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Wan R, Zhou J, Mao R, Zheng Y, Zhou F, Pan L, Hong Y, Jin L, Li S, Zhu C. Methylglyoxal induces endothelial cell apoptosis and coronary microvascular dysfunction through regulating AR-cPLA 2 signaling. Biochim Biophys Acta Mol Basis Dis 2024:167437. [PMID: 39067539 DOI: 10.1016/j.bbadis.2024.167437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2023] [Revised: 07/17/2024] [Accepted: 07/17/2024] [Indexed: 07/30/2024]
Abstract
OBJECTIVE Since diabetic patients with coronary microvascular dysfunction (CMD) exhibit high cardiac mortality and women have higher prevalence of non-obstructive coronary artery disease than men, we tried to expand the limited understanding about the etiology and the sex difference of diabetic CMD. APPROACH AND RESULTS Accumulated methylglyoxal (MGO) due to diabetes promotes vascular damage and it was used for mimicking diabetic status. Flow cytometry analysis and isometric tension measurement were performed to evaluate coronary artery endothelial injury. MGO induced apoptosis of coronary endothelial cells, accompanied by downregulation of androgen receptor (AR). Lentivirus-mediated stable expression of AR in coronary endothelial cells increased anti-apoptotic Bcl-2 expression and attenuated MGO-induced cell apoptosis. cPLA2 activation was the downstream of AR downregulation by MGO treatment. Moreover, MGO also activated cPLA2 rapidly to impair endothelium-dependent vasodilation of coronary arteries from mice. Reactive oxygen species (ROS) overproduction was demonstrated to account for MGO-mediated cPLA2 activation and endothelial dysfunction. Importantly, AR blockade increased endothelial ROS production whereas AR activation protected coronary artery endothelial vasodilatory function from the MGO-induced injury. Although galectin-3 upregulation was confirmed by siRNA knockdown in endothelial cells not to participate in MGO-induced endothelial apoptosis, pharmacological inhibitor of galectin-3 further enhanced MGO-triggered ROS generation and coronary artery endothelial impairment. CONCLUSIONS Our data proposed the AR downregulation-ROS overproduction-cPLA2 activation pathway as one of the mechanisms underlying diabetic CMD and postulated a possible reason for the sex difference of CMD-related angina. Meanwhile, MGO-induced galectin-3 activation played a compensatory role against coronary endothelial dysfunction.
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Affiliation(s)
- Rong Wan
- Department of Pharmacology, School of Basic Medical Sciences, Nanjing Medical University, Nanjing 211166, China; Jiangxi Key Laboratory of Molecular Medicine, the Second Affiliated Hospital of Nanchang University, Nanchang 330006, China
| | - Jun Zhou
- Department of Pharmacology, School of Basic Medical Sciences, Nanjing Medical University, Nanjing 211166, China; Department of Clinical Pharmacy, Jinling Hospital, Affiliated Hospital of Medical School, State Key Laboratory of Analytical Chemistry for Life Science & Jiangsu Key Laboratory of Molecular Medicine, Nanjing University, Nanjing 210002, China
| | - Rongchen Mao
- Department of Pharmacology, School of Basic Medical Sciences, Nanjing Medical University, Nanjing 211166, China
| | - Yuhan Zheng
- Department of Pharmacology, School of Basic Medical Sciences, Nanjing Medical University, Nanjing 211166, China
| | - Feier Zhou
- Department of Pharmacology, School of Basic Medical Sciences, Nanjing Medical University, Nanjing 211166, China
| | - Lihua Pan
- Department of Pharmacology, School of Basic Medical Sciences, Nanjing Medical University, Nanjing 211166, China
| | - Yali Hong
- Department of Pharmacology, School of Basic Medical Sciences, Nanjing Medical University, Nanjing 211166, China
| | - Lai Jin
- Department of Pharmacology, School of Basic Medical Sciences, Nanjing Medical University, Nanjing 211166, China
| | - Shengnan Li
- Department of Pharmacology, School of Basic Medical Sciences, Nanjing Medical University, Nanjing 211166, China
| | - Chao Zhu
- Department of Pharmacology, School of Basic Medical Sciences, Nanjing Medical University, Nanjing 211166, China.
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Loeffler I, Ziller N. Sex-Related Aspects in Diabetic Kidney Disease-An Update. J Clin Med 2023; 12:jcm12082834. [PMID: 37109170 PMCID: PMC10145498 DOI: 10.3390/jcm12082834] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 04/05/2023] [Accepted: 04/12/2023] [Indexed: 04/29/2023] Open
Abstract
Differences between the sexes exist in many diseases, and in most cases, being a specific sex is considered a risk factor in the development and/or progression. This is not quite so clear in diabetic kidney disease (DKD), the development and severity of which depends on many general factors, such as the duration of diabetes mellitus, glycemic control, and biological risk factors. Similarly, sex-specific factors, such as puberty or andro-/menopause, also determine the microvascular complications in both the male and female sex. In particular, the fact that diabetes mellitus itself influences sex hormone levels, which in turn seem to be involved in renal pathophysiology, highlights the complexity of the question of sex differences in DKD. The major objective of this review is to summarize and simplify the current knowledge on biological sex-related aspects in the development/progression but also treatment strategies of human DKD. It also highlights findings from basic preclinical research that may provide explanations for these differences.
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Affiliation(s)
- Ivonne Loeffler
- Department of Internal Medicine III, Jena University Hospital, Friedrich Schiller University, 07747 Jena, Germany
| | - Nadja Ziller
- Department of Internal Medicine III, Jena University Hospital, Friedrich Schiller University, 07747 Jena, Germany
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Pancreas Transplantation in Minorities including Patients with a Type 2 Diabetes Phenotype. URO 2022. [DOI: 10.3390/uro2040026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background: Prior to year 2000, the majority of pancreas transplants (PTx) were performed as simultaneous pancreas-kidney transplants (SPKTs) in Caucasian adults with end stage renal failure secondary to type 1 diabetes mellitus (T1DM) who were middle-aged. In the new millennium, improving outcomes have led to expanded recipient selection that includes patients with a type 2 diabetes mellitus (T2DM) phenotype, which excessively affects minority populations. Methods: Using PubMed® to identify appropriate citations, we performed a literature review of PTx in minorities and in patients with a T2DM phenotype. Results: Mid-term outcomes with SPKT in patients with uremia and circulating C-peptide levels (T2DMphenotype) are comparable to those patients with T1DM although there may exist a selection bias in the former group. Excellent outcomes with SPKT suggests that the pathophysiology of T2DM is heterogeneous with elements consisting of both insulin deficiency and resistance related to beta-cell failure. As a result, increasing endogenous insulin (Cp) production following PTx may lead to freedom checking blood sugars or taking insulin, better metabolic counter-regulation, and improvements in quality of life and life expectancy compared to other available treatment options. Experience with solitary PTx for T2DM or in minorities is limited but largely mirrors the trends reported in SPKT. Conclusions: PTx is a viable treatment option in patients with pancreas endocrine failure who are selected appropriately regardless of diabetes type or recipient race. This review will summarize data that unconventional patient populations with insulin-requiring diabetes may gain value from PTx with an emphasis on contemporary experiences and appropriate selection in minorities in the new millennium.
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Rogers J, Jay CL, Farney AC, Orlando G, Jacobs ML, Harriman D, Gurram V, Sharda B, Gurung K, Reeves‐Daniel A, Doares W, Kaczmorski S, Mena‐Gutierrez A, Sakhovskaya N, Gautreaux MD, Stratta RJ. Simultaneous pancreas‐kidney transplantation in Caucasian versus African American patients: Does recipient race influence outcomes? Clin Transplant 2022; 36:e14599. [PMID: 35044001 PMCID: PMC9285604 DOI: 10.1111/ctr.14599] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 01/11/2022] [Accepted: 01/12/2022] [Indexed: 11/30/2022]
Abstract
The influence of African American (AA) recipient race on outcomes following simultaneous pancreas‐kidney transplantation (SPKT) is uncertain.
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Affiliation(s)
- Jeffrey Rogers
- Department of Surgery Section of Transplantation Atrium Health Wake Forest Baptist Winston‐Salem NC United States
| | - Colleen L. Jay
- Department of Surgery Section of Transplantation Atrium Health Wake Forest Baptist Winston‐Salem NC United States
| | - Alan C. Farney
- Department of Surgery Section of Transplantation Atrium Health Wake Forest Baptist Winston‐Salem NC United States
| | - Giuseppe Orlando
- Department of Surgery Section of Transplantation Atrium Health Wake Forest Baptist Winston‐Salem NC United States
| | - Marie L. Jacobs
- Department of Surgery Section of Transplantation Atrium Health Wake Forest Baptist Winston‐Salem NC United States
| | - David Harriman
- Department of Surgery Section of Transplantation Atrium Health Wake Forest Baptist Winston‐Salem NC United States
| | - Venkat Gurram
- Department of Surgery Section of Transplantation Atrium Health Wake Forest Baptist Winston‐Salem NC United States
| | - Berjesh Sharda
- Department of Surgery Section of Transplantation Atrium Health Wake Forest Baptist Winston‐Salem NC United States
| | - Komal Gurung
- Department of Surgery Section of Transplantation Atrium Health Wake Forest Baptist Winston‐Salem NC United States
| | - Amber Reeves‐Daniel
- Department of Surgery Section of Transplantation Atrium Health Wake Forest Baptist Winston‐Salem NC United States
| | - William Doares
- Department of Surgery Section of Transplantation Atrium Health Wake Forest Baptist Winston‐Salem NC United States
| | - Scott Kaczmorski
- Department of Surgery Section of Transplantation Atrium Health Wake Forest Baptist Winston‐Salem NC United States
| | - Alejandra Mena‐Gutierrez
- Department of Surgery Section of Transplantation Atrium Health Wake Forest Baptist Winston‐Salem NC United States
| | - Natalia Sakhovskaya
- Department of Surgery Section of Transplantation Atrium Health Wake Forest Baptist Winston‐Salem NC United States
| | - Michael D. Gautreaux
- Department of Surgery Section of Transplantation Atrium Health Wake Forest Baptist Winston‐Salem NC United States
| | - Robert J. Stratta
- Department of Surgery Section of Transplantation Atrium Health Wake Forest Baptist Winston‐Salem NC United States
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Wang Y, Zhang J, Zhang J, Wu Y, Zhang R, Ren H, Cooper ME, Liu F. Sex Differences in Biopsy-Confirmed Diabetic Kidney Disease. Front Endocrinol (Lausanne) 2021; 12:670674. [PMID: 34393995 PMCID: PMC8360678 DOI: 10.3389/fendo.2021.670674] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 07/05/2021] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND To investigate the association between sex differences and end-stage kidney disease (ESKD) in patients with biopsy-confirmed diabetic kidney disease (DKD). METHOD We performed a retrospective cohort study. A total of 336 patients with biopsy-confirmed DKD who were followed up for at least 12 months were enrolled. Baseline clinical and pathological data at the time of biopsy were collected. ESKD was defined by an estimated glomerular filtration rate of <15 ml/min/1.73 m2 or initiation of renal replacement therapy. The association between sex differences and ESKD was assessed using the log-rank test and Cox regression. RESULT There were 239 (71%) male and 97 (29%) female patients in our cohort. Female patients had higher systolic blood pressure, total cholesterol and low-density lipoprotein cholesterol levels compared with male. There were a lower proportion of female patients in the very high risk grade according to the chronic kidney disease categories (37% of female vs. 44% of male). During a median follow-up time of 20 months, 101 (57.7%) male and 43 (44.3%) female entered into ESKD, with no significant difference by the log-rank test (P >0.05). Univariate [male: hazard ratio (HR) [95% confidence interval (CI)], 1.005, (0.702-1.439)] and multivariable ([male: HR (95%CI), 1.164, (0.675-2.007)]. Cox regression further showed that sex difference was not significantly associated with ESKD. CONCLUSION Female patients had the higher systolic blood pressure, total cholesterol, LDL-C, compared with male patients. However, there was no significant association observed between sex difference and ESKD in our study.
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Affiliation(s)
- Yiting Wang
- Division of Nephrology, West China Hospital of Sichuan University, Chengdu, China
| | - Jue Zhang
- Division of Nephrology, West China Hospital of Sichuan University, Chengdu, China
| | - Junlin Zhang
- Division of Nephrology, West China Hospital of Sichuan University, Chengdu, China
| | - Yucheng Wu
- Division of Nephrology, West China Hospital of Sichuan University, Chengdu, China
| | - Rui Zhang
- Division of Nephrology, West China Hospital of Sichuan University, Chengdu, China
| | - Honghong Ren
- Division of Nephrology, West China Hospital of Sichuan University, Chengdu, China
| | - Mark E. Cooper
- Department of Diabetes, Central Clinical School, Monash University, Melbourne, VIC, Australia
| | - Fang Liu
- Division of Nephrology, West China Hospital of Sichuan University, Chengdu, China
- *Correspondence: Fang Liu,
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Garvey SL, Khansari MM, Jiang X, Varma R, Shahidi M. Assessment of retinal vascular oxygenation and morphology at stages of diabetic retinopathy in African Americans. BMC Ophthalmol 2020; 20:295. [PMID: 32682412 PMCID: PMC7368779 DOI: 10.1186/s12886-020-01566-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Accepted: 07/10/2020] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Diabetic retinopathy (DR) is a microvascular complication of diabetes and a leading cause of blindness in working-age adults. The likelihood of visual impairment associated with DR is two-fold higher in the African-American (AA) compared to non-Hispanic white. Although alterations in retinal vessel oxygenation and morphology have been reported in DR, there is limited knowledge about these vascular changes in AA subjects. The purpose of the current study was to investigate alterations in retinal vascular oxygen saturation (SO2), vessel diameter (D) and tortuosity at severity stages of DR in AA subjects. METHODS A nested case-control study of 56 AA subjects was conducted. Right eyes were grouped as non-diabetic (ND) (N = 26), no clinical DR (NDR) (N = 19), or moderate/severe non-proliferative DR (NPDR) (N = 11). Imaging was performed using a commercially available scanning laser ophthalmoscope. Images were analyzed to determine retinal arterial and venous SO2 (SO2A and SO2V), diameter (DA and DV), and vessel tortuosity index (VTI) (VTIA and VTIV). RESULTS SO2V and DV were higher in NPDR compared to ND and NDR groups (P < 0.05). There were no significant differences in SO2A and DA among ND, NDR, and NPDR groups (P > 0.8). Maximum VTIA was higher in diabetics (NDR and NPDR) compared to non-diabetics (P < 0.03). There was no significant difference in maximum VTIV among the 3 groups (P = 0.5). CONCLUSIONS The findings advance our understanding of DR pathophysiology in the AA population and may propel identification of race-specific retinal vascular biomarkers for improved diagnosis and monitoring of DR.
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Affiliation(s)
- Sarah L Garvey
- College of Medicine, University of Illinois at Chicago, Chicago, IL, USA
| | - Maziyar M Khansari
- Department of Ophthalmology, University of Southern California, 1450 San Pablo Street, Los Angeles, California, 90033, USA
- Stevens Neuroimaging and Informatics Institute, University of Southern California, Los Angeles, CA, USA
| | - Xuejuan Jiang
- Department of Ophthalmology, University of Southern California, 1450 San Pablo Street, Los Angeles, California, 90033, USA
| | - Rohit Varma
- Southern California Eye Institute, CHA Hollywood Presbyterian Medical Center, Los Angeles, CA, USA
| | - Mahnaz Shahidi
- Department of Ophthalmology, University of Southern California, 1450 San Pablo Street, Los Angeles, California, 90033, USA.
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7
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Hu F, Zhang T. Study on Risk Factors of Diabetic Nephropathy in Obese Patients with Type 2 Diabetes Mellitus. Int J Gen Med 2020; 13:351-360. [PMID: 32753935 PMCID: PMC7352450 DOI: 10.2147/ijgm.s255858] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Accepted: 06/21/2020] [Indexed: 01/13/2023] Open
Abstract
PURPOSE The purpose of this study was to identify diabetic nephropathy risk factors in type 2 diabetes mellitus obese people based on community type 2 diabetes mellitus patients. PATIENTS AND METHODS In the community in Shanghai, we conduct a questionnaire, physical examination, and biochemical examination. The 406 patients included in the analysis were divided into two groups based on whether or not they had diabetic nephropathy. The influencing factors of type 2 diabetes mellitus obese patients were screened by the least absolute shrinkage and selection operator method, and then the influencing factors detected by the least absolute shrinkage and selection operator method were included in the binary logistic regression analysis, and the risk factors for diabetic nephropathy in obese people with type 2 diabetes mellitus were obtained. Finally, the nomogram and forest plot are used to visualize the binary logistic regression results, and the calibration plot and receiver-operating characteristic curve are used to verify the result. RESULTS The results showed that family history of diabetes (OR= 2.091, P= 0.002), disease course (OR=1.050, P= 0.007). hypertension (OR=1.768, P=0.042), hyperuricemia (OR=2.263, P=0.003), systolic blood pressure (OR=1.027, P<0.001), and glycosylated haemoglobin A1c (OR=1.358, P<0.001) were risk factors for diabetic nephropathy. CONCLUSION For obese patients with type 2 diabetes mellitus, they should pay attention to family history of diabetes, disease course and hyperuricemia. Hypertension should be concerned and strictly controlled. Systolic blood pressure and glycosylated haemoglobin A1c will help prolong the survival of diabetic nephropathy patients.
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Affiliation(s)
- Fan Hu
- School of Public Health, Shanghai University of Traditional Chinese Medicine, Shanghai, People’s Republic of China
| | - Taotao Zhang
- School of Public Health, Shanghai University of Traditional Chinese Medicine, Shanghai, People’s Republic of China
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8
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Singh SS, Roeters-van Lennep JE, Lemmers RFH, van Herpt TTW, Lieverse AG, Sijbrands EJG, van Hoek M. Sex difference in the incidence of microvascular complications in patients with type 2 diabetes mellitus: a prospective cohort study. Acta Diabetol 2020; 57:725-732. [PMID: 32025877 PMCID: PMC7220974 DOI: 10.1007/s00592-020-01489-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Accepted: 01/21/2020] [Indexed: 12/17/2022]
Abstract
AIMS Type 2 diabetes mellitus is a major cause of death and disability due to its long-term macro- and microvascular diseases. Although women with type 2 diabetes have more macrovascular diseases, it is unclear whether there are sex differences in the occurrence of microvascular disease. The aim of our study was to investigate sex differences in the incidence of microvascular complications in type 2 diabetes. METHODS Analyses were performed in the DiaGene study, a prospective cohort study for complications of type 2 diabetes, collected in the city of Eindhoven, the Netherlands (n = 1886, mean follow-up time = 6.93 years). Cox proportional hazard models adjusted for risk factors for complications (age, smoking, hypertension, dyslipidemia, HbA1c and duration of type 2 diabetes) were used to analyze the incidence of microvascular complications in men and women. RESULTS The incidence of microalbuminuria was significantly higher in men (HR microalbuminuria 1.64 [CI 1.21-2.24], p = 0.002). Additionally, men are more likely to develop two or three microvascular complications compared to women (OR 2.42 [CI 1.69-3.45], p < 0.001). CONCLUSIONS This study shows that men with type 2 diabetes are more likely to develop microvascular complications, especially microalbuminuria. Furthermore, men seem to have a higher chance of developing multiple microvascular complications. Our results highlight that men and women may not benefit to a similar extent from current treatment approaches to prevent diabetes-related microvascular diseases.
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Affiliation(s)
- Sunny S Singh
- Department of Internal Medicine, Erasmus MC - University Medical Center Rotterdam, Rotterdam, The Netherlands
- Department of Internal Medicine, Maxima Medical Center, Eindhoven, The Netherlands
| | | | - Roosmarijn F H Lemmers
- Department of Internal Medicine, Erasmus MC - University Medical Center Rotterdam, Rotterdam, The Netherlands
| | | | - Aloysius G Lieverse
- Department of Internal Medicine, Maxima Medical Center, Eindhoven, The Netherlands
| | - Eric J G Sijbrands
- Department of Internal Medicine, Erasmus MC - University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Mandy van Hoek
- Department of Internal Medicine, Erasmus MC - University Medical Center Rotterdam, Rotterdam, The Netherlands.
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Maric-Bilkan C. Sex Differences in Diabetic Kidney Disease. Mayo Clin Proc 2020; 95:587-599. [PMID: 32138885 DOI: 10.1016/j.mayocp.2019.08.026] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Revised: 08/21/2019] [Accepted: 08/30/2019] [Indexed: 12/14/2022]
Abstract
While the global prevalence of both type 1 and type 2 diabetes mellitus is similar in men and women, the consequences of diabetes on associated end-organ complications, including diabetic kidney disease appear to be more sex-specific. Particularly, women with diabetes have higher mortality rates for diabetes-related deaths, and higher prevalence of diabetic kidney disease risk factors such as hypertension, hyperglycemia, obesity, and dyslipidemia. However, the evidence for the impact of sex on diabetic kidney disease prevalence and disease progression is limited and inconsistent. Although most studies agree that the protective effect of the female sex against the development of kidney disease is diminished in the setting of diabetes, the reasons for this observation are unclear. Whether or not sex differences exist in the risk of diabetic kidney disease is also unclear, with studies reporting either higher risk in men, women, or no sex differences. Despite the remaining controversies, some of the factors that associate with sex differences in the risk of diabetic kidney disease are age at onset, and type and duration of diabetes. There is growing appreciation of the importance of sex hormones in the regulation of renal function, with estrogens generally considered to be renoprotective. Although some progress has been made towards better understanding of the mechanisms by which sex hormones play a role in the pathophysiology of diabetic kidney disease, the translational potential of this knowledge is still underappreciated. A better understanding of sex differences in diabetic kidney disease may provide basis for personalized and sex-specific treatment of diabetic kidney disease.
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Affiliation(s)
- Christine Maric-Bilkan
- Division of Kidney, Urology and Hematology, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD.
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Gerber C, Cai X, Lee J, Craven T, Scialla J, Souma N, Srivastava A, Mehta R, Paluch A, Hodakowski A, Frazier R, Carnethon MR, Wolf MS, Isakova T. Incidence and Progression of Chronic Kidney Disease in Black and White Individuals with Type 2 Diabetes. Clin J Am Soc Nephrol 2018; 13:884-892. [PMID: 29798889 PMCID: PMC5989671 DOI: 10.2215/cjn.11871017] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Accepted: 03/01/2018] [Indexed: 01/13/2023]
Abstract
BACKGROUND AND OBJECTIVES Type 2 diabetes and associated CKD disproportionately affect blacks. It is uncertain if racial disparities in type 2 diabetes-associated CKD are driven by biologic factors that influence propensity to CKD or by differences in type 2 diabetes care. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS We conducted a post hoc analysis of 1937 black and 6372 white participants of the Action to Control Cardiovascular Risk in Diabetes (ACCORD) trial to examine associations of black race with change in eGFR and risks of developing microalbuminuria, macroalbuminuria, incident CKD (eGFR<60 ml/min per 1.73m2, ≥25% decrease from baseline eGFR, and eGFR slope <-1.6 ml/min per 1.73 m2 per year), and kidney failure or serum creatinine >3.3 mg/dl. RESULTS During a median follow-up that ranged between 4.4 and 4.7 years, 278 black participants (58 per 1000 person-years) and 981 white participants (55 per 1000 person-years) developed microalbuminuria, 122 black participants (16 per 1000 person-years) and 374 white participants (14 per 1000 person-years) developed macroalbuminuria, 111 black participants (21 per 1000 person-years) and 499 white participants (28 per 1000 person-years) developed incident CKD, and 59 black participants (seven per 1000 person-years) and 178 white participants (six per 1000 person-years) developed kidney failure or serum creatinine >3.3 mg/dl. Compared with white participants, black participants had lower risks of incident CKD (hazard ratio, 0.73; 95% confidence intervals, 0.57 to 0.92). There were no significant differences by race in eGFR decline or in risks of microalbuminuria, macroalbuminuria, and kidney failure or of serum creatinine >3.3 mg/dl. CONCLUSIONS Black participants enrolled in a randomized controlled trial had lower rates of incident CKD compared with white participants. Rates of eGFR decline, microalbuminuria, macroalbuminuria, and kidney failure did not vary by race.
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Affiliation(s)
- Claire Gerber
- Center for Translational Metabolism and Health, Institute for Public Health and Medicine
- Division of Nephrology and Hypertension, Department of Medicine, and
| | - Xuan Cai
- Center for Translational Metabolism and Health, Institute for Public Health and Medicine
| | - Jungwha Lee
- Center for Translational Metabolism and Health, Institute for Public Health and Medicine
| | - Timothy Craven
- Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina; and
| | - Julia Scialla
- Division of Nephrology, Department of Medicine, Duke University Medical Center, Duke University, Durham, North Carolina
| | - Nao Souma
- Center for Translational Metabolism and Health, Institute for Public Health and Medicine
| | - Anand Srivastava
- Center for Translational Metabolism and Health, Institute for Public Health and Medicine
- Division of Nephrology and Hypertension, Department of Medicine, and
| | - Rupal Mehta
- Center for Translational Metabolism and Health, Institute for Public Health and Medicine
- Division of Nephrology and Hypertension, Department of Medicine, and
| | - Amanda Paluch
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Alexander Hodakowski
- Center for Translational Metabolism and Health, Institute for Public Health and Medicine
| | - Rebecca Frazier
- Division of Nephrology and Hypertension, Department of Medicine, and
| | - Mercedes R. Carnethon
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Myles Selig Wolf
- Division of Nephrology, Department of Medicine, Duke University Medical Center, Duke University, Durham, North Carolina
| | - Tamara Isakova
- Center for Translational Metabolism and Health, Institute for Public Health and Medicine
- Division of Nephrology and Hypertension, Department of Medicine, and
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11
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Sex differences in micro- and macro-vascular complications of diabetes mellitus. Clin Sci (Lond) 2017; 131:833-846. [PMID: 28424377 DOI: 10.1042/cs20160998] [Citation(s) in RCA: 116] [Impact Index Per Article: 16.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2016] [Revised: 01/24/2017] [Accepted: 01/25/2017] [Indexed: 12/14/2022]
Abstract
Vascular complications are a leading cause of morbidity and mortality in both men and women with type 1 (T1DM) or type 2 (T2DM) diabetes mellitus, however the prevalence, progression and pathophysiology of both microvascular (nephropathy, neuropathy and retinopathy) and macrovascular [coronary heart disease (CHD), myocardial infarction, peripheral arterial disease (PAD) and stroke] disease are different in the two sexes. In general, men appear to be at a higher risk for diabetic microvascular complications, while the consequences of macrovascular complications may be greater in women. Interestingly, in the absence of diabetes, women have a far lower risk of either micro- or macro-vascular disease compared with men for much of their lifespan. Thus, the presence of diabetes confers greater risk for vascular complications in women compared with men and some of the potential reasons, including contribution of sex hormones and sex-specific risk factors are discussed in this review. There is a growing body of evidence that sex hormones play an important role in the regulation of cardiovascular function. While estrogens are generally considered to be cardioprotective and androgens detrimental to cardiovascular health, recent findings challenge these assumptions and demonstrate diversity and complexity of sex hormone action on target tissues, especially in the setting of diabetes. While some progress has been made toward understanding the underlying mechanisms of sex differences in the pathophysiology of diabetic vascular complications, many questions and controversies remain. Future research leading to understanding of these mechanisms may contribute to personalized- and sex-specific treatment for diabetic micro- and macro-vascular disease.
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Migliore CL, Vorderstrasse A, Pan W, Melkus GD. Renal Disease Risk Factors Among Risk Groups Comprised of African American Women With Type 2 Diabetes: A Secondary Analysis. DIABETES EDUCATOR 2015. [PMID: 26202051 DOI: 10.1177/0145721715593814] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
PURPOSE The purpose of this study was to explore and describe the prevalence of renal disease risk factors and the categorization of renal disease risk groups among African American women with type 2 diabetes mellitus (T2DM) who participated in a self-management and coping skills training intervention. We also explored and described the change in renal disease risk factors within and between risk groups, determining if participation in a culturally relevant coping skills training intervention decreased renal disease risk. METHODS This study was a secondary analysis of data from a longitudinal intervention study and included all 109 African American women with T2DM from the primary intervention study. This study examined the prevalence of 4 renal disease risk factors among the women at baseline via descriptive statistics, used cluster analysis to divide the women into risk groups and categorize the risk groups, and also measured the change in risk factors over time among risk groups via mixed modeling. RESULTS A majority of the women had a hemoglobin A1C ≥7% (62.39%) and were obese (75.93%). The high-risk cluster displayed clinically significant declines in mean systolic blood pressure, triglycerides, and A1C in both the control and intervention groups, and the intervention was more effective in reducing triglycerides and A1C levels among high-risk participants than low-risk. Overall, the control, high-risk group exhibited the largest declines in systolic blood pressure, triglycerides, and A1C. CONCLUSIONS This study displays the importance of acknowledging African American women with type 2 diabetes mellitus (T2DM) at high risk for renal disease in health care settings, which is often overlooked, and realizing that renal disease risk reduction is obtainable.
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Affiliation(s)
- Casey L Migliore
- Duke University School of Nursing, Durham, North Carolina (Dr Migliore, Dr Vorderstrasse, Dr Pan)
| | - Allison Vorderstrasse
- Duke University School of Nursing, Durham, North Carolina (Dr Migliore, Dr Vorderstrasse, Dr Pan)
| | - Wei Pan
- Duke University School of Nursing, Durham, North Carolina (Dr Migliore, Dr Vorderstrasse, Dr Pan)
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Bruce MA, Griffith DM, Thorpe RJ. Stress and the kidney. Adv Chronic Kidney Dis 2015; 22:46-53. [PMID: 25573512 DOI: 10.1053/j.ackd.2014.06.008] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2014] [Revised: 06/19/2014] [Accepted: 06/30/2014] [Indexed: 12/30/2022]
Abstract
The prevalence of CKD has increased considerably over the past 2 decades. The rising rates of CKD have been attributed to known comorbidities such as diabetes, hypertension, and obesity; however, recent research has begun to explore the degree to which social, economic, and psychological factors have implications for the prevalence and progression of CKD, especially among high-risk populations such as African Americans. It has been suggested that stress can have implications for CKD, but this area of research has been largely unexplored. One contributing factor associated with the paucity of research on CKD is that many of the social, psychological, and environmental stressors cannot be recreated or simulated in a laboratory setting. Social science has established that stress can have implications for health, and we believe that stress is an important determinant of the development and progression of CKD. We draw heavily from the social scientific and social epidemiologic literature to present an intersectional conceptual frame specifying how stress can have implications for kidney disease, its progression, and its complications through multiple stressors and pathways.
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14
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Stanton RC. Clinical challenges in diagnosis and management of diabetic kidney disease. Am J Kidney Dis 2014; 63:S3-21. [PMID: 24461728 DOI: 10.1053/j.ajkd.2013.10.050] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2013] [Accepted: 10/08/2013] [Indexed: 12/11/2022]
Abstract
Diabetic kidney disease (DKD) is a major and increasing worldwide public health issue. There is a great need for implementing treatments that either prevent or significantly slow the progression of DKD. Although there have been significant improvements in management, the increasing numbers of patients with DKD illustrate that current management is not wholly adequate. The reasons for suboptimal management include the lack of early diagnosis, lack of aggressive interventions, and lack of understanding about which interventions are most successful. There are a number of challenges and controversies regarding the current management of patients with DKD. Understanding of these issues is needed in order to provide the best care to patients with DKD. This article describes some of the clinically important challenges associated with DKD: the current epidemiology and cost burden and the role of biopsy in the diagnosis of DKD. Treatment controversies regarding current pharmacologic and nonpharmacologic approaches are reviewed and recommendations based on the published literature are made.
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Affiliation(s)
- Robert C Stanton
- Kidney and Hypertension Division, Joslin Diabetes Center, Boston, MA.
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15
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Clements MA, Lind M, Raman S, Patton SR, Lipska KJ, Fridlington AG, Tang F, Jones PG, Wu Y, Spertus JA, Kosiborod M. Age at diagnosis predicts deterioration in glycaemic control among children and adolescents with type 1 diabetes. BMJ Open Diabetes Res Care 2014; 2:e000039. [PMID: 25452876 PMCID: PMC4212563 DOI: 10.1136/bmjdrc-2014-000039] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2014] [Revised: 08/23/2014] [Accepted: 09/02/2014] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Poor glycemic control early in the course of type 1 diabetes mellitus (T1DM) increases the risk for microvascular complications. However, predictors of deteriorating control after diagnosis have not been described, making it difficult to identify high-risk patients and proactively provide aggressive interventions. OBJECTIVE We examined whether diagnostic age, gender, and race were associated with deteriorating glycemic control during the first 5 years after diagnosis. PARTICIPANTS 2218 pediatric patients with T1DM. METHODS We conducted a longitudinal cohort study of pediatric patients with T1DM from the Midwest USA, 1993-2009, evaluating within-patient glycated hemoglobin (HbA1c) trajectories constructed from all available HbA1c values within 5 years of diagnosis. RESULTS 52.6% of patients were male; 86.1% were non-Hispanic Caucasian. The mean diagnostic age was 9.0±4.1 years. The mean number of HbA1c values/year/participant was 2.4±0.9. HbA1c trajectories differed markedly across age groups, with older patients experiencing greater deterioration than their younger counterparts (p<0.001). HbA1c trajectories, stratified by age, varied markedly by race (p for race×diagnostic age <0.001). Non-Hispanic African-American patients experienced higher initial HbA1c (8.7% vs 7.6% (71.6 vs 59.6 mmol/mol); p<0.001), and greater deterioration in HbA1c than non-Hispanic Caucasian patients across diagnostic ages (rise of 2.04% vs 0.99% per year (22.3 vs 10.8 mmol/mol/year); p<0.0001). CONCLUSIONS Older diagnostic age and black race are major risk factors for deterioration in glycemic control early in the course of T1DM. These findings can inform efforts to explore the reasons behind these differences and develop preventive interventions for high-risk patients.
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Affiliation(s)
- Mark A Clements
- Children's Mercy Hospitals and Clinics, Kansas City, Missouri, USA
- University of Missouri-Kansas City, Kansas City, Missouri, USA
- University of Kansas Medical Center, KansasCity, Kansas, USA
| | - Marcus Lind
- Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Sripriya Raman
- Children's Mercy Hospitals and Clinics, Kansas City, Missouri, USA
- University of Missouri-Kansas City, Kansas City, Missouri, USA
| | - Susana R Patton
- University of Kansas Medical Center, KansasCity, Kansas, USA
| | - Kasia J Lipska
- Yale University School of Medicine, New Haven, Connecticut, USA
| | - Amanda G Fridlington
- Children's Mercy Hospitals and Clinics, Kansas City, Missouri, USA
- University of Missouri-Kansas City, Kansas City, Missouri, USA
| | - Fengming Tang
- Saint Luke's Mid America Heart Institute, Kansas City, Missouri, USA
| | - Phil G Jones
- Saint Luke's Mid America Heart Institute, Kansas City, Missouri, USA
| | - Yue Wu
- Children's Mercy Hospitals and Clinics, Kansas City, Missouri, USA
| | - John A Spertus
- University of Missouri-Kansas City, Kansas City, Missouri, USA
- Saint Luke's Mid America Heart Institute, Kansas City, Missouri, USA
| | - Mikhail Kosiborod
- University of Missouri-Kansas City, Kansas City, Missouri, USA
- Saint Luke's Mid America Heart Institute, Kansas City, Missouri, USA
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16
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The TNF-alpha -308G/A polymorphism is associated with type 2 diabetes mellitus: an updated meta-analysis. Mol Biol Rep 2013; 41:73-83. [DOI: 10.1007/s11033-013-2839-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2012] [Accepted: 10/26/2013] [Indexed: 12/28/2022]
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Noble JA, Johnson J, Lane JA, Valdes AM. HLA class II genotyping of African American type 1 diabetic patients reveals associations unique to African haplotypes. Diabetes 2013; 62:3292-9. [PMID: 23801574 PMCID: PMC3749336 DOI: 10.2337/db13-0094] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
HLA genotyping was performed in African American type 1 diabetic patients (n = 772) and controls (n = 1,641) in the largest study of African Americans and type 1 diabetes reported to date. Cases were from Children's Hospital and Research Center Oakland and from existing collections (Type 1 Diabetes Genetics Consortium [T1DGC], Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications [DCCT/EDIC], and Genetics of Kidneys in Diabetes [GoKinD]). Controls were from the T1DGC and from newborn bloodspot cards. The diversity of HLA DRB1-DQA1-DQB1 haplotypes and genotypes is far greater than that found in Europeans and European Americans. Association analyses replicated many type 1 diabetes risk effects of European-derived haplotypes but also revealed novel effects for African-derived haplotypes. Notably, the African-specific "DR3" haplotype DRB1*03:02-DQA1*04:01-DQB1*04:02 is protective for type 1 diabetes, in contrast to the common and highly-susceptible DR3 DRB1*03:01-DQA1*05:01-DQB1*02:01. Both DRB1*07:01 and DRB1*13:03 haplotypes are predisposing when they include DQA1*03:01-DQB1*02:01g but are protective with DQA1*02:01-DQB1*02:01g. The heterozygous DR4/DR9 genotype, containing the African-derived "DR9" haplotype DRB1*09:01-DQA1*03:01-DQB1*02:01g, exhibits extremely high risk (odds ratio = 30.88), approaching that for DR3/DR4 in European populations. Disease risk assessment for African Americans differs greatly from risk assessment in European populations. This has profound implications on risk screening programs and underscores the need for high-resolution genotyping of multiple populations for the rational design of screening programs with tests that will fairly represent the population being screened.
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Affiliation(s)
- Janelle A Noble
- Children's Hospital Oakland Research Institute, Oakland, California, USA.
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18
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Serur D, Charlton M. Expanded Criteria Living Donors: How Far Can We Go? Prog Transplant 2012; 22:129-32; quiz 133. [DOI: 10.7182/pit2012244] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
In an effort to expand the deceased donor pool, transplant centers have accepted expanded criteria donors as appropriate for many of the patients in the deceased donor pool. Translating this into the living donor pool is more complex. One must consider not only the quality of the organ procured but the consequences that the nephrectomy might have on the living donors for the rest of their lives. This review examines the available data on higher risk donors and the appropriateness, or lack thereof, of accepting them as kidney donors.
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Affiliation(s)
- David Serur
- New York Presbyterian-Weill Cornell Kidney and Pancreas Transplant Program and The Rogosin Institute
| | - Marian Charlton
- New York Presbyterian-Weill Cornell Kidney and Pancreas Transplant Program and The Rogosin Institute
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19
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Murea M, Ma L, Freedman BI. Genetic and environmental factors associated with type 2 diabetes and diabetic vascular complications. Rev Diabet Stud 2012; 9:6-22. [PMID: 22972441 DOI: 10.1900/rds.2012.9.6] [Citation(s) in RCA: 216] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Faced with a global epidemic of type 2 diabetes (T2D), it is critical that researchers improve our understanding of the pathogenesis of T2D and related vascular complications. These findings may ultimately lead to novel treatment options for disease prevention or delaying progression. Two major paradigms jointly underlie the development of T2D and related coronary artery disease, diabetic nephropathy, and diabetic retinopathy. These paradigms include the genetic risk variants and behavioral/environmental factors. This article systematically reviews the literature supporting genetic determinants in the pathogenesis of T2D and diabetic vasculopathy, and the functional implications of these gene variants on the regulation of beta-cell function and glucose homeostasis. We update the discovery of diabetes and diabetic vasculopathy risk variants, and describe the genetic technologies that have uncovered them. Also, genomic linkage between obesity and T2D is discussed. There is a complementary role for behavioral and environmental factors modulating the genetic susceptibility and diabetes risk. Epidemiological and clinical data demonstrating the effects of behavioral and novel environmental exposures on disease expression are reviewed. Finally, a succinct overview of recent landmark clinical trials addressing glycemic control and its impact on rates of vascular complications is presented. It is expected that novel strategies to exploit the gene- and exposure-related underpinnings of T2D will soon result.
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Affiliation(s)
- Mariana Murea
- Department of Internal Medicine, Section on Nephrology, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA.
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20
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Luan FL, Kommareddi M, Cibrik DM, Samaniego M, Ojo AO. Influence of recipient race on the outcome of simultaneous pancreas and kidney transplantation. Am J Transplant 2010; 10:2074-81. [PMID: 20645942 DOI: 10.1111/j.1600-6143.2010.03211.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Racial differences on the outcome of simultaneous pancreas and kidney (SPK) transplantation have not been well studied. We compared mortality and graft survival of African Americans (AA) recipients to other racial/ethnic groups (non-AA) using the national data. We studied a total of 6585 adult SPK transplants performed in the United States between January 1, 2000 and December 31, 2007. We performed multivariate logistic regression analyses to determine risk factors associated with early graft failure and immune-mediated late graft loss. We used conditional Kaplan-Meier survival and multivariate Cox regression analyses to estimate late death-censored kidney and pancreas graft failure and death between the groups. Although there was no racial disparity in the first 90 days, AA patients had 38% and 47% higher risk for late death-censored kidney and pancreas graft failure, respectively (p = 0.006 and 0.001). AA patients were twice more likely to lose the kidney and pancreas graft due to rejection (OR 2.31 and 1.86, p = 0.002 and 0.008, respectively). Bladder pancreas drainage was associated with inferior patient survival (HR 1.42, 95% CI 1.15, 1.75, p = 0.001). In the era of modern immunosuppression, AA SPK transplant patients continue to have inferior graft outcome. Additional studies to explore the mechanisms of such racial disparity are warranted.
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Affiliation(s)
- F L Luan
- Division of Nephrology, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA.
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21
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Melancon JK, Kucirka LM, Boulware LE, Powe NR, Locke JE, Montgomery RA, Segev DL. Impact of Medicare coverage on disparities in access to simultaneous pancreas and kidney transplantation. Am J Transplant 2009; 9:2785-91. [PMID: 19845587 PMCID: PMC3644052 DOI: 10.1111/j.1600-6143.2009.02845.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
In the setting of disparities in access to simultaneous pancreas and kidney transplantation (SPKT), Medicare coverage for this procedure was initiated July 1999. The impact of this change has not yet been studied. A national cohort of 22 190 type 1 diabetic candidates aged 18-55 for kidney transplantation (KT) alone or SPKT was analyzed. Before Medicare coverage, 57% of Caucasian, 36% of African American and 38% of Hispanic type 1 diabetics were registered for SPKT versus KT alone. After Medicare coverage, these proportions increased to 68%, 45% and 43%, respectively. The overall increase in SPKT registration rate was 27% (95% CI 1.16-1.38). As expected, the increase was more substantial in patients with Medicare primary insurance than those with private insurance (Relative Rate 1.18, 95% CI 1.09-1.28). However, racial disparities were unaffected by this policy change (African American vs. Caucasian: 0.97, 95% CI 0.87-1.09; Hispanic vs. Caucasian: 0.94, 95% CI 0.78-1.05). Even after Medicare coverage, African Americans and Hispanics had almost 30% lower SPKT registration rates than their Caucasian counterparts (95% CI 0.66-0.79 and 0.59-0.80, respectively). Medicare coverage for SPKT succeeded in increasing access for patients with Medicare, but did not affect the substantial racial disparities in access to this procedure.
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Affiliation(s)
- J. K. Melancon
- Department of Surgery, Georgetown University, Washington, DC,Corresponding author: Joseph Keith Melancon,
| | - L. M. Kucirka
- Department of Surgery, Johns Hopkins School of Medicine, Baltimore, MD
| | - L. E. Boulware
- Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD,Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD
| | - N. R. Powe
- Department of Medicine, University of California, San Francisco, CA
| | - J. E. Locke
- Department of Surgery, Johns Hopkins School of Medicine, Baltimore, MD
| | - R. A. Montgomery
- Department of Surgery, Johns Hopkins School of Medicine, Baltimore, MD
| | - D. L. Segev
- Department of Surgery, Johns Hopkins School of Medicine, Baltimore, MD,Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD
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22
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Mayer-Davis EJ, Beyer J, Bell RA, Dabelea D, D'Agostino R, Imperatore G, Lawrence JM, Liese AD, Liu L, Marcovina S, Rodriguez B. Diabetes in African American youth: prevalence, incidence, and clinical characteristics: the SEARCH for Diabetes in Youth Study. Diabetes Care 2009; 32 Suppl 2:S112-22. [PMID: 19246576 PMCID: PMC2647692 DOI: 10.2337/dc09-s203] [Citation(s) in RCA: 128] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To report the prevalence and incidence of type 1 and type 2 diabetes among African American youth and to describe demographic, clinical, and behavioral characteristics. RESEARCH DESIGN AND METHODS Data from the SEARCH for Diabetes in Youth Study, a population-based, multicenter observational study of youth with clinically diagnosed diabetes aged 0-19 years, were used to estimate the prevalence for calendar year 2001 (692 cases) and incidence based on 748 African American case subjects diagnosed in 2002-2005. Characteristics of these youth were obtained during a research visit for 436 African American youth with type 1 diabetes and 212 African American youth with type 2 diabetes. RESULTS Among African American youth aged 0-9 years, prevalence (per 1,000) of type 1 diabetes was 0.57 (95% CI 0.47-0.69) and for those aged 10-19 years 2.04 (1.85-2.26). Among African American youth aged 0-9 years, annual type 1 diabetes incidence (per 100,000) was 15.7 (13.7-17.9) and for those aged 10-19 years 15.7 (13.8-17.8). A1C was >or=9.5% among 50% of youth with type 1 diabetes aged >or=15 years. Across age-groups and sex, 44.7% of African American youth with type 1 diabetes were overweight or obese. Among African American youth aged 10-19 years, prevalence (per 1,000) of type 2 diabetes was 1.06 (0.93-1.22) and annual incidence (per 100,000) was 19.0 (16.9-21.3). About 60% of African American youth with type 2 diabetes had an annual household income of <$25,000. Among those aged >or=15 years, 27.5% had an A1C >or=9.5%, 22.5% had high blood pressure, and, across subgroups of age and sex, >90% were overweight or obese. CONCLUSIONS Type 1 diabetes presents a serious burden among African American youth aged <10 years, and African American adolescents are impacted substantially by both type 1 and type 2 diabetes.
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Affiliation(s)
- Elizabeth J. Mayer-Davis
- Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Jennifer Beyer
- Department of Biostatistical Sciences, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Ronny A. Bell
- Department of Epidemiology and Prevention, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Dana Dabelea
- Department of Preventive Medicine and Biometrics, University of Colorado Denver, Denver, Colorado
| | - Ralph D'Agostino
- Department of Biostatistical Sciences, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Giuseppina Imperatore
- Division of Diabetes Translation, Centers for Disease Control and Prevention/National Center for Chronic Disease Prevention and Health Promotion, Atlanta, Georgia
| | - Jean M. Lawrence
- Department of Research and Evaluation, Kaiser Permanante Southern California, Pasadena, California
| | - Angela D. Liese
- Center for Research in Nutrition and Health Disparities and Department of Epidemiology and Biostatistics, University of South Carolina, Columbia, South Carolina
| | - Lenna Liu
- Child Health Institute, University of Washington, Seattle, Washington
| | | | - Beatriz Rodriguez
- Department of Geriatric Medicine, Pacific Health Research Institute, University of Hawaii at Manoa, Honolulu, Hawaii
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Abstract
The incidence and the rate of progression of nondiabetic renal disease is generally greater in men compared with age-matched women, suggesting that the female sex is protective and/or that the male sex is a risk factor for the development and progression of nondiabetic renal disease. In diabetes, even though the male sex still appears to be a risk factor, this relationship is not as strong as it is in nondiabetic renal disease. Experimental evidence suggests that both estrogens and androgens play an important role in the pathophysiology of renal disease. Thus one of the potential mechanisms for the absence of a clear sex difference in the setting of diabetes may be alterations in sex hormone levels. Indeed, studies suggest that diabetes is a state of an imbalance in sex hormone levels; however, whether these changes correlate with the decline in renal function associated with diabetes is unclear. Furthermore, diabetic renal disease rarely develops before puberty, and the onset of puberty accelerates microalbuminuria, supporting the idea of the involvement of sex hormones in the development and progression of the disease. However, other than a handful of experimental studies indicating that treatment with or removal of sex hormones alters the course of diabetic renal disease, very few studies have actually directly examined the correlation between sex hormones and the disease development and progression. Further studies are necessary to determine the precise contribution of sex hormones in the pathophysiology of diabetic renal disease to develop novel and potentially sex-specific therapeutic treatments.
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Affiliation(s)
- Christine Maric
- Univ. of Mississippi Medical Center, 2500 North State St., Jackson, MS, 39216, USA.
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24
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Abstract
BACKGROUND Across all ages, the incidence and rate of progression of most nondiabetic renal diseases are markedly higher in men compared with age-matched women. These observations suggest that female sex may be renoprotective. In the setting of diabetes, however, this female protection against the development and progression of renal disease is diminished. OBJECTIVE This review aimed to summarize our current understanding of sex differences in the development and progression of diabetic renal disease, and of the contribution of sex hormones, particularly estrogens, to the pathophysiology of this disease. We also attempted to answer why female sex does not protect the diabetic kidney. METHODS Using terms such as gender, sex, diabetes, diabetic nephropathy, estrogens, and sex hormones, the PubMed database was searched for English-language articles; targeted searches were conducted using terms such as gender/sex differences in diabetic renal disease. No restrictions were imposed on publication dates. RESULTS Although the existing data regarding the sex differences in the incidence and progression of diabetic renal disease are inconclusive, the undisputed fact is that women with either type 1 or type 2 diabetes mellitus exhibit a much higher incidence of renal disease compared with nondiabetic women. It is conceivable that the loss of female sex as a renoprotective factor in diabetes may be related to the abnormal regulation of sex hormone concentrations. Both clinical and experimental data suggest that diabetes may be associated with an imbalance in estradiol concentrations. Supplementation with 17beta-estradiol or administration of selective estrogen receptor modulators reduces the incidence of diabetes and attenuates the progression of diabetic renal disease. CONCLUSIONS Serum concentrations of ovarian hormones may provide a new means for predicting future risk of renal complications in diabetes. Exogenous steroid hormones may be an effective treatment for attenuating the progression of diabetic nephropathy.
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Gnudi L, Thomas SM, Viberti G. Mechanical forces in diabetic kidney disease: a trigger for impaired glucose metabolism. J Am Soc Nephrol 2007; 18:2226-32. [PMID: 17634438 DOI: 10.1681/asn.2006121362] [Citation(s) in RCA: 72] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Nephropathy is one of the major microvascular complications of diabetes, and both hemodynamic and metabolic stimuli participate in its development and progression toward ESRD. There is now a greater understanding of the molecular pathways that are activated by high glomerular capillary pressure and hyperglycemia and how they interplay to produce kidney pathology. The observation that overexpression of glucose transporter 1 (GLUT-1) in mesangial cells could induce a "diabetic cellular phenotype" has led to the postulation that the expression of GLUT-1 could be upregulated in glomeruli that are exposed to high pressure. This review suggests a mechanism by which mechanical forces may aggravate a metabolic insult by stimulating excessive cellular glucose uptake. Proposed is the existence of a self-maintaining cycle whereby a hemodynamic stimulus on glomerular cells induces GLUT-1 overexpression followed by greater glucose uptake and activation of intracellular glucose metabolic pathways, resulting in excess TGF-beta1 production. TGF-beta1 in turn, maintains overexpression of GLUT-1, perpetuating a signaling sequence that has, as its ultimate effect, increased extracellular matrix synthesis. This mechanical and metabolic coupling suggests a novel pathophysiologic mechanism of injury in the kidney in diabetes and possibly other glomerular diseases.
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Affiliation(s)
- Luigi Gnudi
- Cardiovascular Division, King's College London, Guy's Hospital, London SE1 9RT, UK.
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26
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Goyal A, Crook ED. Thiazolidinediones and progression of renal disease in patients with diabetes. J Investig Med 2006; 54:56-61. [PMID: 16472474 DOI: 10.2310/6650.2005.05034] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Thiazolidinediones (TZDs) are used in the treatment of type 2 diabetes mellitus (T2DM) and appear to have beneficial effects on markers of cardiovascular or renal risk that are independent of glycemic control. We examined the effects of TZDs on renal survival in a predominantly black population with T2DM. METHODS We performed a retrospective case-control study in patients with T2DM seen in our nephrology clinic in 2001 to 2002. Cases had T2DM and were on a TZD at presentation or for >or= 6 months over follow-up. Controls were matched for sex, age, duration of T2DM, and initial creatinine. Reaching end-stage renal disease (ESRD) was the primary end point. RESULTS From 387 records, 43 cases (34 blacks, 31 females) and 106 controls (96 blacks, 83 females) were identified. The baseline characteristics were similar for both groups. Both groups had moderate renal disease (estimated glomerular filtration rate approximately 40-45 mL/min). Cases had lower systolic blood pressure over follow-up (p=.02), but there was no difference in glycemic control or use of insulin. Renal survival was better among cases (age- and gender-adjusted odds ratio for reaching ESRD 0.17 [95% confidence interval 0.03-0.8]; p=.03). When adjusted for systolic blood pressure over follow-up, the tendency for improved renal survival in cases remained but was no longer significant. CONCLUSION We conclude that TZDs may protect against the progression of renal disease in T2DM. Prospective studies are required to determine the effects of TZDs on renal survival in T2DM.
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Affiliation(s)
- Abhijeet Goyal
- Department of Medicine, Wayne State University School of Medicine and the John.D.Dingell VA Medical Center, Detroit, MI, USA
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