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Afonso RJ, Teixeira M, Murteira D, Tavares N, Neto M, Gomes HA, Jorge BG, Tavares J, Santos M, Soares C. Chronic Kidney Disease Study in Diabetic Patients: Insights From Primary Care Units in Northern Portugal. Cureus 2024; 16:e61417. [PMID: 38947587 PMCID: PMC11214725 DOI: 10.7759/cureus.61417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/31/2024] [Indexed: 07/02/2024] Open
Abstract
Introduction Diabetes mellitus (DM) remains a primary cause of morbidity and mortality, leading to complications such as blindness, kidney failure, and lower limb amputations. Early detection of kidney damage, indicated by microalbuminuria (MA), is crucial for managing DM. Given the impact of these conditions, evaluating the prevalence of chronic kidney disease (CKD) in diabetic populations within primary healthcare is essential. Methodology This was a cross-sectional and observational study. Adults diagnosed with DM type 1 or 2, from five primary care units (PCUs) located in the North of Portugal, were included in this study. Descriptive and correlational statistics were performed using IBM SPSS Statistics for Windows, Version 28.0 (IBM Corp., Armonk, NY). Statistical significance was set to P < 0,05. Logistic regression models were created to identify the factors associated with CKD and DM. Results A sample of 357 diabetic patients was obtained, with 166 (46.5%) females. Of the sample, 250 (70.1%) were aged 65 or older, and the median known duration of DM was 9.36 years. Excess weight or obesity accounted for 79.8%, with a median body mass index of 28.73 kg/m2 and hypertension in 284 (79.6%). An estimated glomerular filtration rate (eGFR) less than 60 mL/min was present in 89 (24.9%) and an MA of 30 mg/dL or higher was present in 68 (19.0%). In total, 130 (36.4%) individuals exhibited eGFR and MA consistent with CKD. Among these, 25 (78.1%) had other identifiable causes of CKD besides DM, hypertension, overweight, or obesity. Binary logistic regression models were constructed to find a relationship between CKD with eGFR < 60 mL/min and MA. A statistically significant association was found between CKD with eGFR < 60 mL/minute and age (odds ratio [OR] = 1.150; P < 0.001), kidney stones (OR = 5.112; P = 0.003), absence of excess weight or obesity (OR = 0.267; P < 0.001). The use of GLP1 agonists showed statistical significance as a predictor (OR = 4.653; P = 0.042) of the presence of MA. Discussion The study investigates the impact of DM and its complications in the surveyed population. While most patients had controlled DM (284, 76.2%), prolonged disease duration correlated with poorer glycemic control, underscoring the need for more effective management strategies in advanced disease stages. Notably, a third of individuals with DM had CKD, with significant implications for therapeutic interventions and heightened risks of renal failure and cardiovascular morbidity. MA was a crucial marker for endothelial injury, with prevalence influenced by DM duration and medication type. However, in many cases, correct identification of CKD was lacking, suggesting under-recognition of renal deterioration in DM. While the study offers valuable insights, its limited sample size and geographic scope warrant cautious interpretation, emphasizing the need for broader, context-specific research to inform comprehensive healthcare strategies. Conclusions In conclusion, this study highlights the significant burden of CKD among diabetic patients, emphasizing the need for proactive screening, personalized management, and accurate diagnosis. Despite limitations, it underscores the importance of early detection and tailored interventions, advocating for improved diabetes care to mitigate renal complications on a broader scale.
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Affiliation(s)
- Ricardo J Afonso
- USF (Family Health Unit) Salvador Machado, Unidade Local de Saúde (ULS) Entre Douro e Vouga, Oliveira de Azeméis, PRT
| | - Maria Teixeira
- USF (Family Health Unit) Salvador Machado, Unidade Local de Saúde (ULS) Entre Douro e Vouga, Oliveira de Azeméis, PRT
| | - Diana Murteira
- USF (Family Health Unit) Salvador Machado, Unidade Local de Saúde (ULS) Entre Douro e Vouga, Oliveira de Azeméis, PRT
| | - Nilza Tavares
- USF (Family Health Unit) Salvador Machado, Unidade Local de Saúde (ULS) Entre Douro e Vouga, Oliveira de Azeméis, PRT
| | - Magui Neto
- USF (Family Health Unit) Salvador Machado, Unidade Local de Saúde (ULS) Entre Douro e Vouga, Oliveira de Azeméis, PRT
| | - Hugo A Gomes
- USF (Family Health Unit) Santo António, Unidade Local de Saúde (ULS) Barcelos/Esposende, Barcelos, PRT
| | - Brenda G Jorge
- USF (Family Health Unit) Salvador Machado, Unidade Local de Saúde (ULS) Entre Douro e Vouga, Oliveira de Azeméis, PRT
| | - Jéssica Tavares
- USF (Family Health Unit) Entre Margens, Unidade Local de Saúde (ULS) Entre Douro e Vouga, Pinheiro da Bemposta, PRT
| | - Maria Santos
- USF (Family Health Unit) Calâmbriga, Unidade Local de Saúde (ULS) Entre Douro e Vouga, Vale de Cambra, PRT
| | - Cristiana Soares
- USF (Family Health Unit) Calâmbriga, Unidade Local de Saúde (ULS) Entre Douro e Vouga, Vale de Cambra, PRT
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Barzilay JI, Farag YMK, Durthaler J. Albuminuria: An Underappreciated Risk Factor for Cardiovascular Disease. J Am Heart Assoc 2024; 13:e030131. [PMID: 38214258 PMCID: PMC10926810 DOI: 10.1161/jaha.123.030131] [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] [Indexed: 01/13/2024]
Abstract
Albuminuria, an established biomarker of the progression of chronic kidney disease, is also recognized as a biomarker for the risk of cardiovascular disease. Elevated urinary albumin excretion indicates kidney damage and systemic vascular disease, including myocardial capillary disease and arterial stiffness. Albuminuria is associated with an increased risk of coronary artery disease, stroke, heart failure, arrhythmias, and microvascular disease. There are now several therapeutic agents that can lead to albuminuria lowering and a reduction in cardiovascular risk. However, screening for albuminuria is still low. Considering the importance of multidisciplinary management of patients with cardiovascular disease, it is crucial that health care professionals managing such patients are aware of the benefits of albuminuria surveillance and management.
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Veiga G, Alves B, Perez M, Alcantara LV, Raimundo J, Zambrano L, Encina J, Pereira EC, Bacci M, Murad N, Fonseca F. NGAL and SMAD1 gene expression in the early detection of diabetic nephropathy by liquid biopsy. J Clin Pathol 2020; 73:713-721. [PMID: 32184218 DOI: 10.1136/jclinpath-2020-206494] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Revised: 02/26/2020] [Accepted: 02/27/2020] [Indexed: 01/01/2023]
Abstract
INTRODUCTION Diabetic nephropathy (DN) is a disease that progresses with the slow and progressive decline of the glomerular filtration rate (GFR); the installation of this pathology is silent and one of the major causes of death in patients with diabetes. AIMS To identify new molecular biomarkers for early identification of the onset of DN in patients with type II diabetes mellitus (DM2). We studied the expression profile of the genes; suppressor of mothers against decapentaplegic type 1 (SMAD1), neutrophil gelatinase-associated lipocalin (NGAL) and type IV collagen (COLIV1A) in peripheral blood and urine sediment samples. METHODS Ninety volunteers, 51 with DM2 and 39 healthy, were recruited from the Faculdade de Medicina do ABC outpatient clinic. We conducted an interview and collected anthropometric data, as well as blood and urine samples for biochemical evaluation and real-time PCR amplification of the genes of interest. RESULTS Gene expression data: peripheral blood NGAL (DM2 0.09758±0.1914 vs CTL 0.02293±0.04578), SMAD1 (blood: DM2 0.01102±0.04059* vs CTL 0.0001317±0.0003609; urine: DM2 0.7195±2.344* vs CTL 0.09812±0.4755), there was no significant expression of COLIV1A. These genes demonstrated good sensitivity and specificity in the receiving operating characteristic curve evaluation. CONCLUSION Our data suggest the potential use of NGAL and SMAD1 gene expression in peripheral blood and urine samples as early biomarkers of DN.
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Affiliation(s)
- Glaucia Veiga
- Centro Universitário Saúde ABC/Faculdade de Medicina do ABC, Santo Andre, Brazil
| | - Beatriz Alves
- Centro Universitário Saúde ABC/Faculdade de Medicina do ABC, Santo Andre, Brazil
| | - Matheus Perez
- Centro Universitário Saúde ABC/Faculdade de Medicina do ABC, Santo Andre, Brazil
| | | | - Joyce Raimundo
- Centro Universitário Saúde ABC/Faculdade de Medicina do ABC, Santo Andre, Brazil
| | - Lysien Zambrano
- Universidad Nacional Autónoma de Honduras, Tegucigalpa, Francisco Morazán, Honduras
| | - Jessica Encina
- Centro Universitário Saúde ABC/Faculdade de Medicina do ABC, Santo Andre, Brazil
| | - Edimar Cristiano Pereira
- Pharmaceutical Sciences Department, Universidade Federal de São Paulo, Diadema, São Paulo, Brazil
| | - Marcelo Bacci
- Centro Universitário Saúde ABC/Faculdade de Medicina do ABC, Santo Andre, Brazil
| | - Neif Murad
- Centro Universitário Saúde ABC/Faculdade de Medicina do ABC, Santo Andre, Brazil
| | - Fernando Fonseca
- Centro Universitário Saúde ABC/Faculdade de Medicina do ABC, Santo Andre, Brazil.,Pharmaceutical Sciences Department, Universidade Federal de São Paulo, Diadema, São Paulo, Brazil
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Kangwagye P, Rwebembera J, Wilson T, Bajunirwe F. Microalbuminuria and Retinopathy among Hypertensive Nondiabetic Patients at a Large Public Outpatient Clinic in Southwestern Uganda. Int J Nephrol 2018; 2018:4802396. [PMID: 29977618 PMCID: PMC6011089 DOI: 10.1155/2018/4802396] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Revised: 04/25/2018] [Accepted: 05/09/2018] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Routine testing of microalbuminuria and retinopathy is not done among patients with high blood pressure in resource-limited settings. We determined the prevalence of microalbuminuria and retinopathy and their risk factors among hypertensive patients at a large hospital in western Uganda. METHODS We consecutively recruited nondiabetic patients with hypertension at the outpatients' clinic over a period of 3 months. Spot urine samples were tested for urine albumin. Direct fundoscopy was done to assess retinal vasculature and optic disc for signs of hypertensive retinopathy. Logistic regression was done with retinopathy and microalbuminuria as primary outcomes. RESULTS We enrolled 334 patients and, of these, 208 (62.3%) were females, with median age of 55 years (range: 25-90). The prevalence of microalbuminuria was 59.3% (95% CI: 50.1-72.2) and that of retinopathy was 66.8% (95% CI: 58.6-76.5). The independent correlates of retinopathy and microalbuminuria were systolic blood pressure (SBP) > 140 mmHg (OR = 2.76, 95% CI: 1.29-5.93) and treatment with beta-blockers (OR = 2.16, 95% CI: 1.05-4.44). Use of ACEIs was unrelated to the study outcomes. CONCLUSION The prevalence of retinopathy and microalbuminuria is high. Clinicians should aim for better control of blood pressure and routinely perform fundoscopy and urine albumin, especially for patients with poorly controlled blood pressure.
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Affiliation(s)
- Peter Kangwagye
- Department of Internal Medicine, Mbarara University of Science and Technology, P.O. BOX 1410, Mbarara, Uganda
| | | | - Tony Wilson
- Department of Internal Medicine, Mbarara University of Science and Technology, P.O. BOX 1410, Mbarara, Uganda
| | - Francis Bajunirwe
- Department of Community Health, Mbarara University of Science and Technology, P.O. BOX 1410, Mbarara, Uganda
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Wang ZJ, Jia D, Tian J, Liu J, Li LJ, Huang YL, Cao XY, Ning CH, Zhao QH, Yu JX, Zhang RY, Zhang YJ, Gao JS, Wu SL. Correlation between the trajectory of systolic blood pressure and new renal damage in a nonhypertensive population. Blood Press Monit 2018; 22:282-289. [PMID: 28763331 DOI: 10.1097/mbp.0000000000000275] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
OBJECTIVE This study aims to investigate the correlation between the trajectory of systolic blood pressure (SBP) and new renal damage in a nonhypertensive population. PATIENTS AND METHODS This prospective cohort study included a total of 14 382 nonhypertensive individuals, employees of Kailuan Group of Companies, who took part in five healthy examinations in 2006-2007, 2008-2009, 2010-2011, 2012-2013, and 2014-2015, and had complete data. These individuals were divided into four groups according to the different trajectories of SBP: low-low, low-stable, middle-high, and high-high groups. The correlation between the trajectory of SBP and new renal damage in a nonhypertensive population was analyzed using a multivariate Cox's proportional hazard regression model. RESULTS (a) A total of 14 382 individuals had complete data and the average age of these individuals was 44.6±10.8 years. Among these, 10 888 (75.7%) individuals were men and 3494 (24.3%) individuals were women. (b) These individuals were divided into four groups according to different trajectories of blood pressure: low-low group, accounting for 13.15% (blood pressure was <106 mmHg); low-stable group, accounting for 53.91% (blood pressure was between 115 and 116 mmHg); middle-high group, accounting for 28.77% (blood pressure was between 125 and 131 mmHg); and high-high group, accounting for 4.6% (blood pressure was between 126 and 151 mmHg). (c) With the increase in the trajectory of SBP, the detection rate of renal damage increased gradually. From the low-low group to the high-high group, the detection rates of estimated glomerular filtration rate (eGFR) less than 60 ml/min/1.73 m were 2.3, 2.4, 3.6, and 4.3%, respectively; the positive rates of urinary protein were 1.7, 2.9, 3.8, and 5.5%, respectively; and the detection rates of eGFR less than 60 ml/min/1.73 m or positive urinary protein were 4, 5.2, 7.3, and 9.3%, respectively (P<0.05). (d) After adjustment for other confounding factors, multivariate Cox's proportional hazard regression analysis showed that compared with the low-low group, the risk of eGFR less than 60 ml/min/1.73 m increased by nearly 1.5 times in the high-high group and in the low-stable, middle-high, and high-high groups, the risks of positive urinary protein, eGFR less than 60 ml/min/1.73 m, or positive urinary protein increased by 1.48-2.34 and 1.20-1.70 times, respectively. CONCLUSION In a nonhypertensive population, the high trajectory of SBP is a risk factor for kidney damage.
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Affiliation(s)
- Zhi-Jun Wang
- Departments of aCardiovasology bEmergency Medicine, North China University of Science and Technology Affiliated Hospital cKailuan General Hospital of Tangshan, Tangshan, China
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Wang Q, Huang J, Sun Y, Zhang W, Gao Y, Yao W, Bian B, Li Y, Wu X, Niu K. Association of microalbuminuria with diabetes is stronger in people with prehypertension compared to those with ideal blood pressure. Nephrology (Carlton) 2017; 23:690-696. [PMID: 28591489 DOI: 10.1111/nep.13082] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Revised: 06/04/2017] [Accepted: 06/05/2017] [Indexed: 11/27/2022]
Abstract
AIM Microalbuminuria (MA) has been demonstrated as a biomarker for microvascular dysfunction. This study is aimed to evaluate the association of glycaemic status with MA in prehypertensive and ideal BP subjects and to evaluate the interaction between glycaemic and blood pressure status as risk factors for MA prevalence. METHODS 1059 subjects aged 40-70 with non-hypertension who were recruited from six districts of Tianjin were divided into a prehypertensive group (622 cases) and an ideal blood BP group (437 cases). Subjects of the prehypertensive group and the ideal BP group were divided respectively into three subgroups: normoglycaemia subgroup, prediabetes subgroup and diabetes subgroup. The prevalence of MA in the above three subgroups of subjects with prehypertension and ideal BP were assessed. We performed a statistical analysis for interaction test between glycaemia and BP status on microalbuminuria in the overall study sample by a multivariate logistic regression model. The association of glycaemic status (defined as normoglycaemia, prediabetes, and diabetes) with MA was evaluated separately in prehypertensive and ideal BP subjects. RESULTS Results showed that the prevalence of MA in both prehypertensive and ideal BP groups rose with the increasing of classification of glycaemic level of subgroups (32.6%, 18.3%, 14.8% vs. 23.1%, 16.2%, 13.4%), the differences in prehypertensive group were statistically significant (Pearson χ2 = 15.24, P < 0.001). The ORs (95% CI) of MA were 1.25 (0.86-1.83) for prediabetes and 2.56 (1.62-4.03) for diabetes in the fully adjusted model. There was no interaction between prediabetes and BP status regarding MA (P = 0.237) but we found a significant interaction between diabetes and BP status (P < 0.001). In the prehypertensive group, multivariate logistic regression models showed that the diabetes subgroup had a significant association with MA, and the adjusted odds ratio of the diabetes subgroup to the normoglycaemia subgroup was 2.68 (95%CI 1.54-4.67) (P < 0.001). However, there was no significant association of glycaemic status with MA in the ideal BP group. Stratified analysis by a multivariate logistic regression model in the whole study population showed that people with both prehypertension and diabetes had the highest risk of MA (adjusted OR = 2.50, 95%CI 1.16-5.36; P = 0.019), compared with those with ideal BP and normoglycaemia (reference group). CONCLUSIONS Our findings suggest that there was a statistically significant association between diabetes and microalbuminuria only in prehypertensive subjects. In addition, our study highlights the interaction between prehypertension and diabetes as a risk factor for MA.
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Affiliation(s)
- Qing Wang
- Department of Cardiology, Tianjin Medical University General Hospital, Tianjin, China
| | - Jingjing Huang
- Department of Cardiology, Tianjin Medical University General Hospital, Tianjin, China
| | - Yuemin Sun
- Department of Cardiology, Tianjin Medical University General Hospital, Tianjin, China
| | - Wenjuan Zhang
- Department of Cardiology, Tianjin Medical University General Hospital, Tianjin, China
| | - Yuxia Gao
- Department of Cardiology, Tianjin Medical University General Hospital, Tianjin, China
| | - Wei Yao
- Department of Cardiology, Tianjin Medical University General Hospital, Tianjin, China
| | - Bo Bian
- Department of Cardiology, Tianjin Medical University General Hospital, Tianjin, China
| | - Yongle Li
- Department of Cardiology, Tianjin Medical University General Hospital, Tianjin, China
| | - Xianming Wu
- Department of Cardiology, Tianjin Medical University General Hospital, Tianjin, China
| | - Kaijun Niu
- Department of Nutrition and Food Science, School of Public Health, Tianjin Medical University, Tianjin, China
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Renal and cardiovascular risk predictive value of two different microalbuminuria screening methods in patients with hypertension with/without diabetes in Portugal. J Hum Hypertens 2016; 30:726-730. [PMID: 26740337 DOI: 10.1038/jhh.2015.120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2015] [Revised: 10/22/2015] [Accepted: 11/03/2015] [Indexed: 11/08/2022]
Abstract
MicRoAlbuminuria sCreening survEy (RACE) was a multicentre, observational, cross-sectional study conducted in primary health-care settings of Portugal. Here, we present a post-hoc analysis from the RACE study, assessing the renal and cardiovascular (CV) risk predictive value of two different microalbuminuria (MA) screening methods, nephelometry with 24-h urine (MA-24 h) and Micral test with occasional urine (MicralA) in patients with hypertension (HTN) with/without type 2 diabetes mellitus (T2DM). Out of 3065 patients, 1173 (38.3%) were in the HTN group without T2DM (HTN) and 1892 (61.7%) in the HTN group with T2DM (HTN+T2DM). The overall prevalence of MA was 50.6% determined by MicralA and 22.1% with MA-24 h. Urinary albumin excretion data obtained by both techniques correlated significantly (rs=0.586; P<0.001). In all subjects, MicralA showed a sensitivity of 93%, specificity of 62% for detection of MA, with a positive predictive value of 41% and negative predictive value of 97%. With both methods, the presence of MA was independently associated with a higher risk (1.5- to 2.9-fold) of CV and renal organ damage in both HTN and HTN+T2DM groups. MicralA, due to its high sensitivity and negative predictive value, can be considered as a valid and reliable method for MA screening in patients with HTN with/without T2DM.
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