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Bashir AAM, Olaniyi KS. Butyrate alleviates renal inflammation and fibrosis in a rat model of polycystic ovarian syndrome by suppression of SDF-1. BMC Pharmacol Toxicol 2023; 24:48. [PMID: 37789355 PMCID: PMC10548736 DOI: 10.1186/s40360-023-00692-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Accepted: 09/27/2023] [Indexed: 10/05/2023] Open
Abstract
BACKGROUND Polycystic ovarian syndrome (PCOS) is a multifactorial condition with metabolic-related complications, such as diabetic nephropathy and chronic renal disorder, which are the leading cause of renal transplant globally. Protective effects of histone deacetylase (HDAC) inhibitors (HDACi) have been documented in metabolic-linked pathologies. Nonetheless, the current study investigated the restorative role of HDACi, butyrate in experimental PCOS-induced renal disorder. MATERIALS AND METHODS Female Wistar rats (8-week-old) were divided into groups; control, butyrate-treated, letrozole and letrozole + butyrate-treated groups. To induce PCOS, 1 mg/kg of letrozole was given (oral gavage) for 21 days. After confirmation of PCOS, 200 mg/kg of butyrate (oral gavage) was administered for 6 weeks. RESULTS Rats with PCOS revealed disruption in glucose homeostasis (hyperinsulinemia and impaired glucose tolerance and insulin resistance) and presented with the phenotypes of PCOS (hyperandrogenism, multiple ovarian cysts and elevated LH/FSH ratio). Increased plasma and renal triglycerides and inflammatory (TNF-α/SDF-1/NF-κB) markers were observed with elevated levels of TGFβ-1, renal lipid peroxidation and redox imbalance (GGT, GSH, HIF-1α). Interestingly, animals with PCOS reported increased body weight as well as renal mass. Whereas, heightened levels of plasma urea, creatinine and creatine kinase indicating renal dysfunction, characterized by renal apoptosis (Caspase-6) and increased HDAC2 levels. Notwithstanding, administration of butyrate averted the alterations. CONCLUSION The present investigation demonstrates that PCOS declines renal function, which is accompanied by renal inflammation, apoptosis and fibrosis. The study further suggests that butyrate, an HDAC2i restores renal function by suppressing renal SDF-1 with subsequent attenuation of renal inflammation, apoptosis and fibrosis.
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Affiliation(s)
- Al-Amin M Bashir
- Cardio/Endo-metabolic and Microbiome Research Unit, Department of Physiology, College of Medicine and Health Sciences, Afe Babalola University, Ado-Ekiti, 360101, Nigeria
| | - Kehinde S Olaniyi
- Cardio/Endo-metabolic and Microbiome Research Unit, Department of Physiology, College of Medicine and Health Sciences, Afe Babalola University, Ado-Ekiti, 360101, Nigeria.
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2
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Mollard R, Cachero K, Luhovyy B, Martin H, Moisiuk S, Mahboobi S, Balshaw R, Collister D, Cahill L, Tennankore KK, Tangri N, MacKay D. Reducing Dietary Acid With Fruit and Vegetables Versus Oral Alkali in People With Chronic Kidney Disease (ReDACKD): A Clinical Research Protocol. Can J Kidney Health Dis 2023; 10:20543581231190180. [PMID: 37560749 PMCID: PMC10408321 DOI: 10.1177/20543581231190180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Accepted: 06/22/2023] [Indexed: 08/11/2023] Open
Abstract
Background Individuals with chronic kidney disease (CKD) can develop metabolic acidosis which, in turn, is associated with faster progression of CKD and an increased need for dialysis. Oral sodium bicarbonate (the current standard of care therapy for metabolic acidosis) is poorly tolerated leading to low adherence. Base-producing or alkalizing Fruit and vegetables have potential as an alternative treatment for metabolic acidosis as they have been shown to reduce acid load arising from the diet. Objective This trial will evaluate the feasibility of providing base-producing fruit and vegetables as a dietary treatment for metabolic acidosis, compared with oral sodium bicarbonate. Design A 2-arm, open-label, dual-center, randomized controlled feasibility trial. Setting Two Canadian sites: a nephrology clinic in Winnipeg, Manitoba, and a nephrology clinic in Halifax, Nova Scotia. Participants Adult participants with G3-G5 CKD and metabolic acidosis. Measurements Participants will undergo baseline measurements and attend 5 study visits over 12 months at which they will have a measurement of feasibility criteria as well as blood pressure, blood and urine biochemistry, 5-repetition chair stand test (STS5), and questionnaires to assess quality of life and symptoms. Furthermore, participants fill out Automated Self-Administered 24-hour recalls (ASA-24) in the beginning, middle, and end of trial. Methods A total of 40 eligible participants will be randomized 1:1 to either base-producing fruit and vegetables (experimental) group or sodium bicarbonate (control) group, beginning from a daily dose of 1500 mg. Limitations Using self-administered dietary assessments, lack of supervision over the consumption of study treatments and the possible disappointment of the control group for not receiving fruit and vegetables would be considered as limitations for this study. However, we are planning to undertake proper practices to overcome the possible limitations. These practices are discussed throughout the article in detail. Conclusions This study will generate data on base-producing fruit and vegetables consumption as a dietary treatment for metabolic acidosis in CKD. The data will be used to design a future multi-center trial looking at slowing CKD progression in people with metabolic acidosis. Trial Registration This study is registered on clinicaltrials.gov with the identifier NCT05113641.
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Affiliation(s)
- Rebecca Mollard
- Department of Food and Human Nutritional Sciences, Faculty of Agriculture and Food Science, University of Manitoba, Winnipeg, Canada
- Chronic Disease Innovation Centre, Seven Oaks General Hospital, University of Manitoba, Winnipeg, Canada
| | - Katrina Cachero
- Department of Food and Human Nutritional Sciences, Faculty of Agriculture and Food Science, University of Manitoba, Winnipeg, Canada
- Chronic Disease Innovation Centre, Seven Oaks General Hospital, University of Manitoba, Winnipeg, Canada
| | - Bohdan Luhovyy
- Department of Applied Human Nutrition, Mount Saint Vincent University, Halifax, NS, Canada
| | - Heather Martin
- Department of Internal Medicine, University of Manitoba, Winnipeg, Canada
| | - Sharon Moisiuk
- Chronic Disease Innovation Centre, Seven Oaks General Hospital, University of Manitoba, Winnipeg, Canada
| | - Sepideh Mahboobi
- Department of Food and Human Nutritional Sciences, Faculty of Agriculture and Food Science, University of Manitoba, Winnipeg, Canada
- Chronic Disease Innovation Centre, Seven Oaks General Hospital, University of Manitoba, Winnipeg, Canada
| | - Robert Balshaw
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada
| | - David Collister
- Chronic Disease Innovation Centre, Seven Oaks General Hospital, University of Manitoba, Winnipeg, Canada
- Division of Nephrology, Department of Medicine, University of Alberta, Edmonton, Canada
| | - Leah Cahill
- Department of Medicine, Dalhousie University, Halifax, NS, Canada
- Nova Scotia Health Authority, Dalhousie University, Halifax, NS, Canada
| | - Karthik K. Tennankore
- Department of Medicine, Dalhousie University, Halifax, NS, Canada
- Nova Scotia Health Authority, Dalhousie University, Halifax, NS, Canada
| | - Navdeep Tangri
- Chronic Disease Innovation Centre, Seven Oaks General Hospital, University of Manitoba, Winnipeg, Canada
- Department of Internal Medicine, University of Manitoba, Winnipeg, Canada
| | - Dylan MacKay
- Department of Food and Human Nutritional Sciences, Faculty of Agriculture and Food Science, University of Manitoba, Winnipeg, Canada
- Department of Internal Medicine, University of Manitoba, Winnipeg, Canada
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Chen R, Zhang L, Zhang M, Wang Y, Liu D, Li Z, Zhang X, Jin H, Liu B, Liu H. The triglyceride-glucose index as a novel marker associated with sarcopenia in non-diabetic patients on maintenance hemodialysis. Ren Fail 2022; 44:1615-1621. [PMID: 36191303 PMCID: PMC9543127 DOI: 10.1080/0886022x.2022.2128373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Objective Sarcopenia is a common complication in patients with end-stage kidney disease. Insulin resistance is present in non-diabetic patients undergoing maintenance hemodialysis (MHD) and is an important factor leading to sarcopenia. The triglyceride–glucose (TyG) index, a reliable indicator for evaluating insulin resistance, is widely used in clinical practice. The present study investigated the association between the TyG index and sarcopenia in non-diabetic patients undergoing MHD. Methods Relevant clinical data of non-diabetic patients undergoing MHD at our center were collected. The TyG index was calculated using the following formula: ln(fasting triglycerides(mg/dL)×fasting blood glucose(mg/dL)/2). Multivariate logistic regression analyses were used to evaluate the associations. The receiver-operating characteristic curve was used to analyze the predictive value of the TyG index in sarcopenia. Results Of the 142 patients undergoing MHD who were included, 75 (52.82%) were men, the mean age was 54.05 ± 13.97 years, and 40 (28.17%) patients satisfied the diagnostic criteria for sarcopenia. The TyG index of participants with sarcopenia was higher compared with those without sarcopenia (8.83 ± 0.45 vs. 8.49 ± 0.50, p < 0.001). The prevalence of sarcopenia increased with increasing TyG index tertile (T1, 8.51%; T2, 31.91%; T3, 43.75%; p = 0.001). Logistic regression analysis indicated that the TyG index was an independent risk factor for sarcopenia (odds ratio, 4.21 [95% confidence interval, 1.85–9.59], p = 0.001). Conclusion A higher TyG index was associated with an increased risk of sarcopenia in non-diabetic patients undergoing MHD; it may be used as a novel marker to reflect the presence of sarcopenia.
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Affiliation(s)
- Ruoxin Chen
- Institute of Nephrology, Zhongda Hospital, Southeast University School of Medicine, Nanjing, China
| | - Liuping Zhang
- Institute of Nephrology, Zhongda Hospital, Southeast University School of Medicine, Nanjing, China
| | - Mengyan Zhang
- Institute of Nephrology, Zhongda Hospital, Southeast University School of Medicine, Nanjing, China
| | - Ying Wang
- Institute of Nephrology, Zhongda Hospital, Southeast University School of Medicine, Nanjing, China
| | - Dan Liu
- Institute of Nephrology, Zhongda Hospital, Southeast University School of Medicine, Nanjing, China
| | - Zuolin Li
- Institute of Nephrology, Zhongda Hospital, Southeast University School of Medicine, Nanjing, China
| | - Xiaoliang Zhang
- Institute of Nephrology, Zhongda Hospital, Southeast University School of Medicine, Nanjing, China
| | - Hui Jin
- Institute of Nutrition, Zhongda Hospital, Southeast University School of Medicine, Nanjing, China
| | - Bicheng Liu
- Institute of Nephrology, Zhongda Hospital, Southeast University School of Medicine, Nanjing, China
| | - Hong Liu
- Institute of Nephrology, Zhongda Hospital, Southeast University School of Medicine, Nanjing, China
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Kaka N, Sethi Y, Patel N, Kaiwan O, Al-Inaya Y, Manchanda K, Uniyal N. Endocrine manifestations of chronic kidney disease and their evolving management: A systematic review. Dis Mon 2022; 68:101466. [PMID: 35965104 DOI: 10.1016/j.disamonth.2022.101466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Chronic Kidney Disease (CKD) shows a wide range of renal abnormalities including the excretory, metabolic, endocrine, and homeostatic function of the kidney. The prognostic impact of the 'endocrine manifestations' which are often overlooked by clinicians cannot be overstated. METHODS AND OBJECTIVES A systematic review was attempted to provide a comprehensive overview of all endocrine abnormalities of CKD and their evolving principles of management, searching databases of PubMed, Embase, and Scopus and covering the literature between 2002 and 2022. RESULTS The endocrine derangements in CKD can be attributed to a myriad of pathologic processes, in particular decreased clearance, impaired endogenous hormone production, uremia-induced cellular dysfunction, and activation of systemic inflammatory pathways. The major disorders include anemia, hyperprolactinemia, insulin resistance, reproductive hormone deficiency, thyroid hormone deficiency, and serum FGF (Fibroblast Growth Factor) alteration. Long-term effects of CKD also include malnutrition and increased cardiovascular risk. The recent times have unveiled their detailed pathogenesis and have seen an evolution in the principles of management which necessitates a revision of current guidelines. CONCLUSION Increased advertence regarding the pathology, impact, and management of these endocrine derangements can help in reducing morbidity as well as mortality in the CKD patients by allowing prompt individualized treatment. Moreover, with timely and appropriate intervention, a long-term reduction in complications, as well as an enhanced quality of life, can be achieved in patients with CKD.
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Affiliation(s)
- Nirja Kaka
- GMERS Medical College, Himmatnagar, Gujarat 382007, India
| | - Yashendra Sethi
- Department of Medicine, Government Doon Medical College, Dehradun, Uttarakhand, India
| | - Neil Patel
- GMERS Medical College, Himmatnagar, Gujarat 382007, India.
| | | | | | | | - Nidhi Uniyal
- Department of Medicine, Government Doon Medical College, Dehradun, Uttarakhand, India
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5
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Trends in insulin resistance: insights into mechanisms and therapeutic strategy. Signal Transduct Target Ther 2022; 7:216. [PMID: 35794109 PMCID: PMC9259665 DOI: 10.1038/s41392-022-01073-0] [Citation(s) in RCA: 141] [Impact Index Per Article: 70.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 06/15/2022] [Accepted: 06/20/2022] [Indexed: 02/06/2023] Open
Abstract
The centenary of insulin discovery represents an important opportunity to transform diabetes from a fatal diagnosis into a medically manageable chronic condition. Insulin is a key peptide hormone and mediates the systemic glucose metabolism in different tissues. Insulin resistance (IR) is a disordered biological response for insulin stimulation through the disruption of different molecular pathways in target tissues. Acquired conditions and genetic factors have been implicated in IR. Recent genetic and biochemical studies suggest that the dysregulated metabolic mediators released by adipose tissue including adipokines, cytokines, chemokines, excess lipids and toxic lipid metabolites promote IR in other tissues. IR is associated with several groups of abnormal syndromes that include obesity, diabetes, metabolic dysfunction-associated fatty liver disease (MAFLD), cardiovascular disease, polycystic ovary syndrome (PCOS), and other abnormalities. Although no medication is specifically approved to treat IR, we summarized the lifestyle changes and pharmacological medications that have been used as efficient intervention to improve insulin sensitivity. Ultimately, the systematic discussion of complex mechanism will help to identify potential new targets and treat the closely associated metabolic syndrome of IR.
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Mahmoud T, Borgi L. The Interplay Between Nutrition, Metabolic, and Endocrine Disorders in Chronic Kidney Disease. Semin Nephrol 2021; 41:180-188. [PMID: 34140096 DOI: 10.1016/j.semnephrol.2021.03.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
The kidneys are responsible for maintaining our bodies' homeostasis through excretion, biodegradation, and synthesis of different hormones. Therefore, a decline in renal function often results in significant derangements in hormone levels. The most common metabolic and endocrine abnormalities seen in patients with chronic kidney disease include deficiencies in erythropoietin, calcitriol, triiodothyronine, testosterone, and estrogen. In addition, accumulation of hormones such as adiponectin, leptin, triglycerides, and prolactin also is seen. Subsequently, this can lead to the development of a wide range of clinical consequences including but not limited to anemia, hyperparathyroidism, insulin resistance, anorexia-cachexia, infertility, bone disorders, and cardiovascular diseases. These disorders can negatively affect the prognosis and quality of life of patients with chronic kidney disease, and, thus, early diagnosis, nutritional intervention, and pharmacologic treatment is imperative.
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Affiliation(s)
- Tala Mahmoud
- Faculty of Medicine, University of Balamand, Beirut, Lebanon
| | - Lea Borgi
- Renal Division, Brigham and Women's Hospital, Boston, MA.
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7
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Manzanilla Valdez ML, Segura Campos MR. Renal and Hepatic Disease: Cnidoscolus aconitifolius as Diet Therapy Proposal for Prevention and Treatment. J Am Coll Nutr 2020; 40:646-664. [PMID: 33301380 DOI: 10.1080/07315724.2020.1810171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
The lack of prevention of noncommunicable diseases (NCDs) has caused an increase in the mortality rate including conditions such as chronic kidney disease (CKD) and liver disease (LD). The high complexity of CKD and LD results in alterations in the metabolism of carbohydrates, proteins, and lipids. One of the changes observed in CKD and LD is the decrease in albumin, elevation of PO4-3, K+, creatinine, urea, and transaminase enzymes. The pharmacological treatment is expensive. Nowadays, phytotherapy is an option to treat NCDs. Aqueous, ethanolic, methanolic, and ethyl acetate extracts of Cnidoscolus aconitifolius have shown nephroprotective and hepatoprotective potential and can be an alternative to prevent and treat CKD and LD. C. aconitifolius, known as Chaya by Mayas in Yucatán, is a shrub that is consumed in Mexico and in the world, has a low cost, it is very accessible, and can growth in extreme weather. The aim of this review is to show the potential biological effects of C. aconitifolius extracts, and the association of the phytochemicals in the extract. It is known that different solvents result in the uptake of different phytochemicals. These have shown various effects such as hypoglycemic, hypotensive, hypolipidemic, and antioxidant, being a natural alternative to the treatment of NCDs.Key teaching pointsPhytotherapy is a proposal to treat NCDs.Cnidoscolus aconitifolius extracts have a hypotensive effect.Cnidoscolus aconitifolius extracts reduce blood sugar in diabetic rats.Chaya extracts are no toxic for renal and hepatic cells.
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Mannon EC, O'Connor PM. Alkali supplementation as a therapeutic in chronic kidney disease: what mediates protection? Am J Physiol Renal Physiol 2020; 319:F1090-F1104. [PMID: 33166183 DOI: 10.1152/ajprenal.00343.2020] [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] [Indexed: 12/14/2022] Open
Abstract
Sodium bicarbonate (NaHCO3) has been recognized as a possible therapy to target chronic kidney disease (CKD) progression. Several small clinical trials have demonstrated that supplementation with NaHCO3 or other alkalizing agents slows renal functional decline in patients with CKD. While the benefits of NaHCO3 treatment have been thought to result from restoring pH homeostasis, a number of studies have now indicated that NaHCO3 or other alkalis may provide benefit regardless of the presence of metabolic acidosis. These data have raised questions as to how NaHCO3 protects the kidneys. To date, the physiological mechanism(s) that mediates the reported protective effect of NaHCO3 in CKD remain unclear. In this review, we first examine the evidence from clinical trials in support of a beneficial effect of NaHCO3 and other alkali in slowing kidney disease progression and their relationship to acid-base status. Then, we discuss the physiological pathways that have been proposed to underlie these renoprotective effects and highlight strengths and weaknesses in the data supporting each pathway. Finally, we discuss how answering key questions regarding the physiological mechanism(s) mediating the beneficial actions of NaHCO3 therapy in CKD is likely to be important in the design of future clinical trials. We conclude that basic research in animal models is likely to be critical in identifying the physiological mechanisms underlying the benefits of NaHCO3 treatment in CKD. Gaining an understanding of these pathways may lead to the improved implementation of NaHCO3 as a therapy in CKD and perhaps other disease states.
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Affiliation(s)
- Elinor C Mannon
- Department of Physiology, Augusta University, Augusta, Georgia
| | - Paul M O'Connor
- Department of Physiology, Augusta University, Augusta, Georgia
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9
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Garibotto G, Picciotto D, Saio M, Esposito P, Verzola D. Muscle protein turnover and low-protein diets in patients with chronic kidney disease. Nephrol Dial Transplant 2020; 35:741-751. [PMID: 32378720 DOI: 10.1093/ndt/gfaa072] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Accepted: 02/28/2020] [Indexed: 02/07/2023] Open
Abstract
Adaptation to a low-protein diet (LPD) involves a reduction in the rate of amino acid (AA) flux and oxidation, leading to more efficient use of dietary AA and reduced ureagenesis. Of note, the concept of 'adaptation' to low-protein intakes has been separated from the concept of 'accommodation', the latter term implying a decrease in protein synthesis, with development of wasting, when dietary protein intake becomes inadequate, i.e. beyond the limits of the adaptive mechanisms. Acidosis, insulin resistance and inflammation are recognized mechanisms that can increase protein degradation and can impair the ability to activate an adaptive response when an LPD is prescribed in a chronic kidney disease (CKD) patient. Current evidence shows that, in the short term, clinically stable patients with CKD Stages 3-5 can efficiently adapt their muscle protein turnover to an LPD containing 0.55-0.6 g protein/kg or a supplemented very-low-protein diet (VLPD) by decreasing muscle protein degradation and increasing the efficiency of muscle protein turnover. Recent long-term randomized clinical trials on supplemented VLPDs in patients with CKD have shown a very good safety profile, suggesting that observations shown by short-term studies on muscle protein turnover can be extrapolated to the long-term period.
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Affiliation(s)
- Giacomo Garibotto
- Division of Nephrology, Dialysis and Transplantation, Department of Internal Medicine and IRCCS Ospedale Policlinico San Martino, University of Genova, Genova, Italy
| | - Daniela Picciotto
- Division of Nephrology, Dialysis and Transplantation, Department of Internal Medicine and IRCCS Ospedale Policlinico San Martino, University of Genova, Genova, Italy
| | - Michela Saio
- Division of Nephrology, Dialysis and Transplantation, Department of Internal Medicine and IRCCS Ospedale Policlinico San Martino, University of Genova, Genova, Italy
| | - Pasquale Esposito
- Division of Nephrology, Dialysis and Transplantation, Department of Internal Medicine and IRCCS Ospedale Policlinico San Martino, University of Genova, Genova, Italy
| | - Daniela Verzola
- Division of Nephrology, Dialysis and Transplantation, Department of Internal Medicine and IRCCS Ospedale Policlinico San Martino, University of Genova, Genova, Italy
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10
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Mediterranean Diet Nutrients to Turn the Tide against Insulin Resistance and Related Diseases. Nutrients 2020; 12:nu12041066. [PMID: 32290535 PMCID: PMC7230471 DOI: 10.3390/nu12041066] [Citation(s) in RCA: 124] [Impact Index Per Article: 31.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 04/06/2020] [Accepted: 04/10/2020] [Indexed: 12/11/2022] Open
Abstract
Insulin resistance (IR), defined as an attenuated biological response to circulating insulin, is a fundamental defect in obesity and type 2 diabetes (T2D), and is also linked to a wide spectrum of pathological conditions, such as non-alcoholic fatty liver disease (NAFLD), cognitive impairment, endothelial dysfunction, chronic kidney disease (CKD), polycystic ovary syndrome (PCOS), and some endocrine tumors, including breast cancer. In obesity, the unbalanced production of pro- and anti-inflammatory adipocytokines can lead to the development of IR and its related metabolic complications, which are potentially reversible through weight-loss programs. The Mediterranean diet (MedDiet), characterized by high consumption of extra-virgin olive oil (EVOO), nuts, red wine, vegetables and other polyphenol-rich elements, has proved to be associated with greater improvement of IR in obese individuals, when compared to other nutritional interventions. Also, recent studies in either experimental animal models or in humans, have shown encouraging results for insulin-sensitizing nutritional supplements derived from MedDiet food sources in the modulation of pathognomonic traits of certain IR-related conditions, including polyunsaturated fatty acids from olive oil and seeds, anthocyanins from purple vegetables and fruits, resveratrol from grapes, and the EVOO-derived, oleacein. Although the pharmacological properties and clinical uses of these functional nutrients are still under investigation, the molecular mechanism(s) underlying the metabolic benefits appear to be compound-specific and, in some cases, point to a role in gene expression through an involvement of the nuclear high-mobility group A1 (HMGA1) protein.
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11
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Mohamad HE, Asker ME, Keshawy MM, Abdel Aal SM, Mahmoud YK. Infliximab ameliorates tumor necrosis factor-alpha exacerbated renal insulin resistance induced in rats by regulating insulin signaling pathway. Eur J Pharmacol 2020; 872:172959. [PMID: 32004528 DOI: 10.1016/j.ejphar.2020.172959] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 01/24/2020] [Accepted: 01/24/2020] [Indexed: 12/17/2022]
Abstract
Infliximab (IFX), a monoclonal antibody for tumor necrosis factor-alpha (TNF-α), is known to restore blood glucose homeostasis. However, its effects on improving renal insulin resistance (IR) are not yet studied. So we investigate the impact of infliximab on renal insulin signaling pathway in IR rat model regarding to metformin (MET). The induced IR was confirmed by a high oral glucose tolerance test, an elevation of lipid profile and the homeostatic model assessment of insulin resistance 2 (HOMA-IR 2) values. Subsequently, IR rats were concurrently treated with either MET (100 mg/kg/day) or IFX (one dose 5 mg/kg) besides IR and normal control (NC) groups. Four weeks later, IR control rats displayed hyperglycemia, hyperinsulinemia and elevation in HOMA-IR 2, renal function markers and renal tissue TNF-α, interleukins-1β and 6 (Il-1β, IL-6) and suppressor of cytokines signaling 3 (SOCS3) contents as well as glomerulosclerosis when compared to NC group. Additionally, the phosphorylation of renal insulin receptor substrate 1 (IRS1), phosphatidylinositol 3-kinase (PI3K) and protein kinase B (Akt) were markedly impaired. Treatment with either MET or IFX significantly improved IR and kidney functions. The effects of the drugs were achieved by the downregulation of renal inflammatory cytokines and SOCS3 levels and the amelioration of the renal IRS1/PI3K/Akt pathway. In conclusion, MET and IFX ameliorated the TNF-α worsening effect on IR in rat renal tissues by regulating insulin signaling. Interestingly, infliximab was superior to metformin in regulating insulin signaling pathway. Therefore, infliximab could be used as an adjuvant therapy in improving renal IR.
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Affiliation(s)
- Hoda E Mohamad
- Department of Biochemistry, Faculty of Pharmacy, Zagazig University, Zagazig, 44519, Egypt.
| | - Mervat E Asker
- Department of Biochemistry, Faculty of Pharmacy, Zagazig University, Zagazig, 44519, Egypt
| | - Mohammed M Keshawy
- Department of Internal Medicine, Nephrology Division, Faculty of Medicine, Ismailia, 41522, Suez Canal University, Egypt
| | - Sara M Abdel Aal
- Department of Histology& Cell Biology, Faculty of Medicine, Zagazig University, Zagazig, 44519, Egypt
| | - Yasmin K Mahmoud
- Department of Biochemistry, Faculty of Pharmacy, Zagazig University, Zagazig, 44519, Egypt
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Wesson DE, Buysse JM, Bushinsky DA. Mechanisms of Metabolic Acidosis-Induced Kidney Injury in Chronic Kidney Disease. J Am Soc Nephrol 2020; 31:469-482. [PMID: 31988269 DOI: 10.1681/asn.2019070677] [Citation(s) in RCA: 104] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Retrospective analyses and single-center prospective studies identify chronic metabolic acidosis as an independent and modifiable risk factor for progression of CKD. In patients with CKD, untreated chronic metabolic acidosis often leads to an accelerated reduction in GFR. Mechanisms responsible for this reduction include adaptive responses that increase acid excretion but lead to a decline in kidney function. Metabolic acidosis in CKD stimulates production of intrakidney paracrine hormones including angiotensin II, aldosterone, and endothelin-1 (ET-1) that mediate the immediate benefit of increased kidney acid excretion, but their chronic upregulation promotes inflammation and fibrosis. Chronic metabolic acidosis also stimulates ammoniagenesis that increases acid excretion but also leads to ammonia-induced complement activation and deposition of C3 and C5b-9 that can cause tubule-interstitial damage, further worsening disease progression. These effects, along with acid accumulation in kidney tissue, combine to accelerate progression of kidney disease. Treatment of chronic metabolic acidosis attenuates these adaptive responses; reduces levels of angiotensin II, aldosterone, and ET-1; reduces ammoniagenesis; and diminishes inflammation and fibrosis that may lead to slowing of CKD progression.
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Affiliation(s)
- Donald E Wesson
- Baylor Scott & White Health and Wellness Center, Dallas, Texas; .,Department of Internal Medicine, Texas A&M College of Medicine, Bryan, Texas
| | | | - David A Bushinsky
- Division of Nephrology, University of Rochester School of Medicine, Rochester, New York
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13
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Ma J, Karnovsky A, Afshinnia F, Wigginton J, Rader DJ, Natarajan L, Sharma K, Porter AC, Rahman M, He J, Hamm L, Shafi T, Gipson D, Gadegbeku C, Feldman H, Michailidis G, Pennathur S. Differential network enrichment analysis reveals novel lipid pathways in chronic kidney disease. Bioinformatics 2019; 35:3441-3452. [PMID: 30887029 PMCID: PMC6748777 DOI: 10.1093/bioinformatics/btz114] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Revised: 01/31/2019] [Accepted: 02/12/2019] [Indexed: 12/28/2022] Open
Abstract
MOTIVATION Functional enrichment testing methods can reduce data comprising hundreds of altered biomolecules to smaller sets of altered biological 'concepts' that help generate testable hypotheses. This study leveraged differential network enrichment analysis methodology to identify and validate lipid subnetworks that potentially differentiate chronic kidney disease (CKD) by severity or progression. RESULTS We built a partial correlation interaction network, identified highly connected network components, applied network-based gene-set analysis to identify differentially enriched subnetworks, and compared the subnetworks in patients with early-stage versus late-stage CKD. We identified two subnetworks 'triacylglycerols' and 'cardiolipins-phosphatidylethanolamines (CL-PE)' characterized by lower connectivity, and a higher abundance of longer polyunsaturated triacylglycerols in patients with severe CKD (stage ≥4) from the Clinical Phenotyping Resource and Biobank Core. These finding were replicated in an independent cohort, the Chronic Renal Insufficiency Cohort. Using an innovative method for elucidating biological alterations in lipid networks, we demonstrated alterations in triacylglycerols and cardiolipins-phosphatidylethanolamines that precede the clinical outcome of end-stage kidney disease by several years. AVAILABILITY AND IMPLEMENTATION A complete list of NetGSA results in HTML format can be found at http://metscape.ncibi.org/netgsa/12345-022118/cric_cprobe/022118/results_cric_cprobe/main.html. The DNEA is freely available at https://github.com/wiggie/DNEA. Java wrapper leveraging the cytoscape.js framework is available at http://js.cytoscape.org. SUPPLEMENTARY INFORMATION Supplementary data are available at Bioinformatics online.
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Affiliation(s)
- Jing Ma
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Alla Karnovsky
- Department of Computational Medicine & Bioinformatics, Ann Arbor, MI, USA
- Michigan Regional Comprehensive Metabolomics Resource Core, Ann Arbor, MI, USA
| | - Farsad Afshinnia
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Janis Wigginton
- Michigan Regional Comprehensive Metabolomics Resource Core, Ann Arbor, MI, USA
| | - Daniel J Rader
- Department of Medicine, Translational-Clinical Research, University of Pennsylvania, Philadelphia, PA, USA
| | - Loki Natarajan
- Department of Family Medicine and Public Health, University of California at San Diego, San Diego, CA, USA
| | - Kumar Sharma
- Department of Internal Medicine, University of Texas Health at San Antonio, San Antonio, TX, USA
| | - Anna C Porter
- Department of Internal Medicine, University of Illinois at Chicago, Chicago, IL, USA
| | - Mahboob Rahman
- Department of Internal Medicine, Case-Western Reserve University, Cleveland, OH, USA
| | - Jiang He
- Department of Epidemiology, Tulane University School of Medicine, Tulane University, New Orleans, LA, USA
| | - Lee Hamm
- School of Medicine, Division of Nephrology and Hypertension, Tulane University, New Orleans, LA, USA
| | - Tariq Shafi
- Department of Internal Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Debbie Gipson
- Department of Pediatrics, University of Michigan, Ann Arbor, MI, USA
| | - Crystal Gadegbeku
- Department of Internal Medicine, Temple University, Philadelphia, PA, USA
| | - Harold Feldman
- Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, PA, USA
| | - George Michailidis
- Michigan Regional Comprehensive Metabolomics Resource Core, Ann Arbor, MI, USA
- Department of Statistics and the Informatics Institute, University of Florida, Gainesville, FL, USA
| | - Subramaniam Pennathur
- Michigan Regional Comprehensive Metabolomics Resource Core, Ann Arbor, MI, USA
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
- Department of Molecular and Integrative Physiology, University of Michigan, Ann Arbor, MI, USA
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Duong TV, Shih CK, Wong TC, Chen HH, Chen TH, Hsu YH, Peng SJ, Kuo KL, Liu HC, Lin ET, Su CT, Yang SH. Insulin Resistance and Cardiovascular Risks in Different Groups of Hemodialysis Patients: A Multicenter Study. BIOMED RESEARCH INTERNATIONAL 2019; 2019:1541593. [PMID: 31309101 PMCID: PMC6594339 DOI: 10.1155/2019/1541593] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Revised: 02/20/2019] [Accepted: 05/16/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND To investigate the association between insulin resistance (IR) and cardiovascular disease (CVD) risks among hemodialysis patients. METHODS We conducted a cross-sectional study between 2013 and 2017, on 384 hemodialysis patients from seven hospital-based-dialysis centers. HOMA-IR is classified according to median value. The CVD risks were defined by the K/DOQI Guidelines. Logistic regression analysis was used. RESULTS Patients' age was 60.9 ± 11.8, 58.1% men, and 40.3% overweight/obese. The median of HOMA-IR was 5.4, 82.8% high systolic blood pressure, and 85.7% hyperhomocysteinemia. In multivariate analysis, IR was significantly associated with higher odds of low high-density lipoprotein cholesterol, high triglyceride, and impaired fasting glucose in groups of normal weight, overweight/obese, nondiabetes, diabetes, and overall sample. IR linked with elevated high-sensitive C-reactive protein in normal weight patients (odd ratio, OR=2.21, 95% confidence interval, 1.16-4.22, p < .05), with hypoalbuminemia in normal weight patients (OR=8.31, 95% CI, 2.35-29.37, p < .01), in nondiabetes patients (OR=6.59, 95% CI, 1.81-23.95, p < .01), and overall sample (OR=3.07, 1.51-6.23, p < .01). CONCLUSIONS The level of IR and prevalence of CVD risks were high in hemodialysis patients. IR was independently associated with CVD risks.
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Affiliation(s)
- Tuyen Van Duong
- School of Nutrition and Health Sciences, Taipei Medical University, Taipei, Taiwan
| | - Chun-Kuang Shih
- School of Nutrition and Health Sciences, Taipei Medical University, Taipei, Taiwan
| | - Te-Chih Wong
- Department of Nutrition and Health Sciences, Chinese Culture University, Taipei, Taiwan
| | - Hsi-Hsien Chen
- Department of Nephrology, Taipei Medical University Hospital, Taipei, Taiwan
- School of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Tso-Hsiao Chen
- School of Medicine, Taipei Medical University, Taipei, Taiwan
- Department of Nephrology, Taipei Medical University- Wan Fang Hospital, Taipei, Taiwan
| | - Yung-Ho Hsu
- School of Medicine, Taipei Medical University, Taipei, Taiwan
- Division of Nephrology, Department of Internal Medicine, Taipei Medical University- Shuang Ho Hospital, Taipei, Taiwan
| | - Sheng-Jeng Peng
- Division of Nephrology, Cathay General Hospital, Taipei, Taiwan
| | - Ko-Lin Kuo
- Division of Nephrology, Taipei Tzu-Chi Hospital, Taipei, Taiwan
| | - Hsiang-Chung Liu
- Department of Nephrology, Wei Gong Memorial Hospital, Miaoli, Taiwan
| | - En-Tzu Lin
- Department of Nephrology, Lotung Poh-Ai Hospital, Yilan, Taiwan
| | - Chien-Tien Su
- School of Public Health, Taipei Medical University, Taipei, Taiwan
- Department of Family Medicine, Taipei Medical University Hospital, Taipei, Taiwan
| | - Shwu-Huey Yang
- School of Nutrition and Health Sciences, Taipei Medical University, Taipei, Taiwan
- Research Center of Geriatric Nutrition, Taipei Medical University, Taipei, Taiwan
- Nutrition Research Center, Taipei Medical University Hospital, Taipei, Taiwan
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Impact of Percent Body Fat on All-Cause Mortality among Adequate Dialysis Patients with and without Insulin Resistance: A Multi-Center Prospective Cohort Study. Nutrients 2019; 11:nu11061304. [PMID: 31181824 PMCID: PMC6627844 DOI: 10.3390/nu11061304] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Revised: 06/04/2019] [Accepted: 06/04/2019] [Indexed: 12/24/2022] Open
Abstract
The association between body fat and mortality in hemodialysis patients remains controversial. We examined the effect of percent body fat (PBF) on all-cause mortality among adequate hemodialysis patients with and without insulin resistance (IR). A prospective cohort study was conducted on 365 adequate hemodialysis patients (equilibrated Kt/V ≥ 1.2) from seven hospitals. Patients’ characteristics and clinical and biochemical parameters were assessed at baseline between September 2013 and April 2017. Patients were followed up for all-cause mortality until April 2018. The median value of homeostatic model assessment (HOMA-IR) was used to classify IR. Cox proportional hazard models were utilized to examine predictors of all-cause mortality. During 1.4 (1.0–3.2) years of follow-up, 46 patients died. In patients with IR (HOMA-IR ≥ 5.18), PBF was significantly higher in the survival group than in the death group (31.3 ± 9.0 vs. 25.4 ± 8.2, p = 0.005). After controlling for confounding factors, PBF was significantly associated with lower risk for all-cause mortality in patients with IR (hazard ratio, 0.94; 95% confidence interval, 0.89–1.00; p = 0.033). The association was not observed in patients without IR. In conclusion, percent body fat shows a protective effect on survival in hemodialysis patients with IR.
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Chen YC, Li CY, Tsai SJ, Chen YC. Anti-hepatitis C virus therapy in chronic kidney disease patients improves long-term renal and patient survivals. World J Clin Cases 2019; 7:1270-1281. [PMID: 31236391 PMCID: PMC6580345 DOI: 10.12998/wjcc.v7.i11.1270] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Revised: 04/14/2019] [Accepted: 04/18/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Hepatitis C virus (HCV) infection is a documented risk factor for chronic kidney disease (CKD) and progression to end-stage renal disease (ESRD). However, to date there are no reports on the long-term hard endpoints (ESRD and death) of anti-HCV therapy [interferon-based therapy (IBT) or new direct-acting antivirals] in CKD patients. Direct-acting antivirals are not available in Taiwan's single-payer national health insurance database currently released for research. Therefore, we hypothesized that a retrospective analysis of the long-term outcomes of IBT in CKD patients will serve as a proxy for direct-acting antivirals to increase our understanding of progression to ESRD following HCV infection. AIM To evaluate the long-term outcomes (ESRD and death) of anti-HCV therapy, especially IBT, in HCV-infected patients with stage 1-5 CKD. METHODS We analyzed 93894 Taiwanese adults diagnosed with CKD and without HBV infection. Of these, 4.9% were infected with HCV. Of the 4582 HCV-infected CKD patients, 482 (10.5%) received IBT (treated cohort). They were matched 1:4 with 1928 untreated HCV-infected CKD patients (untreated cohort) by propensity scores and year, which further matched 1:2 by propensity scores with 3856 CKD patients without HCV infection (uninfected cohort). All participants were followed until the occurrence of ESRD, death, or the end of 2012. The association between HCV infection, IBT use, and risks of ESRD and death was analyzed using competing risk analysis. RESULTS Taking the uninfected cohort as a reference, the adjusted hazard ratios for ESRD, after adjusting for competing mortality, were 0.34 (0.14-0.84, P = 0.019) and 1.28 (1.03-1.60, P = 0.029) in the treated and untreated cohorts, respectively. The treated cohort had a 29% (0.54-0.92, P = 0.011) decrease in mortality compared to the untreated cohort, in which the mortality was 31% (1.18-1.45, P < 0.001) higher than in the uninfected cohort. The reduced risks of ESRD (0.14, 0.03-0.58, P = 0.007) and death (0.57, 0.41-0.79, P = 0.001) were greatest in HCV-infected CKD patients who received at least 4 mo of IBT, which accounted for 74% of the treated cohort. CONCLUSION Adequate anti-HCV therapy in CKD patients improves long-term renal and patient survival.
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Affiliation(s)
- Yi-Chun Chen
- Division of Nephrology, Department of Internal Medicine, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi County 622, Taiwan
- School of Medicine, Tzu Chi University, Hualien 970, Taiwan
| | - Chung-Yi Li
- Department and Graduate Institute of Public Health, College of Medicine, National Cheng Kung University, Tainan 701, Taiwan
- Department of Public Health, College of Public Health, China Medical University, Taichung 404, Taiwan
| | - Shiang-Jiun Tsai
- Department of Medical Research, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi County 622, Taiwan
| | - Yen-Chun Chen
- Division of Hepato-Gastroenterology, Department of Internal Medicine, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi County 622, Taiwan
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Kim GS, Oh HH, Kim SH, Kim BO, Byun YS. Association between prediabetes (defined by HbA1 C, fasting plasma glucose, and impaired glucose tolerance) and the development of chronic kidney disease: a 9-year prospective cohort study. BMC Nephrol 2019; 20:130. [PMID: 30992067 PMCID: PMC6469043 DOI: 10.1186/s12882-019-1307-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2018] [Accepted: 03/21/2019] [Indexed: 01/03/2023] Open
Abstract
Background The aim of the present study was to investigate the clinical impact of prediabetes on the development of incident chronic kidney disease (CKD) in a Korean adult population, using data from the Korea Genome and Epidemiology Study. Methods This prospective cohort study included 7728 Korean adults without baseline CKD and type 2 diabetes. Prediabetes was defined by impaired fasting glucose (IFG), impaired glucose tolerance (IGT), and HbA1C level. CKD was defined as estimated glomerular filtration rate < 60 mL/min/1.73 m2. We assessed the predictive value of prediabetes for the incidence of CKD, and investigated the incidence of cardiovascular disease including coronary artery disease and stroke. Results Over a median follow-up period of 8.7 years, 871 of 7728 (11.3%) subjects developed incident CKD. Patients with prediabetes, as defined by IGT or HbA1C, developed incident CKD more frequently than the non-prediabetic group did. The risk of CKD development at follow-up was analyzed according to different prediabetes definitions. Compared with the non-prediabetic group, the IGT- (Hazard ratio [HR] = 1.135, 95% confidence interval [CI] = 1.182–1.310, P = 0.043) and HbA1C-defined prediabetic groups (HR = 1.391, 95% CI = 1.213–1.595, P < 0.001) were significantly associated with incident CKD after adjusting for traditional CKD risk factors; however, IFG was not associated with incident CKD. Conclusion IGT- or HbA1C-defined prediabetes is an independent predictor of incident CKD. The measurement of these parameters might enable early detection of CKD risk, allowing physicians to initiate preventive measures and improve patient outcomes.
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Affiliation(s)
- Gwang Sil Kim
- Division of Cardiology, Department of Internal Medicine, Sanggye Paik Hospital, Inje University, Dongil-ro 1342, Nowon-gu, Seoul, 01757, South Korea
| | - Hyun Ho Oh
- Division of Nephrology, Department of Internal Medicine, Sanggye Paik Hospital, Inje University, Seoul, South Korea
| | - Sang Hyun Kim
- Division of Nephrology, Department of Internal Medicine, Sanggye Paik Hospital, Inje University, Seoul, South Korea
| | - Byung Ok Kim
- Division of Cardiology, Department of Internal Medicine, Sanggye Paik Hospital, Inje University, Dongil-ro 1342, Nowon-gu, Seoul, 01757, South Korea
| | - Young Sup Byun
- Division of Cardiology, Department of Internal Medicine, Sanggye Paik Hospital, Inje University, Dongil-ro 1342, Nowon-gu, Seoul, 01757, South Korea.
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18
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Both insulin resistance and metabolic syndrome accelerate the progression of chronic kidney disease among Chinese adults: results from a 3-year follow-up study. Int Urol Nephrol 2018; 50:2239-2244. [DOI: 10.1007/s11255-018-1934-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Accepted: 07/06/2018] [Indexed: 10/28/2022]
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Xu H, Carrero JJ. Insulin resistance in chronic kidney disease. Nephrology (Carlton) 2018; 22 Suppl 4:31-34. [PMID: 29155496 DOI: 10.1111/nep.13147] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/30/2017] [Indexed: 11/27/2022]
Abstract
This review provides an overview of insulin resistance (IR) in patients with chronic kidney disease (CKD). IR is a pathological state in which target tissues fail to respond normally to insulin. IR is understood as a consequence of CKD and its prevalence rises particularly in advanced CKD stages. Mechanisms leading to IR are complex and multifactorial, involving post-receptor signaling defects, unhealthy lifestyles, metabolic acidosis, inflammation, oxidative stress, vitamin D deficiency, anemia, and uremic toxicity, as shown by human and experimental studies over the last 30 years. Whereas hyperinsulinemic euglycemic clamp is the gold standard, it is unpractical at the bedside, and either estimated IR indices by fasting glucose or insulin and oral glucose tolerance tests (OGTT) provide satisfactory estimates of IR also in patients with CKD. IR is likely to play a key role in the development of cardiometabolic complications, but not all studies associate IR with the risk of cardiovascular events and death. Various interventions at the level of lifestyle modifications, adaptations in dialysis therapy (such as use of icodextrin based solutions) and pharmacological strategies such as thiazolidinediones or vitamin D therapy may improve IR in patient with CKD.
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Affiliation(s)
- Hong Xu
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Juan J Carrero
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
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Bi X, Ai H, Wu Q, Fan Q, Ding F, Hu C, Ding W. Insulin Resistance Is Associated with Interleukin 1β (IL-1β) in Non-Diabetic Hemodialysis Patients. Med Sci Monit 2018; 24:897-902. [PMID: 29436520 PMCID: PMC5819312 DOI: 10.12659/msm.906269] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
Background Insulin resistance (IR) and inflammation are associated with increased risk of complications in chronic kidney disease (CKD) patients. However, the relationship between IR and the important proinflammatory interleukin-1β (IL-1β) is unclear in CKD patients. Material/Methods We conducted a cross-sectional study including 79 non-diabetic patients who received hemodialysis after the exclusion process. Homeostasis model assessment (HOMA-IR) and leptin adiponectin ratio (LAR) were used to evaluate IR. Inflammation was assessed through C-reactive protein (CRP), interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α), and IL-1β evaluation. We tested associations of IR with IL-1β using logistic analysis and linear regression. Results Patients were divided into a HOMA-IR-positive group and a HOMA-IR-negative group. Although there were no differences between the 2 groups in terms of etiological causes, age, sex, BMI, triglyceride, cholesterol, ferritin, uric acid, and inflammatory indicators such as CRP, we found that IL-6, TNF-α, and IL-1β were significantly increased in the HOMA-IR-positive group compared with the HOMA-IR-negative group. Moreover, IL-1β contributed to HOMA-IR positivity and was positively correlated with LAR after adjusting for possible confounding factors. Conclusions Insulin resistance correlates positively with IL-1β among non-diabetic hemodialysis patients, which suggests that IL-1β may be involved in the pathogenesis of IR in this setting.
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Affiliation(s)
- Xiao Bi
- Division of Nephrology, Shanghai Ninth People's Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China (mainland)
| | - Honglan Ai
- Division of Nephrology, Shanghai Ninth People's Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China (mainland)
| | - Qiaoming Wu
- Division of Nephrology, Shanghai Ninth People's Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China (mainland)
| | - Qiang Fan
- Division of Nephrology, Shanghai Ninth People's Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China (mainland)
| | - Feng Ding
- Division of Nephrology, Shanghai Ninth People's Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China (mainland)
| | - Chun Hu
- Division of Nephrology, Shanghai Ninth People's Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China (mainland)
| | - Wei Ding
- Division of Nephrology, Shanghai Ninth People's Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China (mainland)
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Chauveau P, Lasseur C, Nodimar C, Prezelin-Reydit M, Trolonge S, Combe C, Aparicio M. [Dietary acid load: A novel target for the nephrologist?]. Nephrol Ther 2018; 14:240-246. [PMID: 29289517 DOI: 10.1016/j.nephro.2017.10.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Accepted: 10/02/2017] [Indexed: 10/18/2022]
Abstract
The acid production of endogenous origin depends mainly on the metabolism of the food and varies with the nature of these. Of the order of 1mEq/kg/day for contemporary food in industrialized countries, it is reduced by more than one third among vegetarians and close to neutrality among vegans. The dietary acid load is eliminated by the normal kidneys, thus maintaining the acid-base equilibrium. In the setting of CKD, it will overflow the capacities of the nephrons, generating a retention of H+ ions, promoting subclinical acidosis. This tissue retention of H+ ions was confirmed by direct techniques in animal models and indirect techniques in humans. The systemic retention of H+ ions and the accompanying compensatory mechanisms have negative consequences on bone tissue, skeletal muscle, cardiovascular risk and renal function. In the animal, the substitution of casein (acid) by soy (alkaline) prevents metabolic acidosis and slows the progression of renal insufficiency. In man, various prospective studies have confirmed that the risk of renal insufficiency was positively correlated with the dietary acid load. Conversely, bicarbonate supplementation and/or a diet enriched with fruits and vegetables, have a favorable effect on renal insufficiency, including in subjects with normal bicarbonate. These results lead to reconsider the K/DOQI recommendations to correct acidosis when the bicarbonate level falls below 22mEq/L, since tissue retention of H+ ions and its negative consequences appear at higher or even normal levels of bicarbonates.
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Affiliation(s)
- Philippe Chauveau
- Service de néphrologie transplantation dialyse, hôpital Pellegrin, CHU de Bordeaux, place Amélie-Raba-Léon, 33076 Bordeaux, France; Aurad-Aquitaine, 2, allée des Demoiselles, 33170 Gradignan, France.
| | - Catherine Lasseur
- Service de néphrologie transplantation dialyse, hôpital Pellegrin, CHU de Bordeaux, place Amélie-Raba-Léon, 33076 Bordeaux, France; Aurad-Aquitaine, 2, allée des Demoiselles, 33170 Gradignan, France
| | - Céline Nodimar
- Service de néphrologie transplantation dialyse, hôpital Pellegrin, CHU de Bordeaux, place Amélie-Raba-Léon, 33076 Bordeaux, France; Aurad-Aquitaine, 2, allée des Demoiselles, 33170 Gradignan, France
| | - Mathilde Prezelin-Reydit
- Service de néphrologie transplantation dialyse, hôpital Pellegrin, CHU de Bordeaux, place Amélie-Raba-Léon, 33076 Bordeaux, France; Aurad-Aquitaine, 2, allée des Demoiselles, 33170 Gradignan, France
| | | | - Christian Combe
- Service de néphrologie transplantation dialyse, hôpital Pellegrin, CHU de Bordeaux, place Amélie-Raba-Léon, 33076 Bordeaux, France; Unité Inserm 1026, université Bordeaux, 33076 Bordeaux, France
| | - Michel Aparicio
- Service de néphrologie transplantation dialyse, hôpital Pellegrin, CHU de Bordeaux, place Amélie-Raba-Léon, 33076 Bordeaux, France
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Rysz J, Franczyk B, Ciałkowska-Rysz A, Gluba-Brzózka A. The Effect of Diet on the Survival of Patients with Chronic Kidney Disease. Nutrients 2017; 9:E495. [PMID: 28505087 PMCID: PMC5452225 DOI: 10.3390/nu9050495] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Revised: 04/14/2017] [Accepted: 05/10/2017] [Indexed: 12/20/2022] Open
Abstract
The prevalence of chronic kidney disease (CKD) is high and it is gradually increasing. Individuals with CKD should introduce appropriate measures to hamper the progression of kidney function deterioration as well as prevent the development or progression of CKD-related diseases. A kidney-friendly diet may help to protect kidneys from further damage. Patients with kidney damage should limit the intake of certain foods to reduce the accumulation of unexcreted metabolic products and also to protect against hypertension, proteinuria and other heart and bone health problems. Despite the fact that the influence of certain types of nutrients has been widely studied in relation to kidney function and overall health in CKD patients, there are few studies on the impact of a specific diet on their survival. Animal studies demonstrated prolonged survival of rats with CKD fed with protein-restricted diets. In humans, the results of studies are conflicting. Some of them indicate slowing down of the progression of kidney disease and reduction in proteinuria, but other underline significant worsening of patients' nutritional state, which can be dangerous. A recent systemic study revealed that a healthy diet comprising many fruits and vegetables, fish, legumes, whole grains, and fibers and also the cutting down on red meat, sodium, and refined sugar intake was associated with lower mortality in people with kidney disease. The aim of this paper is to review the results of studies concerning the impact of diet on the survival of CKD patients.
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Affiliation(s)
- Jacek Rysz
- Department of Nephrology, Hypertension and Family Medicine, Medical University of Lodz, Zeromskiego 113, 90-549 Lodz, Poland.
| | - Beata Franczyk
- Department of Nephrology, Hypertension and Family Medicine, Medical University of Lodz, Zeromskiego 113, 90-549 Lodz, Poland.
| | - Aleksandra Ciałkowska-Rysz
- Palliative Medicine Unit, Chair of Oncology, Medical University of Lodz, Zeromskiego 113, 90-549 Lodz, Poland.
| | - Anna Gluba-Brzózka
- Department of Nephrology, Hypertension and Family Medicine, WAM Teaching Hospital of Lodz, Zeromskiego 113, 90-549 Lodz, Poland.
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Barreto Silva MI, Cavalieri VVDS, Lemos CCDS, Klein MRST, Bregman R. Body adiposity predictors of vitamin D status in nondialyzed patients with chronic kidney disease: A cross-sectional analysis in a tropical climate city. Nutrition 2017; 33:240-247. [DOI: 10.1016/j.nut.2016.06.012] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2015] [Revised: 05/16/2016] [Accepted: 06/16/2016] [Indexed: 01/27/2023]
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Bellasi A, Di Micco L, Santoro D, Marzocco S, De Simone E, Cozzolino M, Di Lullo L, Guastaferro P, Di Iorio B. Correction of metabolic acidosis improves insulin resistance in chronic kidney disease. BMC Nephrol 2016; 17:158. [PMID: 27770799 PMCID: PMC5075179 DOI: 10.1186/s12882-016-0372-x] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2016] [Accepted: 10/12/2016] [Indexed: 01/12/2023] Open
Abstract
Background Correction of metabolic acidosis (MA) with nutritional therapy or bicarbonate administration is widely used in chronic kidney disease (CKD) patients. However, it is unknown whether these interventions reduce insulin resistance (IR) in diabetic patients with CKD. We sought to evaluate the effect of MA correction on endogenous insulin action in diabetic type 2 (DM2) CKD patients. Methods A total of 145 CKD subjects (83 men e 62 women) with DM2 treated with oral antidiabetic drugs were included in the study and followed up to 1 year. All patients were randomly assigned 1:1 to either open-label (A) oral bicarbonate to achieve serum bicarbonate levels of 24–28 mmol/L (treatment group) or (B) no treatment (control group). The Homeostatic model assessment (HOMA) index was used to evaluate IR at study inception and conclusion. Parametric and non-parametric tests as well as linear regression were used. Results At baseline no differences in demographic and clinical characteristics between the two groups was observed. Average dose of bicarbonate in the treatment group was 0.7 ± 0.2 mmol/kg. Treated patients showed a better metabolic control as confirmed by lower insulin levels (13.4 ± 5.2 vs 19.9 ± 6.3; for treated and control subjects respectively; p < 0.001), Homa-IR (5.9[5.0-7.0] vs 6.3[5.3–8.2]; p = 0.01) and need for oral antidiabetic drugs. The serum bicarbonate and HOMA-IR relationship was non-linear and the largest HOMA-IR reduction was noted for serum bicarbonate levels between 24 and 28 mmol/l. Adjustment for confounders, suggests that serum bicarbonate rather than treatment drives the effect on HOMA-IR. Conclusions Serum bicarbonate is related to IR and the largest HOMA-IR reduction is noted for serum bicarbonate between 24 and 28 mmol/l. Treatment with bicarbonate influences IR. However, changes in serum bicarbonate explains the effect of treatment on HOMA index. Future efforts are required to validate these results in diabetic and non-diabetic CKD patients. Trial registration The trial was registered at www.clinicaltrial.gov (Use of Bicarbonate in Chronic Renal Insufficiency (UBI) study - NCT01640119)
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Affiliation(s)
- Antonio Bellasi
- Department of Nephrology and Dialysis, ASST-Lariana, Ospedale Sant' Anna, Como, (CO), Italy
| | - Lucia Di Micco
- Department of Nephrology and Dialysis, UOC Nefrologia, PO "A Landolfi", Via Melito, snc, I-83029, Solofra, (AV), Italy
| | - Domenico Santoro
- Department of Clinical and Experimental Medicine, Unit of Nephrology, University of Messina, Messina, Italy
| | - Stefania Marzocco
- Department of Pharmacy, School of Pharmacy, University of Salerno, Fisciano, (SA), Italy
| | - Emanuele De Simone
- Department of Nephrology and Dialysis, UOC Nefrologia, PO "A Landolfi", Via Melito, snc, I-83029, Solofra, (AV), Italy
| | - Mario Cozzolino
- Department of Health Sciences, University of Milan, Milan, Italy
| | - Luca Di Lullo
- Department of Nephrology and Dialysis, Ospedale Parodi, Delfino, Colleferro, (Rome), Italy
| | | | - Biagio Di Iorio
- Department of Nephrology and Dialysis, UOC Nefrologia, PO "A Landolfi", Via Melito, snc, I-83029, Solofra, (AV), Italy.
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25
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Garibotto G, Sofia A, Russo R, Paoletti E, Bonanni A, Parodi EL, Viazzi F, Verzola D. Insulin sensitivity of muscle protein metabolism is altered in patients with chronic kidney disease and metabolic acidosis. Kidney Int 2015; 88:1419-1426. [PMID: 26308671 PMCID: PMC4678169 DOI: 10.1038/ki.2015.247] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2015] [Revised: 06/05/2015] [Accepted: 06/25/2015] [Indexed: 12/23/2022]
Abstract
An emergent hypothesis is that a resistance to the anabolic drive by insulin may contribute to loss of strength and muscle mass in patients with chronic kidney disease (CKD). We tested whether insulin resistance extends to protein metabolism using the forearm perfusion method with arterial insulin infusion in 7 patients with CKD and metabolic acidosis (bicarbonate 19 mmol/l) and 7 control individuals. Forearm glucose balance and protein turnover (2H-phenylalanine kinetics) were measured basally and in response to insulin infused at different rates for 2 h to increase local forearm plasma insulin concentration by approximately 20 and 50 μU/ml. In response to insulin, forearm glucose uptake was significantly increased to a lesser extent (−40%) in patients with CKD than controls. In addition, whereas in the controls net muscle protein balance and protein degradation were decreased by both insulin infusion rates, in patients with CKD net protein balance and protein degradation were sensitive to the high (0.035 mU/kg per min) but not the low (0.01 mU/kg per min) insulin infusion. Besides blunting muscle glucose uptake, CKD and acidosis interfere with the normal suppression of protein degradation in response to a moderate rise in plasma insulin. Thus, alteration of protein metabolism by insulin may lead to changes in body tissue composition which may become clinically evident in conditions characterized by low insulinemia.
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Affiliation(s)
- Giacomo Garibotto
- Department of Internal Medicine, Division of Nephrology, Dialysis and Transplantation, University of Genoa and IRCCS AOU San Martino-IST, Genoa, Italy
| | - Antonella Sofia
- Department of Internal Medicine, Division of Nephrology, Dialysis and Transplantation, University of Genoa and IRCCS AOU San Martino-IST, Genoa, Italy
| | - Rodolfo Russo
- Department of Internal Medicine, Division of Nephrology, Dialysis and Transplantation, University of Genoa and IRCCS AOU San Martino-IST, Genoa, Italy
| | - Ernesto Paoletti
- Department of Internal Medicine, Division of Nephrology, Dialysis and Transplantation, University of Genoa and IRCCS AOU San Martino-IST, Genoa, Italy
| | - Alice Bonanni
- Department of Internal Medicine, Division of Nephrology, Dialysis and Transplantation, University of Genoa and IRCCS AOU San Martino-IST, Genoa, Italy
| | - Emanuele L Parodi
- Department of Internal Medicine, Division of Nephrology, Dialysis and Transplantation, University of Genoa and IRCCS AOU San Martino-IST, Genoa, Italy
| | - Francesca Viazzi
- Department of Internal Medicine, Division of Nephrology, Dialysis and Transplantation, University of Genoa and IRCCS AOU San Martino-IST, Genoa, Italy
| | - Daniela Verzola
- Department of Internal Medicine, Division of Nephrology, Dialysis and Transplantation, University of Genoa and IRCCS AOU San Martino-IST, Genoa, Italy
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