/11/2017] [Accepted: 05/15/2017] [Indexed: 02/07/2023]
Abstract
A collective century of discoveries establishes the importance of the renin angiotensin aldosterone system in maintaining blood pressure, fluid volume and electrolyte homeostasis via autocrine, paracrine and endocrine signaling. While research continues to yield new functions of angiotensin II and angiotensin-(1-7), the gap between basic research and clinical application of these new findings is widening. As data accumulates on the efficacy of angiotensin converting enzyme inhibitors and angiotensin II receptor blockers as drugs of fundamental importance in the treatment of cardiovascular and renal disorders, it is becoming apparent that the achieved clinical benefits is suboptimal and surprisingly no different than what can be achieved with other therapeutic interventions. We discuss this issue and summarize new pathways and mechanisms effecting the synthesis and actions of angiotensin II. The presence of renin-independent non-canonical pathways for angiotensin II production are largely unaffected by agents inhibiting renin angiotensin system activity. Hence, new efforts should be directed to develop drugs that can effectively block the synthesis and/or action of intracellular angiotensin II. Improved drug penetration into cardiac or renal sites of disease, inhibiting chymase the primary angiotensin II forming enzyme in the human heart, and/or inhibiting angiotensinogen synthesis would all be more effective strategies to inhibit the system. Additionally, given the role of angiotensin II in the maintenance of renal homeostatic mechanisms, any new inhibitor should possess greater selectivity of targeting pathogenic angiotensin II signaling processes and thereby limit inappropriate inhibition.
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Affiliation(s)
- Carlos M Ferrario
- Department of Surgery, Wake Forest University Health Science, Medical Center Blvd., Winston Salem, NC 27157, United States.
| | - Adam E Mullick
- Cardiovascular Antisense Drug Discovery, Ionis Pharmaceuticals, Inc., Carlsbad, CA 92010, United States
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New diagnostics for hypertension in diabetes and the role of chronotherapy: a new perspective. Cardiovasc Endocrinol 2016. [DOI: 10.1097/xce.0000000000000103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Lee YY, Yang CK, Weng YM, Chuang CH, Yu W, Chen JC, Li WC. All Components of Metabolic Syndrome Are Associated with Microalbuminuria in a Chinese Population. PLoS One 2016; 11:e0157303. [PMID: 27327443 PMCID: PMC4915633 DOI: 10.1371/journal.pone.0157303] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2015] [Accepted: 05/30/2016] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND AND AIM Albuminuria is a well-known predictor of poor renal and cardiovascular outcomes and associated with increased risk of all-cause mortality. The study aimed to evaluate the associations between metabolic characteristics and the presence of albuminuria. METHODS This cross-sectional study included 18,384 adult Chinese who participated in health examinations during 2013-2014. Differences in clinical characteristics were compared for microalbuminuria (MAU) and albuminuria, and between genders. Potential risk factors associated with the risk of developing MAU and albuminuria were analyzed using univariate logistic regression. Multiple logistic regression was applied to further identify the independent associations between different levels of risk factors and the presence of MAU and albuminuria. The area under the ROC curve (AUC) was used to determine the discriminatory ability of metabolic risk factors in detecting albuminuria. RESULTS There were significant gender differences in clinical characteristics according to albuminuria status. Risk for the presence of albuminuria was significantly associated with age, male gender, waist circumference (WC), waist-to-height ratio (WHtR), hypertension, fasting plasma glucose (FPG), and triglycerides to high-density lipoprotein cholesterol ratio (TG/HDL-C) in univariate logistic regression. Multiple logistic regression analysis indicated that the factors significantly associated with the presence of MAU were WC > 90cm, WHtR at 0.6-0.7, hypertension, FPG > 6.1 mmole/L, and TG/HDL-C ratio > 1.6. The optimal cutoffs for risk factors of metabolic syndrome (MetS) to predict albuminuria in males and females were: WC, 90.8 vs. 80.0 cm; WHtR, 0.53 vs. 0.52; MAP, 97.9 vs. 91.9 mmHg; FPG, 5.40 vs. 5.28 mmole/L; and TG/HDL-C, 1.13 vs. 1.08. CONCLUSION MetS and all its components were associated with the presence of MAU in a health check-up population in China. Gender specific and optimal cutoffs for MetS components associated with the presence of MAU were determined.
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Affiliation(s)
- Yi-Yen Lee
- Division of Pediatric Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
- Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Chih-Kai Yang
- Department of Emergency Medicine, Xiamen Chang-Gung Hospital, Xiamen, China
| | - Yi-Ming Weng
- Department of Emergency Medicine, Xiamen Chang-Gung Hospital, Xiamen, China
- Department of Emergency Medicine, Chang-Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
- Department of Medicine, College of Medicine, Chang-Gung University, Taoyuan, Taiwan
| | - Chung-Hsun Chuang
- Department of Emergency Medicine, Xiamen Chang-Gung Hospital, Xiamen, China
- Department of Emergency Medicine, Chang-Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
| | - Wei Yu
- Department of Health Management, Xiamen Chang-Gung Hospital, Xiamen, China
| | - Jih-Chang Chen
- Department of Emergency Medicine, Chang-Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
- Department of Medicine, College of Medicine, Chang-Gung University, Taoyuan, Taiwan
| | - Wen-Cheng Li
- Department of Emergency Medicine, Xiamen Chang-Gung Hospital, Xiamen, China
- Department of Emergency Medicine, Chang-Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
- * E-mail:
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Bonnet F, Balkau B, Natali A. Family history of diabetes predisposes to cardiovascular disease among patients with type 2 diabetes: What is the nature of the association? DIABETES & METABOLISM 2016; 42:139-41. [DOI: 10.1016/j.diabet.2016.04.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/20/2016] [Accepted: 04/24/2016] [Indexed: 11/26/2022]
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Agarwal A, Hegde A, Yadav C, Ahmad A, Manjrekar PA, Srikantiah RM. Assessment of oxidative stress and inflammation in prediabetes-A hospital based cross-sectional study. Diabetes Metab Syndr 2016; 10:S123-S126. [PMID: 27016886 DOI: 10.1016/j.dsx.2016.03.009] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2016] [Accepted: 03/05/2016] [Indexed: 01/06/2023]
Abstract
BACKGROUND AND AIM Prediabetes is associated with dysglycemia, obesity, inflammation and endothelial dysfunction, contributing towards the pathogenesis of cardiovascular diseases rendering them vulnerable for the same. The current study intended to explore the risk of cardiovascular disease (CVD) related with prediabetes by assessing oxidative stress and inflammation using serum interleukin-6 (IL-6), myeloperoxidase (MPO) and urine microalbumin (MA) and their correlation with fasting plasma glucose (FPG) and physical measurements. MATERIALS AND METHODS Based on FPG values, 80 subjects were grouped into prediabetes and healthy controls. IL-6 and MPO were estimated in serum sample whereas MA was estimated in random urine sample. RESULTS Prediabetes group had significantly increased (p<0.05) mean anthropometric measurements and IL-6, MPO and MA as compared to healthy controls. MPO had significant correlation with FPG (r-0.388) in the prediabetes group. IL-6 and MPO showed a positive correlation with body mass index (BMI (r-0.339, r-0.327)), waist circumference (WC (r-484, r-0.493)) and waist-to-hip ratio (WHR (r-0.430, r-0.493)) while MA did not correlate with FPG and anthropometric measurements. CONCLUSION This study suggests that prediabetes is associated with central adiposity, inflammation and oxidative stress predisposing them to an increased risk for CVD.
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Affiliation(s)
- Ashish Agarwal
- Department of Biochemistry, Kasturba Medical College, Manipal University, ,Mangalore 575004, Karnataka, India
| | - Anupama Hegde
- Department of Biochemistry, Kasturba Medical College, Manipal University, ,Mangalore 575004, Karnataka, India.
| | - Charu Yadav
- Department of Biochemistry, Kasturba Medical College, Manipal University, ,Mangalore 575004, Karnataka, India
| | - Afzal Ahmad
- Department of Biochemistry, Kasturba Medical College, Manipal University, ,Mangalore 575004, Karnataka, India
| | - Poornima A Manjrekar
- Department of Biochemistry, Kasturba Medical College, Manipal University, ,Mangalore 575004, Karnataka, India
| | - Rukmini M Srikantiah
- Department of Biochemistry, Kasturba Medical College, Manipal University, ,Mangalore 575004, Karnataka, India
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Villa-Zapata L, Warholak T, Slack M, Malone D, Murcko A, Runger G, Levengood M. Predictive modeling using a nationally representative database to identify patients at risk of developing microalbuminuria. Int Urol Nephrol 2015; 48:249-56. [DOI: 10.1007/s11255-015-1183-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2015] [Accepted: 11/30/2015] [Indexed: 10/22/2022]
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Penno G, Solini A, Zoppini G, Fondelli C, Trevisan R, Vedovato M, Cavalot F, Gruden G, Lamacchia O, Laviola L, Orsi E, Pugliese G. Independent correlates of urinary albumin excretion within the normoalbuminuric range in patients with type 2 diabetes: The Renal Insufficiency And Cardiovascular Events (RIACE) Italian Multicentre Study. Acta Diabetol 2015; 52:971-81. [PMID: 26155957 DOI: 10.1007/s00592-015-0789-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2015] [Accepted: 06/21/2015] [Indexed: 10/23/2022]
Abstract
AIMS Within the normoalbuminuric range, low albuminuria (LA, 10-29 mg/24 h) is associated with higher adverse cardiovascular and renal outcomes than normal albuminuria (NA, <10 mg/24 h). This cross-sectional analysis of the cohort from the Renal Insufficiency And Cardiovascular Events (RIACE) Italian Multicentre Study was aimed at assessing the independent correlates of LA versus NA in patients with type 2 diabetes. METHODS This analysis involved 11,538 normoalbuminuric patients (73.2 % of the entire RIACE cohort): 6023 (52.2 %) with NA and 5515 (47.8 %) with LA. Binary logistic regression analysis with backward conditional variable selection was applied to assess the independent correlates of LA versus NA. RESULTS Compared with NA subjects, LA patients were more frequently males, older and with family history of hypertension, had longer diabetes duration, lower HDL cholesterol, and higher haemoglobin (Hb) A1c, triglycerides, and blood pressure (BP), use of anti-hyperglycaemic and anti-hypertensive drugs, and prevalence of metabolic syndrome, retinopathy, chronic kidney disease, any cardiovascular disease, myocardial infarction, and coronary and peripheral events. Men with LA were also more frequently current or former smokers and had higher body mass index, waist circumference, and non-HDL cholesterol. Independent correlates of LA were age (OR 1.018), family history of hypertension (OR 1.321), smoking status (former, OR 1.158; current, OR 1.237), HbA1c (OR 1.062), waist circumference (OR 1.050), triglycerides (OR 1.001), and diastolic BP (OR 1.014), together with use of anti-hyperglycaemic and anti-hypertensive agents. CONCLUSIONS Several risk factors are associated with increased albuminuria within the normoalbuminuric range. As most of these factors are potentially modifiable, treating them aggressively might reduce the excess risk associated with LA. TRIAL REGISTRATION NCT00715481; www.ClinicalTrials.gov .
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Affiliation(s)
- Giuseppe Penno
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Anna Solini
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Giacomo Zoppini
- Division of Endocrinology and Metabolic Diseases, University of Verona, Verona, Italy
| | | | - Roberto Trevisan
- Endocrinology and Diabetes Unit, Azienda Ospedaliera Papa Giovanni XXIII, Bergamo, Italy
| | - Monica Vedovato
- Department of Clinical and Experimental Medicine, University of Padua, Padua, Italy
| | - Franco Cavalot
- Department of Clinical and Biological Sciences, University of Turin, Orbassano, Turin, Italy
| | - Gabriella Gruden
- Department of Internal Medicine, University of Turin, Turin, Italy
| | - Olga Lamacchia
- Department of Medical Sciences, University of Foggia, Foggia, Italy
| | - Luigi Laviola
- Section of Internal Medicine, Endocrinology, Andrology and Metabolic Diseases, Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy
| | - Emanuela Orsi
- Diabetes Unit, IRCCS "Cà Granda - Ospedale Maggiore Policlinico" Foundation, Milan, Italy
| | - Giuseppe Pugliese
- Department of Clinical and Molecular Medicine, "La Sapienza" University, Via di Grottarossa, 1035-1039, 00189, Rome, Italy.
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13
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Li MF, Feng QM, Li LX, Tu YF, Zhang R, Dong XH, Lu JX, Bao YQ, Jia WP, Hu RM. High-normal urinary albumin-to-creatinine ratio is independently associated with metabolic syndrome in Chinese patients with type 2 diabetes mellitus: A cross-sectional community-based study. J Diabetes Investig 2015; 6:354-9. [PMID: 25969722 PMCID: PMC4420569 DOI: 10.1111/jdi.12307] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2014] [Revised: 10/01/2014] [Accepted: 11/03/2014] [Indexed: 12/03/2022] Open
Abstract
Aims/Introduction Microalbuminuria is positively related to metabolic syndrome (MetS). Our aim was to investigate whether urinary albumin-to-creatinine ratio (UACR) within the normal range is independently associated with MetS in Chinese community-based patients with type 2 diabetes. Materials and Methods A total of 514 participants (206 males and 308 females; mean age 66 years) with UACR less than 3.5 mg/mmol were enrolled from two downtown areas of Shanghai. The participants were stratified into quartiles according to UACR levels. The prevalence of MetS was assessed and compared among the four groups by binary logistic regression. Results Compared with participants with UACRs in the first quartile, the other quartiles had a higher prevalence of MetS (65.9%, 74.4% and 81.3%, respectively, P = 0.001) after adjustment for sex and age. After adjusting for potential confounders, participants in the second to the fourth quartile group had a 1.36-, 1.84- and 2.73-fold risk of MetS, respectively, relative to those in the lowest quartile. Furthermore, UACR, whether as quartile groups or as a continuous variable, is an independent predictor of MetS after fully adjusting for other variables. Conclusions These results suggest that UACR even within the normal range is independently associated with MetS in Chinese community-based patients with type 2 diabetes mellitus.
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Affiliation(s)
- Mei-Fang Li
- Department of Emergency, Shanghai Jiao Tong University Affiliated Sixth People's Hospital Shanghai, China ; Department of Endocrinology and Metabolism, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai Key Clinical Center for Metabolic Diseases, Shanghai Diabetes Institute, Shanghai Clinical Center for Diabetes, Shanghai Key Clinical Center for Metabolic Diseases, Shanghai Key Laboratory of Diabetes Mellitus Shanghai, China
| | - Qi-Ming Feng
- Department of Emergency, Shanghai Jiao Tong University Affiliated Sixth People's Hospital Shanghai, China
| | - Lian-Xi Li
- Department of Endocrinology and Metabolism, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai Key Clinical Center for Metabolic Diseases, Shanghai Diabetes Institute, Shanghai Clinical Center for Diabetes, Shanghai Key Clinical Center for Metabolic Diseases, Shanghai Key Laboratory of Diabetes Mellitus Shanghai, China
| | - Yin-Fang Tu
- Department of Endocrinology and Metabolism, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai Key Clinical Center for Metabolic Diseases, Shanghai Diabetes Institute, Shanghai Clinical Center for Diabetes, Shanghai Key Clinical Center for Metabolic Diseases, Shanghai Key Laboratory of Diabetes Mellitus Shanghai, China
| | - Rong Zhang
- Department of Endocrinology and Metabolism, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai Key Clinical Center for Metabolic Diseases, Shanghai Diabetes Institute, Shanghai Clinical Center for Diabetes, Shanghai Key Clinical Center for Metabolic Diseases, Shanghai Key Laboratory of Diabetes Mellitus Shanghai, China
| | - Xue-Hong Dong
- Department of Endocrinology and Metabolism, HuaShan Hospital, Institute of Endocrinology and Diabetology at Fudan University Shanghai, China
| | - Jun-Xi Lu
- Department of Endocrinology and Metabolism, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai Key Clinical Center for Metabolic Diseases, Shanghai Diabetes Institute, Shanghai Clinical Center for Diabetes, Shanghai Key Clinical Center for Metabolic Diseases, Shanghai Key Laboratory of Diabetes Mellitus Shanghai, China
| | - Yu-Qian Bao
- Department of Endocrinology and Metabolism, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai Key Clinical Center for Metabolic Diseases, Shanghai Diabetes Institute, Shanghai Clinical Center for Diabetes, Shanghai Key Clinical Center for Metabolic Diseases, Shanghai Key Laboratory of Diabetes Mellitus Shanghai, China
| | - Wei-Ping Jia
- Department of Endocrinology and Metabolism, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai Key Clinical Center for Metabolic Diseases, Shanghai Diabetes Institute, Shanghai Clinical Center for Diabetes, Shanghai Key Clinical Center for Metabolic Diseases, Shanghai Key Laboratory of Diabetes Mellitus Shanghai, China
| | - Ren-Ming Hu
- Department of Endocrinology and Metabolism, HuaShan Hospital, Institute of Endocrinology and Diabetology at Fudan University Shanghai, China
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14
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Park SY, Park YK, Cho KH, Choi HJ, Han JH, Han KD, Han BD, Yoon YJ, Kim YH. Normal range albuminuria and metabolic syndrome in South Korea: the 2011-2012 Korean National Health and Nutrition Examination Survey. PLoS One 2015; 10:e0125615. [PMID: 25978637 PMCID: PMC4433278 DOI: 10.1371/journal.pone.0125615] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2015] [Accepted: 03/24/2015] [Indexed: 01/21/2023] Open
Abstract
Background It is well-known that there is a close relationship between metabolic syndrome (MetS) and microalbuminuria. However, some recent studies have found that even normal range albuminuria was associated with MetS and cardiometabolic risk factors. The purpose of this study is to analyze the relationship between MetS and normal range albuminuria and to calculate the cutoff value for albuminuria that correlates with MetS in the representative fraction of Korean population. Methods Data were obtained from the 2011–2012 Korea National Health and Nutrition Examination Survey and included 9,650 subjects aged ≥19 years. We measured metabolic parameters: fasting blood glucose, waist circumference, blood pressure, and lipids, and albumin-to-creatinine ratio (ACR). The optimal ACR cutoff points for MetS were examined by the receiver operating characteristic curve. Multivariate logistic regression was used to obtain the prevalence of MetS and its components according to the ACR levels. Results The first cutoff value of ACR were 4.8 mg/g for subjects with ≥3 components of MetS. There was a graded association between ACR and prevalence of MetS and its components. If ACR was <4 mg/g, there was no significant increase in the prevalence of MetS or its components. From the ACR level of 4–5 mg/g, the prevalence of MetS significantly increased after adjusting for age, sex, body mass index, smoking, alcohol intake, exercise, and medications for diabetes mellitus and hypertension (odds ratio; 95% confidence intervals = 1.416; 1.041–1.926). Conclusions Albuminuria within the normal range (around 5 mg/g) was associated with prevalence of MetS in the Korean population.
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Affiliation(s)
- Si-Young Park
- Department of Family Medicine, Eulji University College of Medicine, Daejeon, South Korea
| | - Yong-Kyu Park
- Department of Medical Statistics, Catholic University College of Medicine, Seoul, South Korea
| | - Kyung-Hwan Cho
- Department of Family Medicine, Korea University College of Medicine, Seoul, South Korea
| | - Hee-Jeong Choi
- Department of Family Medicine, Eulji University College of Medicine, Daejeon, South Korea
| | - Jee-Hye Han
- Department of Family Medicine, Eulji University College of Medicine, Daejeon, South Korea
| | - Kyung-Do Han
- Department of Medical Statistics, Catholic University College of Medicine, Seoul, South Korea
| | - Byung-Duck Han
- Department of Family Medicine, Korea University College of Medicine, Seoul, South Korea
| | - Yeo-Joon Yoon
- Department of Family Medicine, Korea University College of Medicine, Seoul, South Korea
| | - Yang-Hyun Kim
- Department of Family Medicine, Korea University College of Medicine, Seoul, South Korea
- * E-mail:
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15
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Petrica L, Vlad A, Gluhovschi G, Gadalean F, Dumitrascu V, Vlad D, Popescu R, Velciov S, Gluhovschi C, Bob F, Ursoniu S, Petrica M, Jianu DC. Glycated peptides are associated with the variability of endothelial dysfunction in the cerebral vessels and the kidney in type 2 diabetes mellitus patients: a cross-sectional study. J Diabetes Complications 2015; 29:230-7. [PMID: 25511877 DOI: 10.1016/j.jdiacomp.2014.11.014] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2014] [Revised: 11/23/2014] [Accepted: 11/25/2014] [Indexed: 11/19/2022]
Abstract
BACKGROUND Diabetic atherosclerosis and microangiopathy parallel diabetic nephropathy. The aim of our study was to evaluate the pattern of endothelial dysfunction in two vascular territories, the kidney and the brain, both affected by diabetic vasculopathic complications. The endothelial variability was evaluated in relation to advanced glycation end-products modified peptides. METHODS Seventy patients with type 2 diabetes mellitus and 11 healthy subjects were assessed concerning urine albumin: creatinine ratio, plasma and urinary advanced glycation end-products, plasma asymmetric dimethyl-arginine, serum cystatin C, intima-media thickness in the common carotid arteries, the pulsatility index, the resistance index in the internal carotid arteries and the middle cerebral arteries, the cerebrovascular reactivity through the breath-holding test. RESULTS The breath-holding index correlated with asymmetric dimethyl-arginine (R²=0.151; p<0.001), plasma advanced glycation end-products (R²=0.173; p<0.001), C-reactive protein (R²=0.587; p<0.001), duration of diabetes mellitus (R²=0.146; p=0.001), cystatin C (R²=0.220; p<0.001), estimated glomerular filtration rate (R²=0.237; p=0.001). Urine albumin: creatinine ratio correlated with urinary advanced glycation end-products (R²=0.257; p<0.001), but not with asymmetric dimethyl-arginine (R²=0.029; p=0.147). CONCLUSIONS In type 2 diabetic patients endothelial dysfunction in the cerebral vessels appears to be dissociated from glomerular endothelial dysfunction in early diabetic nephropathy. Advanced glycation end-products could impact both the cerebral vessels and the glomerular endothelium.
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MESH Headings
- Aged
- Albuminuria/etiology
- Arginine/analogs & derivatives
- Arginine/blood
- Biomarkers/blood
- Biomarkers/urine
- Breath Holding
- Cohort Studies
- Cross-Sectional Studies
- Diabetes Mellitus, Type 2/complications
- Diabetic Angiopathies/blood
- Diabetic Angiopathies/metabolism
- Diabetic Angiopathies/physiopathology
- Diabetic Angiopathies/urine
- Diabetic Nephropathies/blood
- Diabetic Nephropathies/metabolism
- Diabetic Nephropathies/physiopathology
- Diabetic Nephropathies/urine
- Endothelium, Vascular/metabolism
- Endothelium, Vascular/physiopathology
- Female
- Glomerular Filtration Rate
- Glycation End Products, Advanced/blood
- Glycation End Products, Advanced/metabolism
- Glycation End Products, Advanced/urine
- Humans
- Kidney/blood supply
- Kidney/metabolism
- Kidney/physiopathology
- Male
- Middle Aged
- Outpatient Clinics, Hospital
- Romania
- Severity of Illness Index
- Vasculitis, Central Nervous System/complications
- Vasculitis, Central Nervous System/metabolism
- Vasculitis, Central Nervous System/physiopathology
- Vasculitis, Central Nervous System/urine
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Affiliation(s)
- Ligia Petrica
- "Victor Babes" University of Medicine and Pharmacy, Timisoara, Romania; Department of Nephrology, County Emergency Hospital, Timisoara, Romania.
| | - Adrian Vlad
- "Victor Babes" University of Medicine and Pharmacy, Timisoara, Romania; Department of Diabetes and Metabolic Diseases, County Emergency Hospital, Timisoara, Romania.
| | - Gheorghe Gluhovschi
- "Victor Babes" University of Medicine and Pharmacy, Timisoara, Romania; Department of Nephrology, County Emergency Hospital, Timisoara, Romania.
| | - Florica Gadalean
- "Victor Babes" University of Medicine and Pharmacy, Timisoara, Romania; Department of Nephrology, County Emergency Hospital, Timisoara, Romania.
| | - Victor Dumitrascu
- "Victor Babes" University of Medicine and Pharmacy, Timisoara, Romania; Department of Pharmacology, County Emergency Hospital, Clinical Laboratory, Timisoara, Romania.
| | - Daliborca Vlad
- "Victor Babes" University of Medicine and Pharmacy, Timisoara, Romania; Department of Pharmacology, County Emergency Hospital, Clinical Laboratory, Timisoara, Romania.
| | - Roxana Popescu
- "Victor Babes" University of Medicine and Pharmacy, Timisoara, Romania; Clinical Laboratory, Department of Cellular Biology, County Emergency Hospital, Timisoara, Romania.
| | - Silvia Velciov
- "Victor Babes" University of Medicine and Pharmacy, Timisoara, Romania; Department of Nephrology, County Emergency Hospital, Timisoara, Romania.
| | - Cristina Gluhovschi
- "Victor Babes" University of Medicine and Pharmacy, Timisoara, Romania; Department of Nephrology, County Emergency Hospital, Timisoara, Romania.
| | - Flaviu Bob
- "Victor Babes" University of Medicine and Pharmacy, Timisoara, Romania; Department of Nephrology, County Emergency Hospital, Timisoara, Romania.
| | - Sorin Ursoniu
- "Victor Babes" University of Medicine and Pharmacy, Timisoara, Romania; Department of Public Health Medicine, "Victor Babes" University of Medicine and Pharmacy, Timisoara, Romania.
| | - Maxim Petrica
- Department of Neurology, County Emergency Hospital, Timisoara, Romania.
| | - Dragos Catalin Jianu
- "Victor Babes" University of Medicine and Pharmacy, Timisoara, Romania; Department of Neurology, County Emergency Hospital, Timisoara, Romania.
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16
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Petrica L, Vlad A, Gluhovschi G, Zamfir A, Popescu C, Gadalean F, Dumitrascu V, Vlad D, Popescu R, Velciov S, Gluhovschi C, Bob F, Milas O, Ursoniu S. Glycated peptides are associated with proximal tubule dysfunction in type 2 diabetes mellitus. Int J Clin Exp Med 2015; 8:2516-2525. [PMID: 25932197 PMCID: PMC4402844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2014] [Accepted: 01/25/2015] [Indexed: 06/04/2023]
Abstract
BACKGROUND Advanced glycation end-products have been involved in the pathogenesis of proximal tubule dysfunction which characterizes diabetic tubulopathy. METHODS A total of 76 Type 2 diabetes mellitus patients and 28 healthy controls were evaluated concerning a potential association of glycated peptides with proximal tubule dysfunction by assessing urine albumin:creatinine ratio, urinary alpha1-microglobulin, urinary neutrophil gelatinase-associated lipocalin, plasma and urinary advanced glycation end-products, plasma asymmetric dimethyl-arginine, serum cystatin C. Fully automated chip-nanoelectrospray ionization and high-capacity ion trap multistage mass spectrometry characterized the urinary proteomic profile. RESULTS The urinary glycated proteins displayed a molecular weight of 15,121.4 Da in normoalbuminuric patients and of 30,180.4 Da in microalbuminuric patients. Urinary alpha1-microglobulin and neutrophil gelatinase-associated lipocalin correlated with urinary advanced glycation end-products (R(2)=0.586; R(2)=0.415), urine albumin: creatinine ratio (R(2)=0.292; R(2)=0.116), estimated glomerular filtration rate (R(2)=0.172; R(2)=0.135), serum cystatin C (R(2)=0.146; R(2)=0.129), but not with asymmetric dimethyl-arginine. In multivariable regression analysis models, the correlations for urinary alpha1-microglobulin and neutrophil gelatinase-associated lipocalin remained significant with urine albumin: creatinine ratio, urinary advanced glycation end-products, estimated glomerular filtration rate (P<0.0001, R(2)=0.674; P<0.0001, R(2)=0.551; P<0.0001, R(2)=0.482). CONCLUSIONS In patients with Type 2 diabetes mellitus urinary glycated peptides are associated with proximal tubule dysfunction. The proteomic patterns of urinary glycated peptides could differentiate normo- from microalbuminuric patients and may explain a potential relation between the size and the glycation status of glycated peptides, and the extent of proximal tubule dysfunction. The lack of correlation between parameters of endothelial dysfunction and proximal tubule dysfunction cannot exclude glomerular involvement in early diabetic nephropathy.
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Affiliation(s)
- Ligia Petrica
- Department of Nephrology, “Victor Babes” University of Medicine and PharmacyTimisoara, Romania
| | - Adrian Vlad
- Department of Diabetes and Metabolic Diseases, “Victor Babes” University of Medicine and PharmacyTimisoara, Romania
| | - Gheorghe Gluhovschi
- Department of Nephrology, “Victor Babes” University of Medicine and PharmacyTimisoara, Romania
| | - Alina Zamfir
- National Institute for Research and Development of Electrochemistry and Condensed MatterTimisoara, Romania
| | - Cristina Popescu
- Department of Experimental and Applied Biology, Institute of Life Sciences, “Vasile Goldis” Western UniversityArad, Romania
| | - Florica Gadalean
- Department of Nephrology, “Victor Babes” University of Medicine and PharmacyTimisoara, Romania
| | - Victor Dumitrascu
- Department of Pharmacology, “Victor Babes” University of Medicine and PharmacyTimisoara, Romania
| | - Daliborca Vlad
- Department of Pharmacology, “Victor Babes” University of Medicine and PharmacyTimisoara, Romania
| | - Roxana Popescu
- Department of Cellular Biology, “Victor Babes” University of Medicine and PharmacyTimisoara, Romania
| | - Silvia Velciov
- Department of Nephrology, “Victor Babes” University of Medicine and PharmacyTimisoara, Romania
| | - Cristina Gluhovschi
- Department of Nephrology, “Victor Babes” University of Medicine and PharmacyTimisoara, Romania
| | - Flaviu Bob
- Department of Nephrology, “Victor Babes” University of Medicine and PharmacyTimisoara, Romania
| | - Oana Milas
- Department of Nephrology, County Emergency HospitalTimisoara, Romania
| | - Sorin Ursoniu
- Department of Public Health Medicine, “Victor Babes” University of Medicine and PharmacyTimisoara, Romania
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17
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Petrica L, Vlad A, Gluhovschi G, Gadalean F, Dumitrascu V, Gluhovschi C, Velciov S, Bob F, Vlad D, Popescu R, Milas O, Ursoniu S. Proximal tubule dysfunction is associated with podocyte damage biomarkers nephrin and vascular endothelial growth factor in type 2 diabetes mellitus patients: a cross-sectional study. PLoS One 2014; 9:e112538. [PMID: 25397960 PMCID: PMC4232371 DOI: 10.1371/journal.pone.0112538] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2014] [Accepted: 10/09/2014] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND There is an ongoing debate as to whether early diabetic nephropathy in Type 2 diabetes mellitus may be attributed to the glomerulus or to the proximal tubule. Urinary excretion of nephrin and vascular endothelial growth factor may increase even in the normoalbuminuria stage. In the course of diabetic nephropathy, the proximal tubule may be involved in the uptake of urinary nephrin and vascular endothelial growth factor. MATERIALS AND METHODS Two groups of consecutive Type 2 diabetes mellitus outpatients (38 normo-, 32 microalbuminuric) and 21 healthy subjects were enrolled in a cross-sectional study and evaluated concerning the relation of proximal tubule dysfunction with the podocyte biomarkers excretion, assessed by ELISA methods. The impact of advanced glycation end-products on this relation was also queried. RESULTS Urinary alpha1-microglobulin and kidney injury molecule-1 correlated with urinary albumin:creatinine ratio (R2 = 0.269; p < 0.001; R2 = 0.125; p < 0.001), nephrinuria (R2 = 0.529; p<0.001; R2 = 0.203; p < 0.001), urinary vascular endothelial growth factor (R2 = 0.709; p < 0.001; R2 = 0.360; p < 0.001), urinary advanced glycation end-products (R2 = 0.578; p < 0.001; R2 = 0.405; p < 0.001), serum cystatin C (R2 = 0.130; p < 0.001; R2 = 0.128; p<0.001), and glomerular filtration rate (R2 = 0.167; p < 0.001; R2 = 0.166; p < 0.001); nephrinuria and urinary vascular endothelial growth factor correlated with urinary albumin:creatinine ratio (R2 = 0.498; p < 0.001; R2 = 0.227; p<0.001), urinary advanced glycation end-products (R2 = 0.251; p < 0.001; R2 = 0.308; p < 0.001), serum cystatin C (R2 = 0.157; p < 0.001; R2 = 0.226; p < 0.001), and glomerular filtration rate (R2 = 0.087; p = 0.007; R2 = 0.218; p < 0.001). CONCLUSIONS In Type 2 diabetes mellitus there is an association of proximal tubule dysfunction with podocyte damage biomarkers, even in the normoalbuminuria stage. This observation suggests a potential role of the proximal tubule in urinary nephrin and urinary vascular endothelial growth factor processing in early diabetic nephropathy, a fact which could be related to advanced glycation end-products intervention. Podocyte damage and proximal tubule dysfunction biomarkers could be validated as a practical approach to the diagnosis of early diabetic nephropathy by further studies on larger cohorts.
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Affiliation(s)
- Ligia Petrica
- “Victor Babes” University of Medicine and Pharmacy, Dept. of Nephrology, Timisoara, Romania
- County Emergency Hospital, Timisoara, Romania
| | - Adrian Vlad
- “Victor Babes” University of Medicine and Pharmacy, Dept. of Diabetes and Metabolic Diseases, Timisoara, Romania
- County Emergency Hospital, Timisoara, Romania
| | - Gheorghe Gluhovschi
- “Victor Babes” University of Medicine and Pharmacy, Dept. of Nephrology, Timisoara, Romania
- County Emergency Hospital, Timisoara, Romania
| | - Florica Gadalean
- “Victor Babes” University of Medicine and Pharmacy, Dept. of Nephrology, Timisoara, Romania
- County Emergency Hospital, Timisoara, Romania
| | - Victor Dumitrascu
- “Victor Babes” University of Medicine and Pharmacy, Department of Pharmacology, Timisoara, Romania
- County Emergency Hospital, Timisoara, Romania
| | - Cristina Gluhovschi
- “Victor Babes” University of Medicine and Pharmacy, Dept. of Nephrology, Timisoara, Romania
- County Emergency Hospital, Timisoara, Romania
| | - Silvia Velciov
- “Victor Babes” University of Medicine and Pharmacy, Dept. of Nephrology, Timisoara, Romania
- County Emergency Hospital, Timisoara, Romania
| | - Flaviu Bob
- “Victor Babes” University of Medicine and Pharmacy, Dept. of Nephrology, Timisoara, Romania
- County Emergency Hospital, Timisoara, Romania
| | - Daliborca Vlad
- “Victor Babes” University of Medicine and Pharmacy, Department of Pharmacology, Timisoara, Romania
- County Emergency Hospital, Timisoara, Romania
| | - Roxana Popescu
- “Victor Babes” University of Medicine and Pharmacy, Dept. of Cellular Biology, Timisoara, Romania
- County Emergency Hospital, Timisoara, Romania
| | - Oana Milas
- County Emergency Hospital, Timisoara, Romania
| | - Sorin Ursoniu
- “Victor Babes” University of Medicine and Pharmacy, Dept. of Public Health Medicine, Timisoara, Romania
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18
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Rossen NB, Knudsen ST, Fleischer J, Hvas AM, Ebbehøj E, Poulsen PL, Hansen KW. Targeting nocturnal hypertension in type 2 diabetes mellitus. Hypertension 2014; 64:1080-7. [PMID: 25259747 DOI: 10.1161/hypertensionaha.114.03958] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Several studies in different populations have suggested that nighttime blood pressure (BP) is a stronger predictor of cardiovascular events than daytime BP. Consequently, treatment strategies to target nighttime BP have come into focus. The aim of the present study was to investigate the effect of change of administration time of antihypertensive drugs. We included 41 patients with type 2 diabetes mellitus and nocturnal hypertension (nighttime systolic BP >120 mm Hg) in an open-label, crossover study. Patients were randomized to 8 weeks of either morning or bedtime administration of all of the individual's once-daily antihypertensive drugs, followed by 8 weeks of switched dosing regimen. Bedtime administration of antihypertensive drugs resulted in a significant reduction in nighttime (7.5 mm Hg; P<0.001) and 24-hour (3.1 mm Hg; P=0.014) systolic BP, with a nonsignificant reduction in daytime (1.3 mm Hg; P=0.336) systolic BP. We did not find morning BP surge to be different between dosing regimens. Levels of C-reactive protein were significantly lower with bedtime administration, which may indicate an effect on low-grade inflammation. We found no difference in urinary albumin excretion, regardless of albuminuria status. Urinary sodium/creatinine was significantly increased and urinary osmolality significantly reduced with bedtime administration, which can be interpreted as increased nocturnal natriuresis. In patients with type 2 diabetes mellitus and nocturnal hypertension, administration of once-daily antihypertensive drugs at bedtime may be favorable. The increased nocturnal natriuresis may reflect increased effect of bedtime-administered thiazides and renin-angiotensin system inhibitors, suggesting a potential mechanism of the observed effects on BP with chronotherapeutic intervention.
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Affiliation(s)
- Niklas Blach Rossen
- From the Department of Medicine, Silkeborg Regional Hospital, Silkeborg, Denmark (N.B.R., K.W.H.); and Department of Endocrinology and Internal Medicine (N.B.R., S.T.K., E.E., P.L.P.), Medical Research Laboratory (J.F.), and Department of Clinical Biochemistry (A.-M.H.), Aarhus University Hospital, Aarhus, Denmark.
| | - Søren Tang Knudsen
- From the Department of Medicine, Silkeborg Regional Hospital, Silkeborg, Denmark (N.B.R., K.W.H.); and Department of Endocrinology and Internal Medicine (N.B.R., S.T.K., E.E., P.L.P.), Medical Research Laboratory (J.F.), and Department of Clinical Biochemistry (A.-M.H.), Aarhus University Hospital, Aarhus, Denmark
| | - Jesper Fleischer
- From the Department of Medicine, Silkeborg Regional Hospital, Silkeborg, Denmark (N.B.R., K.W.H.); and Department of Endocrinology and Internal Medicine (N.B.R., S.T.K., E.E., P.L.P.), Medical Research Laboratory (J.F.), and Department of Clinical Biochemistry (A.-M.H.), Aarhus University Hospital, Aarhus, Denmark
| | - Anne-Mette Hvas
- From the Department of Medicine, Silkeborg Regional Hospital, Silkeborg, Denmark (N.B.R., K.W.H.); and Department of Endocrinology and Internal Medicine (N.B.R., S.T.K., E.E., P.L.P.), Medical Research Laboratory (J.F.), and Department of Clinical Biochemistry (A.-M.H.), Aarhus University Hospital, Aarhus, Denmark
| | - Eva Ebbehøj
- From the Department of Medicine, Silkeborg Regional Hospital, Silkeborg, Denmark (N.B.R., K.W.H.); and Department of Endocrinology and Internal Medicine (N.B.R., S.T.K., E.E., P.L.P.), Medical Research Laboratory (J.F.), and Department of Clinical Biochemistry (A.-M.H.), Aarhus University Hospital, Aarhus, Denmark
| | - Per Løgstrup Poulsen
- From the Department of Medicine, Silkeborg Regional Hospital, Silkeborg, Denmark (N.B.R., K.W.H.); and Department of Endocrinology and Internal Medicine (N.B.R., S.T.K., E.E., P.L.P.), Medical Research Laboratory (J.F.), and Department of Clinical Biochemistry (A.-M.H.), Aarhus University Hospital, Aarhus, Denmark
| | - Klavs Würgler Hansen
- From the Department of Medicine, Silkeborg Regional Hospital, Silkeborg, Denmark (N.B.R., K.W.H.); and Department of Endocrinology and Internal Medicine (N.B.R., S.T.K., E.E., P.L.P.), Medical Research Laboratory (J.F.), and Department of Clinical Biochemistry (A.-M.H.), Aarhus University Hospital, Aarhus, Denmark
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Sandholm N, Forsblom C, Mäkinen VP, McKnight AJ, Osterholm AM, He B, Harjutsalo V, Lithovius R, Gordin D, Parkkonen M, Saraheimo M, Thorn LM, Tolonen N, Wadén J, Tuomilehto J, Lajer M, Ahlqvist E, Möllsten A, Marcovecchio ML, Cooper J, Dunger D, Paterson AD, Zerbini G, Groop L, Tarnow L, Maxwell AP, Tryggvason K, Groop PH. Genome-wide association study of urinary albumin excretion rate in patients with type 1 diabetes. Diabetologia 2014; 57:1143-53. [PMID: 24595857 DOI: 10.1007/s00125-014-3202-3] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2014] [Accepted: 02/04/2014] [Indexed: 01/15/2023]
Abstract
AIMS/HYPOTHESIS An abnormal urinary albumin excretion rate (AER) is often the first clinically detectable manifestation of diabetic nephropathy. Our aim was to estimate the heritability and to detect genetic variation associated with elevated AER in patients with type 1 diabetes. METHODS The discovery phase genome-wide association study (GWAS) included 1,925 patients with type 1 diabetes and with data on 24 h AER. AER was analysed as a continuous trait and the analysis was stratified by the use of antihypertensive medication. Signals with a p value <10(-4) were followed up in 3,750 additional patients with type 1 diabetes from seven studies. RESULTS The narrow-sense heritability, captured with our genotyping platform, was estimated to explain 27.3% of the total AER variability, and 37.6% after adjustment for covariates. In the discovery stage, five single nucleotide polymorphisms in the GLRA3 gene were strongly associated with albuminuria (p < 5 × 10(-8)). In the replication group, a nominally significant association (p = 0.035) was observed between albuminuria and rs1564939 in GLRA3, but this was in the opposite direction. Sequencing of the surrounding genetic region in 48 Finnish and 48 UK individuals supported the possibility that population-specific rare variants contribute to the synthetic association observed at the common variants in GLRA3. The strongest replication (p = 0.026) was obtained for rs2410601 between the PSD3 and SH2D4A genes. Pathway analysis highlighted natural killer cell mediated immunity processes. CONCLUSIONS/INTERPRETATION This study suggests novel pathways and molecular mechanisms for the pathogenesis of albuminuria in type 1 diabetes.
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Affiliation(s)
- Niina Sandholm
- Folkhälsan Institute of Genetics, Folkhälsan Research Center, Biomedicum Helsinki, Helsinki, Finland
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Abstract
OBJECTIVE The rationale for this study was to review the data on microalbuminuria (MA), an amount of albumin in the urine of 30-299 mg/day, in patients with diabetes in the context of cardiovascular risk and development of kidney disease. The objective was to review the pathophysiology of MA in patients with diabetes and review the data from trials regarding MA in the context of risk for cardiovascular events or kidney disease progression. RESEARCH DESIGN AND METHODS Data sources were all PubMed-referenced articles in English-language peer-reviewed journals since 1964. Studies selected had to have a minimum 1-year follow-up and be either a randomized trial linking MA to cardiovascular or kidney disease outcome, a meta-analysis/systematic review, or a large observational cohort study. RESULTS The data suggest that MA is a risk marker for cardiovascular events and possibly for kidney disease development. Its presence alone, however, does not indicate established kidney disease, especially if the estimated glomerular filtration rate is >60 mL/min/1.73 m(2). An increase in MA, when blood pressure and other risk factors are controlled, portends a poor prognosis for kidney outcomes over time. Early in the course of diabetes, aggressive risk factor management focused on glycemic and blood pressure goals is important to delay kidney disease development and reduce cardiovascular risk. CONCLUSIONS MA is a marker of cardiovascular disease risk and should be monitored per guidelines once or twice a year for progression to macroalbuminuria and kidney disease development, especially if plasma glucose, lipids, and blood pressure are at guideline goals.
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Abstract
Chronic kidney disease (CKD) and its associated morbidity pose a worldwide health problem. As well as risk of endstage renal disease requiring renal replacement therapy, cardiovascular disease is the leading cause of premature death among the CKD population. Proteinuria is a marker of renal injury that can often be detected earlier than any tangible decline in glomerular filtration rate. As well as being a risk marker for decline in renal function, proteinuria is now widely accepted as an independent risk factor for cardiovascular morbidity and mortality. This review will address the prognostic implications of proteinuria in the general population as well as other specific disease states including diabetes, hypertension and heart failure. A variety of pathophysiological mechanisms that may underlie the relationship between renal and cardiovascular disease have been proposed, including insulin resistance, inflammation, and endothelial dysfunction. As proteinuria has evolved into a therapeutic target for cardiovascular risk reduction in the clinical setting we will also review therapeutic strategies that should be considered for patients with persistent proteinuria.
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Affiliation(s)
- Gemma Currie
- University of Glasgow, Institute of Cardiovascular and Medical Sciences, Glasgow, UK
| | - Christian Delles
- University of Glasgow, Institute of Cardiovascular and Medical Sciences, Glasgow, UK
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22
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Oh CM, Park SK, Kim HS, Kim YH, Kim O, Ryoo JH. High-normal albuminuria predicts metabolic syndrome in middle-aged Korean men: a prospective cohort study. Maturitas 2013; 77:149-54. [PMID: 24287176 DOI: 10.1016/j.maturitas.2013.10.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2013] [Revised: 09/09/2013] [Accepted: 10/16/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVE High-normal albuminuria has recently been associated with an elevated risk of cardiovascular disease. However, it is uncertain whether high-normal albuminuria is associated with metabolic syndrome (MetS). The objective of this prospective cohort study was to investigate whether a temporal relationship exists between a high-normal urine albumin-to-creatinine ratio (UACR) and the development of MetS. STUDY DESIGN A total of 4338 healthy Korean men who had their UACRs and MetS components assessed in 2005 were enrolled in the study. A MetS-free cohort of 1364 individuals, who did not have any conditions that would have excluded them from the study, was followed up until 2010. MAIN OUTCOME MEASURE MetS was defined according to the joint interim statement of the International Diabetes Federation Task Force on Epidemiology and Prevention. RESULTS Cox proportional hazards models were used to estimate the hazard ratio (HR) associated with normal UACR values stratified into following tertiles: <3.12 μg/mg, ≥3.12, <4.87 μg/mg, and ≥4.87 μg/mg. The UACR was categorised into the following tertiles. During 4470.6 person-years of follow-up, 247 incident cases of MetS developed between 2006 and 2010. The third UACR tertile was associated with the development of MetS after adjusting for multiple baseline covariates (HR 1.57; 95% confidence interval: 1.14-2.18). CONCLUSIONS On the basis of our 5-year follow-up study, a high-normal UACR predicts the development of MetS in Korean men.
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Affiliation(s)
- Chang-Mo Oh
- The Korea Central Cancer Registry, National Cancer Center, Goyang, Republic of Korea; Department of Preventive Medicine, School of Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - Sung Keun Park
- Total Healthcare Center, Kangbuk Samsung Hospital, Sungkyunkwan University, School of Medicine, Seoul, Republic of Korea; Department of Preventive Medicine, School of Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - Hyun Soo Kim
- Department of Anesthesiology and Pain Medicine, Sungkyunkwan University School of Medicine, Kangbuk Samsung Hospital, Seoul, Republic of Korea
| | - Yun Hong Kim
- Department of Anesthesiology and Pain Medicine, Sungkyunkwan University School of Medicine, Kangbuk Samsung Hospital, Seoul, Republic of Korea
| | - Oksun Kim
- Department of Nursing Science, College of Nursing Science, Kyung Hee University, Seoul, Republic of Korea
| | - Jae-Hong Ryoo
- Department of Preventive Medicine, School of Medicine, Kyung Hee University, Seoul, Republic of Korea.
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Fomin VV. ANGIOTENSIN II RECEPTOR ANTAGONISTS AND NEPHROPROTECTION: PLACE OF OLMESARTAN. КАРДИОВАСКУЛЯРНАЯ ТЕРАПИЯ И ПРОФИЛАКТИКА 2013. [DOI: 10.15829/1728-8800-2013-4-82-85] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
The paper presents the results of experimental studies and clinical trials which demonstrate nephroprotective effects of olmesartan.
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Affiliation(s)
- V. V. Fomin
- I.M. Sechenov First Moscow State Medical University, Moscow
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Zhang J, Chen Y, Xu Y, Li M, Wang T, Xu B, Sun J, Xu M, Lu J, Bi Y. Low-Grade Albuminuria Is Associated with Metabolic Syndrome and Its Components in Middle-Aged and Elderly Chinese Population. PLoS One 2013; 8:e65597. [PMID: 23805186 PMCID: PMC3689760 DOI: 10.1371/journal.pone.0065597] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2012] [Accepted: 04/30/2013] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Micro-albuminuria has been well established as one of the risk factors of metabolic syndrome (MetS). However, the association of MetS and its components with low-grade albuminuria among those with normal urinary albumin excretion has not been clearly elucidated in Chinese population. METHODOLOGY AND FINDINGS A cross-sectional study was conducted among 9,579 participants with normal urinary albumin excretion, who were recruited from Jia Ding District, Shanghai, China. The single-void first morning urine sample was collected for urinary albumin and creatinine measurements, and urinary albumin-to-creatinine ratio (UACR) was calculated as urinary albumin divided by creatinine. Low-grade albuminuria was classified as sex-specific upper UACR quartile in this population. MetS was defined according to the National Cholesterol Education Program Adult Treatment Panel III criteria. The prevalence of MetS and its components increased across the UACR quartiles (all P trend <0.01). A multivariable adjusted logistic regression analysis revealed that the prevalence of MetS was gradually elevated according to the UACR quartiles (adjusted odds ratios [ORs] were 1.14, 1.24 and 1.59 for UACR quartiles 2, 3 and 4, compared with the lowest quartile; P trend<0.0001). In the further stratified logistic regression analyses, the associations between low-grade albuminuria and MetS were significant in both sex strata (male and female), both age strata (<60 and ≥60 years), both body mass index strata (<24 and ≥24 kg/m(2)), and both diabetes strata (yes and no). Compared to the lowest UACR quartile, the participants in the highest quartile of UACR had the highest prevalence of central obesity (OR = 1.43; 95%CI = 1.25-1.63), high blood pressure (OR = 1.64; 95%CI = 1.43-1.87), hyperglycemia (OR = 1.52; 95%CI = 1.30-1.78) and high triglycerides (OR = 1.19; 95%CI = 1.04-1.37). CONCLUSIONS AND SIGNIFICANCE Low-grade albuminuria was significantly associated with the increasing prevalence of MetS and its components in the middle-aged and elderly Chinese population with normal urinary albumin excretion.
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Affiliation(s)
- Jie Zhang
- Shanghai Clinical Center for Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Department of Endocrine and Metabolic Diseases, Rui-jin Hospital, Shanghai Jiao-Tong University School of Medicine, Shanghai, China
| | - Yuhong Chen
- Shanghai Clinical Center for Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Department of Endocrine and Metabolic Diseases, Rui-jin Hospital, Shanghai Jiao-Tong University School of Medicine, Shanghai, China
- Key Laboratory for Endocrine and Metabolic Diseases of Ministry of Health, Rui-Jin Hospital, Shanghai Jiao-Tong University School of Medicine, E-Institute of Shanghai Universities, Shanghai, China
| | - Yu Xu
- Shanghai Clinical Center for Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Department of Endocrine and Metabolic Diseases, Rui-jin Hospital, Shanghai Jiao-Tong University School of Medicine, Shanghai, China
- Key Laboratory for Endocrine and Metabolic Diseases of Ministry of Health, Rui-Jin Hospital, Shanghai Jiao-Tong University School of Medicine, E-Institute of Shanghai Universities, Shanghai, China
| | - Mian Li
- Shanghai Clinical Center for Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Department of Endocrine and Metabolic Diseases, Rui-jin Hospital, Shanghai Jiao-Tong University School of Medicine, Shanghai, China
| | - Tiange Wang
- Shanghai Clinical Center for Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Department of Endocrine and Metabolic Diseases, Rui-jin Hospital, Shanghai Jiao-Tong University School of Medicine, Shanghai, China
| | - Baihui Xu
- Shanghai Clinical Center for Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Department of Endocrine and Metabolic Diseases, Rui-jin Hospital, Shanghai Jiao-Tong University School of Medicine, Shanghai, China
| | - Jichao Sun
- Shanghai Clinical Center for Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Department of Endocrine and Metabolic Diseases, Rui-jin Hospital, Shanghai Jiao-Tong University School of Medicine, Shanghai, China
- Institute of Health Sciences, Shanghai Institutes for Biological Sciences, Chinese Academy of Sciences and Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Min Xu
- Shanghai Clinical Center for Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Department of Endocrine and Metabolic Diseases, Rui-jin Hospital, Shanghai Jiao-Tong University School of Medicine, Shanghai, China
- Key Laboratory for Endocrine and Metabolic Diseases of Ministry of Health, Rui-Jin Hospital, Shanghai Jiao-Tong University School of Medicine, E-Institute of Shanghai Universities, Shanghai, China
| | - Jieli Lu
- Shanghai Clinical Center for Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Department of Endocrine and Metabolic Diseases, Rui-jin Hospital, Shanghai Jiao-Tong University School of Medicine, Shanghai, China
- Key Laboratory for Endocrine and Metabolic Diseases of Ministry of Health, Rui-Jin Hospital, Shanghai Jiao-Tong University School of Medicine, E-Institute of Shanghai Universities, Shanghai, China
| | - Yufang Bi
- Shanghai Clinical Center for Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Department of Endocrine and Metabolic Diseases, Rui-jin Hospital, Shanghai Jiao-Tong University School of Medicine, Shanghai, China
- Key Laboratory for Endocrine and Metabolic Diseases of Ministry of Health, Rui-Jin Hospital, Shanghai Jiao-Tong University School of Medicine, E-Institute of Shanghai Universities, Shanghai, China
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Chatzikyrkou C, Menne J. Update on the ROADMAP clinical trial report: olmesartan for the prevention or delay of microalbuminuria development in type 2 diabetes. Expert Rev Cardiovasc Ther 2013; 10:1087-92. [PMID: 23098143 DOI: 10.1586/erc.12.100] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Albuminuria is associated with renal disease progression and cardiovascular disease development or cardiovascular complications in individuals at low, medium and high risk for these outcomes. Furthermore, in patients with vascular disease, changes in albuminuria independently predict mortality and cardiovascular and renal outcomes, and drug-induced lowering of albuminuria with the use of angiotensin-converting enzyme inhibitors and angiotensin receptor blockers confers long-term cardiovascular and renal protection. However, few studies have directly examined whether these agents might also prevent the development of albuminuria and whether this translates into protection from cardiovascular disease events. The ROADMAP trial was conducted in an attempt to give answers to these questions. The results provide evidence that pharmacological blockade of angiotensin II receptors is effective in reducing the risk of new-onset albuminuria in type 2 diabetic patients. The study was not able to determine if this will also lead to a long-term reduction of cardiovascular morbidity and mortality.
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26
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Prevalence of abnormal urinary albumin excretion in elderly people: a Spanish survey. Int Urol Nephrol 2013; 45:553-60. [DOI: 10.1007/s11255-013-0380-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2012] [Accepted: 01/09/2013] [Indexed: 11/26/2022]
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Lv J, Perkovic V, Foote CV, Craig ME, Craig JC, Strippoli GFM. Antihypertensive agents for preventing diabetic kidney disease. Cochrane Database Syst Rev 2012; 12:CD004136. [PMID: 23235603 PMCID: PMC11357690 DOI: 10.1002/14651858.cd004136.pub3] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Various blood pressure-lowering agents, and particularly inhibitors of the renin-angiotensin system (RAS), are widely used for people with diabetes to prevent the onset of diabetic kidney disease (DKD) and adverse cardiovascular outcomes. This is an update of a Cochrane review first published in 2003 and updated in 2005. OBJECTIVES This systematic review aimed to assess the benefits and harms of blood pressure lowering agents in people with diabetes mellitus and a normal amount of albumin in the urine (normoalbuminuria). SEARCH METHODS In January 2011 we searched the Cochrane Renal Group's Specialised Register through contact with the Trials Search Co-ordinator. SELECTION CRITERIA Randomised controlled trials (RCTs) comparing any antihypertensive agent with placebo or another agent in hypertensive or normotensive patients with diabetes and no kidney disease (albumin excretion rate < 30 mg/d) were included. DATA COLLECTION AND ANALYSIS Two investigators independently extracted data on kidney and other patient-relevant outcomes (all-cause mortality and serious cardiovascular events), and assessed study quality. Analysis was by a random effects model was applied to analyse results which were expressed as risk ratio (RR) and 95% confidence intervals (CI). MAIN RESULTS We identified 26 studies that enrolling 61,264 participants. Angiotensin-converting enzyme inhibitors (ACEi) reduced the risk of new onset of microalbuminuria, macroalbuminuria or both when compared to placebo (8 studies, 11,906 patients: RR 0.71, 95% CI 0.56 to 0.89), with similar benefits in people with and without hypertension (P = 0.74), and when compared to calcium channel blockers (5 studies, 1253 participants: RR 0.60, 95% CI 0.42 to 0.85). ACEi reduced the risk of death when compared to placebo (6 studies, 11,350 participants: RR 0.84, 95% CI 0.73 to 0.97). No effect was observed for angiotensin receptor blockers (ARB) when compared to placebo for new microalbuminuria, macroalbuminuria or both (5 studies, 7653 participants: RR 0.90, 95% CI 0.68 to 1.19) or death (5 studies, 7653 participants: RR 1.12, 95% CI 0.88 to 1.41); however, meta-regression suggested possible benefits from ARB for preventing kidney disease in high risk patients. There was a trend towards benefit from use of combined ACEi and ARB for prevention of DKD compared with ACEi alone (2 studies, 4171 participants: RR 0.88, 95% CI 0.78 to 1.00).The risk of cough was significantly increased with ACEi when compared to placebo (6 studies, 11,791 patients: RR 1.84, 95% CI 1.24 to 2.72), however there was no significant difference in the risk of headache or hyperkalaemia. There was no significant difference in the risk of cough, headache or hyperkalaemia when ARB was to placebo. On average risk of bias was judged to be either low (27% to 69%) or unclear (i.e. no information available) (8% to 73%). Blinding of participants, incomplete outcome data and selective reporting were judged to be high in 23%, 31% and 31% of studies, respectively. AUTHORS' CONCLUSIONS ACEi were found to prevent new onset DKD and death in normoalbuminuric people with diabetes, and could therefore be used in this population. More data are needed to clarify the role of ARB and other drug classes in preventing DKD.
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Affiliation(s)
- Jicheng Lv
- The George Institute for Global HealthRenal and Metabolic DivisionLevel 10, KGV Building, RPAHMissenden RdCamperdownNSWAustralia2050
| | - Vlado Perkovic
- The George Institute for Global HealthRenal and Metabolic DivisionLevel 10, KGV Building, RPAHMissenden RdCamperdownNSWAustralia2050
| | - Celine V Foote
- The George Institute for Global HealthRenal and Metabolic DivisionLevel 10, KGV Building, RPAHMissenden RdCamperdownNSWAustralia2050
| | - Maria E Craig
- University of New South WalesDivison of Women's and Children's HealthSt George HospitalGray StreetKogarahNSWAustralia2025
| | - Jonathan C Craig
- The Children's Hospital at WestmeadCochrane Renal Group, Centre for Kidney ResearchWestmeadNSWAustralia2145
| | - Giovanni FM Strippoli
- The Children's Hospital at WestmeadCochrane Renal Group, Centre for Kidney ResearchWestmeadNSWAustralia2145
- University of BariDepartment of Emergency and Organ TransplantationBariItaly70100
- Mario Negri Sud ConsortiumDepartment of Clinical Pharmacology and EpidemiologySanta Maria ImbaroItaly
- The University of SydneySydney School of Public HealthSydneyAustralia
- DiaverumMedical‐Scientific OfficeLundSweden
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Hillis GS, Hata J, Woodward M, Perkovic V, Arima H, Chow CK, Zoungas S, Patel A, Poulter NR, Mancia G, Williams B, Chalmers J. Resting heart rate and the risk of microvascular complications in patients with type 2 diabetes mellitus. J Am Heart Assoc 2012; 1:e002832. [PMID: 23316296 PMCID: PMC3541618 DOI: 10.1161/jaha.112.002832] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2012] [Accepted: 07/27/2012] [Indexed: 12/17/2022]
Abstract
Background A higher resting heart rate is associated with an increased probability of cardiovascular complications and premature death in patients with type 2 diabetes mellitus. The impact of heart rate on the risk of developing microvascular complications, such as diabetic retinopathy and nephropathy, is, however, unknown. The present study tests the hypothesis that a higher resting heart rate is associated with an increased incidence and a greater progression of microvascular complications in patients with type 2 diabetes mellitus. Methods and Results The relation between baseline resting heart rate and the development of a major microvascular event was examined in 11 140 patients who participated in the Action in Diabetes and Vascular Disease: Preterax and Diamicron Modified Release Controlled Evaluation (ADVANCE) study. Major microvascular events were defined as a composite of new or worsening nephropathy or new or worsening retinopathy. Patients with a higher baseline heart rate were at increased risk of a new major microvascular complication during follow-up (adjusted hazard ratio: 1.13 per 10 beats per minute; 95% confidence interval: 1.07–1.20; P<0.001). The excess hazard was evident for both nephropathy (adjusted hazard ratio: 1.16 per 10 beats per minute; 95% confidence interval: 1.08–1.25) and retinopathy (adjusted hazard ratio: 1.11 per 10 beats per minute; 95% confidence interval: 1.02–1.21). Conclusion Patients with type 2 diabetes mellitus who have a higher resting heart rate experience a greater incidence of new-onset or progressive nephropathy and retinopathy. Clinical Trial Registration URL: http://www.clinicaltrials.gov. Unique identifier: NCT00145925. http://www.advance-trial.com/static/html/prehome/prehome.asp
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Affiliation(s)
- Graham S Hillis
- The George Institute for Global Health, University of Sydney, Australia.
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Volpe M. Preventing cardiovascular events with angiotensin II receptor blockers: a closer look at telmisartan and valsartan. Expert Rev Cardiovasc Ther 2012; 10:1061-72. [PMID: 23030295 DOI: 10.1586/erc.12.80] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Angiotensin II receptor blockers (ARBs) inhibit the renin-angiotensin system. As a result, these agents provide beneficial effects in terms of cardiovascular (CV) and renal protection, independent of their blood pressure-lowering effects. Telmisartan and valsartan are the most intensively studied ARBs for the effects on CV outcomes. Randomized clinical trials assessing morbidity and mortality end points have included a range of patient types, including those with hypertension, hypertension with Type 2 diabetes, high CV risk without hypertension, ischemic heart disease, stroke and heart failure. Few head-to-head comparisons between telmisartan and valsartan have been performed. However, some blood pressure-independent properties of these two ARBs can be scrutinized from separate studies in the available literature.
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Affiliation(s)
- Massimo Volpe
- Department of Clinical and Molecular Science, Division of Cardiology, Faculty of Medicine, University of Rome Sapienza, Sant'Andrea Hospital, Rome, Italy.
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Abe M, Maruyama N, Suzuki H, Inoshita A, Yoshida Y, Okada K, Soma M. L/N-type calcium channel blocker cilnidipine reduces plasma aldosterone, albuminuria, and urinary liver-type fatty acid binding protein in patients with chronic kidney disease. Heart Vessels 2012; 28:480-9. [PMID: 22914905 DOI: 10.1007/s00380-012-0274-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2012] [Accepted: 07/13/2012] [Indexed: 12/20/2022]
Abstract
Cilnidipine inhibits both L- and N-type calcium channels and has been shown to dilate efferent arterioles as effectively as afferent arterioles. We conducted an open-label, randomized trial to compare the effects of cilnidipine against those of amlodipine on blood pressure (BP), albuminuria, and plasma aldosterone concentration in hypertensive patients with mild- to moderate-stage chronic kidney disease. Patients with BP ≥130/80 mmHg, an estimated glomerular filtration rate of 90-30 ml/min/1.73 m(2), and albuminuria ≥30 mg/g, despite treatment with the maximum recommended dose of angiotensin II receptor blockers, were randomly assigned to two groups. Patients received either 10 mg/day cilnidipine (increased to 20 mg/day; n = 35) or 2.5 mg/day amlodipine (increased to 5 mg/day; n = 35). After 48 weeks of treatment, a significant and comparable reduction in systolic and diastolic BP was observed in both groups. The percent reduction in the urinary albumin to creatinine ratio and liver-type fatty acid binding protein (L-FABP) in the cilnidipine group was significantly greater than in the amlodipine group. Although plasma renin activity did not differ between the two groups, the plasma aldosterone level was significantly decreased in the cilnidipine group. Cilnidipine therefore appears to reduce albuminuria, urinary L-FABP, and plasma aldosterone levels more than amlodipine, and these effects are independent of BP reduction.
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Affiliation(s)
- Masanori Abe
- Division of Nephrology, Hypertension and Endocrinology, Department of Internal Medicine, Nihon University School of Medicine, 30-1, Oyaguchi Kami-chou, Itabashi-ku, Tokyo, 173-8610, Japan.
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Shemirani H, Khosravi A, Hemmati R, Gharipour M. Body Mass Index or Microalbuminuria, Which One is More Important for the Prediction and Prevention of Diastolic Dysfunction in Non-diabetic Hypertensive Patients? Int J Prev Med 2012; 3:211-20. [PMID: 22448314 PMCID: PMC3309635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2011] [Accepted: 09/15/2011] [Indexed: 10/25/2022] Open
Abstract
BACKGROUND Numerous studies have now demonstrated that heart failure with a normal ejection fraction (HFnlEF) is common. Hypertension is also the most commonly associated cardiac condition in patients with HFnlEF. Despite the observed link between microalbuminuria, obesity, and cardiovascular disorders, this question has remained - 'Which is more important for the prediction and prevention of diastolic dysfunction in non-diabetic hypertensive patients?' METHODS The current study was a cross-section study conducted on a total of 126 non-diabetic hypertensive patients screened to identify those with hypertension. Urine creatinine was measured by the picric acid method and urine albumin content was measured by a sensitive, nephelometric technique. The urinary albumin/creatinine ratio (UACR) was determined as an indicator of microalbuminuria. Complete two-dimensional, doppler, and tissue-doppler echocardiography was performed and the recording of the diastolic function parameters was carried out. RESULTS High body mass index and high systolic blood pressure were positively correlated with the appearance of left ventricular hypertrophy, whereas, the UACR index had no significant relationship with hypertrophy. Multivariable analysis also showed that advanced age and systolic blood pressure were significantly associated with the E/E annulus parameter. CONCLUSION According to our investigation obesity is more important than microalbuminuria for the prediction and prevention of diastolic dysfunction in non-diabetic hypertensive patients.
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Affiliation(s)
- Hasan Shemirani
- Department of Cardiology, Faculty of Medicine, Isfahan University of Medical Sciences (IUMS), Isfahan, Iran
| | - Alireza Khosravi
- Hypertension Research Center, Isfahan Cardiovascular Research Institute, IUMS, Isfahan, Iran,Correspondence to: Asso. Prof. Alireza Khosravi, Cardiology Department, Faculty of Medicine, and Hypertension Research Center, Isfahan University of Medical Sciences, Isfahan, Iran E-mail: mail:
| | - Rohola Hemmati
- Cardiology Department, Faculty of Medicine, Elam University of Medical Sciences, Elam, Iran
| | - Mojgan Gharipour
- Hypertension Research Center, Isfahan Cardiovascular Research Institute, IUMS, Isfahan, Iran
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Early angiotensin-converting enzyme inhibition in Alport syndrome delays renal failure and improves life expectancy. Kidney Int 2011; 81:494-501. [PMID: 22166847 DOI: 10.1038/ki.2011.407] [Citation(s) in RCA: 218] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Alport syndrome inevitably leads to end-stage renal disease and there are no therapies known to improve outcome. Here we determined whether angiotensin-converting enzyme inhibitors can delay time to dialysis and improve life expectancy in three generations of Alport families. Patients were categorized by renal function at the initiation of therapy and included 33 with hematuria or microalbuminuria, 115 with proteinuria, 26 with impaired renal function, and 109 untreated relatives. Patients were followed for a period whose mean duration exceeded two decades. Untreated relatives started dialysis at a median age of 22 years. Treatment of those with impaired renal function significantly delayed dialysis to a median age of 25, while treatment of those with proteinuria delayed dialysis to a median age of 40. Significantly, no patient with hematuria or microalbuminuria advanced to renal failure so far. Sibling pairs confirmed these results, showing that earlier therapy in younger patients significantly delayed dialysis by 13 years compared to later or no therapy in older siblings. Therapy significantly improved life expectancy beyond the median age of 55 years of the no-treatment cohort. Thus, Alport syndrome is treatable with angiotensin-converting enzyme inhibition to delay renal failure and therapy improves life expectancy in a time-dependent manner. This supports the need for early diagnosis and early nephroprotective therapy in oligosymptomatic patients.
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Petrica L, Vlad A, Petrica M, Jianu CD, Gluhovschi G, Gadalean F, Dumitrascu V, Ianculescu C, Firescu C, Giju S, Gluhovschi C, Bob F, Velciov S, Bozdog G, Milas O, Marian R, Ursoniu S. Pioglitazone delays proximal tubule dysfunction and improves cerebral vessel endothelial dysfunction in normoalbuminuric people with type 2 diabetes mellitus. Diabetes Res Clin Pract 2011; 94:22-32. [PMID: 21726916 DOI: 10.1016/j.diabres.2011.05.032] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2011] [Revised: 05/22/2011] [Accepted: 05/23/2011] [Indexed: 11/22/2022]
Abstract
AIM The renal and cerebral protective effects of pioglitazone were assessed in normoalbuminuric patients with type 2 diabetes mellitus (DM). METHODS A total of 68 normoalbuminuric type 2 DM patients were enrolled in a one-year open-label randomized controlled trial: 34 patients (pioglitazone-metformin) vs. 34 patients (glimepiride-metformin). All patients were assessed concerning urinary albumin: creatinine ratio (UACR), urinary alpha1-microglobulin, urinary beta2-microglobulin, plasma asymmetric dymethyl-arginine (ADMA), GFR, hsC-reactive protein, fibrinogen, HbA1c; pulsatility index, resistance index in the internal carotid artery and middle cerebral artery, intima-media thickness in the common carotid artery; cerebrovascular reactivity was evaluated through the breath-holding test. RESULTS At 1 year there were differences between groups regarding ADMA, urinary beta2-microglobulin, urinary alpha1-microglobulin, parameters of inflammation, serum creatinine, GFR, UACR, the cerebral haemodynamic indices. Significant correlations were found between alpha 1-microglobulin-UACR (R(2)=0.143; P=0.001) and GFR (R(2)=0.081; P=0.01); beta2-microglobulin-UACR (R(2)=0.241; P=0.0001) and GFR (R(2)=0.064; P=0.036); ADMA-GFR (R(2)=0.338; P=0.0001), parameters of inflammation, HbA1c, duration of DM, cerebral indices. There were no correlations between ADMA-UACR, urinary alpha1-microglobulin and beta2-microglobulin. CONCLUSION Proximal tubule (PT) dysfunction precedes albuminuria and is dissociated from endothelial dysfunction in patients with type 2 DM. Pioglitazone delays PT dysfunction and improves cerebral vessels endothelial dysfunction in normoalbuminuric patients with type 2 DM.
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Affiliation(s)
- Ligia Petrica
- Department of Nephrology, Victor Babes University of Medicine and Pharmacy, County Emergency Hospital, Timisoara, Romania.
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Jennersjö PES, Wijkman M, Wiréhn AB, Länne T, Engvall J, Nystrom FH, Östgren CJ. Circadian blood pressure variation in patients with type 2 diabetes--relationship to macro- and microvascular subclinical organ damage. Prim Care Diabetes 2011; 5:167-173. [PMID: 21546328 DOI: 10.1016/j.pcd.2011.04.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2011] [Revised: 04/03/2011] [Accepted: 04/07/2011] [Indexed: 10/18/2022]
Abstract
AIMS To explore the association between nocturnal blood pressure (BP) dipper status and macro- and microvascular organ damage in type 2 diabetes. METHODS Cross-sectional data from 663 patients with type 2 diabetes, aged 55-66 years, were analysed. Nurses measured office BP and ambulatory BP during 24h. Individuals with ≥ 10% difference in nocturnal systolic blood pressure (SBP) relative to daytime values were defined as dippers. Non-dippers were defined as <10% nocturnal decrease in SBP. Estimated glomerular filtration rate (GFR) was calculated and microalbuminuria was measured by albumin:creatinine ratio (ACR). Aortic pulse wave velocity (PWV) was measured with applanation tonometry over the carotid and femoral arteries. RESULTS We identified 433 dippers and 230 subjects with a nocturnal non-dipping pattern. Nocturnal SBP dipping was independently of office SBP associated with decreased PWV (p = 0.008), lower ACR (p = 0.001) and NT-proBNP (p = 0.001) and increased GFR (p<0.001). CONCLUSIONS We conclude that diurnal BP variation provides further information about early macro- and microvascular subclinical organ damage that goes beyond standardized office BP measurements in patients with type 2 diabetes.
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Affiliation(s)
- Pär E son Jennersjö
- Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
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Bonnet F, Gauthier E, Gin H, Hadjadj S, Halimi JM, Hannedouche T, Rigalleau V, Romand D, Roussel R, Zaoui P. Expert consensus on management of diabetic patients with impairment of renal function. DIABETES & METABOLISM 2011; 37 Suppl 2:S1-25. [DOI: 10.1016/s1262-3636(11)70961-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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Kawai T, Takei I, Shimada A, Hirata T, Tanaka K, Saisho Y, Irie J, Horimai C, Matsumoto H, Itoh H. Effects of olmesartan medoxomil, an angiotensin II type 1 receptor antagonist, on plasma concentration of B-type natriuretic peptide, in hypertensive patients with type 2 diabetes mellitus: a preliminary, observational, open-label study. Clin Drug Investig 2011; 31:237-45. [PMID: 21184621 DOI: 10.2165/11586510-000000000-00000] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
BACKGROUND AND OBJECTIVE Angiotensin II type 1 (AT1) receptor antagonists (angiotensin receptor blockers [ARBs]) are widely used for the treatment of not only hypertension but also cardiac dysfunction. B-type natriuretic peptide (BNP) is secreted mainly by the cardiac ventricle and plays an important role in the regulation of blood pressure (BP) and body fluid. It has been established that the plasma level of BNP is increased in patients with chronic heart failure in proportion to the severity of cardiac dysfunction. Because cardiac dysfunction is closely associated with a high risk of mortality in patients with diabetes mellitus, early identification and prevention of cardiac dysfunction are important. The objective of this study was to determine the effects of olmesartan medoxomil, a novel ARB, on the plasma level of BNP in hypertensive patients with type 2 diabetes. METHODS This was a preliminary, prospective, observational, open-label study. Sixty-eight type 2 diabetic patients with hypertension (systolic BP [SBP]≥140 mmHg or diastolic BP [DBP]≥90 mmHg) received olmesartan medoxomil 10–20 mg/day for 24 weeks. Plasma levels of BNP, as well as several clinical parameters of glycaemic control and lipid metabolism, were compared before and after 24 weeks of treatment. Another group consisting of 22 age- and body mass index-matched subjects not treated with olmesartan medoxomil was observed for reference purposes. RESULTS In the olmesartan medoxomil group, mean±SD SBP decreased from 152.8±16.4 at baseline to 146.8±14.4 mmHg after 24 weeks' treatment (p<0.05); similarly, mean±SD DBP decreased from 85.6±10.5 to 81.3±11.6 mmHg (p<0.05). In 53 subjects in whom plasma levels of BNP could be measured both before and after treatment, mean±SD BNP decreased from 41.3±49.9 to 32.5±36.3 pg/mL (p<0.05). Change in plasma BNP level over the 24-week treatment period in the olmesartan medoxomil group was not correlated with change in SBP or DBP. Multiple regression analysis revealed that change in plasma BNP level was not correlated with baseline value of or change in any other parameters. No other parameters in the olmesartan medoxomil group, and no parameters in the non-olmesartan medoxomil reference group, showed significant changes. CONCLUSION The current preliminary study showed that olmesartan medoxomil treatment might decrease plasma BNP levels, independent of its BP-lowering effect, in hypertensive patients with type 2 diabetes.
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Affiliation(s)
- Toshihide Kawai
- Department of Internal Medicine, School of Medicine, Keio University, Tokyo, Japan.
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Afsar B, Elsurer R, Güner E, Kirkpantur A. Which anthropometric parameter is best related with urinary albumin excretion and creatinine clearance in type 2 diabetes: body mass index, waist circumference, waist-to-hip ratio, or conicity index? J Ren Nutr 2011; 21:472-8. [PMID: 21454092 DOI: 10.1053/j.jrn.2010.12.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2010] [Revised: 12/17/2010] [Accepted: 12/20/2010] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVE We analyzed the relationships between body mass index (BMI), waist circumference (WC), waist-to-hip ratio, and conicity index and 24-hour urinary albumin excretion rate (UAER) and creatinine clearance. DESIGN Cross-sectional study. SETTING Patients presenting to a state hospital. PATIENTS Study involved patients with type 2 diabetes. METHODS Study participants underwent medical history examination, measurement of office blood pressure (BP), measurement of anthropometric factors and calculations (including BMI, WC, waist-to-hip ratio, and conicity index), physical examination, biochemical analysis, and 24-hour urine specimen collection to determine creatinine clearance and UAER. RESULTS In all, 202 patients with type 2 diabetes (male/female: 91/111, aged: 58.4 ± 10.1 years) were included. It was found that 24-hour UAER correlated with WC (rho: +0.176, P = .012), serum albumin (rho: -0.324, P < .0001), and systolic BP (rho: +0.153, P = .029), whereas creatinine clearance correlated with age (rho: -0.152, P = .031), BMI (rho: +0.191, P = .007), albumin level (rho: +0.365, P < .0001), and uric acid level (rho: -0.369, P < .0001). The stepwise linear regression analysis revealed that WC (P = .012), glycosylated hemoglobin (P = .018), and systolic BP (P = .043) were found to be independently related to logarithmically converted 24-hour UAER, whereas creatinine clearance was found to be related to duration of diabetes (P = .001), BMI (P = .008), presence of peripheral arterial disease (P = .021), fasting serum glucose level (P = .003), and uric acid level (P < .0001). However, after correction for body surface area, BMI was no longer associated with creatinine clearance. CONCLUSION Among the anthropometric parameters, only an increase in WC was found to be independently related to 24-hour UAER. Although BMI was associated with creatinine clearance, this association was lost after creatinine clearance was corrected for body surface area.
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Affiliation(s)
- Baris Afsar
- Department of Nephrology, Zonguldak Atatürk State Hospital, Turkey.
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Böger CA, Chen MH, Tin A, Olden M, Köttgen A, de Boer IH, Fuchsberger C, O'Seaghdha CM, Pattaro C, Teumer A, Liu CT, Glazer NL, Li M, O'Connell JR, Tanaka T, Peralta CA, Kutalik Z, Luan J, Zhao JH, Hwang SJ, Akylbekova E, Kramer H, van der Harst P, Smith AV, Lohman K, de Andrade M, Hayward C, Kollerits B, Tönjes A, Aspelund T, Ingelsson E, Eiriksdottir G, Launer LJ, Harris TB, Shuldiner AR, Mitchell BD, Arking DE, Franceschini N, Boerwinkle E, Egan J, Hernandez D, Reilly M, Townsend RR, Lumley T, Siscovick DS, Psaty BM, Kestenbaum B, Haritunians T, Bergmann S, Vollenweider P, Waeber G, Mooser V, Waterworth D, Johnson AD, Florez JC, Meigs JB, Lu X, Turner ST, Atkinson EJ, Leak TS, Aasarød K, Skorpen F, Syvänen AC, Illig T, Baumert J, Koenig W, Krämer BK, Devuyst O, Mychaleckyj JC, Minelli C, Bakker SJ, Kedenko L, Paulweber B, Coassin S, Endlich K, Kroemer HK, Biffar R, Stracke S, Völzke H, Stumvoll M, Mägi R, Campbell H, Vitart V, Hastie ND, Gudnason V, Kardia SL, Liu Y, Polasek O, Curhan G, Kronenberg F, Prokopenko I, Rudan I, Ärnlöv J, Hallan S, Navis G, Parsa A, Ferrucci L, Coresh J, Shlipak MG, Bull SB, Paterson AD, Wichmann HE, Wareham NJ, Loos RJ, Rotter JI, Pramstaller PP, Cupples LA, Beckmann JS, Yang Q, Heid IM, Rettig R, Dreisbach AW, Bochud M, Fox CS, Kao W. CUBN is a gene locus for albuminuria. J Am Soc Nephrol 2011; 22:555-70. [PMID: 21355061 PMCID: PMC3060449 DOI: 10.1681/asn.2010060598] [Citation(s) in RCA: 180] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2010] [Accepted: 10/19/2010] [Indexed: 11/03/2022] Open
Abstract
Identification of genetic risk factors for albuminuria may alter strategies for early prevention of CKD progression, particularly among patients with diabetes. Little is known about the influence of common genetic variants on albuminuria in both general and diabetic populations. We performed a meta-analysis of data from 63,153 individuals of European ancestry with genotype information from genome-wide association studies (CKDGen Consortium) and from a large candidate gene study (CARe Consortium) to identify susceptibility loci for the quantitative trait urinary albumin-to-creatinine ratio (UACR) and the clinical diagnosis microalbuminuria. We identified an association between a missense variant (I2984V) in the CUBN gene, which encodes cubilin, and both UACR (P = 1.1 × 10(-11)) and microalbuminuria (P = 0.001). We observed similar associations among 6981 African Americans in the CARe Consortium. The associations between this variant and both UACR and microalbuminuria were significant in individuals of European ancestry regardless of diabetes status. Finally, this variant associated with a 41% increased risk for the development of persistent microalbuminuria during 20 years of follow-up among 1304 participants with type 1 diabetes in the prospective DCCT/EDIC Study. In summary, we identified a missense CUBN variant that associates with levels of albuminuria in both the general population and in individuals with diabetes.
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Affiliation(s)
- Carsten A. Böger
- Department of Internal Medicine II, University Medical Center Regensburg, Regensburg, Germany
| | - Ming-Huei Chen
- Department of Neurology, Boston University School of Medicine, Boston, Massachusetts
| | - Adrienne Tin
- Department of Epidemiology and the Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, Maryland
| | - Matthias Olden
- Department of Internal Medicine II, University Medical Center Regensburg, Regensburg, Germany
- Department of Epidemiology and Preventive Medicine, Regensburg University Medical Center, Regensburg, Germany
| | - Anna Köttgen
- Department of Epidemiology and the Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, Maryland
- Renal Division, University Hospital of Freiburg, Freiburg, Germany
| | - Ian H. de Boer
- Division of Nephrology, University of Washington, Seattle, Washington
| | - Christian Fuchsberger
- Institute of Genetic Medicine, European Academy of Bolzano/Bozen (EURAC), Italy and Affiliated Institute of the University of Lübeck, Lübeck, Germany
| | - Conall M. O'Seaghdha
- Division of Nephrology, Brigham and Women's Hospital and Harvard Medical School, Boston Massachusetts
| | - Cristian Pattaro
- Institute of Genetic Medicine, European Academy of Bolzano/Bozen (EURAC), Italy and Affiliated Institute of the University of Lübeck, Lübeck, Germany
| | - Alexander Teumer
- Interfaculty Institute for Genetics and Functional Genomics, University of Greifswald, Greifswald, Germany
| | - Ching-Ti Liu
- Department of Biostatistics, Boston University School of Public Health and NHLBI's Framingham Heart Study, Boston Massachusetts
| | - Nicole L. Glazer
- Cardiovascular Health Research Unit and Department of Biostatistics, University of Washington, Seattle, Washington
| | - Man Li
- Department of Epidemiology and the Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, Maryland
| | | | - Toshiko Tanaka
- Medstar Research Institute, Baltimore, Maryland
- Clinical Research Branch, National Institute on Aging, Baltimore, Maryland
| | - Carmen A. Peralta
- Division of Nephrology, University of California, San Francisco Medical School and San Francisco VA Medical Center, San Francisco, California
| | - Zoltán Kutalik
- Department of Medical Genetics, University of Lausanne, Lausanne, Switzerland
- Swiss Institute of Bioinformatics, Lausanne, Switzerland
| | - Jian'an Luan
- MRC Epidemiology Unit, Institute of Metabolic Science, Addenbrooke's Hospital, Cambridge, United Kingdom
| | - Jing Hua Zhao
- MRC Epidemiology Unit, Institute of Metabolic Science, Addenbrooke's Hospital, Cambridge, United Kingdom
| | - Shih-Jen Hwang
- NHLBI's Framingham Heart Study and the Center for Population Studies, Framingham, Massachusetts
| | | | | | - Pim van der Harst
- Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Albert V. Smith
- University of Iceland, Reykjavik, Iceland
- Icelandic Heart Association, Hjartavernd, Holtasmara, Kopavogur, Iceland
| | - Kurt Lohman
- Department of Biostatistical Sciences, Wake Forest University, Division of Public Health Sciences, Winston-Salem, North Carolina
| | - Mariza de Andrade
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota
| | - Caroline Hayward
- MRC Human Genetics Unit, Institute of Genetics and Molecular Medicine, Western General Hospital, Crewe Road, Edinburgh, Scotland
| | - Barbara Kollerits
- Innsbruck Medical University, Division of Genetic Epidemiology, Innsbruck, Austria
| | - Anke Tönjes
- Department of Medicine, University of Leipzig, Leipzig, Germany
| | - Thor Aspelund
- University of Iceland, Reykjavik, Iceland
- Icelandic Heart Association, Hjartavernd, Holtasmara, Kopavogur, Iceland
| | - Erik Ingelsson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Gudny Eiriksdottir
- Icelandic Heart Association, Hjartavernd, Holtasmara, Kopavogur, Iceland
| | - Lenore J. Launer
- Laboratory of Epidemiology, Demography, and Biometry, NIA, Bethesda, Maryland
| | - Tamara B. Harris
- Laboratory of Epidemiology, Demography, and Biometry, NIA, Bethesda, Maryland
| | - Alan R. Shuldiner
- University of Maryland School of Medicine, Geriatric Research and Education Clinical Center, Veterans Administration Medical Center, Baltimore, Maryland
| | | | - Dan E. Arking
- McKusick-Nathans Institute of Genetic Medicine, Johns Hopkins Medical Institutions, Baltimore, Maryland
| | - Nora Franceschini
- University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Eric Boerwinkle
- Human Genetics Center, University of Texas Health Science Center, Houston, Texas
| | - Josephine Egan
- Laboratory of Clinical Investigation, National Institute on Aging, Baltimore, Maryland
| | - Dena Hernandez
- Laboratory of Neurogenetics, National Institute on Aging, Bethesda, Maryland
| | - Muredach Reilly
- University of Pennsylvania Division of Cardiology, Perelman Center for Advanced Medicine, Philadelphia, Pennsylvania
| | - Raymond R. Townsend
- University of Pennsylvania Renal Electrolyte and Hypertension Division, Philadelphia, Pennsylvania
| | - Thomas Lumley
- Cardiovascular Health Research Unit and Department of Biostatistics, University of Washington, Seattle, Washington
| | - David S. Siscovick
- Departments of Epidemiology and Medicine, University of Washington, Seattle, Washington
| | - Bruce M. Psaty
- Cardiovascular Health Research Unit, Departments of Medicine, Epidemiology, and Health Services and Group Health Research Institute, Group Health Cooperative, Seattle, Washington
| | - Bryan Kestenbaum
- Division of Nephrology, University of Washington, Seattle, Washington
| | - Talin Haritunians
- Medical Genetics Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | - Sven Bergmann
- Department of Medical Genetics, University of Lausanne, Lausanne, Switzerland
- Swiss Institute of Bioinformatics, Lausanne, Switzerland
| | - Peter Vollenweider
- Department of Internal Medicine, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Gerard Waeber
- Department of Internal Medicine, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Vincent Mooser
- Genetics Division, GlaxoSmithKline, King of Prussia, Pennsylvania
| | - Dawn Waterworth
- Genetics Division, GlaxoSmithKline, King of Prussia, Pennsylvania
| | - Andrew D. Johnson
- NHLBI's Framingham Heart Study and the Center for Population Studies, Framingham, Massachusetts
| | - Jose C. Florez
- Center for Human Genetic Research and Diabetes Research Center (Diabetes Unit), Massachusetts General Hospital, Boston, Massachusetts, Program in Medical and Population Genetics, Broad Institute, Cambridge, Massachussetts, and Department of Medicine, Harvard Medical School, Boston, Massachusetts
| | - James B. Meigs
- Department of General Internal Medicine, Massachussetts General Hospital, Boston, Massachusetts
| | - Xiaoning Lu
- Department of Biostatistics, Boston University School of Public Health and NHLBI's Framingham Heart Study, Boston Massachusetts
| | - Stephen T. Turner
- Department of Internal Medicine, Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota
| | - Elizabeth J. Atkinson
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota
| | - Tennille S. Leak
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Knut Aasarød
- St Olav University Hospital, Trondheim, Norway
- Faculty of Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Frank Skorpen
- Faculty of Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Ann-Christine Syvänen
- Molecular Medicine, Department of Medical Sciences, Science for Life Laboratory, Uppsala University, Uppsala, Sweden
| | - Thomas Illig
- Institute of Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany
| | - Jens Baumert
- Institute of Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany
| | - Wolfgang Koenig
- Zentrum für Innere Medizin, Klinik für Innere Medizin II - Kardiologie, Universitätsklinikum Ulm, Ulm, Germany
| | - Bernhard K. Krämer
- University Medical Centre Mannheim, 5th Department of Medicine, Mannheim, Germany
| | - Olivier Devuyst
- NEFR Unit Université Catholique de Louvain Medical School, Brussels, Belgium
| | | | - Cosetta Minelli
- Institute of Genetic Medicine, European Academy of Bolzano/Bozen (EURAC), Italy and Affiliated Institute of the University of Lübeck, Lübeck, Germany
| | - Stephan J.L. Bakker
- Department of Internal Medicine, University Medical Center, Groningen, University of Groningen, Groningen, The Netherlands
| | - Lyudmyla Kedenko
- First Department of Internal Medicine, Paracelsus Medical University, Salzburg, Austria
| | - Bernhard Paulweber
- First Department of Internal Medicine, Paracelsus Medical University, Salzburg, Austria
| | - Stefan Coassin
- Innsbruck Medical University, Division of Genetic Epidemiology, Innsbruck, Austria
| | - Karlhans Endlich
- Institute of Anatomy and Cell Biology, University of Greifswald, Greifswald, Germany
| | - Heyo K. Kroemer
- Institute of Pharmacology, University of Greifswald, Greifswald, Germany
| | - Reiner Biffar
- Clinic for Prosthodontic Dentistry, Gerostomatology and Material Science, University of Greifswald, Greifswald, Germany
| | - Sylvia Stracke
- Nephrology Clinic for Internal Medicine A, University of Greifswald, Greifswald, Germany
| | - Henry Völzke
- Institute for Community Medicine, University of Greifswald, Greifswald, Germany
| | | | - Reedik Mägi
- Wellcome Trust Centre for Human Genetics, and Oxford Centre for Diabetes, Endocrinology and Metabolism, University of Oxford, United Kingdom
| | - Harry Campbell
- Centre for Population Health Sciences, University of Edinburgh, Edinburgh, Scotland
| | - Veronique Vitart
- MRC Human Genetics Unit, Institute of Genetics and Molecular Medicine, Western General Hospital, Crewe Road, Edinburgh, Scotland
| | - Nicholas D. Hastie
- MRC Human Genetics Unit, Institute of Genetics and Molecular Medicine, Western General Hospital, Crewe Road, Edinburgh, Scotland
| | - Vilmundur Gudnason
- University of Iceland, Reykjavik, Iceland
- Icelandic Heart Association, Hjartavernd, Holtasmara, Kopavogur, Iceland
| | - Sharon L.R. Kardia
- University of Michigan School of Public Health, Department of Epidemiology, University of Michigan, Ann Arbor, Michigan
| | - Yongmei Liu
- Department of Biostatistical Sciences, Wake Forest University, Division of Public Health Sciences, Winston-Salem, North Carolina
| | | | - Gary Curhan
- Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Florian Kronenberg
- Innsbruck Medical University, Division of Genetic Epidemiology, Innsbruck, Austria
| | - Inga Prokopenko
- Wellcome Trust Centre for Human Genetics, and Oxford Centre for Diabetes, Endocrinology and Metabolism, University of Oxford, United Kingdom
| | - Igor Rudan
- Center for Population Health Sciences, University of Edinburgh Medical School, Edinburgh, Scotland
| | - Johan Ärnlöv
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Stein Hallan
- St Olav University Hospital, Trondheim, Norway
- Faculty of Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Gerjan Navis
- Department of Internal Medicine, University Medical Center, Groningen, University of Groningen, Groningen, The Netherlands
| | - the CKDGen Consortium
- Department of Internal Medicine II, University Medical Center Regensburg, Regensburg, Germany
- Department of Neurology, Boston University School of Medicine, Boston, Massachusetts
- Department of Epidemiology and the Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, Maryland
- Department of Epidemiology and Preventive Medicine, Regensburg University Medical Center, Regensburg, Germany
- Renal Division, University Hospital of Freiburg, Freiburg, Germany
- Division of Nephrology, University of Washington, Seattle, Washington
- Institute of Genetic Medicine, European Academy of Bolzano/Bozen (EURAC), Italy and Affiliated Institute of the University of Lübeck, Lübeck, Germany
- Division of Nephrology, Brigham and Women's Hospital and Harvard Medical School, Boston Massachusetts
- Interfaculty Institute for Genetics and Functional Genomics, University of Greifswald, Greifswald, Germany
- Department of Biostatistics, Boston University School of Public Health and NHLBI's Framingham Heart Study, Boston Massachusetts
- Cardiovascular Health Research Unit and Department of Biostatistics, University of Washington, Seattle, Washington
- University of Maryland School of Medicine, Baltimore, Maryland
- Medstar Research Institute, Baltimore, Maryland
- Clinical Research Branch, National Institute on Aging, Baltimore, Maryland
- Division of Nephrology, University of California, San Francisco Medical School and San Francisco VA Medical Center, San Francisco, California
- Department of Medical Genetics, University of Lausanne, Lausanne, Switzerland
- Swiss Institute of Bioinformatics, Lausanne, Switzerland
- MRC Epidemiology Unit, Institute of Metabolic Science, Addenbrooke's Hospital, Cambridge, United Kingdom
- NHLBI's Framingham Heart Study and the Center for Population Studies, Framingham, Massachusetts
- Jackson State University, Jackson, Mississippi
- Loyola University, Maywood, Illinois
- Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
- University of Iceland, Reykjavik, Iceland
- Icelandic Heart Association, Hjartavernd, Holtasmara, Kopavogur, Iceland
- Department of Biostatistical Sciences, Wake Forest University, Division of Public Health Sciences, Winston-Salem, North Carolina
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota
- MRC Human Genetics Unit, Institute of Genetics and Molecular Medicine, Western General Hospital, Crewe Road, Edinburgh, Scotland
- Innsbruck Medical University, Division of Genetic Epidemiology, Innsbruck, Austria
- Department of Medicine, University of Leipzig, Leipzig, Germany
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Laboratory of Epidemiology, Demography, and Biometry, NIA, Bethesda, Maryland
- University of Maryland School of Medicine, Geriatric Research and Education Clinical Center, Veterans Administration Medical Center, Baltimore, Maryland
- University of Maryland School of Medicine, Baltimore, Maryland
- McKusick-Nathans Institute of Genetic Medicine, Johns Hopkins Medical Institutions, Baltimore, Maryland
- University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
- Human Genetics Center, University of Texas Health Science Center, Houston, Texas
- Laboratory of Clinical Investigation, National Institute on Aging, Baltimore, Maryland
- Laboratory of Neurogenetics, National Institute on Aging, Bethesda, Maryland
- University of Pennsylvania Division of Cardiology, Perelman Center for Advanced Medicine, Philadelphia, Pennsylvania
- University of Pennsylvania Renal Electrolyte and Hypertension Division, Philadelphia, Pennsylvania
- Departments of Epidemiology and Medicine, University of Washington, Seattle, Washington
- Cardiovascular Health Research Unit, Departments of Medicine, Epidemiology, and Health Services and Group Health Research Institute, Group Health Cooperative, Seattle, Washington
- Medical Genetics Institute, Cedars-Sinai Medical Center, Los Angeles, California
- Department of Internal Medicine, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
- Genetics Division, GlaxoSmithKline, King of Prussia, Pennsylvania
- Center for Human Genetic Research and Diabetes Research Center (Diabetes Unit), Massachusetts General Hospital, Boston, Massachusetts, Program in Medical and Population Genetics, Broad Institute, Cambridge, Massachussetts, and Department of Medicine, Harvard Medical School, Boston, Massachusetts
- Department of General Internal Medicine, Massachussetts General Hospital, Boston, Massachusetts
- Department of Internal Medicine, Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
- St Olav University Hospital, Trondheim, Norway
- Faculty of Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- Molecular Medicine, Department of Medical Sciences, Science for Life Laboratory, Uppsala University, Uppsala, Sweden
- Institute of Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany
- Zentrum für Innere Medizin, Klinik für Innere Medizin II - Kardiologie, Universitätsklinikum Ulm, Ulm, Germany
- University Medical Centre Mannheim, 5th Department of Medicine, Mannheim, Germany
- NEFR Unit Université Catholique de Louvain Medical School, Brussels, Belgium
- Center for Public Health Genomics, Charlottesville, Virginia
- Department of Internal Medicine, University Medical Center, Groningen, University of Groningen, Groningen, The Netherlands
- First Department of Internal Medicine, Paracelsus Medical University, Salzburg, Austria
- Institute of Anatomy and Cell Biology, University of Greifswald, Greifswald, Germany
- Institute of Pharmacology, University of Greifswald, Greifswald, Germany
- Clinic for Prosthodontic Dentistry, Gerostomatology and Material Science, University of Greifswald, Greifswald, Germany
- Nephrology Clinic for Internal Medicine A, University of Greifswald, Greifswald, Germany
- Institute for Community Medicine, University of Greifswald, Greifswald, Germany
- Wellcome Trust Centre for Human Genetics, and Oxford Centre for Diabetes, Endocrinology and Metabolism, University of Oxford, United Kingdom
- Centre for Population Health Sciences, University of Edinburgh, Edinburgh, Scotland
- University of Michigan School of Public Health, Department of Epidemiology, University of Michigan, Ann Arbor, Michigan
- Gen-Info Ltd., Zagreb, Croatia
- Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
- Center for Population Health Sciences, University of Edinburgh Medical School, Edinburgh, Scotland
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
- University of Maryland School of Medicine, Baltimore, Maryland
- Welch Center for Prevention, Epidemiology & Clinical Research, Johns Hopkins University, Baltimore, Maryland
- General Internal Medicine, University of California, San Francisco, San Francisco, California
- Samuel Lunenfeld Research Institute of Mount Sinai Hospital, Prosserman Centre for Health Research, Toronto, Ontario, Canada
- The Hospital for Sick Children, Toronto, Ontario, Canada
- Institute of Medical Informatics, Biometry and Epidemiology, Ludwig-Maximilians-Universität, Munich, Germany
- Klinikum Grosshadern, Munich, Germany
- Service of Medical Genetics, Centre Hospitalier Universitaire Vaudois and University of Lausanne, Lausanne, Switzerland
- Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts
- Institute of Physiology, University of Greifswald, Greifswald, Germany
- University of Mississippi Division of Nephrology, University of Mississippi, Jackson, Mississippi
- University Institute of Social and Preventive Medicine, Centre Hospitalier Universitaire Vaudois and University of Lausanne, IUMSP, Lausanne, Switzerland; and
- Division of Endocrinology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Afshin Parsa
- University of Maryland School of Medicine, Baltimore, Maryland
| | - Luigi Ferrucci
- Clinical Research Branch, National Institute on Aging, Baltimore, Maryland
| | - Josef Coresh
- Welch Center for Prevention, Epidemiology & Clinical Research, Johns Hopkins University, Baltimore, Maryland
| | - Michael G. Shlipak
- General Internal Medicine, University of California, San Francisco, San Francisco, California
| | - Shelley B. Bull
- Samuel Lunenfeld Research Institute of Mount Sinai Hospital, Prosserman Centre for Health Research, Toronto, Ontario, Canada
| | | | - on behalf of DCCT/EDIC
- Department of Internal Medicine II, University Medical Center Regensburg, Regensburg, Germany
- Department of Neurology, Boston University School of Medicine, Boston, Massachusetts
- Department of Epidemiology and the Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, Maryland
- Department of Epidemiology and Preventive Medicine, Regensburg University Medical Center, Regensburg, Germany
- Renal Division, University Hospital of Freiburg, Freiburg, Germany
- Division of Nephrology, University of Washington, Seattle, Washington
- Institute of Genetic Medicine, European Academy of Bolzano/Bozen (EURAC), Italy and Affiliated Institute of the University of Lübeck, Lübeck, Germany
- Division of Nephrology, Brigham and Women's Hospital and Harvard Medical School, Boston Massachusetts
- Interfaculty Institute for Genetics and Functional Genomics, University of Greifswald, Greifswald, Germany
- Department of Biostatistics, Boston University School of Public Health and NHLBI's Framingham Heart Study, Boston Massachusetts
- Cardiovascular Health Research Unit and Department of Biostatistics, University of Washington, Seattle, Washington
- University of Maryland School of Medicine, Baltimore, Maryland
- Medstar Research Institute, Baltimore, Maryland
- Clinical Research Branch, National Institute on Aging, Baltimore, Maryland
- Division of Nephrology, University of California, San Francisco Medical School and San Francisco VA Medical Center, San Francisco, California
- Department of Medical Genetics, University of Lausanne, Lausanne, Switzerland
- Swiss Institute of Bioinformatics, Lausanne, Switzerland
- MRC Epidemiology Unit, Institute of Metabolic Science, Addenbrooke's Hospital, Cambridge, United Kingdom
- NHLBI's Framingham Heart Study and the Center for Population Studies, Framingham, Massachusetts
- Jackson State University, Jackson, Mississippi
- Loyola University, Maywood, Illinois
- Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
- University of Iceland, Reykjavik, Iceland
- Icelandic Heart Association, Hjartavernd, Holtasmara, Kopavogur, Iceland
- Department of Biostatistical Sciences, Wake Forest University, Division of Public Health Sciences, Winston-Salem, North Carolina
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota
- MRC Human Genetics Unit, Institute of Genetics and Molecular Medicine, Western General Hospital, Crewe Road, Edinburgh, Scotland
- Innsbruck Medical University, Division of Genetic Epidemiology, Innsbruck, Austria
- Department of Medicine, University of Leipzig, Leipzig, Germany
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Laboratory of Epidemiology, Demography, and Biometry, NIA, Bethesda, Maryland
- University of Maryland School of Medicine, Geriatric Research and Education Clinical Center, Veterans Administration Medical Center, Baltimore, Maryland
- University of Maryland School of Medicine, Baltimore, Maryland
- McKusick-Nathans Institute of Genetic Medicine, Johns Hopkins Medical Institutions, Baltimore, Maryland
- University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
- Human Genetics Center, University of Texas Health Science Center, Houston, Texas
- Laboratory of Clinical Investigation, National Institute on Aging, Baltimore, Maryland
- Laboratory of Neurogenetics, National Institute on Aging, Bethesda, Maryland
- University of Pennsylvania Division of Cardiology, Perelman Center for Advanced Medicine, Philadelphia, Pennsylvania
- University of Pennsylvania Renal Electrolyte and Hypertension Division, Philadelphia, Pennsylvania
- Departments of Epidemiology and Medicine, University of Washington, Seattle, Washington
- Cardiovascular Health Research Unit, Departments of Medicine, Epidemiology, and Health Services and Group Health Research Institute, Group Health Cooperative, Seattle, Washington
- Medical Genetics Institute, Cedars-Sinai Medical Center, Los Angeles, California
- Department of Internal Medicine, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
- Genetics Division, GlaxoSmithKline, King of Prussia, Pennsylvania
- Center for Human Genetic Research and Diabetes Research Center (Diabetes Unit), Massachusetts General Hospital, Boston, Massachusetts, Program in Medical and Population Genetics, Broad Institute, Cambridge, Massachussetts, and Department of Medicine, Harvard Medical School, Boston, Massachusetts
- Department of General Internal Medicine, Massachussetts General Hospital, Boston, Massachusetts
- Department of Internal Medicine, Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
- St Olav University Hospital, Trondheim, Norway
- Faculty of Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- Molecular Medicine, Department of Medical Sciences, Science for Life Laboratory, Uppsala University, Uppsala, Sweden
- Institute of Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany
- Zentrum für Innere Medizin, Klinik für Innere Medizin II - Kardiologie, Universitätsklinikum Ulm, Ulm, Germany
- University Medical Centre Mannheim, 5th Department of Medicine, Mannheim, Germany
- NEFR Unit Université Catholique de Louvain Medical School, Brussels, Belgium
- Center for Public Health Genomics, Charlottesville, Virginia
- Department of Internal Medicine, University Medical Center, Groningen, University of Groningen, Groningen, The Netherlands
- First Department of Internal Medicine, Paracelsus Medical University, Salzburg, Austria
- Institute of Anatomy and Cell Biology, University of Greifswald, Greifswald, Germany
- Institute of Pharmacology, University of Greifswald, Greifswald, Germany
- Clinic for Prosthodontic Dentistry, Gerostomatology and Material Science, University of Greifswald, Greifswald, Germany
- Nephrology Clinic for Internal Medicine A, University of Greifswald, Greifswald, Germany
- Institute for Community Medicine, University of Greifswald, Greifswald, Germany
- Wellcome Trust Centre for Human Genetics, and Oxford Centre for Diabetes, Endocrinology and Metabolism, University of Oxford, United Kingdom
- Centre for Population Health Sciences, University of Edinburgh, Edinburgh, Scotland
- University of Michigan School of Public Health, Department of Epidemiology, University of Michigan, Ann Arbor, Michigan
- Gen-Info Ltd., Zagreb, Croatia
- Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
- Center for Population Health Sciences, University of Edinburgh Medical School, Edinburgh, Scotland
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
- University of Maryland School of Medicine, Baltimore, Maryland
- Welch Center for Prevention, Epidemiology & Clinical Research, Johns Hopkins University, Baltimore, Maryland
- General Internal Medicine, University of California, San Francisco, San Francisco, California
- Samuel Lunenfeld Research Institute of Mount Sinai Hospital, Prosserman Centre for Health Research, Toronto, Ontario, Canada
- The Hospital for Sick Children, Toronto, Ontario, Canada
- Institute of Medical Informatics, Biometry and Epidemiology, Ludwig-Maximilians-Universität, Munich, Germany
- Klinikum Grosshadern, Munich, Germany
- Service of Medical Genetics, Centre Hospitalier Universitaire Vaudois and University of Lausanne, Lausanne, Switzerland
- Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts
- Institute of Physiology, University of Greifswald, Greifswald, Germany
- University of Mississippi Division of Nephrology, University of Mississippi, Jackson, Mississippi
- University Institute of Social and Preventive Medicine, Centre Hospitalier Universitaire Vaudois and University of Lausanne, IUMSP, Lausanne, Switzerland; and
- Division of Endocrinology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - H.-Erich Wichmann
- Institute of Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany
- Institute of Medical Informatics, Biometry and Epidemiology, Ludwig-Maximilians-Universität, Munich, Germany
- Klinikum Grosshadern, Munich, Germany
| | - Nicholas J. Wareham
- MRC Epidemiology Unit, Institute of Metabolic Science, Addenbrooke's Hospital, Cambridge, United Kingdom
| | - Ruth J.F. Loos
- MRC Epidemiology Unit, Institute of Metabolic Science, Addenbrooke's Hospital, Cambridge, United Kingdom
| | - Jerome I. Rotter
- Medical Genetics Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | - Peter P. Pramstaller
- Institute of Genetic Medicine, European Academy of Bolzano/Bozen (EURAC), Italy and Affiliated Institute of the University of Lübeck, Lübeck, Germany
| | - L. Adrienne Cupples
- Department of Biostatistics, Boston University School of Public Health and NHLBI's Framingham Heart Study, Boston Massachusetts
| | - Jacques S. Beckmann
- Service of Medical Genetics, Centre Hospitalier Universitaire Vaudois and University of Lausanne, Lausanne, Switzerland
| | - Qiong Yang
- Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts
| | - Iris M. Heid
- Department of Epidemiology and Preventive Medicine, Regensburg University Medical Center, Regensburg, Germany
- Institute of Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany
| | - Rainer Rettig
- Institute of Physiology, University of Greifswald, Greifswald, Germany
| | - Albert W. Dreisbach
- University of Mississippi Division of Nephrology, University of Mississippi, Jackson, Mississippi
| | - Murielle Bochud
- University Institute of Social and Preventive Medicine, Centre Hospitalier Universitaire Vaudois and University of Lausanne, IUMSP, Lausanne, Switzerland; and
| | - Caroline S. Fox
- NHLBI's Framingham Heart Study and the Center for Population Studies, Framingham, Massachusetts
- Division of Endocrinology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - W.H.L. Kao
- Department of Epidemiology and the Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, Maryland
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Muller DN, Kvakan H, Luft FC. Immune-related effects in hypertension and target-organ damage. Curr Opin Nephrol Hypertens 2011; 20:113-7. [PMID: 21245763 DOI: 10.1097/mnh.0b013e3283436f88] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
PURPOSE OF REVIEW Several studies published in the past three decades have suggested that inflammation and activation of immunity are central features in the pathogenesis of atherosclerosis, ischemic myocardial injury, and also in hypertension-induced target organ damage. A better understanding of this field could help us to explain the increased cardiovascular risk in patients with chronic inflammation. RECENT FINDINGS Recent studies have demonstrated that macrophages and various T-cell subtypes play a pivotal role in the regulation of blood pressure and target organ damage. Hypertensive stimuli such as the effector molecule of the renin-angiotensin system, angiotensin II, not only regulate vascular tone and sodium balance, but also activate immune cells and promote cell infiltration into target organs. Experimental and clinical evidence show that adaptive transfer of immune cells, rendering mice deficient for a certain subset of immune cells, or immunosuppressive treatment affects blood pressure and ameliorates target organ damage. SUMMARY The aim of this review is to summarize and discuss some of the more recent insights as to how immune cells might affect the regulation of blood pressure and the pathogenesis of hypertension-induced target organ damage.
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Affiliation(s)
- Dominik N Muller
- Max-Delbrück Center for Molecular Medicine, Lindenberger Weg 80, Berlin, Germany.
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40
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Oliveras A, Armario P, Martell-Clarós N, Ruilope LM, de la Sierra A. Urinary albumin excretion is associated with nocturnal systolic blood pressure in resistant hypertensives. Hypertension 2011; 57:556-60. [PMID: 21220713 DOI: 10.1161/hypertensionaha.110.165563] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Microalbuminuria is a known marker of subclinical organ damage. Its prevalence is higher in patients with resistant hypertension than in subjects with blood pressure at goal. On the other hand, some patients with apparently well-controlled hypertension still have microalbuminuria. The current study aimed to determine the relationship between microalbuminuria and both office and 24-hour ambulatory blood pressure. A cohort of 356 patients (mean age 64 ± 11 years; 40.2% females) with resistant hypertension (blood pressure ≥ 140 and/or 90 mm Hg despite treatment with ≥ 3 drugs, diuretic included) were selected from Spanish hypertension units. Patients with estimated glomerular filtration rate <30 mL/min/1.73 m(2) were excluded. All patients underwent clinical and demographic evaluation, complete laboratory analyses, and good technical-quality 24-hour ambulatory blood pressure monitoring. Urinary albumin/creatinine ratio was averaged from 3 first-morning void urine samples. Microalbuminuria (urinary albumin/creatinine ratio ≥ 2.5 mg/mmol in males or ≥ 3.5 mg/mmol in females) was detected in 46.6%, and impaired renal function (estimated glomerular filtration rate <60 mL/min/1.73 m(2)) was detected in 26.8%. Bivariate analyses showed significant associations of microalbuminuria with older age, reduced estimated glomerular filtration rate, increased nighttime systolic blood pressure, and elevated daytime, nighttime, and 24-hour diastolic blood pressure. In a logistic regression analysis, after age and sex adjustment, elevated nighttime systolic blood pressure (multivariate odds ratio, 1.014 [95% CI, 1.001 to 1.026]; P=0.029) and reduced estimated glomerular filtration rate (multivariate odds ratio, 2.79 [95% CI, 1.57 to 4.96]; P=0.0005) were independently associated with the presence of microalbuminuria. We conclude that microalbuminuria is better associated with increased nighttime systolic blood pressure than with any other office and 24-hour ambulatory blood pressure monitoring parameters.
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Affiliation(s)
- Anna Oliveras
- Hypertension Unit, Nephrology Department, Hospital Universitari del Mar, Passeig Marítim 25-29, 08003 Barcelona, Spain.
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41
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Renin inhibition and microalbuminuria development: meaningful predictor of kidney disease progression. Curr Opin Nephrol Hypertens 2010; 19:437-43. [PMID: 20644476 DOI: 10.1097/mnh.0b013e32833d14c3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Microalbuminuria is an indicator of increased cardiovascular disease risk. Herein, we review microalbuminuria as a predictor of the onset and progression of renal disease in people with and without diabetes. We evaluate the data on the use of direct renin inhibitors (DRIs) for treatment of hypertension with microalbuminuria. RECENT FINDINGS It is known that DRIs have an antiproteinuric effect, whether used alone or with an angiotensin receptor blocker (ARB), independent of its hypotensive effects in patients with type 2 diabetes. A current study will determine if adding the DRI aliskiren to an angiotensin-converting enzyme inhibitor (ACEi) or an ARB will reduce cardiovascular and renal risk in patients with type 2 diabetes. SUMMARY DRIs are the latest addition to the class of renin-angiotensin-aldosterone system (RAAS) inhibitors available for patients with hypertension and kidney disease. Whether these drugs can improve upon the reduction of cardiovascular and renal risk with an ACEi or an ARB is unknown. Microalbuminuria is a surrogate marker for both cardiovascular and possibly renal endpoints. However, an ongoing issue is that the majority of patients with microalbuminuria will die of cardiovascular events before the onset of end-stage renal disease, limiting the value of using longitudinal measures of microalbuminuria progression as a measure of therapeutic benefit with newer RAAS-blocking drugs such as DRIs.
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Ferrario CM, Smith RD. Role of olmesartan in combination therapy in blood pressure control and vascular function. Vasc Health Risk Manag 2010; 6:701-9. [PMID: 20859541 PMCID: PMC2941783 DOI: 10.2147/vhrm.s6663] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2010] [Indexed: 12/23/2022] Open
Abstract
Angiotensin receptor blockers have emerged as a first-line therapy in the management of hypertension and hypertension-related comorbidities. Since national and international guidelines have stressed the need to control blood pressure to <140/90 mmHg in uncomplicated hypertension and <130/80 mmHg in those with associated comorbidities such as diabetes or chronic kidney disease, these goal blood pressures can only be achieved through combination therapy. Of several drugs that can be effectively combined to attain the recommended blood pressure goals, fixed-dose combinations of angiotensin receptor blockers and the calcium channel blocker amlodipine provide additive antihypertensive effects associated with a safe profile and increased adherence to therapy. In this article, we review the evidence regarding the beneficial effects of renin–angiotensin system blockade with olmesartan medoxomil and amlodipine in terms of blood pressure control and improvement of vascular function and target organ damage.
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Affiliation(s)
- Carlos M Ferrario
- Wake Forest University School of Medicine, Winston-Salem, North Carolina 27157, USA.
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