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Santulli G, Visco V, Ciccarelli M, Ferrante MNV, De Masi P, Pansini A, Virtuoso N, Pirone A, Guerra G, Verri V, Macina G, Taurino A, Komici K, Mone P. Frail hypertensive older adults with prediabetes and chronic kidney disease: insights on organ damage and cognitive performance - preliminary results from the CARYATID study. Cardiovasc Diabetol 2024; 23:125. [PMID: 38600564 PMCID: PMC11007948 DOI: 10.1186/s12933-024-02218-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Accepted: 03/28/2024] [Indexed: 04/12/2024] Open
Abstract
BACKGROUND Hypertension and chronic kidney disease (CKD) pose significant public health challenges, sharing intertwined pathophysiological mechanisms. Prediabetes is recognized as a precursor to diabetes and is often accompanied by cardiovascular comorbidities such as hypertension, elevating the risk of pre-frailty and frailty. Albuminuria is a hallmark of organ damage in hypertension amplifying the risk of pre-frailty, frailty, and cognitive decline in older adults. We explored the association between albuminuria and cognitive impairment in frail older adults with prediabetes and CKD, assessing cognitive levels based on estimated glomerular filtration rate (eGFR). METHODS We conducted a study involving consecutive frail older patients with hypertension recruited from March 2021 to March 2023 at the ASL (local health unit of the Italian Ministry of Health) of Avellino, Italy, followed up after three months. Inclusion criteria comprised age over 65 years, prior diagnosis of hypertension without secondary causes, prediabetes, frailty status, Montreal Cognitive Assessment (MoCA) score < 26, and CKD with eGFR > 15 ml/min. RESULTS 237 patients completed the study. We examined the association between albuminuria and MoCA Score, revealing a significant inverse correlation (r: 0.8846; p < 0.0001). Subsequently, we compared MoCA Score based on eGFR, observing a significant difference (p < 0.0001). These findings were further supported by a multivariable regression analysis, with albuminuria as the dependent variable. CONCLUSIONS Our study represents the pioneering effort to establish a significant correlation between albuminuria and eGFR with cognitive function in frail hypertensive older adults afflicted with prediabetes and CKD.
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Affiliation(s)
- Gaetano Santulli
- Department of Medicine, Division of Cardiology, Wilf Family Cardiovascular Research Institute, Einstein - Mount Sinai Diabetes Research Center (ES-DRC), Einstein Institute for Aging Research, Albert Einstein College of Medicine, New York, NY, USA.
- Department of Molecular Pharmacology, Einstein Institute for Neuroimmunology and Inflammation (INI), Fleischer Institute for Diabetes and Metabolism (FIDAM), Albert Einstein College of Medicine, New York, NY, USA.
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Fisciano, Italy.
- International Translational Research and Medical Education (ITME) Consortium, Academic Research Unit, Naples, Italy.
| | - Valeria Visco
- Department of Medicine, Surgery and Dentistry, University of Salerno, Baronissi, Italy
| | - Michele Ciccarelli
- Department of Medicine, Surgery and Dentistry, University of Salerno, Baronissi, Italy
| | | | | | | | - Nicola Virtuoso
- Cardiology Unit, University Hospital "San Giovanni di Dio e Ruggi d'Aragona", Salerno, Italy
| | | | - Germano Guerra
- International Translational Research and Medical Education (ITME) Consortium, Academic Research Unit, Naples, Italy
- Department of Medicine and Health Sciences "Vincenzo Tiberio", University of Molise, Campobasso, Italy
| | | | | | | | - Klara Komici
- Department of Medicine and Health Sciences "Vincenzo Tiberio", University of Molise, Campobasso, Italy
| | - Pasquale Mone
- Department of Medicine, Division of Cardiology, Wilf Family Cardiovascular Research Institute, Einstein - Mount Sinai Diabetes Research Center (ES-DRC), Einstein Institute for Aging Research, Albert Einstein College of Medicine, New York, NY, USA.
- ASL Avellino, Avellino, Italy.
- Department of Medicine and Health Sciences "Vincenzo Tiberio", University of Molise, Campobasso, Italy.
- Casa di Cura "Montevergine", Mercogliano, Avellino, Italy.
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León-Jiménez D, Miramontes-González JP, Márquez-López L, Astudillo-Martín F, Beltrán-Romero LM, Moreno-Obregón F, Escalada-San Martín J. Basal insulin analogues in people with diabetes and chronic kidney disease. Diabet Med 2022; 39:e14679. [PMID: 34449911 DOI: 10.1111/dme.14679] [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: 02/05/2021] [Revised: 07/27/2021] [Accepted: 08/25/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Diabetic kidney disease is the leading cause of chronic kidney disease (CKD) and end-stage kidney disease (ESKD) worldwide. ESKD has a high prevalence in patients with diabetes mellitus (DM). CKD increases the chances of hypoglycaemia by different mechanisms, causes insulin resistance and a decrease in insulin metabolism. Both the "Kidney Disease: Improving Global Outcomes" (KDIGO) and "American Diabetes Association" (ADA) guidelines recommend the use of insulin as part of treatment, but the type of basal insulin is not specified. METHODS We reviewed the literature to determine whether first- and second-generation basal insulins are effective and safe in CKD patients. We reviewed specific pivotal studies conducted by pharmaceutical laboratories, as well as independent studies. CONCLUSIONS Basal insulins are safe and effective in patients with CKD and diabetes mellitus but we do not have specific studies. Given that CKD is one of the main complications of type 2 DM, and insulin specific treatment in the final stages, the absence of studies is striking. Real-life data are also important since trials such as pivotal studies do not fully represent actual patients. Treatment should be individualized until we have specific trials in this type of population.
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Affiliation(s)
- David León-Jiménez
- Clinical Epidemiology and Vascular Unit, Internal Medicine, Clinical Unit for Comprehensive Medical Care (UCAMI), Instituto de Biomedicina de Sevilla (IBIS, Hospital Universitario Virgen del Rocío SAS/CSIC, Universidad de Sevilla, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - José Pablo Miramontes-González
- Internal Medicine Unit, Facultad de Medicina, Hospital Universitario Río Hortega, Instituto De Investigaciones Biomédicas De Salamanca-IBSAL, Universidad de Valladolid, Valladolid, Spain
| | - Laura Márquez-López
- Internal Medicine, Clinical Unit for Comprehensive Medical Care (UCAMI), Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | | | - Luis M Beltrán-Romero
- Clinical Epidemiology and Vascular Unit, Internal Medicine, Clinical Unit for Comprehensive Medical Care (UCAMI), Instituto de Biomedicina de Sevilla (IBIS, Hospital Universitario Virgen del Rocío SAS/CSIC, Universidad de Sevilla, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | | | - Javier Escalada-San Martín
- Department Of Endocrinology and Nutrition, Biomedical Research Networking Center For Physiopathology of Obesity and Nutrition (CIBERON), ISCIII, Diabetes and Metabolic Diseases Group, Clínica Universidad De Navarra, Instituto De Investigación Sanitaria De Navarra (IdiSNA), Pamplona, Spain
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An efficient machine learning approach to nephrology through iris recognition. DISCOVER ARTIFICIAL INTELLIGENCE 2021. [DOI: 10.1007/s44163-021-00010-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
AbstractIridology is a technique in science used to analyze color, patterns, and various other properties of the iris to assess an individual's general health. Few regions in the iris are connected by nerves coming from different organs of body, this shows some special unique qualities which is advantageous along with which assist in psychological condition, particular organ conditions and construction of the body. The structural and designed patterns present on specific part of iris represent the level of intensity of disorder caused by the organs. This method of approach can be employed as reasonable and logical guidelines for the detection and identification of disorders. Therefore, after scanning the image of iris advance study of disorder can be carried out for detecting the condition of organ. Initially by the service of an adaptive histogram, the image of eye should be separated from part of the image captured. Next the images of iris are classified and recognized using machine learning algorithm Support Vector machine or Support Vector Networks. The features are extracted from images of iris using white Gaussian filters which are then used as a feature descriptor. These descriptors count the occurrences of gradient orientation and magnitude in localized portions of an image. Then convert the image of iris to a gray scaled image, final image is standardized. Next is to convert it into rectangular shape and then assembling the HMM images of eyes related to the kidney. The final level is to diagnose the edge of image of iris HMM. By analysing end results, condition of the organ can be diagnosed and results can be obtained from the iris recognition system.
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Dinu M, Colombini B, Pagliai G, Giangrandi I, Cesari F, Gori A, Giusti B, Marcucci R, Sofi F. Effects of vegetarian versus Mediterranean diet on kidney function: Findings from the CARDIVEG study. Eur J Clin Invest 2021; 51:e13576. [PMID: 33955547 PMCID: PMC8459224 DOI: 10.1111/eci.13576] [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: 03/18/2021] [Revised: 04/12/2021] [Accepted: 04/12/2021] [Indexed: 12/26/2022]
Abstract
BACKGROUND The aim of the present study was to assess the effects of a lacto-ovo-vegetarian diet (VD), compared to a Mediterranean diet (MD), on kidney function in a group of subjects with medium-to-low cardiovascular risk profile. METHODS We analysed 107 subjects (82 women, 25 men; median age 52) who followed a VD (n = 54) and a MD (n = 53) for 3 months in the CARDIVEG study, a randomized, open, crossover trial that compared the effects of these 2 diets on cardiovascular disease risk. RESULTS The effect of the two diets on kidney function markers was evaluated by conducting a general linear model for repeated measurements adjusted for possible confounding factors such as age, sex, physical activity, alcohol, smoking, hypertension, LDL cholesterol, glucose and body weight change. A significant reduction in creatinine (-5.3%; P < .001), urea nitrogen levels (-9%; P = .001), blood urea nitrogen (BUN) (-8.7%; P = .001) and BUN/creatinine ratio (-5.8%; P < .001), and an increase in estimated glomerular filtration rate (eGFR) (+3.5%; P = .001) was observed during the VD period. On the contrary, no significant changes were noted in the MD group. Variations obtained in the two dietary interventions were significantly different (P < .0001) for creatinine levels, BUN/creatinine and eGFR, for which opposite trends were observed in the VD and MD groups. CONCLUSIONS In a selected group of subjects with medium-to-low cardiovascular risk profile, a 3 month VD period determined significant improvements in kidney function markers. Further trials are needed to confirm these results.
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Affiliation(s)
- Monica Dinu
- Department of Experimental and Clinical MedicineUniversity of FlorenceFlorenceItaly
| | - Barbara Colombini
- Department of Experimental and Clinical MedicineUniversity of FlorenceFlorenceItaly
| | - Giuditta Pagliai
- Department of Experimental and Clinical MedicineUniversity of FlorenceFlorenceItaly
| | | | - Francesca Cesari
- Atherohtombotic Diseases UnitCareggi University HospitalFlorenceItaly
| | - Annamaria Gori
- Department of Experimental and Clinical MedicineUniversity of FlorenceFlorenceItaly
- Atherohtombotic Diseases UnitCareggi University HospitalFlorenceItaly
| | - Betti Giusti
- Department of Experimental and Clinical MedicineUniversity of FlorenceFlorenceItaly
- Atherohtombotic Diseases UnitCareggi University HospitalFlorenceItaly
| | - Rossella Marcucci
- Department of Experimental and Clinical MedicineUniversity of FlorenceFlorenceItaly
- Atherohtombotic Diseases UnitCareggi University HospitalFlorenceItaly
| | - Francesco Sofi
- Department of Experimental and Clinical MedicineUniversity of FlorenceFlorenceItaly
- Clinical Nutrition UnitCareggi University HospitalFlorenceItaly
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Kim SH. A Nuanced Relationship Between Prediabetes and Chronic Kidney Disease. J Clin Endocrinol Metab 2020; 105:5748205. [PMID: 32086934 DOI: 10.1210/clinem/dgaa079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Accepted: 02/11/2020] [Indexed: 11/19/2022]
Affiliation(s)
- Sun H Kim
- Division of Endocrinology, Gerontology and Metabolism, Department of Medicine, Stanford University School of Medicine, Stanford, CA; and Stanford Diabetes Research Center, Stanford University School of Medicine, Stanford, CA
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Kakitapalli Y, Ampolu J, Madasu SD, Sai Kumar MLS. Detailed Review of Chronic Kidney Disease. KIDNEY DISEASES 2019; 6:85-91. [PMID: 32309290 DOI: 10.1159/000504622] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Accepted: 10/30/2019] [Indexed: 01/09/2023]
Abstract
Background Nephropathy problems in the Udhanam region of Andhra Pradesh in India have motivated researchers to investigate the various factors related to chronic kidney disease (CKD). Initially, studies came across the markers of identification of CKD, i.e., glomerular filtration rate (GFR) and albumin creatinine rate, as global markers of identification. Cystatin C (Cys C) and its reciprocal (1/Cys C) are used to calculate GFR. This is a very easy method compared to the more accurate methods such as radiolabelled tracer clearances, which are invasive, may involve radiation, and require several hours to perform, e.g., 99-diethylene triamine penta-acetic acid (<sup>99m</sup>Tc-DTPA) and <sup>51</sup>Cr-EDTA. This article provides the causes (or risk factors), symptoms, and complications of CKD in a clear manner such that even common people can easily understand. Once a patient is detected and proved to be affected by CKD then the patient as well as the caretakers, including doctors, must follow some constraints. Thereby it is possible to prevent CKD progression in the patient. Modern methods are needed to prevent the pathogens which are responsible for CKD. Summary With the help of various engineering techniques one can easily design controllers to assess as well as to prevent CKD permanently. The easiest procedure for identifying CKD is to screen people. Current recommendations suggest screening of individuals with diabetes, hypertension, cardiovascular disease, and family history of kidney diseases in the course of routine health check-ups. Much work has been done in medical sciences in the area of CKD, but there is still scope for further research. From the recent studies, advanced tools such as data mining, etc., are considered to be the current trend in the area of CKD. Key Message From this article, the authors propose that patients who are already affected by urinary tract infection, acute kidney injury, and a family history of CKD should be examined via some basic tests for the presence of CKD.
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Affiliation(s)
- Yesubabu Kakitapalli
- Department of Electrical and Electronics Engineering, Aditya Institute of Technology and Management, Tekkali, India
| | - Janakiram Ampolu
- Department of Electrical and Electronics Engineering, Aditya Institute of Technology and Management, Tekkali, India
| | - Satya Dinesh Madasu
- Department of Electrical and Electronics Engineering, Bapatla Engineering College, Bapatla, India
| | - M L S Sai Kumar
- Department of Electrical and Electronics Engineering, National Institute of Technology Jamshedpur, Jamshedpur, India
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Chawla R, Makkar BM, Aggarwal S, Bajaj S, Das AK, Ghosh S, Gupta A, Gupta S, Jaggi S, Jana J, Keswadev J, Kalra S, Keswani P, Kumar V, Maheshwari A, Moses A, Nawal CL, Panda J, Panikar V, Ramchandani GD, Rao PV, Saboo B, Sahay R, Setty KR, Viswanathan V, Aravind SR, Banarjee S, Bhansali A, Chandalia HB, Das S, Gupta OP, Joshi S, Kumar A, Kumar KM, Madhu SV, Mittal A, Mohan V, Munichhoodappa C, Ramachandran A, Sahay BK, Sai J, Seshiah V, Zargar AH. RSSDI consensus recommendations on insulin therapy in the management of diabetes. Int J Diabetes Dev Ctries 2019. [DOI: 10.1007/s13410-019-00783-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
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Wilke RA, Qamar M, Lupu RA, Gu S, Zhao J. Chronic Kidney Disease in Agricultural Communities. Am J Med 2019; 132:e727-e732. [PMID: 30998912 PMCID: PMC6801052 DOI: 10.1016/j.amjmed.2019.03.036] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Revised: 03/07/2019] [Accepted: 03/12/2019] [Indexed: 01/18/2023]
Abstract
Patients residing in agricultural communities have a high risk of developing chronic kidney disease. In the Great Plains, geo-environmental risk factors (eg, variable climate, temperature, air quality, water quality, and drought) combine with agro-environmental risk factors (eg, exposure to fertilizers, soil conditioners, herbicides, fungicides, and pesticides) to increase risk for toxic nephropathy. However, research defining the specific influence of agricultural chemicals on the progression of kidney disease in rural communities has been somewhat limited. By linking retrospective clinical data within electronic medical records to environmental data from sources like US Environmental Protection Agency, analytical models are beginning to provide insight into the impact of agricultural practices on the rate of progression for kidney disease in rural communities.
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Affiliation(s)
- Russell A Wilke
- Department of Internal Medicine, Sanford School of Medicine, University of South Dakota, Vermillion.
| | - Mohammad Qamar
- Department of Nephrology and Transplantation, Sanford Medical Center, Sioux Falls, South Dakota
| | - Roxana A Lupu
- Department of Clinical Informatics, Sanford Medical Center, Sioux Falls, South Dakota
| | - Shaopeng Gu
- Department of Mathematics and Statistics, South Dakota State University, Brookings
| | - Jing Zhao
- Department of Biomedical Informatics, The Ohio State University, Columbus
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Lessey G, Stavropoulos K, Papademetriou V. Mild to moderate chronic kidney disease and cardiovascular events in patients with type 2 diabetes mellitus. Vasc Health Risk Manag 2019; 15:365-373. [PMID: 31686830 PMCID: PMC6709811 DOI: 10.2147/vhrm.s203925] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2019] [Accepted: 05/01/2019] [Indexed: 12/20/2022] Open
Abstract
Chronic kidney disease (CKD) has become a major public health problem in the USA and worldwide. A large majority of patients with CKD have mild to moderate disease and microalbuminuria. It has increasingly been noted that patients with CKD have a significantly higher risk of cardiovascular outcomes compared to patients with normal kidney function. Many studies have shown increased risk beginning at stage 3 CKD but risk has been elevated in patients with milder degrees of kidney dysfunction in some studies. This risk may be better predicted by the degree of albuminuria in the earlier stages of CKD. Data addressing interventions to improve outcomes in patients with mild to moderate CKD are scarce. In this paper, we examined data and post hoc analyses from the ORIGIN and ACCORD trials. Data indicate that intensive treatment of diabetes in patients with CKD actually may result in adverse outcomes. The mechanism by which CKD results in increased cardiovascular risk is not clear. Patients with CKD frequently have the traditional risk factors that cause cardiovascular disease and there are mechanisms that are unique to CKD that promote the development of cardiovascular disease. In this article, we describe in some detail traditional, newer and novel risk factors that play a role in the development of CKD and heart disease.
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Affiliation(s)
- Gayatri Lessey
- Department of Medicine, Georgetown University Hospital, Washington, DC, USA
| | - Konstantinos Stavropoulos
- Department of Medicine, Georgetown University Hospital, Washington, DC, USA.,Department of Medicine, VA Medical Center, Washington, DC, USA
| | - Vasilios Papademetriou
- Department of Medicine, Georgetown University Hospital, Washington, DC, USA.,Department of Medicine, VA Medical Center, Washington, DC, USA
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Comments on Chronic Kidney Disease, Basal Insulin Glargine, and Health Outcomes in People with Dysglycemia: The Origin Study. Am J Med 2018; 131:e315. [PMID: 29909846 DOI: 10.1016/j.amjmed.2018.01.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Accepted: 01/04/2018] [Indexed: 11/24/2022]
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Affiliation(s)
- Vasilios Papademetriou
- Georgetown University, Director Cardiovascular Research, VA Medical Center, Washington, DC
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