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Development and implementation of patient-level prediction models of end-stage renal disease for type 2 diabetes patients using fast healthcare interoperability resources. Sci Rep 2022; 12:11232. [PMID: 35789173 PMCID: PMC9253099 DOI: 10.1038/s41598-022-15036-6] [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: 01/13/2022] [Accepted: 06/16/2022] [Indexed: 12/04/2022] Open
Abstract
This study aimed to develop a model to predict the 5-year risk of developing end-stage renal disease (ESRD) in patients with type 2 diabetes mellitus (T2DM) using machine learning (ML). It also aimed to implement the developed algorithms into electronic medical records (EMR) system using Health Level Seven (HL7) Fast Healthcare Interoperability Resources (FHIR). The final dataset used for modeling included 19,159 patients. The medical data were engineered to generate various types of features that were input into the various ML classifiers. The classifier with the best performance was XGBoost, with an area under the receiver operator characteristics curve (AUROC) of 0.95 and area under the precision recall curve (AUPRC) of 0.79 using three-fold cross-validation, compared to other models such as logistic regression, random forest, and support vector machine (AUROC range, 0.929–0.943; AUPRC 0.765–0.792). Serum creatinine, serum albumin, the urine albumin-to-creatinine ratio, Charlson comorbidity index, estimated GFR, and medication days of insulin were features that were ranked high for the ESRD risk prediction. The algorithm was implemented in the EMR system using HL7 FHIR through an ML-dedicated server that preprocessed unstructured data and trained updated data.
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2
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Li Y, Ji X, Ni W, Luo Y, Ding B, Ma J, Zhu J. Serum albumin and albuminuria predict the progression of chronic kidney disease in patients with newly diagnosed type 2 diabetes: a retrospective study. PeerJ 2021; 9:e11735. [PMID: 34268015 PMCID: PMC8269640 DOI: 10.7717/peerj.11735] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Accepted: 06/16/2021] [Indexed: 01/18/2023] Open
Abstract
Background Diabetes-related kidney disease is associated with end-stage renal disease and a high mortality rate. However, data on risk factors associated with kidney disease in patients with newly diagnosed type 2 diabetes mellitus (DM) remains insufficient. The aim of the present study was to identify the risk factors significantly associated with chronic kidney disease progression in patients with newly diagnosed type 2 DM. Methods We reviewed a total of 254 consecutive patients who were newly diagnosed with type 2 diabetes at Nanjing First Hospital from January to December 2014. They were observed for two years, and baseline and biochemical variables were used to identify significant predictors of kidney failure progression. Kidney failure progression was defined as a ≥ 30% increase in serum creatine level. Results The mean age of patients was 58.96 years, 37.4% were women, and 57.1% had hypertension. Kidney function progressed in 40 patients (15.75%). Multivariable logistic regression analyses showed that serum albumin (p = 0.015) and microalbuminuria (p < 0.001) were associated with kidney failure progression in patients with newly diagnosed type 2 DM. Those with lower estimated glomerular filtration rate (eGFR; 30–60 ml/min/1.73 m2) at baseline had lower serum albumin levels compared to those of patients with higher eGFR. The albuminuria levels were higher in patients with lower eGFR than in those with eGFR ≥ 90 ml/min/1.73 m2. Receiver operating characteristic curve analysis showed that the area under the curve was 0.754 (95% CI [0.670–0. 0.837]). Conclusions The overall rate of chronic kidney disease progression is relatively high, and low serum albumin and high albuminuria levels are associated with kidney failure progression in newly diagnosed diabetic patients.
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Affiliation(s)
- Yujiao Li
- Department of Endocrinology, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Xiaobing Ji
- Department of Nephrology, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Wenji Ni
- Department of Endocrinology, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Yong Luo
- Department of Endocrinology, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Bo Ding
- Department of Endocrinology, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Jianhua Ma
- Department of Endocrinology, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Jian Zhu
- Department of Endocrinology, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu, China
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3
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Kilis-Pstrusinska K. Carnosine and Kidney Diseases: What We Currently Know? Curr Med Chem 2020; 27:1764-1781. [PMID: 31362685 DOI: 10.2174/0929867326666190730130024] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Revised: 07/01/2019] [Accepted: 07/23/2019] [Indexed: 01/26/2023]
Abstract
Carnosine (beta-alanyl-L-histidine) is an endogenously synthesised dipeptide which is present in different human tissues e.g. in the kidney. Carnosine is degraded by enzyme serum carnosinase, encoding by CNDP1 gene. Carnosine is engaged in different metabolic pathways in the kidney. It reduces the level of proinflammatory and profibrotic cytokines, inhibits advanced glycation end products' formation, moreover, it also decreases the mesangial cell proliferation. Carnosine may also serve as a scavenger of peroxyl and hydroxyl radicals and a natural angiotensin-converting enzyme inhibitor. This review summarizes the results of experimental and human studies concerning the role of carnosine in kidney diseases, particularly in chronic kidney disease, ischemia/reperfusion-induced acute renal failure, diabetic nephropathy and also drug-induced nephrotoxicity. The interplay between serum carnosine concentration and serum carnosinase activity and polymorphism in the CNDP1 gene is discussed. Carnosine has renoprotective properties. It has a promising potential for the treatment and prevention of different kidney diseases, particularly chronic kidney disease which is a global public health issue. Further studies of the role of carnosine in the kidney may offer innovative and effective strategies for the management of kidney diseases.
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4
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Zhu H, Liu X, Zhang C, Li Q, An X, Liu S, Wu L, Zhang B, Yuan Y, Xing C. Association of urinary acidification function with the progression of diabetic kidney disease in patients with type 2 diabetes. J Diabetes Complications 2019; 33:107419. [PMID: 31473080 DOI: 10.1016/j.jdiacomp.2019.107419] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Revised: 08/10/2019] [Accepted: 08/16/2019] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Although diabetic kidney disease (DKD) has been considered as a glomerulocentric disease in the past few decades, growing evidence demonstrated that tubular damage was indispensable in its pathogenesis and progression. This study was designed to investigate the association of urinary acidification dysfunction with the progression of DKD in type 2 diabetic patients. METHODS Here the urinary acidification functions were measured from 80 participants with renal biopsy-proven DKD. The different kinds of renal tubular transportation dysfunction were analyzed, including the dysfunction of bicarbonate reabsorption, titratable acid secretion, and ammonium secretion. In addition, patients were followed up for 17 (interquartile range, 11-32) months to evaluate the effect of urinary acidification dysfunction in the progression of DKD. RESULTS The most common urinary acidification dysfunction was the disorder of ammonium secretion, accounting for 53.75%. The more proteinuria excretion and the lower glomerular filtration rate (GFR) were observed in the urinary titratable acid disorder group than the normal group, and the same results were obtained for ammonium secretion disorder. Urine titratable acid was positively correlated with eGFR whereas it was inversely correlated with proteinuria, serum creatinine, and BUN. Moreover, 24 h urine protein, serum creatinine, BUN and cystatin C increased from DKD stage II to stage IV, whereas the eGFR and urine titratable acid decreased in the same way. Furthermore, Kaplan-Meier analysis and Cox regression showed that the disorder of titratable acid was an independent risk factor for DKD progression. CONCLUSIONS The dysfunction of urinary titratable acid is a potential biomarker for the severity of proteinuria, eGFR and glomerular lesions in patients with DKD. Moreover, the titratable acid disorder is an independent risk factor of the DKD progression.
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MESH Headings
- Acidosis, Renal Tubular/complications
- Acidosis, Renal Tubular/diagnosis
- Acidosis, Renal Tubular/epidemiology
- Acidosis, Renal Tubular/etiology
- Acids/analysis
- Acids/metabolism
- Adult
- Aged
- Biomarkers/metabolism
- Biomarkers/urine
- Comorbidity
- Diabetes Mellitus, Type 2/complications
- Diabetes Mellitus, Type 2/epidemiology
- Diabetes Mellitus, Type 2/pathology
- Diabetes Mellitus, Type 2/urine
- Diabetic Nephropathies/complications
- Diabetic Nephropathies/epidemiology
- Diabetic Nephropathies/pathology
- Diabetic Nephropathies/urine
- Disease Progression
- Female
- Glomerular Filtration Rate
- Humans
- Hydrogen-Ion Concentration
- Kidney/metabolism
- Kidney/physiopathology
- Kidney Failure, Chronic/diagnosis
- Kidney Failure, Chronic/epidemiology
- Kidney Failure, Chronic/physiopathology
- Kidney Failure, Chronic/urine
- Male
- Middle Aged
- Prognosis
- Proteinuria/epidemiology
- Proteinuria/etiology
- Proteinuria/urine
- Urine/chemistry
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Affiliation(s)
- Huanhuan Zhu
- Department of Nephrology, the First Affiliated Hospital of Nanjing Medical University, Nanjing Medical University, Nanjing, China
| | - Xi Liu
- Department of Nephrology, the First Affiliated Hospital of Nanjing Medical University, Nanjing Medical University, Nanjing, China
| | - Chengning Zhang
- Department of Nephrology, the First Affiliated Hospital of Nanjing Medical University, Nanjing Medical University, Nanjing, China
| | - Qing Li
- Department of Nephrology, the First Affiliated Hospital of Nanjing Medical University, Nanjing Medical University, Nanjing, China
| | - Xiaofei An
- Department of Endocrinology, Jiangsu Province Hospital of Chinese Medicine, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
| | - Simeng Liu
- Department of Nephrology, the First Affiliated Hospital of Nanjing Medical University, Nanjing Medical University, Nanjing, China
| | - Lin Wu
- Department of Nephrology, the First Affiliated Hospital of Nanjing Medical University, Nanjing Medical University, Nanjing, China
| | - Bo Zhang
- Department of Nephrology, the First Affiliated Hospital of Nanjing Medical University, Nanjing Medical University, Nanjing, China
| | - Yanggang Yuan
- Department of Nephrology, the First Affiliated Hospital of Nanjing Medical University, Nanjing Medical University, Nanjing, China.
| | - Changying Xing
- Department of Nephrology, the First Affiliated Hospital of Nanjing Medical University, Nanjing Medical University, Nanjing, China.
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5
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Chao AT, Chee Fang S, Lam BC, Cheng AK, Low SK, Su Chi L. Effect of bariatric surgery on diabetic nephropathy in obese type 2 diabetes patients in a retrospective 2-year study: A local pilot. Diab Vasc Dis Res 2018; 15:139-144. [PMID: 29153006 DOI: 10.1177/1479164117742315] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
PURPOSE To determine the effects of bariatric surgery on albuminuria in obese patients with type 2 diabetes mellitus. METHODS Retrospective analyses of clinical records of obese patients with type 2 diabetes mellitus who had either micro- or macroalbuminuria and had undergone various bariatric surgery were retrieved from a local hospital database. Their clinical data from follow-up appointments including albuminuria were analysed. RESULTS Of the 46 subjects with type 2 diabetes mellitus, 15 subjects had diabetic nephropathy and had pre- and post-bariatric surgery urine albumin-to-creatinine ratio or urine protein-to-creatinine ratio data available for analysis; 13 out of the 15 subjects (86.7%) showed improvement of urine albumin-to-creatinine ratio or urine protein-to-creatinine ratio after surgery; 2 showed equivocal results; 9 of 13 subjects (69.2%) showed remission of diabetic nephropathy; 7 of these 9 patients had microalbuminuria before surgery, 2 had macroalbuminuria before surgery. There were significant improvements to glycosylated haemoglobin, fasting plasma glucose, blood pressure and body weight post surgery. The usage of insulin and oral medications dropped significantly post surgery for all subjects. CONCLUSION This study shows that bariatric surgery significantly improves diabetic nephropathy in obese type 2 diabetes mellitus subjects. The results suggest that in our local type 2 diabetes mellitus patients, it is possible not only to improve metabolic parameters, but also to reverse what may be considered established microvascular complications by means of bariatric surgery.
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Affiliation(s)
| | - Sum Chee Fang
- 1 Diabetes Centre, Khoo Teck Puat Hospital, Singapore
| | - Benjamin Cc Lam
- 2 Family and Community Medicine Department, Khoo Teck Puat Hospital, Singapore
| | - Anton Ks Cheng
- 3 General Surgery Department, Khoo Teck Puat Hospital, Singapore
| | - Serena Km Low
- 4 Clinical Research Unit, Khoo Teck Puat Hospital, Singapore
| | - Lim Su Chi
- 4 Clinical Research Unit, Khoo Teck Puat Hospital, Singapore
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6
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Albrecht T, Zhang S, Braun JD, Xia L, Rodriquez A, Qiu J, Peters V, Schmitt CP, van den Born J, Bakker SJL, Lammert A, Köppel H, Schnuelle P, Krämer BK, Yard BA, Hauske SJ. The CNDP1 (CTG) 5 Polymorphism Is Associated with Biopsy-Proven Diabetic Nephropathy, Time on Hemodialysis, and Diabetes Duration. J Diabetes Res 2017; 2017:9506730. [PMID: 28553654 PMCID: PMC5434468 DOI: 10.1155/2017/9506730] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Revised: 02/23/2017] [Accepted: 03/13/2017] [Indexed: 11/18/2022] Open
Abstract
Considering that the homozygous CNDP1 (CTG)5 genotype affords protection against diabetic nephropathy (DN) in female patients with type 2 diabetes, this study assessed if this association remains gender-specific when applying clinical inclusion criteria (CIC-DN) or biopsy proof (BP-DN). Additionally, it assessed if the prevalence of the protective genotype changes with diabetes duration and time on hemodialysis and if this occurs in association with serum carnosinase (CN-1) activity. Whereas the distribution of the (CTG)5 homozygous genotype in the no-DN and CIC-DN patients was comparable, a lower frequency was found in the BP-DN patients, particularly in females. We observed a significant trend towards high frequencies of the (CTG)5 homozygous genotype with increased time on dialysis. This was also observed for diabetes duration but only reached significance when both (CTG)5 homo- and heterozygous patients were included. CN-1 activity negatively correlated with time on hemodialysis and was lower in (CTG)5 homozygous patients. The latter remained significant in female subjects after gender stratification. We confirm the association between the CNDP1 genotype and DN to be likely gender-specific. Although our data also suggest that (CTG)5 homozygous patients may have a survival advantage on dialysis and in diabetes, this hypothesis needs to be confirmed in a prospective cohort study.
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Affiliation(s)
- Thomas Albrecht
- Fifth Medical Department (Nephrology/Endocrinology/Rheumatology), University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany
- *Thomas Albrecht:
| | - Shiqi Zhang
- Fifth Medical Department (Nephrology/Endocrinology/Rheumatology), University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany
- Department of Endocrinology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Jana D. Braun
- Fifth Medical Department (Nephrology/Endocrinology/Rheumatology), University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany
| | - Li Xia
- Fifth Medical Department (Nephrology/Endocrinology/Rheumatology), University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany
- Department of Endocrinology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Angelica Rodriquez
- Fifth Medical Department (Nephrology/Endocrinology/Rheumatology), University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany
| | - Jiedong Qiu
- Fifth Medical Department (Nephrology/Endocrinology/Rheumatology), University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany
| | - Verena Peters
- Centre for Pediatric and Adolescent Medicine, University of Heidelberg, Heidelberg, Germany
| | - Claus P. Schmitt
- Centre for Pediatric and Adolescent Medicine, University of Heidelberg, Heidelberg, Germany
| | - Jacob van den Born
- Nephrology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Stephan J. L. Bakker
- Nephrology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Alexander Lammert
- Fifth Medical Department (Nephrology/Endocrinology/Rheumatology), University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany
| | - Hannes Köppel
- Fifth Medical Department (Nephrology/Endocrinology/Rheumatology), University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany
| | - Peter Schnuelle
- Fifth Medical Department (Nephrology/Endocrinology/Rheumatology), University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany
| | - Bernhard K. Krämer
- Fifth Medical Department (Nephrology/Endocrinology/Rheumatology), University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany
| | - Benito A. Yard
- Fifth Medical Department (Nephrology/Endocrinology/Rheumatology), University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany
| | - Sibylle J. Hauske
- Fifth Medical Department (Nephrology/Endocrinology/Rheumatology), University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany
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7
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Abstract
Bariatric surgery is the most effective treatment for weight loss and glycaemic control. The focus of clinical studies and clinical experience has predominantly been on the numerical reductions of bodyweight and glucose after surgery. In this Series paper, we examine evidence on the efficacy of bariatric surgery for pancreatic, renal, retinal, peripheral nervous, cardiovascular, hepatic, and reproductive end-organ damage or disease. The overall conclusions are that, in most cases, patients' end-organ damage is expected to either stabilise or improve postoperatively. However, some of these clinical outcomes have not been assessed with robust methods and, in many cases, do not have support from randomised controlled clinical trials comparing bariatric surgery with non-surgical interventions. Such trials are urgently needed to inform patients and clinicians on whether the risks of surgery outweigh the significant benefits for end-organ health.
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Affiliation(s)
- Alexander D Miras
- Molecular and Metabolic Imaging group, Institute of Clinical Sciences, Imperial College London, Hammersmith Hospital, London, UK.
| | - Carel W le Roux
- Diabetes Complications Research Centre, UCD Conway Institute, School of Medicine and Medical Science, University College Dublin, Dublin, Ireland; Department of Gastrosurgical Research and Education, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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8
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Improving compliance with screening of diabetic patients for microalbuminuria in primary care practice. ISRN ENDOCRINOLOGY 2013; 2013:893913. [PMID: 24224095 PMCID: PMC3810193 DOI: 10.1155/2013/893913] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/07/2013] [Accepted: 09/04/2013] [Indexed: 01/24/2023]
Abstract
Studies showed suboptimal compliance rate of primary care physicians with microalbuminuria screening. This study evaluated impact of electronic medical records (EMR) and computerized physicians reminders on compliance rate and showed small to modest improvement. Combining EMR with quality control monitoring has significantly improved compliance [OR 1.556, 95% CI 1.251–1.935, P = 0.006].
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9
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Effects of bariatric surgery on diabetic nephropathy after 5 years of follow-up. Surg Obes Relat Dis 2012; 9:7-14. [PMID: 23211651 DOI: 10.1016/j.soard.2012.08.016] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2012] [Revised: 08/05/2012] [Accepted: 08/17/2012] [Indexed: 12/28/2022]
Abstract
BACKGROUND Studies have reported that the benefits of bariatric surgery extend beyond durable weight loss and include significant improvement in glycemic control. We hypothesized that improving diabetes control may have positive effects on end-organ complications of this disease, such as diabetic nephropathy (DN). METHODS We identified all patients with type 2 diabetes mellitus (T2DM) who underwent bariatric surgery at our institution and had completed a 5-year follow-up. Patients' current diabetes status (remission, improvement, or no change) was determined by biochemical analyses and medication review. The presence of DN, preoperatively and postoperatively, was determined by urinary albumin/creatinine ratio (uACR). RESULTS Fifty-two T2DM patients underwent bariatric surgery and had completed 5-year follow-up, including serial uACR measurements (25% male; age 51.2 ± 10.1 years). Preoperative body mass index (BMI) was 49 ± 8.7 kg/m(2), mean duration of T2DM was 8.6 years (range .3-39), and baseline HbA(1c) was 7.7% ± 1.4%. DN, as indicated by microalbuminuria (30-300 mg/g) or macroalbuminuria (>300 mg/g), was present in 37.6% preoperatively. Of these, DN resolved in 58.3% at a mean follow-up of 66 months (range 60-92 ). Among those with no evidence of DN preoperatively, albuminuria proceeded to develop 5 years later in only 25%. The 5-year remission and improvement rates for T2DM were 44% and 33%, respectively. Mean reductions in fasting glucose and glycosylated hemoglobin (HbA(1c)) were 36.6 mg/dL and 1.2%, respectively. CONCLUSION Bariatric surgery can induce a significant and sustainable improvement in T2DM and improve or halt the development of microvascular complications such as nephropathy. Considering that diabetes is often a progressive disease, these results are clinically important and warrant further investigation.
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10
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Galler A, Haberland H, Näke A, Hofer S, Holder M, Raile K, Holl RW. Natural course of untreated microalbuminuria in children and adolescents with type 1 diabetes and the importance of diabetes duration and immigrant status: longitudinal analysis from the prospective nationwide German and Austrian diabetes survey DPV. Eur J Endocrinol 2012; 166:493-501. [PMID: 22199141 DOI: 10.1530/eje-11-0695] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To identify risk factors for the development and progression of untreated persistent microalbuminuria in children and adolescents with type 1 diabetes. DESIGN AND METHODS A total number of 683 children and adolescents with type 1 diabetes recruited from the prospective nationwide German and Austrian diabetes survey (DPV) were included in the analysis. Inclusion criteria were onset of type 1 diabetes under the age of 11 years, diabetes duration of more than 1 year and continuous follow-up over 5 years with at least two documented urine analyses per year. Subjects treated with angiotensin-converting enzyme inhibitors were excluded. Risk factors such as sex, body mass index SDS, diabetes duration, HbA1c, total cholesterol, HDL-cholesterol, LDL-cholesterol, systolic and diastolic blood pressure, and immigrant status were analysed by logistic regression. RESULTS At baseline (age 10.5 ± 0.1 years, diabetes duration 4.6 ± 2.4 years and HbA1c 7.4 ± 1.1%), 75.6% of children had normoalbuminuria, 15.7% had intermittent microalbuminuria, 8.6% had persistent microalbuminuria and 0.1% had macroalbuminuria. After a follow-up of 5 years, 59.4% of adolescents continued to have normoalbuminuria, 18.4% had progression, 15.2% had regression of microalbuminuria, and in 6.9% of the subjects, microalbuminuria remained unchanged. We found significant associations between persistent microalbuminuria at baseline and during each year of follow-up (P < 0.0001). Logistic regression analysis identified diabetes duration and immigrant status as significant factors for microalbuminuria (P = 0.009 and P = 0.009). CONCLUSIONS The survey in a real-world setting shows that diabetes duration and immigrant status are risk factors for the development and progression of untreated microalbuminuria in children and adolescents with type 1 diabetes.
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Affiliation(s)
- Angela Galler
- Charité - Universitätsmedizin Berlin, Paediatric Endocrinology and Diabetology, University Hospital for Children and Adolescents, Campus Virchow Klinikum, Augustenburger Platz 1, 13353 Berlin, Germany.
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11
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Ninichuk V, Khandoga AG, Segerer S, Loetscher P, Schlapbach A, Revesz L, Feifel R, Khandoga A, Krombach F, Nelson PJ, Schlöndorff D, Anders HJ. The role of interstitial macrophages in nephropathy of type 2 diabetic db/db mice. THE AMERICAN JOURNAL OF PATHOLOGY 2007; 170:1267-76. [PMID: 17392166 PMCID: PMC1829460 DOI: 10.2353/ajpath.2007.060937] [Citation(s) in RCA: 74] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Diabetic nephropathy is associated with interstitial macrophage infiltrates, but their contribution to disease progression is unclear. We addressed this question by blockade of chemokine receptor (CCR)1 because CCR1 mediates the macrophage recruitment to the renal interstitium. In fact, when CCR1 was blocked with BL5923, a novel orally available CCR1 antagonist, the interstitial recruitment of ex vivo labeled macrophages was markedly decreased in uninephrectomized male db/db mice with advanced diabetic nephropathy. Likewise, BL5923 (60 mg/kg, twice a day) orally administered from months 5 to 6 of life reduced the numbers of interstitial macrophages in uninephrectomized db/db mice. This was associated with reduced numbers of Ki-67 proliferating tubular epithelial and interstitial cells, tubular atrophy, and interstitial fibrosis in uninephrectomized db/db mice. Glomerular pathology and proteinuria were not affected by the CCR1 antagonist. BL5923 reduced renal mRNA expression of Ccl2, Ccr1, Ccr2, Ccr5, transforming growth factor-beta1, and collagen I-alpha1 when compared with untreated uninephrectomized male db/db mice of the same age. Thus, we identified a previously unrecognized role for interstitial macrophages for tubulointerstitial injury, loss of peritubular microvasculature, interstitial inflammation, and fibrosis in type 2 diabetic db/db mice. These data identify oral treatment with the CCR1 antagonist BL5923 as a potential therapy for late-stage diabetic nephropathy.
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MESH Headings
- Administration, Oral
- Animals
- Antigens, Differentiation/analysis
- Cell Line
- Cells, Cultured
- Diabetes Mellitus, Type 2/complications
- Diabetic Neuropathies/etiology
- Diabetic Neuropathies/pathology
- Gene Expression/drug effects
- Immunohistochemistry
- Kidney/drug effects
- Kidney/metabolism
- Kidney/pathology
- Kidney Glomerulus/drug effects
- Kidney Glomerulus/metabolism
- Kidney Glomerulus/pathology
- Kidney Tubules/drug effects
- Kidney Tubules/metabolism
- Kidney Tubules/pathology
- Macrophages/metabolism
- Macrophages/pathology
- Male
- Mice
- Mice, Inbred C57BL
- Mice, Obese
- Microscopy, Fluorescence
- RNA, Messenger/genetics
- RNA, Messenger/metabolism
- Receptors, CCR1
- Receptors, CCR2
- Receptors, Chemokine/antagonists & inhibitors
- Receptors, Chemokine/genetics
- Receptors, Chemokine/metabolism
- Reverse Transcriptase Polymerase Chain Reaction
- Transforming Growth Factor beta1/genetics
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Affiliation(s)
- Volha Ninichuk
- Medizinische Poliklinik, Klinikum der Universität München-Innenstadt, Pettenkoferstr. 8a, 80336 Munchen, Germany
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12
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Redon J. Measurement of microalbuminuria – what the nephrologist should know. Nephrol Dial Transplant 2005; 21:573-6. [PMID: 16384822 DOI: 10.1093/ndt/gfk014] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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