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Atta S, Vo-Dinh T. Improved solution-based SERS detection of creatinine by inducing hydrogen-bonding interaction for effective analyte capture. Talanta 2024; 278:126373. [PMID: 38901075 DOI: 10.1016/j.talanta.2024.126373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Revised: 05/20/2024] [Accepted: 06/05/2024] [Indexed: 06/22/2024]
Abstract
Recently, solution-based surface-enhanced Raman scattering (SERS) detection technique has been widely recognized due to its cost-effectiveness, simplicity, and ease of use. However, solution-based SERS is limited for practical applications mainly because of the weak adsorption affinity of the target biomolecules to the surface of plasmonic nanoparticles. Herein, we developed a highly sensitive solution-based SERS sensing platform based on mercaptopropionic acid (MPA)-capped silver-coated gold nanostars (SGNS@MPA), which allows efficient enrichment on the nanostars surface for improved detection of an analyte: creatinine, a potential biomarker of chronic kidney disease (CKD). The SGNS@MPA exhibited high enrichment ability towards creatinine molecules in alkaline medium (pH-9) through multiple hydrogen bonding interaction, which causes aggregation of the nanoparticles and enhances the SERS signal of creatinine. The detection limit for creatinine was achieved at 0.1 nM, with a limit of detection (LOD) value of 14.6 pM. As a proof-of-concept demonstration, we conducted the first quantitative detection of creatinine in noninvasive human fluids, such as saliva and sweat, under separation-free conditions. We achieved a detection limit of up to 1 nM for both saliva and sweat, with LOD values as low as 0.136 nM for saliva and 0.266 nM for sweat. Overall, our molecular enrichment strategy offers a new way to improve the solution-based SERS detection technique for real-world practical applications in point-of-care settings and low-resource settings.
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Affiliation(s)
- Supriya Atta
- Fitzpatrick Institute for Photonics, Durham, NC, 27708, USA; Department of Biomedical Engineering, Duke University, Durham, NC, 27708, USA
| | - Tuan Vo-Dinh
- Fitzpatrick Institute for Photonics, Durham, NC, 27708, USA; Department of Biomedical Engineering, Duke University, Durham, NC, 27708, USA; Department of Chemistry, Duke University, Durham, NC, 27708, USA.
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2
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Li T, Geng L, Yang Y, Liu G, Li H, Long C, Chen Q. Protective effect of phospholipids in lipoproteins against diabetic kidney disease: A Mendelian randomization analysis. PLoS One 2024; 19:e0302485. [PMID: 38691537 PMCID: PMC11062548 DOI: 10.1371/journal.pone.0302485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 04/05/2024] [Indexed: 05/03/2024] Open
Abstract
BACKGROUND The etiology of diabetic kidney disease is complex, and the role of lipoproteins and their lipid components in the development of the disease cannot be ignored. However, phospholipids are an essential component, and no Mendelian randomization studies have yet been conducted to examine potential causal associations between phospholipids and diabetic kidney disease. METHODS Relevant exposure and outcome datasets were obtained through the GWAS public database. The exposure datasets included various phospholipids, including those in LDL, IDL, VLDL, and HDL. IVW methods were the primary analytical approach. The accuracy of the results was validated by conducting heterogeneity, MR pleiotropy, and F-statistic tests. MR-PRESSO analysis was utilized to identify and exclude outliers. RESULTS Phospholipids in intermediate-density lipoprotein (OR: 0.8439; 95% CI: 0.7268-0.9798), phospholipids in large low- density lipoprotein (OR: 0.7913; 95% CI: 0.6703-0.9341), phospholipids in low- density lipoprotein (after removing outliers, OR: 0.788; 95% CI: 0.6698-0.9271), phospholipids in medium low- density lipoprotein (OR: 0.7682; 95% CI: 0.634-0.931), and phospholipids in small low-density lipoprotein (after removing outliers, OR: 0.8044; 95% CI: 0.6952-0.9309) were found to be protective factors. CONCLUSIONS This study found that a higher proportion of phospholipids in intermediate-density lipoprotein and the various subfractions of low-density lipoprotein, including large LDL, medium LDL, and small LDL, is associated with a lower risk of developing diabetic kidney disease.
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Affiliation(s)
- Tongyi Li
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Liangliang Geng
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Yunjiao Yang
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Guannan Liu
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Haichen Li
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Cong Long
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Qiu Chen
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
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3
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Liu J, Wang H, Liu Q, Long S, Wu Y, Wang N, Lin W, Chen G, Lin M, Wen J. Klotho exerts protection in chronic kidney disease associated with regulating inflammatory response and lipid metabolism. Cell Biosci 2024; 14:46. [PMID: 38584258 PMCID: PMC11000353 DOI: 10.1186/s13578-024-01226-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 03/27/2024] [Indexed: 04/09/2024] Open
Abstract
BACKGROUND The anti-aging protein Klotho plays a protective role in kidney disease, but its potential as a biomarker for chronic kidney disease (CKD) is controversial. Additionally, the main pathways through which Klotho exerts its effects on CKD remain unclear. Therefore, we used bioinformatics and clinical data analysis to determine its role in CKD. RESULTS We analyzed the transcriptomic and clinical data from the Nephroseq v5 database and found that the Klotho gene was mainly expressed in the tubulointerstitium, and its expression was significantly positively correlated with estimated glomerular filtration rate (eGFR) and negatively correlated with blood urea nitrogen (BUN) in CKD. We further found that Klotho gene expression was mainly negatively associated with inflammatory response and positively associated with lipid metabolism in CKD tubulointerstitium by analyzing two large sample-size CKD tubulointerstitial transcriptome datasets. By analyzing 10-year clinical data from the National Health and Nutrition Examination Survey (NHANES) 2007-2016, we also found that Klotho negatively correlated with inflammatory biomarkers and triglyceride and positively correlated with eGFR in the CKD population. Mediation analysis showed that Klotho could improve renal function in the general population by modulating the inflammatory response and lipid metabolism, while in the CKD population, it primarily manifested by mediating the inflammatory response. Restricted cubic spline (RCS) analysis showed that the optimal concentration range for Klotho to exert its biological function was around 1000 pg/ml. Kaplan-Meier curves showed that lower cumulative hazards of all-cause mortality in participants with higher levels of Klotho. We also demonstrated that Klotho could reduce cellular inflammatory response and improve cellular lipid metabolism by establishing an in vitro model similar to CKD. CONCLUSIONS Our results suggest that Klotho exerts protection in CKD, which may be mainly related to the regulation of inflammatory response and lipid metabolism, and it can serve as a potential biomarker for CKD.
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Affiliation(s)
- Junhui Liu
- Shengli Clinical Medical College of Fujian Medical University, Fujian Medical University, Fuzhou, China
- Department of Endocrinology, Fujian Provincial Hospital, Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China
| | - Huaicheng Wang
- Shengli Clinical Medical College of Fujian Medical University, Fujian Medical University, Fuzhou, China
| | - Qinyu Liu
- Shengli Clinical Medical College of Fujian Medical University, Fujian Medical University, Fuzhou, China
- Department of Endocrinology, Fujian Provincial Hospital, Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China
| | - Shushu Long
- Shengli Clinical Medical College of Fujian Medical University, Fujian Medical University, Fuzhou, China
- Department of Endocrinology, Fujian Provincial Hospital, Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China
| | - Yanfang Wu
- Shengli Clinical Medical College of Fujian Medical University, Fujian Medical University, Fuzhou, China
- Department of Endocrinology, Fujian Provincial Hospital, Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China
| | - Nengying Wang
- Shengli Clinical Medical College of Fujian Medical University, Fujian Medical University, Fuzhou, China
- Department of Endocrinology, Fujian Provincial Hospital, Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China
| | - Wei Lin
- Shengli Clinical Medical College of Fujian Medical University, Fujian Medical University, Fuzhou, China
- Department of Endocrinology, Fujian Provincial Hospital, Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China
| | - Gang Chen
- Shengli Clinical Medical College of Fujian Medical University, Fujian Medical University, Fuzhou, China.
- Department of Endocrinology, Fujian Provincial Hospital, Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China.
| | - Miao Lin
- Shengli Clinical Medical College of Fujian Medical University, Fujian Medical University, Fuzhou, China.
- Department of Nephrology, Provincial Clinical College, Fujian Provincial Hospital, Fujian Medical University, Fuzhou, China.
| | - Junping Wen
- Shengli Clinical Medical College of Fujian Medical University, Fujian Medical University, Fuzhou, China.
- Department of Endocrinology, Fujian Provincial Hospital, Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China.
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4
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Nusinovici S, Li H, Chong C, Yu M, Sørensen IMH, Bisgaard LS, Christoffersen C, Bro S, Liu S, Liu JJ, Chi LS, Wong TY, Tan GSW, Cheng CY, Sabanayagam C. Blood biomarkers improve the prediction of prevalent and incident severe chronic kidney disease. J Nephrol 2024:10.1007/s40620-023-01872-w. [PMID: 38308753 DOI: 10.1007/s40620-023-01872-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 12/26/2023] [Indexed: 02/05/2024]
Abstract
BACKGROUND The prevalence of chronic kidney disease (CKD) is high. Identification of cases with CKD or at high risk of developing it is important to tailor early interventions. The objective of this study was to identify blood metabolites associated with prevalent and incident severe CKD, and to quantify the corresponding improvement in CKD detection and prediction. METHODS Data from four cohorts were analyzed: Singapore Epidemiology of Eye Diseases (SEED) (n = 8802), Copenhagen Chronic Kidney Disease (CPH) (n = 916), Singapore Diabetic Nephropathy (n = 714), and UK Biobank (UKBB) (n = 103,051). Prevalent CKD (stages 3-5) was defined as estimated glomerular filtration rate (eGFR) < 60 mL/min/1.73 m2; incident severe CKD as CKD-related mortality or kidney failure occurring within 10 years. We used multivariable regressions to identify, among 146 blood metabolites, those associated with CKD, and quantify the corresponding increase in performance. RESULTS Chronic kidney disease prevalence (stages 3-5) and severe incidence were 11.4% and 2.2% in SEED, and 2.3% and 0.2% in UKBB. Firstly, phenylalanine (Odds Ratio [OR] 1-SD increase = 1.83 [1.73, 1.93]), tyrosine (OR = 0.75 [0.71, 0.79]), docosahexaenoic acid (OR = 0.90 [0.85, 0.95]), citrate (OR = 1.41 [1.34, 1.47]) and triglycerides in medium high density lipoprotein (OR = 1.07 [1.02, 1.13]) were associated with prevalent stages 3-5 CKD. Mendelian randomization analyses suggested causal relationships. Adding these metabolites beyond traditional risk factors increased the area under the curve (AUC) by 3% and the sensitivity by 7%. Secondly, lactate (HR = 1.33 [1.08, 1.64]) and tyrosine (HR = 0.74 [0.58, 0.95]) were associated with incident severe CKD among individuals with eGFR < 90 mL/min/1.73 m2 at baseline. These metabolites increased the c-index by 2% and sensitivity by 5% when added to traditional risk factors. CONCLUSION The performance improvements of CKD detection and prediction achieved by adding metabolites to traditional risk factors are modest and further research is necessary to fully understand the clinical implications of these findings.
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Affiliation(s)
- Simon Nusinovici
- Singapore Eye Research Institute, Singapore National Eye Centre, 20 College Road, The Academia, Level 6, Singapore, 169856, Singapore.
- Eye-ACP, Duke-NUS Medical School, Singapore, Singapore.
| | - Hengtong Li
- Singapore Eye Research Institute, Singapore National Eye Centre, 20 College Road, The Academia, Level 6, Singapore, 169856, Singapore
| | - Crystal Chong
- Singapore Eye Research Institute, Singapore National Eye Centre, 20 College Road, The Academia, Level 6, Singapore, 169856, Singapore
| | - Marco Yu
- Singapore Eye Research Institute, Singapore National Eye Centre, 20 College Road, The Academia, Level 6, Singapore, 169856, Singapore
- Eye-ACP, Duke-NUS Medical School, Singapore, Singapore
| | | | - Line Stattau Bisgaard
- Department of Clinical Biochemistry, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
- Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Christina Christoffersen
- Department of Clinical Biochemistry, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
- Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Susanne Bro
- Department of Nephrology, Rigshospitalet University Hospital, Copenhagen, Denmark
| | - Sylvia Liu
- Clinical Research Unit, Diabetes Centre, Department of Medicine, Khoo Teck Puat Hospital, Singapore, Singapore
| | - Jian-Jun Liu
- Clinical Research Unit, Diabetes Centre, Department of Medicine, Khoo Teck Puat Hospital, Singapore, Singapore
| | - Lim Su Chi
- Clinical Research Unit, Diabetes Centre, Department of Medicine, Khoo Teck Puat Hospital, Singapore, Singapore
- Saw Swee Hock School of Public Heath, National University of Singapore, Singapore, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Tien-Yin Wong
- Singapore Eye Research Institute, Singapore National Eye Centre, 20 College Road, The Academia, Level 6, Singapore, 169856, Singapore
- Eye-ACP, Duke-NUS Medical School, Singapore, Singapore
- Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Gavin S W Tan
- Singapore Eye Research Institute, Singapore National Eye Centre, 20 College Road, The Academia, Level 6, Singapore, 169856, Singapore
- Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Ching-Yu Cheng
- Singapore Eye Research Institute, Singapore National Eye Centre, 20 College Road, The Academia, Level 6, Singapore, 169856, Singapore
- Eye-ACP, Duke-NUS Medical School, Singapore, Singapore
- Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Charumathi Sabanayagam
- Singapore Eye Research Institute, Singapore National Eye Centre, 20 College Road, The Academia, Level 6, Singapore, 169856, Singapore
- Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
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Alvarenga L, Cardozo LFMF, Ribeiro-Alves M, Damasceno NRT, Berretta AA, Lima JA, Khosla P, Fouque D, Mafra D. Effects of turmeric extract supplementation on the lipid and lipoprotein subfraction profile in hemodialysis patients: A randomised, double-blind, crossover and controlled trial. Phytother Res 2023; 37:3424-3437. [PMID: 37042623 DOI: 10.1002/ptr.7814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 03/16/2023] [Accepted: 03/18/2023] [Indexed: 04/13/2023]
Abstract
Dyslipidemia is common in patients with chronic kidney disease. Curcumin, a bioactive polyphenol from Curcuma longa, can improve lipid profile. This study aims to analyze the effects of Curcuma Longa extract supplementation on lipid profile and lipoprotein subfractions in hemodialysis (HD) patients. This is a longitudinal, double-blind, washout-period randomized clinical trial. The patients were randomized into two groups: the curcumin group (n = 10) (orange and carrot juice with 2.5 g of Curcuma Longa extract) and the control group (n = 11) (juice without curcumin) 3x/w during HD sessions for 3 months. After the washout period, patients continued the supplementation as a crossover for the same period. The lipid profile was measured using enzymatic assays. The high-density lipoprotein and low-density lipoprotein subfractions analyses were performed using LipoprintTM. In the curcumin group, the triglyceride values tended to decrease with a different triglyceride variation between the pre and post-intervention for the control and curcumin groups of 38.5 (19.8) mg/dL (p = 0.06). There was no statistical difference in the others parameters. In conclusion, Curcuma longa extract may be a good nutritional strategy to reduce triglyceride plasma levels in hemodialysis patients, but it seems ineffective for the other parameter.
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Affiliation(s)
- L Alvarenga
- Graduate Program in Biological Sciences-Physiology, Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil
| | - L F M F Cardozo
- Graduate Program in Cardiovascular Sciences, Fluminense Federal University (UFF), Niterói, Brazil
| | - M Ribeiro-Alves
- HIV/AIDS Clinical Research Center, National Institute of Infectology (INI/Fiocruz), Rio de Janeiro, State of Rio de Janeiro, Brazil
| | - N R T Damasceno
- Department of Nutrition, Faculty of Public Health, University of São Paulo (FSP-USP), São Paulo, Brazil
| | - A A Berretta
- Research, Development, and Innovation Department, Apis Flora Indl. Coml. Ltda., Ribeirão Preto, São Paulo, Brazil
| | - J A Lima
- Research, Development, and Innovation Department, Apis Flora Indl. Coml. Ltda., Ribeirão Preto, São Paulo, Brazil
| | - P Khosla
- Department of Nutrition and Food Science, Wayne State University, Detroit, Michigan, USA
| | - D Fouque
- Department of Nephrology, Centre Hopitalier Lyon Sud, INSERM 1060, CENS, Université de Lyon, Lyon, France
| | - D Mafra
- Graduate Program in Biological Sciences-Physiology, Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil
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Gupta N, Yadav DK, Gautam S, Kumar A, Kumar D, Prasad N. Nuclear Magnetic Resonance-Based Metabolomics Approach Revealed the Intervention Effect of Using Complementary and Alternative Medicine (CAM) by CKD Patients. ACS OMEGA 2023; 8:7722-7737. [PMID: 36872986 PMCID: PMC9979328 DOI: 10.1021/acsomega.2c06469] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Accepted: 01/26/2023] [Indexed: 06/18/2023]
Abstract
Chronic kidney disease (CKD) is the end point of a number of systemic chronic diseases. The prevalence of CKD is increasing worldwide and recent epidemiological studies are showing the high prevalence of renal failure in CKD patients using complementary and alternative medicines (CAMs). Clinicians believe that biochemical profiles of CKD patients using CAM (referred here to as CAM-CKD) may be different compared to those on standard clinical treatment and should be managed differently. The present study aims to explore the potential of the NMR-based metabolomics approach to reveal the serum metabolic disparity between CKD and CAM-CKD patients with respect to normal control (NC) subjects and if the differential metabolic patterns can provide rationale for the efficacy and safety of standard and/or alternative therapies. Serum samples were obtained from 30 CKD patients, 43 CAM-CKD patients, and 47 NC subjects. The quantitative serum metabolic profiles were measured using 1D 1H CPMG NMR experiments performed at 800 MHz NMR spectrometer. The serum metabolic profiles were compared using various multivariate statistical analysis tools available on MetaboAnalyst (freely available web-based software) such as partial least-squares discriminant analysis (PLS-DA) and random forest (a machine learning) classification method. The discriminatory metabolites were identified based on variable importance in projection (VIP) statistics and further evaluated for statistical significance (i.e., p < 0.05) using either Student t-test or ANOVA statistics. PLS-DA models were capable of clustering CKD and CAM-CKD with considerably high values of Q 2 and R 2. Compared to CAM-CKD patients, the sera of CKD patients were characterized by (a) elevated levels of urea, creatinine, citrate, glucose, glycerol, and phenylalanine and phenylalanine-to-tyrosine ratio (PTR) and (b) decreased levels of various amino acids (such leucine, isoleucine, valine, and alanine), high-density lipoproteins, lactate, and acetate. These changes suggested that CKD patients manifest severe oxidative stress, hyperglycemia (with dampened glycolysis), increased protein energy wasting, and reduced lipid/membrane metabolism. Statistically significant and strong positive correlation of PTR with serum creatinine levels suggested the role of oxidative stress in the progression of kidney disease. Significant differences in metabolic patterns between CKD and CAM-CKD patients were observed. With respect to NC subjects, the serum metabolic changes were more aberrant in CKD patients compared to CAM-CKD patients. The aberrant metabolic changes in CKD patients with manifestations of higher oxidative stress compared to CAM-CKD patients could explain clinical discrepancies between CKD and CAM-CKD patients and further advocate the use of different treatment strategies for CKD and CAM-CKD patients.
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Affiliation(s)
- Nikhil Gupta
- Centre
of Biomedical Research (CBMR), Lucknow, Uttar Pradesh 226014, India
- Department
of Chemistry, Banaras Hindu University, Varanasi, Uttar Pradesh 221005, India
| | | | - Sonam Gautam
- Department
of Nephrology, SGPGIMS, Lucknow, Uttar Pradesh 226014, India
| | - Ashish Kumar
- Department
of Chemistry, Banaras Hindu University, Varanasi, Uttar Pradesh 221005, India
| | - Dinesh Kumar
- Centre
of Biomedical Research (CBMR), Lucknow, Uttar Pradesh 226014, India
| | - Narayan Prasad
- Department
of Nephrology, SGPGIMS, Lucknow, Uttar Pradesh 226014, India
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7
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Cheng Y, Zhang H, Zheng H, Yin H, Wang Y, Wang H, Gu L, Yin D. Association between serum uric acid/HDL-cholesterol ratio and chronic kidney disease: a cross-sectional study based on a health check-up population. BMJ Open 2022; 12:e066243. [PMID: 36581406 PMCID: PMC9806076 DOI: 10.1136/bmjopen-2022-066243] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVE Evidence suggests that both serum uric acid (SUA) and high-density lipoprotein cholesterol (HDL-C) are risk factors for chronic kidney disease (CKD). The SUA-to-HDL-C ratio (UHR) has recently attracted attention as a new biomarker to evaluate the role between inflammatory and anti-inflammatory substances. Thus, we explored the association between UHR and CKD in a large Chinese population. DESIGN A cross-sectional study. SETTING Annual health check-up population in Nanjing. PARTICIPANTS 19 458 individuals who underwent an annual health check-up in 2019 were included in our study. MAIN OUTCOME MEASURE CKD was diagnosed according to an estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m2. RESULTS Correlation analysis showed that UHR was negatively associated with eGFR after adjusting for confounding factors (r=-0.34). In addition, participants in the highest quartile of UHR had a higher risk of CKD than those in the lowest quartiles (OR=9.28, p<0.001). CONCLUSION We found that high UHR values were positively associated with CKD risk in health check-up population. An increased UHR may be a useful measure by which to assess CKD risk in the preclinical stage.
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Affiliation(s)
- Yang Cheng
- Center for Health Management, Jiangsu Province Geriatric Hospital, Nanjing, China
| | - Hao Zhang
- Department of Nephrology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Hui Zheng
- Center for Health Management, Jiangsu Province Geriatric Hospital, Nanjing, China
| | - Hongli Yin
- Center for Health Management, Jiangsu Province Geriatric Hospital, Nanjing, China
| | - Ying Wang
- Center for Health Management, Jiangsu Province Geriatric Hospital, Nanjing, China
| | - Hui Wang
- Center for Health Management, Jiangsu Province Geriatric Hospital, Nanjing, China
| | - Liubao Gu
- Division of Clinical Epidemiology, Jiangsu Province Geriatric Hospital, Nanjing, China
| | - Donghua Yin
- Center for Health Management, Jiangsu Province Geriatric Hospital, Nanjing, China
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8
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Lu Z, Liu C, Wu Q, Deng Y. High-coverage targeted lipidomics could reveal lipid alterations and evaluate therapeutic efficacy of membranous nephropathy. Nutr Metab (Lond) 2022; 19:68. [PMID: 36224633 PMCID: PMC9559911 DOI: 10.1186/s12986-022-00701-4] [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] [Received: 07/10/2022] [Accepted: 09/10/2022] [Indexed: 11/10/2022] Open
Abstract
Background Membrane nephropathy (MN) often presents as nephrotic syndrome with characteristic lipid metabolism that could not be explained by lipid indicators commonly used in clinical practice. Studies have shown that invigorating spleen and qi, activating blood and detoxication in the treatment of MN is an effective method proved by randomized controlled clinical trial. However, the alterations of lipid profile before and after traditional Chinese medicine (TCM) treatment and the related lipid markers that affect the therapeutic effect have not been fully clarified. Methods We analyzed plasma lipid profiles of 92 patients with MN before and after TCM treatment by high-coverage targeted lipidomics. Results 675 lipids were identified, of which 368 stably expressed lipids (coefficient of variation less than 30% and deletion value less than 10%) were eventually included for statistical analysis. 105 lipids were altered mainly including spingolipids, glycerides, glycerophosholipid, fatty acyl and steroids, among which, the abundance of ceramides (Cers), sphingomyelins (SMs), diacylglycerols (DGs), phosphatidylcholines (PCs) were lower than those before treatment with statistically significant difference. The WGCNA network to analyze the correlation between the collective effect and the therapeutic effect showed that the triglyceride (TG) molecules were most relevant to the therapeutic effect. Analysis of 162 triglyceride molecules showed that 11 TGs were significantly down-regulated in the effective group which were concentrated in carbon atom number of 52–56 and double bond number of 0–4. TGs molecules including TG56:2-FA20:0, TG56:2-FA20:1, TG56:3-FA20:0 and TG56:5-FA20:2 were most closely related to the therapeutic effect of TCM after adjusting the influence of clinical factors. ROC curve analysis showed that these four lipids could further improve the predictive efficacy of treatment based on clinical indicators. Conclusion Our work demonstrated that the therapeutic effect of invigorating spleen and qi, activating blood and detoxication in the treatment of MN may be exerted by regulating lipid metabolism. High-coverage targeted lipidomics provided a non-invasive tool for discovery of lipid markers to improve the predictive efficacy of TCM therapy.
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Affiliation(s)
- Zhenzhen Lu
- Department of Nephrology, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, 725 Wanping Road, Shanghai, 200032, China
| | - Conghui Liu
- Key Laboratory of Systems Health Science of Zhejiang Province, School of Life Science, Hangzhou Institute for Advanced Study, University of Chinese Academy of Sciences, Hangzhou, 310024, China
| | - Qingqing Wu
- Shanghai Institute of Biochemistry and Cell Biology, Center for Excellence in Molecular Cell Science, Chinese Academy of Sciences, 320 Yueyang Road, Shanghai, 200031, China.
| | - Yueyi Deng
- Department of Nephrology, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, 725 Wanping Road, Shanghai, 200032, China.
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9
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Goicoechea M, Álvarez V, Segarra A, Polaina M, Martín-Reyes G, Robles NR, Escudero V, Orellana C, Bea Granell S, de Juan-Ribera J, Fernández Lucas M, Graña JM, Reque J, Sánchez Hernández R, Villamayor S, Górriz JL. Lipid profile of patients treated with evolocumab in Spanish hospital nephrology units (RETOSS NEFRO). Nefrologia 2022; 42:301-310. [PMID: 36210619 DOI: 10.1016/j.nefroe.2022.05.005] [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: 11/13/2020] [Revised: 05/13/2021] [Accepted: 06/13/2021] [Indexed: 06/16/2023] Open
Abstract
BACKGROUND AND OBJECTIVE To describe the clinical characteristics, the reasons for initiating therapy and the effects of treatment in the initial phase of evolocumab availability in the Nephrology Units of Spain. MATERIAL AND METHODS Retrospective, observational and multicentric study that included patients initiating treatment with evolocumab (from February 2016 to August 2018), in 15 Nephrology Units in Spain. The demographic and clinical characteristics of the patients, the lipid lowering treatment and the evolution of the lipid profiles between 24 weeks pre-initiation and 12±4 weeks post-initiation of evolocumab were reviewed. RESULTS 60 patients were enrolled: 53.3% women; mean (SD) age, 56.9 (12.8) years, 45.0% with familial hypercholesterolemia (FH) (5.0% homozygous and 40.0% heterozygous) and 65.0% with atherosclerotic cardiovascular disease. The mean (SD) eGFR was 62.6 (30.0) ml/min/1.73m2 (51.7% of patients had eGFR <60ml/min/1.73m2 [CKD stage>2]), 50.0% had proteinuria (>300mg/g) and 10.0% had nephrotic syndrome. Other CV risk factors were hypertension (75.0%), diabetes (25.0%), and smoking (21.7%). A 40.0% of patients were statin intolerant. At evolocumab initiation, 41.7% of patients were on a high intensity statin, 18.3% on moderate intensity statin and 50.0% were receiving ezetimibe. Mean (SD) LDL-c at evolocumab initiation was 179.7 (62.9) mg/dL (53.4% of patients with LDL-c ≥160mg/dL and 29.3% ≥190mg/dL). After 12 weeks, evolocumab resulted in LDL-c reductions of 60.1%. At week 12, 90.0% of patients reached LDL-c levels <100mg/dL, 70.0% <70mg/dL, and 55.0% <55mg/dL, while mean eGFR levels and statin use remained stable. CONCLUSION In Nephrology Units of Spain, evolocumab was predominantly prescribed in patients with FH, chronic renal disease (CRD>2) and secondary prevention, with LDL-c levels above those recommended by the guidelines. Evolocumab used in clinical practice significantly reduced the LDL-c levels in all patients included in the study.
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Affiliation(s)
- Marian Goicoechea
- Servicio de Nefrología, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
| | - Vicente Álvarez
- Servicio de Nefrología, Hospital Universitario de La Princesa, Madrid, Spain
| | - Alfonso Segarra
- Servicio de Nefrología, Hospital Arnau de Vilanova, Lérida, Spain
| | - Manuel Polaina
- Servicio de Nefrología, Complejo Hospitalario de Jaén, Jaén, Spain
| | - Guillermo Martín-Reyes
- Unidad de Gestión Clínica de Nefrología, Hospital Regional Universitario, Universidad de Málaga, Málaga, Spain; Servicio de Nefrología, IBIMA, REDinREN (RD16/0009/0006), Málaga, Spain
| | | | - Verónica Escudero
- Servicio de Nefrología, Hospital Universitario Dr. Peset, Valencia, Spain
| | - Cristhian Orellana
- Servicio de Nefrología, Hospital Universitario Puerta del Mar, Cádiz, Spain
| | - Sergio Bea Granell
- Servicio de Nefrología, Consorcio Hospital General Universitario de Valencia, Valencia, Spain
| | | | | | - Jose Maria Graña
- Servicio de Nefrología, Hospital Universitario de la Ribera, Alzira, Valencia, Spain
| | - Javier Reque
- Servicio de Nefrología, Hospital Rey Don Jaime, Castellón, Spain
| | - Rosa Sánchez Hernández
- Servicio de Nefrología, Hospital Universitario General de Villalba, Villalba, Madrid, Spain
| | | | - Jose Luis Górriz
- Servicio de Nefrología, Hospital Clínico Universitario, INCLIVA, Universidad de Valencia, Valencia, Spain
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10
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Quiroga B, Ramos PM, Horrillo AS, Ortiz A, Valdivieso JM, Carrero JJ. Triglycerides-glucose index and the risk of cardiovascular events in persons with non-diabetic chronic kidney disease. Clin Kidney J 2022; 15:1705-1712. [PMID: 36003671 PMCID: PMC9394724 DOI: 10.1093/ckj/sfac073] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Indexed: 11/12/2022] Open
Abstract
Background Chronic kidney disease (CKD) is associated with high rates of cardiovascular events. We
here explored whether the recently described triglycerides–glucose index (TyG) predicted
the incidence of major adverse cardiovascular events (MACE) in these patients. Methods This observationa study was undertaken of 1142 persons with CKD and free from diabetes
and 460 controls from the prospective NEFRONA study. The study exposure was the TyG
index at cohort inclusion. The study outcome was MACE (cardiovascular death, nonfatal
myocardial infarction, nonfatal stroke and hospitalization for unstable angina).
Covariates included demographics, comorbidities, lipid profile, renal function and
glycaemic control. Cox regression models evaluated the association between TyG index and
4-point MACE in patients with CKD. Results TyG was higher [median 8.63 (interquartile range 8.32–8.95)] in patients with CKD
compared with controls (P < 0.001). TyG increased across albuminuria categories but
was similar for glomerular filtration rate categories among patients with CKD stages
3–5. During 46 ± 13 months of follow-up, 49 (4.3%) MACE were registered. TyG predicted
the occurrence of MACE {hazard ratio (HR) 1.95 [95% confidence interval (CI) 1.11–3.40]
per TyG unit increase; and HR 2.29 (95% CI 1.24–4.20] for TyG values above the median of
8.63 units}. Sensitivity analysis for subgroups of participants according to age, kidney
function, body mass index and imaging evidence of atherosclerosis yielded similar
results, as did adjusted analysis. Neither triglycerides nor glucose alone was
associated with MACE. Conclusions The TyG index is associated with the occurrence of major cardiovascular events in
persons free from diabetes with non-dialysis dependent CKD.
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Affiliation(s)
- Borja Quiroga
- IIS-La Princesa. Nephrology Department, Hospital Universitario de la Princesa, Madrid, Spain
| | | | - Ana Sánchez Horrillo
- IIS-La Princesa. Nephrology Department, Hospital Universitario de la Princesa, Madrid, Spain
| | - Alberto Ortiz
- IIS-Fundación Jimenez Diaz, School of Medicine, Universidad Autónoma de Madrid, Fundación Renal Iñigo Alvarez de Toledo-IRSIN, REDinREN, Instituto de Investigación Carlos III, Madrid, Spain
| | - José Manuel Valdivieso
- Vascular and Renal Translational Research Group, UDETMA, REDinREN del ISCIII, IRBLleida, Lleida, Spain
| | - Juan Jesús Carrero
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
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11
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Muñoz Ramos P, Gil Giraldo Y, Álvarez-Chiva V, Arroyo D, Sango Merino C, Moncho Francés F, Ocaña J, Reque J, Sánchez-Álvarez E, Górriz JL, Quiroga B. Proteinuria-Lowering Effects of Proprotein Convertase Subtilisin/Kexin Type 9 Inhibitors in Chronic Kidney Disease Patients: A Real-World Multicentric Study. Metabolites 2021; 11:metabo11110760. [PMID: 34822418 PMCID: PMC8618891 DOI: 10.3390/metabo11110760] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2021] [Revised: 11/01/2021] [Accepted: 11/03/2021] [Indexed: 01/22/2023] Open
Abstract
Control of dyslipidemia in chronic kidney disease (CKD) is not always guaranteed with statins and/or ezetimibe. Proprotein convertase subtilisin/kexin type 9 inhibitors (PCSK9i) have opened up a new era in lipid control, but their effect on renal function and proteinuria in real life have not yet been evaluated. The aim of the present study was to analyze the evolution of renal function and proteinuria in a cohort of CKD patients treated with PCSK9i. This retrospective multicentric cohort study included CKD patients treated with PCSK9i. Baseline epidemiological data, comorbidities and laboratory findings (including estimated glomerular filtration rate [eGFR], proteinuria and lipid profile) were collected. The evolution of renal function, proteinuria and lipid profile was analyzed during the 1-year follow-up. The cohort included 76 patients (68% male, mean age 66 ± 10 years). The mean baseline creatinine was 1.55 ± 0.77 mg/dL, and the mean eGFR was 52 ± 22 mL/min/1.73 m2. Reductions in LDL-cholesterol, total cholesterol and triglycerides during the first month were 51 ± 25%, 32 ± 25% and 11 ± 40%, respectively, levels that remained stable throughout the first year (p < 0.001 for LDL-cholesterol and total cholesterol trends and p = 0.002 for triglyceride trend). During follow-up, proteinuria improved from 57 (9–481) to 30 (7–520) mg/g (p = 0.021). In addition, eGFR remained stable, and no adverse events were reported. In our cohort, dyslipidemia treatment with PCSK9i was associated with decreased proteinuria in CKD patients, an effect that might be due to reduced lipid nephrotoxicity. Clinical trials are needed to further investigate whether this impact on proteinuria can significantly slow CKD progression in the long term.
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Affiliation(s)
- Patricia Muñoz Ramos
- Nephrology Department, Hospital Universitario de La Princesa, 28006 Madrid, Spain; (P.M.R.); (Y.G.G.); (V.Á.-C.)
| | - Yohana Gil Giraldo
- Nephrology Department, Hospital Universitario de La Princesa, 28006 Madrid, Spain; (P.M.R.); (Y.G.G.); (V.Á.-C.)
| | - Vicente Álvarez-Chiva
- Nephrology Department, Hospital Universitario de La Princesa, 28006 Madrid, Spain; (P.M.R.); (Y.G.G.); (V.Á.-C.)
| | - David Arroyo
- Nephrology Department, Hospital General Universitario Gregorio Marañón, 28007 Madrid, Spain;
| | - Cristina Sango Merino
- Nephrology Department, Hospital de Cabueñes, 33394 Gijón, Spain; (C.S.M.); (E.S.-Á.)
| | - Francesc Moncho Francés
- Nephrology Department, Hospital Clínico Universitario, INCLIVA, Universidad de Valencia, 46010 Valencia, Spain; (F.M.F.); (J.L.G.)
| | - Javier Ocaña
- Nephrology Department, Fundación Hospital de Alcorcón, 28922 Madrid, Spain;
| | - Javier Reque
- Nephrology Department, Hospital General de Castellón, 12004 Castelló de la Plana, Spain;
| | | | - José Luis Górriz
- Nephrology Department, Hospital Clínico Universitario, INCLIVA, Universidad de Valencia, 46010 Valencia, Spain; (F.M.F.); (J.L.G.)
| | - Borja Quiroga
- Nephrology Department, Hospital Universitario de La Princesa, 28006 Madrid, Spain; (P.M.R.); (Y.G.G.); (V.Á.-C.)
- Correspondence: ; Tel.: +34-915-202-200
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12
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Chen CHS, Kuo TC, Kuo HC, Tseng YJ, Kuo CH, Yuan TH, Chan CC. Lipidomics of children and adolescents exposed to multiple industrial pollutants. ENVIRONMENTAL RESEARCH 2021; 201:111448. [PMID: 34119529 DOI: 10.1016/j.envres.2021.111448] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 05/21/2021] [Accepted: 05/28/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND There are limited studies on the lipidomics of children and adolescents exposed to multiple industrial pollutants. OBJECTIVES In this study, we aimed to investigate lipid profile perturbations in 99 children and adolescents (aged 9-15) who lived in a polluted area surrounding the largest petrochemical complex in Taiwan. Previous studies have reported increased risks of acute and chronic diseases including liver dysfunctions and chronic kidney disease (CKD) in residents living in this area. METHODS We measured urinary concentrations of 11 metals and metalloids and polycyclic aromatic hydrocarbons (PAHs) metabolite 1-hydroxypyrene (1-OHP) as exposure biomarkers, and urinary oxidative stress biomarkers and serum acylcarnitines as early health effect biomarkers. The association between individual exposure biomarkers and early health effect biomarkers were analyzed using linear regression, while association of combined exposure biomarkers with four oxidative stress biomarkers and acylcarnitines were analyzed using weighted quantile sum (WQS) regression. Lipid profiles were analyzed using an untargeted liquid chromatography mass spectrometry-based technique. "Meet-in-the-middle" approach was applied to identify potential lipid features that linked multiple industrial pollutants exposure with early health effects. RESULTS We identified 15 potential lipid features that linked elevated multiple industrial pollutants exposure with three increased oxidative stress biomarkers and eight deregulated serum acylcarnitines, including one lysophosphatidylcholines (LPCs), four phosphatidylcholines (PCs), and two sphingomyelins (SMs) that were up-regulated in high exposure group compared to low exposure group, and two LPCs, four PCs, and two phosphatidylinositols (PIs) down-regulated in high exposure group compared to low exposure group. CONCLUSION Our findings could provide information for understanding the health effects, including early indicators and biological mechanism identification, of children and adolescents exposed to multiple industrial pollutants during critical stages of development.
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Affiliation(s)
- Chi-Hsin S Chen
- Master of Public Health Program, College of Public Health, National Taiwan University. No. 17, Xu-Zhou Road, Taipei, 10055, Taiwan
| | - Tien-Chueh Kuo
- The Metabolomics Core Laboratory, Center of Genomic Medicine, National Taiwan University. No. 1, Sec. 4, Roosevelt Road, Taipei, 10617, Taiwan; Graduate Institute of Biomedical Electronics and Bioinformatics, College of Electrical Engineering and Computer Science, National Taiwan University. No. 1, Sec. 4, Roosevelt Road, Taipei, 10617, Taiwan
| | - Han-Chun Kuo
- The Metabolomics Core Laboratory, Center of Genomic Medicine, National Taiwan University. No. 1, Sec. 4, Roosevelt Road, Taipei, 10617, Taiwan
| | - Yufeng J Tseng
- Graduate Institute of Biomedical Electronics and Bioinformatics, College of Electrical Engineering and Computer Science, National Taiwan University. No. 1, Sec. 4, Roosevelt Road, Taipei, 10617, Taiwan; Department of Computer Science and Information Engineering, College of Electrical Engineering and Computer Science, National Taiwan University. No. 1, Sec. 4, Roosevelt Road, Taipei, 10617, Taiwan
| | - Ching-Hua Kuo
- School of Pharmacy, College of Medicine, National Taiwan University. No. 33, Linsen S. Road, Taipei, 10055, Taiwan
| | - Tzu-Hsuen Yuan
- Department of Health and Welfare, College of City Management, University of Taipei, Taipei, Taiwan. No.101, Sec. 2, Zhongcheng Rd., Shilin Dist., Taipei City, 11153, Taiwan
| | - Chang-Chuan Chan
- Institute of Environmental and Occupational Health Sciences, College of Public Health, National Taiwan University. No. 17, Xu-Zhou Road, Taipei, 10055, Taiwan.
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13
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Dong L, Wei W, Han M, Xu G. Utility of non-HDL-C in predicting proteinuria remission of idiopathic membranous nephropathy: a retrospective cohort study. Lipids Health Dis 2021; 20:122. [PMID: 34587945 PMCID: PMC8482680 DOI: 10.1186/s12944-021-01558-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 09/14/2021] [Indexed: 11/10/2022] Open
Abstract
Background Idiopathic membranous nephropathy (IMN) may have various clinical outcomes. Hyperlipidemia is quite common in IMN. However, the utility of the lipid profile in predicting outcomes remains unknown. This study aimed to explore the correlation between hyperlipidemia and proteinuria remission in IMN. Methods 256 patients who diagnosed with IMN confirmed by renal biopsy in Wuhan Tongji Hospital from January 2016 to October 2020 were included in this study. The end point was defined as a combination of partial and complete remission. Cox proportional-hazards regression analysis and Kaplan–Meier curve were applied to assess the prognostic value of the lipid profile for proteinuria remission. Results A total of 153 (59.8%) patients achieved remission and 103 (40.2%) did not. The levels of total cholesterol, low-density lipoprotein, and non-high-density lipoprotein were significantly lower in the remission group than in the non-remission group. Non-high-density lipoprotein level revealed the strongest correlation with proteinuria (Spearman’s rho = 0.42; P < 0.001). The multivariate analysis demonstrated that serum total cholesterol [hazard ratio (HR): 0.883; 95% confidence interval (CI): 0.813–0.958; P = 0.003] and non-high-density lipoprotein cholesterol (HR: 0.892; 95% CI: 0.820–0.970; P = 0.007) levels were independent markers to predict proteinuria remission in IMN. Conclusions Among the lipid profile, the non-high-density lipoprotein level exhibited the strongest correlation with proteinuria in IMN. Moreover, elevated serum cholesterol and non-high-density lipoprotein cholesterol concentrations at baseline predicted probability of proteinuria non-remission in IMN.
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Affiliation(s)
- Lei Dong
- Department of Nephrology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, No. 1095 Jiefang Avenue, Wuhan, D-430030, Hubei, China
| | - Wang Wei
- Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, No. 1095 Jiefang Avenue, Wuhan, D-430030, Hubei, China
| | - Min Han
- Department of Nephrology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, No. 1095 Jiefang Avenue, Wuhan, D-430030, Hubei, China.
| | - Gang Xu
- Department of Nephrology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, No. 1095 Jiefang Avenue, Wuhan, D-430030, Hubei, China.
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14
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Aguilar-Ramirez D, Alegre-Díaz J, Herrington WG, Staplin N, Ramirez-Reyes R, Gnatiuc L, Hill M, Romer F, Torres J, Trichia E, Wade R, Collins R, Emberson JR, Kuri-Morales P, Tapia-Conyer R. Association of Kidney Function With NMR-Quantified Lipids, Lipoproteins, and Metabolic Measures in Mexican Adults. J Clin Endocrinol Metab 2021; 106:2828-2839. [PMID: 34216216 PMCID: PMC8475241 DOI: 10.1210/clinem/dgab497] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Indexed: 11/19/2022]
Abstract
CONTEXT Chronic kidney disease (CKD) and diabetes are associated with dyslipidemia, metabolic abnormalities, and atherosclerotic risk. Nuclear magnetic resonance (NMR) spectroscopy provides much more detail on lipoproteins than traditional assays. METHODS In about 38 000 participants from the Mexico City Prospective Study, aged 35 to 84 years and not using lipid-lowering medication, NMR spectroscopy quantified plasma concentrations of lipoprotein particles, their lipidic compositions, and other metabolic measures. Linear regression related low estimated glomerular filtration rate (eGFR; <60 mL/min/1.73 m2) to each NMR measure after adjustment for confounders and for multiplicity. Analyses were done separately for those with and without diabetes. RESULTS Among the 38 081 participants (mean age 52 years, 64% women), low eGFR was present for 4.8% (306/6403) of those with diabetes and 1.2% (365/31 678) of those without diabetes. Among both those with and without diabetes, low eGFR was significantly associated with higher levels of 58 NMR measures, including apolipoprotein B (Apo-B), the particle numbers of most Apo-B containing lipoproteins, the cholesterol and triglycerides carried in these lipoproteins, several fatty acids, total cholines and phosphatidylcholine, citrate, glutamine, phenylalanine, β-OH-butyrate, and the inflammatory measure glycoprotein-A, and significantly lower levels of 13 NMR measures, including medium and small high-density lipoprotein particle measures, very low-density lipoprotein particle size, the ratio of saturated:total fatty acids, valine, tyrosine, and aceto-acetate. CONCLUSIONS In this Mexican population with high levels of adiposity and diabetes, low kidney function was associated with widespread alterations in lipidic and metabolic profiles, both in those with and without diabetes. These alterations may help explain the higher atherosclerotic risk experienced by people with CKD.
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Affiliation(s)
- Diego Aguilar-Ramirez
- Clinical Trial Service Unit & Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Jesus Alegre-Díaz
- Faculty of Medicine, National Autonomous University of Mexico, Mexico City, Mexico
| | - William G Herrington
- Clinical Trial Service Unit & Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
- MRC Population Health Research Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Natalie Staplin
- Clinical Trial Service Unit & Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
- MRC Population Health Research Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Raúl Ramirez-Reyes
- Faculty of Medicine, National Autonomous University of Mexico, Mexico City, Mexico
| | - Louisa Gnatiuc
- Clinical Trial Service Unit & Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Michael Hill
- Clinical Trial Service Unit & Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
- MRC Population Health Research Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Frederik Romer
- Clinical Trial Service Unit & Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Jason Torres
- Clinical Trial Service Unit & Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Eirini Trichia
- Clinical Trial Service Unit & Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Rachel Wade
- Clinical Trial Service Unit & Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
- MRC Population Health Research Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Rory Collins
- Clinical Trial Service Unit & Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Jonathan R Emberson
- Clinical Trial Service Unit & Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
- MRC Population Health Research Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Pablo Kuri-Morales
- Faculty of Medicine, National Autonomous University of Mexico, Mexico City, Mexico
| | - Roberto Tapia-Conyer
- Faculty of Medicine, National Autonomous University of Mexico, Mexico City, Mexico
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15
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Goicoechea M, Álvarez V, Segarra A, Polaina M, Martín-Reyes G, Robles NR, Escudero V, Orellana C, Bea Granell S, de Juan-Ribera J, Fernández Lucas M, Graña JM, Reque J, Sánchez Hernández R, Villamayor S, Górriz JL. Lipid profile of patients treated with evolocumab in Spanish hospital nephrology units (RETOSS NEFRO). Nefrologia 2021; 42:S0211-6995(21)00133-8. [PMID: 34389184 DOI: 10.1016/j.nefro.2021.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 05/13/2021] [Accepted: 06/13/2021] [Indexed: 10/20/2022] Open
Abstract
BACKGROUND AND OBJECTIVE To describe the clinical characteristics, the reasons for initiating therapy and the effects of treatment in the initial phase of evolocumab availability in the Nephrology Units of Spain. MATERIAL AND METHODS Retrospective, observational and multicentric study that included patients initiating treatment with evolocumab (from February 2016 to August 2018), in 15 Nephrology Units in Spain. The demographic and clinical characteristics of the patients, the lipid lowering treatment and the evolution of the lipid profiles between 24 weeks pre-initiation and 12±4 weeks post-initiation of evolocumab were reviewed. RESULTS Sixty patients were enrolled: 53.3% women; mean (SD) age, 56.9 (12.8) years, 45.0% with familial hypercholesterolemia (FH) (5.0% homozygous and 40.0% heterozygous) and 65.0% with atherosclerotic cardiovascular (CV) disease. The mean (SD) eGFR was 62.6 (30.0)ml/min/1.73m2 (51.7% of patients had eGFR<60ml/min/1.73m2 [CKD stage>2]), 50.0% had proteinuria (>300mg/g) and 10.0% had nephrotic syndrome. Other CV risk factors were hypertension (75.0%), diabetes (25.0%), and smoking (21.7%). A 40.0% of patients were statin intolerant. At evolocumab initiation, 41.7% of patients were on a high-intensity statin, 18.3% on moderate intensity statin and 50.0% were receiving ezetimibe. Mean (SD) LDL-c at evolocumab initiation was 179.7 (62.9)mg/dL (53.4% of patients with LDL-c≥160mg/dL and 29.3%≥190mg/dL). After 12 weeks, evolocumab resulted in LDL-c reductions of 60.1%. At week 12, 90.0% of patients reached LDL-c levels <100mg/dL, 70.0% <70mg/dL, and 55.0% <55mg/dL, while mean eGFR levels and statin use were remained stable. CONCLUSION In Nephrology Units of Spain, evolocumab was predominantly prescribed in patients with FH, chronic renal disease (CRD>2) and secondary prevention, with LDL-c levels above those recommended by the guidelines. Evolocumab used in clinical practice significantly reduced the LDL-c levels in all patients included in the study.
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Affiliation(s)
- Marian Goicoechea
- Servicio de Nefrología, Hospital General Universitario Gregorio Marañón, Madrid, España.
| | - Vicente Álvarez
- Servicio de Nefrología, Hospital Universitario de La Princesa, Madrid, España
| | - Alfonso Segarra
- Servicio de Nefrología, Hospital Arnau de Vilanova, Lérida, España
| | - Manuel Polaina
- Servicio de Nefrología, Complejo Hospitalario de Jaén, Jaén, España
| | - Guillermo Martín-Reyes
- Unidad de Gestión Clínica de Nefrología, Hospital Regional Universitario, Universidad de Málaga, Málaga, España; Servicio de Nefrología, IBIMA, REDinREN (RD16/0009/0006), Málaga, España
| | | | - Verónica Escudero
- Servicio de Nefrología, Hospital Universitario Dr. Peset, Valencia, España
| | - Cristhian Orellana
- Servicio de Nefrología, Hospital Universitario Puerta del Mar, Cádiz, España
| | - Sergio Bea Granell
- Servicio de Nefrología, Consorcio Hospital General Universitario de Valencia, Valencia, España
| | | | | | - Jose Maria Graña
- Servicio de Nefrología, Hospital Universitario de la Ribera, Alzira, Valencia, España
| | - Javier Reque
- Servicio de Nefrología, Hospital Rey Don Jaime, Castellón, España
| | - Rosa Sánchez Hernández
- Servicio de Nefrología, Hospital Universitario General de Villalba, Villalba, Madrid, España
| | | | - Jose Luis Górriz
- Servicio de Nefrología, Hospital Clínico Universitario, INCLIVA, Universidad de Valencia, Valencia, España
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16
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Shrestha P, Yazdani S, Vivès RR, El Masri R, Dam W, van de Sluis B, van den Born J. Proteinuria converts hepatic heparan sulfate to an effective proprotein convertase subtilisin kexin type 9 enzyme binding partner. Kidney Int 2021; 99:1369-1381. [PMID: 33609572 DOI: 10.1016/j.kint.2021.01.023] [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] [Received: 07/28/2020] [Revised: 01/06/2021] [Accepted: 01/14/2021] [Indexed: 12/22/2022]
Abstract
Hepatic uptake of triglyceride-rich remnant lipoproteins is mediated by the low-density lipoprotein receptor, a low-density lipoprotein receptor related protein and the heparan sulfate proteoglycan, syndecan-1. Heparan sulfate proteoglycan also mediates low-density lipoprotein receptor degradation by a regulator of cholesterol homeostasis, proprotein convertase subtilisin kexin type 9 (PCSK9), thereby hampering triglyceride-rich remnant lipoproteins uptake. In this study, we investigated the effects of proteinuria on PCSK9, hepatic heparan sulfate proteoglycan and plasma triglyceride-rich remnant lipoproteins. Adriamycin-injected rats developed proteinuria, elevated triglycerides and total cholesterol (all significantly increased). Proteinuria associated with triglycerides and total cholesterol and serum PCSK9 (all significant associations) without loss of the low-density lipoprotein receptor as evidenced by immunofluorescence staining and western blotting. In proteinuric rats, PCSK9 accumulated in sinusoids, whereas in control rats PCSK9 was localized in the cytoplasm of hepatocytes. Molecular profiling revealed that the heparan sulfate side chains of heparan sulfate proteoglycan to be hypersulfated in proteinuric rats. Competition assays revealed sulfation to be a major determinant for PCSK9 binding. PCSK9 partly colocalized with hypersulfated heparan sulfate in proteinuric rats, but not in control rats. Hence, proteinuria induces hypersulfated hepatic heparan sulfate proteoglycans, increasing their affinity to PCSK9. This might impair hepatic triglyceride-rich remnant lipoproteins uptake, causing proteinuria-associated dyslipidemia. Thus, our study reveals PCSK9/heparan sulfate may be a novel target to control dyslipidemia.
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Affiliation(s)
- Pragyi Shrestha
- Department of Nephrology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Saleh Yazdani
- Laboratory of Molecular Cell Biology, Institute of Botany and Microbiology, Department of Biology, KU Leuven, Leuven, Belgium; Vlaams Institute of Biotechnology Leuven Center for Microbiology, Leuven, Belgium
| | - Romain R Vivès
- University Grenoble Alpes, Institute of Structural Biology (IBS), Atomic Energy and Alternative Energies Commission (CEA), French National Centre for Scientific Research (CNRS), Grenoble, France
| | - Rana El Masri
- University Grenoble Alpes, Institute of Structural Biology (IBS), Atomic Energy and Alternative Energies Commission (CEA), French National Centre for Scientific Research (CNRS), Grenoble, France
| | - Wendy Dam
- Department of Nephrology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Bart van de Sluis
- Department of Pediatrics, Section Molecular Genetics, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Jacob van den Born
- Department of Nephrology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.
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Niu SF, Wu CK, Chuang NC, Yang YB, Chang TH. Early Chronic Kidney Disease Care Programme delays kidney function deterioration in patients with stage I-IIIa chronic kidney disease: an observational cohort study in Taiwan. BMJ Open 2021; 11:e041210. [PMID: 33468527 PMCID: PMC7817788 DOI: 10.1136/bmjopen-2020-041210] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES To investigate the effect of the Early Chronic Kidney Disease (CKD) Care Programme on CKD progression in patients with CKD stage I-IIIa. DESIGN Observational cohort study. SETTING Taipei Medical University Research Database from three affiliated hospitals. PARTICIPANTS Adult non-pregnant patients with CKD stage I-IIIa from Taipei Medical University Research Database between 1 January 2012 and 31 August 2017 were recruited. These patients were divided into Early CKD Care Programme participants (case) and non-participants (control). The models were matched by age, sex, estimated glomerular filtration rate and CKD stage with 1:2 propensity score to reduce bias between two groups. OUTCOME MEASURES The risks of CKD stage I-IIIa progression to IIIb between Early CKD Care Programme participants and non-participants. RESULTS Compared with the control group, the case group demonstrated more comorbidities and higher proportions of hypertension, diabetes mellitus, gout, dyslipidaemia, heart disease and cerebrovascular disease, but had lower risk of progression to CKD stage IIIb before and (HR 0.72; 95% CI 0.61 to 0.85) and after (adjusted HR (aHR) 0.67; 95% CI 0.55 to 0.81) adjustments. Moreover, Kaplan-Meier analysis revealed the cumulative incidence of CKD stage IIIb was significantly lower in the case group than in the control group. Finally, the programme was an independent protective factor against progression to stage IIIb, especially in patients with CKD stage IIIa before (HR 0.72; 95% CI 0.61 to 0.85) and after (aHR 0.67; 95% CI 0.55 to 0.81) adjustments. CONCLUSIONS The Early CKD Care Programme is an independent protective factor against progression of early CKD.
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Affiliation(s)
- Shu-Fen Niu
- Department of Nursing, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan
- Department of Nursing, Fu Jen Catholic University, New Taipei, Taiwan
- College of Nursing, Taipei Medical University, Taipei, Taiwan
| | - Chung-Kuan Wu
- Division of Nephrology, Department of Internal Medicine, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan
- School of Medicine, Fu Jen Catholic University, New Taipei, Taiwan
| | - Nai-Chen Chuang
- Clinical Data Center, Office of Data Science, Taipei Medical University, Taipei, Taiwan
| | - Ya-Bei Yang
- Division of Cardiovascular Surgery, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan
| | - Tzu-Hao Chang
- Clinical Big Data Research Center, Taipei Medical University Hospital, Taipei, Taiwan
- Graduate Institute of Biomedical Informatics, College of Medical Science and Technology, Taipei Medical University, Taipei, Taiwan
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18
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Pallarés-Carratalá V, Quesada JA, Orozco-Beltrán D, Amigó-Grau N, Lopez-Pineda A, Fernández Giménez A, Gil-Guillén VF, Correig X, Masana L, Monleón D, Redón J, Pascual R, Carratalá-Munuera C. Analysis of LDL and HDL size and number by nuclear magnetic resonance in a healthy working population: The LipoLab Study. Int J Clin Pract 2021; 75:e13610. [PMID: 32648987 DOI: 10.1111/ijcp.13610] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Revised: 07/01/2020] [Accepted: 07/06/2020] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND AND AIM Atherosclerosis is the underlying process in cardiovascular disease (CVD), the first cause of death in developed countries. We aimed to identify people with no known CVD and normal values of LDL-C and HDL-C, but with alterations in the number and size of lipoprotein particles (as measured by nuclear magnetic resonance [NMR]) and to analyse their sociodemographic, clinical and biochemical characteristics. METHODS Cross-sectional study in occupational risks prevention centre in Castellón (Spain) in 2017 and 2018, in consecutively recruited adults (18-65 years) with no known CVD. Sociodemographic, clinical and biochemical variables were collected. Lipid profiles were analysed (Liposcale test), along with the concentration, size and number of the main types of lipoprotein particles, determined by 2D diffusion-ordered NMR spectroscopy. Using contingency tables, we analysed the characteristics of people with normal LDL and HDL cholesterol but abnormal levels of LDL and HDL particles. The magnitude of association between explanatory variables and abnormal levels of each kind of lipoprotein was assessed with multivariable logistic regression models. RESULTS Of the 400 total participants (31.3% women; age 46.4 ± 4.3 years), 169 had normal LDL and HDL cholesterol. Abnormal lipoprotein particle values depended on the subtype: prevalence of abnormal LDL levels ranged from 8.3% to 36.7%; and of HDL, from 28.4% to 42.6%. High systolic blood pressure and total cholesterol were significantly associated with abnormal LDL levels. Male sex and high systolic blood pressure were associated with abnormalities in HDL. CONCLUSIONS An extended lipids profile, obtained by NMR, enables the identification of people with normal HDL-C and LDL-C levels who present abnormal levels of LDL-P and/or HDL-P. Higher total cholesterol, systolic blood pressure, BMI and male sex were significantly associated with these abnormal values.
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Affiliation(s)
- Vicente Pallarés-Carratalá
- Health Surveillance Unit, Castellón Mutual Insurance Union, Castellon, Spain
- Department of Medicine, Jaume I University, Castellón, Spain
| | - Jose A Quesada
- Department of Clinical Medicine, Miguel Hernandez University, San Juan de Alicante, Spain
| | - Domingo Orozco-Beltrán
- Department of Clinical Medicine, Miguel Hernandez University, San Juan de Alicante, Spain
| | - Nuria Amigó-Grau
- Biosfer Teslab, Reus, SL, Spain
- CIBER of Diabetes and Associated Metabolic Disorders (CIBERDEM), Madrid, Spain
| | - Adriana Lopez-Pineda
- Department of Clinical Medicine, Miguel Hernandez University, San Juan de Alicante, Spain
| | | | - Vicente F Gil-Guillén
- Department of Clinical Medicine, Miguel Hernandez University, San Juan de Alicante, Spain
- Research Unit General University Hospital of Elda, Elda, Spain
| | - Xavier Correig
- CIBER of Diabetes and Associated Metabolic Disorders (CIBERDEM), Madrid, Spain
- Metabolomics Platform, Universitat Rovira i Virgili, IISPV, Reus-Tarragona, Spain
| | - Lluis Masana
- CIBER of Diabetes and Associated Metabolic Disorders (CIBERDEM), Madrid, Spain
- Unit of research in lipids and arteriosclerosis (URLA), Hospital Universitari Sant Joan de Reus, Reus, Spain
| | - Daniel Monleón
- Department of Pathology, Universidad de Valencia, Spain
- INCLIVA Research Institute, University of Valencia, Valencia, Spain
| | - Josep Redón
- INCLIVA Research Institute, University of Valencia, Valencia, Spain
| | - Reyes Pascual
- Department of Clinical Medicine, Miguel Hernandez University, San Juan de Alicante, Spain
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Opazo-Ríos L, Mas S, Marín-Royo G, Mezzano S, Gómez-Guerrero C, Moreno JA, Egido J. Lipotoxicity and Diabetic Nephropathy: Novel Mechanistic Insights and Therapeutic Opportunities. Int J Mol Sci 2020; 21:E2632. [PMID: 32290082 PMCID: PMC7177360 DOI: 10.3390/ijms21072632] [Citation(s) in RCA: 143] [Impact Index Per Article: 35.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 04/07/2020] [Accepted: 04/08/2020] [Indexed: 02/06/2023] Open
Abstract
Lipotoxicity is characterized by the ectopic accumulation of lipids in organs different from adipose tissue. Lipotoxicity is mainly associated with dysfunctional signaling and insulin resistance response in non-adipose tissue such as myocardium, pancreas, skeletal muscle, liver, and kidney. Serum lipid abnormalities and renal ectopic lipid accumulation have been associated with the development of kidney diseases, in particular diabetic nephropathy. Chronic hyperinsulinemia, often seen in type 2 diabetes, plays a crucial role in blood and liver lipid metabolism abnormalities, thus resulting in increased non-esterified fatty acids (NEFA). Excessive lipid accumulation alters cellular homeostasis and activates lipogenic and glycogenic cell-signaling pathways. Recent evidences indicate that both quantity and quality of lipids are involved in renal damage associated to lipotoxicity by activating inflammation, oxidative stress, mitochondrial dysfunction, and cell-death. The pathological effects of lipotoxicity have been observed in renal cells, thus promoting podocyte injury, tubular damage, mesangial proliferation, endothelial activation, and formation of macrophage-derived foam cells. Therefore, this review examines the recent preclinical and clinical research about the potentially harmful effects of lipids in the kidney, metabolic markers associated with these mechanisms, major signaling pathways affected, the causes of excessive lipid accumulation, and the types of lipids involved, as well as offers a comprehensive update of therapeutic strategies targeting lipotoxicity.
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Affiliation(s)
- Lucas Opazo-Ríos
- Renal, Vascular and Diabetes Research Laboratory, IIS-Fundación Jiménez Díaz, Universidad Autónoma de Madrid, Spanish Biomedical Research Centre in Diabetes and Associated Metabolic Disorders (CIBERDEM), 28040 Madrid, Spain; (L.O.-R.); (G.M.-R.); (C.G.-G.); (J.E.)
| | - Sebastián Mas
- Renal, Vascular and Diabetes Research Laboratory, IIS-Fundación Jiménez Díaz, Universidad Autónoma de Madrid, Spanish Biomedical Research Centre in Diabetes and Associated Metabolic Disorders (CIBERDEM), 28040 Madrid, Spain; (L.O.-R.); (G.M.-R.); (C.G.-G.); (J.E.)
| | - Gema Marín-Royo
- Renal, Vascular and Diabetes Research Laboratory, IIS-Fundación Jiménez Díaz, Universidad Autónoma de Madrid, Spanish Biomedical Research Centre in Diabetes and Associated Metabolic Disorders (CIBERDEM), 28040 Madrid, Spain; (L.O.-R.); (G.M.-R.); (C.G.-G.); (J.E.)
| | - Sergio Mezzano
- Laboratorio de Nefrología, Facultad de Medicina, Universidad Austral de Chile, 5090000 Valdivia, Chile;
| | - Carmen Gómez-Guerrero
- Renal, Vascular and Diabetes Research Laboratory, IIS-Fundación Jiménez Díaz, Universidad Autónoma de Madrid, Spanish Biomedical Research Centre in Diabetes and Associated Metabolic Disorders (CIBERDEM), 28040 Madrid, Spain; (L.O.-R.); (G.M.-R.); (C.G.-G.); (J.E.)
| | - Juan Antonio Moreno
- Department of Cell Biology, Physiology and Immunology, University of Cordoba, 14004 Cordoba, Spain
- Maimonides Biomedical Research Institute of Cordoba (IMIBIC), University of Cordoba, 14004 Cordoba, Spain
- Hospital Universitario Reina Sofía, 14004 Cordoba, Spain
| | - Jesús Egido
- Renal, Vascular and Diabetes Research Laboratory, IIS-Fundación Jiménez Díaz, Universidad Autónoma de Madrid, Spanish Biomedical Research Centre in Diabetes and Associated Metabolic Disorders (CIBERDEM), 28040 Madrid, Spain; (L.O.-R.); (G.M.-R.); (C.G.-G.); (J.E.)
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20
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Simeoni M, Borrelli S, Garofalo C, Fuiano G, Esposito C, Comi A, Provenzano M. Atherosclerotic-nephropathy: an updated narrative review. J Nephrol 2020; 34:125-136. [PMID: 32270411 DOI: 10.1007/s40620-020-00733-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Accepted: 04/03/2020] [Indexed: 12/13/2022]
Abstract
The increased prevalence of chronic kidney disease (CKD) in elderly patients recognizes, as main cause, the long-term exposure to atherosclerosis and hypertension. Chronic ischemic damage due to critical renal arterial stenosis induces oxidative stress and intra-renal inflammation, resulting in fibrosis and microvascular remodelling, that is the histological picture of atherosclerotic renal vascular disease (ARVD). The concomitant presence of a long history of hypertension may generate intimal thickening and luminal narrowing of renal arteries and arterioles, glomerulosclerosis, interstitial fibrosis and tubular atrophy, more typically expression of hypertensive nephropathy. These complex mechanisms contribute to the development of CKD and the progression to End Stage Kidney Disease. In elderly CKD patients, the distinction among these nephropathies may be problematic; therefore, ischemic and hypertensive nephropathies can be joined in a unique clinical syndrome defined as atherosclerotic nephropathy. The availability of novel diagnostic procedures, such as intra-vascular ultrasound and BOLD-MRI, in addition to traditional imaging, have opened new scenarios, because these tools allow to identify ischemic lesions responsive to renal revascularization. Indeed, although trials have deflated the role of renal revascularization on the renal outcomes, it should be still used to avoid dialysis initiation and/or to reduce blood pressure in selected elderly patients at high risk. Nonetheless, lifestyle modifications (smoking cessation, increased physical activity), statins and antiplatelet use, as well as cautious use of renin-angiotensin system inhibitors, remain the main therapeutic approach aimed at slowing the renal damage progression. Mesenchymal stem cells and Micro-RNA are promising target of anti-fibrotic therapy, which might provide potential benefit in ARVD patients, though safety and efficacy profile in humans is unknown too.
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Affiliation(s)
| | - Silvio Borrelli
- Nephrology and Dialysis Unit, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Carlo Garofalo
- Nephrology and Dialysis Unit, University of Campania "Luigi Vanvitelli", Naples, Italy.
| | - Giorgio Fuiano
- Nephrology Units at University "Magna Graecia", Catanzaro, Italy
| | | | - Alessandro Comi
- Nephrology Units at University "Magna Graecia", Catanzaro, Italy
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21
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Pontremoli R, Bellizzi V, Bianchi S, Bigazzi R, Cernaro V, Del Vecchio L, De Nicola L, Leoncini G, Mallamaci F, Zoccali C, Buemi M. Management of dyslipidaemia in patients with chronic kidney disease: a position paper endorsed by the Italian Society of Nephrology. J Nephrol 2020; 33:417-430. [PMID: 32065354 PMCID: PMC7220980 DOI: 10.1007/s40620-020-00707-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Accepted: 01/24/2020] [Indexed: 12/19/2022]
Abstract
Chronic kidney disease (CKD) represents a major public health issue worldwide and entails a high burden of cardiovascular events and mortality. Dyslipidaemia is common in patients with CKD and it is characterized by a highly atherogenic profile with relatively low levels of HDL-cholesterol and high levels of triglyceride and oxidized LDL-cholesterol. Overall, current literature indicates that lowering LDL-cholesterol is beneficial for preventing major atherosclerotic events in patients with CKD and in kidney transplant recipients while the evidence is less clear in patients on dialysis. Lipid lowering treatment is recommended in all patients with stage 3 CKD or worse, independently of baseline LDL-cholesterol levels. Statin and ezetimibe are the cornerstones in the management of dyslipidaemia in patients with CKD, however alternative and emerging lipid-lowering therapies may acquire a central role in near future. This position paper endorsed by the Italian Society of Nephrology aims at providing useful information on the topic of dyslipidaemia in CKD and at assisting decision making in the management of these patients.
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Affiliation(s)
- Roberto Pontremoli
- Università degli Studi and I.R.C.C.S. Ospedale Policlinico San Martino, Viale Benedetto XV 6, 16132, Genoa, Italy.
| | - Vincenzo Bellizzi
- Division of Nephrology, Dialysis and Transplantation, University Hospital "San Giovanni di Dio e Ruggi d'Aragona", Via San Leonardo, 84131, Salerno, Italy
| | - Stefano Bianchi
- Nephrology and Dialysis Complex Operative Unit, Department of Internal Medicine, ASL Toscana Nordovest, Livorno, Italy
| | - Roberto Bigazzi
- Nephrology and Dialysis Complex Operative Unit, Department of Internal Medicine, ASL Toscana Nordovest, Livorno, Italy
| | - Valeria Cernaro
- Unit of Nephrology and Dialysis, Department of Clinical and Experimental Medicine, University of Messina, Via Consolare Valeria 1, 98125, Messina, Italy
| | - Lucia Del Vecchio
- Department of Nephrology and Dialysis, A. Manzoni Hospital, ASST Lecco, Lecco, Italy
| | - Luca De Nicola
- Nephrology Division, Department of Advanced Medical and Surgical Sciences, University of Campania "L. Vanvitelli", Piazza Miraglia, 80138, Naples, Italy
| | - Giovanna Leoncini
- Università degli Studi and I.R.C.C.S. Ospedale Policlinico San Martino, Viale Benedetto XV 6, 16132, Genoa, Italy
| | - Francesca Mallamaci
- Nephrology, Dialysis and Transplantation Unit, Ospedali Riuniti, Reggio Calabria, Italy.,CNR-IFC, Clinical Epidemiology and Pathophysiology of Renal Diseases and Hypertension, Nefrologia-Ospedali Riuniti, 89100, Reggio Calabria, Italy
| | - Carmine Zoccali
- Nephrology, Dialysis and Transplantation Unit, Ospedali Riuniti, Reggio Calabria, Italy
| | - Michele Buemi
- Unit of Nephrology and Dialysis, Department of Clinical and Experimental Medicine, University of Messina, Via Consolare Valeria 1, 98125, Messina, Italy
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22
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The Role and Function of HDL in Patients with Chronic Kidney Disease and the Risk of Cardiovascular Disease. Int J Mol Sci 2020; 21:ijms21020601. [PMID: 31963445 PMCID: PMC7014265 DOI: 10.3390/ijms21020601] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Revised: 01/09/2020] [Accepted: 01/10/2020] [Indexed: 02/06/2023] Open
Abstract
Chronic kidney disease (CKD) is a worldwide health problem with steadily increasing occurrence. Significantly elevated cardiovascular morbidity and mortality have been observed in CKD. Cardiovascular diseases are the most important and frequent cause of death of CKD patients globally. The presence of CKD is related to disturbances in lipoprotein metabolism whose consequences are dyslipidemia and the accumulation of atherogenic particles. CKD not only fuels the reduction of high-density lipoprotein (HDL) cholesterol concentration, but also it modifies the composition of this lipoprotein. The key role of HDL is the participation in reverse cholesterol transport from peripheral tissues to the liver. Moreover, HDL prevents the oxidation of low-density lipoprotein (LDL) cholesterol by reactive oxygen species (ROS) and protects against the adverse effects of oxidized LDL (ox-LDL) on the endothelium. Numerous studies have demonstrated the ability of HDL to promote the production of nitric oxide (NO) by endothelial cells (ECs) and to exert antiapoptotic and anti-inflammatory effects. Increasing evidence suggests that in patients with chronic inflammatory disorders, HDLs may lose important antiatherosclerotic properties and become dysfunctional. So far, no therapeutic strategy to raise HDL, or alter the ratio of HDL subfractions, has been successful in slowing the progression of CKD or reducing cardiovascular disease in patients either with or without CKD.
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23
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Impact of dyslipidemia on estimated glomerular filtration rate in apparently healthy children and adolescents: the CASPIAN-V study. World J Pediatr 2019; 15:471-475. [PMID: 31240635 DOI: 10.1007/s12519-019-00270-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Accepted: 05/23/2019] [Indexed: 12/14/2022]
Abstract
BACKGROUND Chronic kidney disease (CKD) is a leading risk factor for development of cardiovascular disease (CVD). Dyslipidemia is also known as risk factor for CVD development. However, the association of dyslipidemia with glomerular injury among healthy children and adolescents remains controversial. We aimed to investigate the relationship between estimated glomerular filtration rate (eGFR) and lipid profile risk factors among healthy children and adolescents. METHODS In this nationwide survey, 3808 participants (1992 males, 1816 females), aged 7-18 years, were selected by cluster random sampling method from 30 provinces in Iran. Body mass index (BMI) and systolic and diastolic blood pressures were measured. Blood samples were obtained for serum creatinine, fasting blood glucose, total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), and triglyceride (TG) determinations. GFR was estimated using Schwartz equation. RESULTS Girls had higher eGFR than boys (P = 0.04). In a multiple regression analysis, eGFR demonstrated a positive correlation with systolic blood pressure, BMI, fasting glucose, TC, HDL-C, and TG. By the analysis of covariance, TC, HDL-C, and TG showed a negative correlation with eGFR after adjustments for BMI, systolic and diastolic blood pressures, and fasting glucose (OR = 0.56, 95% CI = 0.29-0.89). CONCLUSION The study showed that dyslipidemia is associated with reduced eGFR among the healthy children and adolescents.
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Abstract
An increased risk of cardiovascular disease, independent of conventional risk factors, is present even at minor levels of renal impairment and is highest in patients with end-stage renal disease (ESRD) requiring dialysis. Renal dysfunction changes the level, composition and quality of blood lipids in favour of a more atherogenic profile. Patients with advanced chronic kidney disease (CKD) or ESRD have a characteristic lipid pattern of hypertriglyceridaemia and low HDL cholesterol levels but normal LDL cholesterol levels. In the general population, a clear relationship exists between LDL cholesterol and major atherosclerotic events. However, in patients with ESRD, LDL cholesterol shows a negative association with these outcomes at below average LDL cholesterol levels and a flat or weakly positive association with mortality at higher LDL cholesterol levels. Overall, the available data suggest that lowering of LDL cholesterol is beneficial for prevention of major atherosclerotic events in patients with CKD and in kidney transplant recipients but is not beneficial in patients requiring dialysis. The 2013 Kidney Disease: Improving Global Outcomes (KDIGO) Clinical Practice Guideline for Lipid Management in CKD provides simple recommendations for the management of dyslipidaemia in patients with CKD and ESRD. However, emerging data and novel lipid-lowering therapies warrant some reappraisal of these recommendations.
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25
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Valdivielso JM, Rodríguez-Puyol D, Pascual J, Barrios C, Bermúdez-López M, Sánchez-Niño MD, Pérez-Fernández M, Ortiz A. Atherosclerosis in Chronic Kidney Disease: More, Less, or Just Different? Arterioscler Thromb Vasc Biol 2019; 39:1938-1966. [PMID: 31412740 DOI: 10.1161/atvbaha.119.312705] [Citation(s) in RCA: 152] [Impact Index Per Article: 30.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Patients with chronic kidney disease (CKD) are at an increased risk of premature mortality, mainly from cardiovascular causes. The association between CKD on hemodialysis and accelerated atherosclerosis was described >40 years ago. However, more recently, it has been suggested that the increase in atherosclerosis risk is actually observed in early CKD stages, remaining stable thereafter. In this regard, interventions targeting the pathogenesis of atherosclerosis, such as statins, successful in the general population, have failed to benefit patients with very advanced CKD. This raises the issue of the relative contribution of atherosclerosis versus other forms of cardiovascular injury such as arteriosclerosis or myocardial injury to the increased cardiovascular risk in CKD. In this review, the pathophysiogical contributors to atherosclerosis in CKD that are shared with the general population, or specific to CKD, are discussed. The NEFRONA study (Observatorio Nacional de Atherosclerosis en NEFrologia) prospectively assessed the prevalence and progression of subclinical atherosclerosis (plaque in vascular ultrasound), confirming an increased prevalence of atherosclerosis in patients with moderate CKD. However, the adjusted odds ratio for subclinical atherosclerosis increased with CKD stage, suggesting a contribution of CKD itself to subclinical atherosclerosis. Progression of atherosclerosis was closely related to CKD progression as well as to the baseline presence of atheroma plaque, and to higher phosphate, uric acid, and ferritin and lower 25(OH) vitamin D levels. These insights may help design future clinical trials of stratified personalized medicine targeting atherosclerosis in patients with CKD. Future primary prevention trials should enroll patients with evidence of subclinical atherosclerosis and should provide a comprehensive control of all known risk factors in addition to testing any additional intervention or placebo.
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Affiliation(s)
- José M Valdivielso
- From the Vascular & Renal Translational Research Group and UDETMA, IRBLleida. Spanish Research Network for Renal Diseases (RedInRen. ISCIII), Lleida, Spain (J.M.V., M.B.-L.)
| | - Diego Rodríguez-Puyol
- Nephrology Unit, Fundación para la investigación del Hospital Universitario Príncipe de Asturias, RedInRen, Alcalá de Henares, Madrid, Spain (D.R.-P.)
| | - Julio Pascual
- Department of Nephrology, Institute Mar for Medical Research, Hospital del Mar, RedInRen, Barcelona, Spain (J.P., C.B.)
| | - Clara Barrios
- Department of Nephrology, Institute Mar for Medical Research, Hospital del Mar, RedInRen, Barcelona, Spain (J.P., C.B.)
| | - Marcelino Bermúdez-López
- From the Vascular & Renal Translational Research Group and UDETMA, IRBLleida. Spanish Research Network for Renal Diseases (RedInRen. ISCIII), Lleida, Spain (J.M.V., M.B.-L.)
| | - Maria Dolores Sánchez-Niño
- IIS-Fundacion Jimenez Diaz, School of Medicine, University Autonoma of Madrid, FRIAT and RedInRen, Madrid, Spain (M.D.S.-N., A.O.)
| | | | - Alberto Ortiz
- IIS-Fundacion Jimenez Diaz, School of Medicine, University Autonoma of Madrid, FRIAT and RedInRen, Madrid, Spain (M.D.S.-N., A.O.)
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Bermudez-Lopez M, Forne C, Amigo N, Bozic M, Arroyo D, Bretones T, Alonso N, Cambray S, Del Pino MD, Mauricio D, Gorriz JL, Fernandez E, Valdivielso JM. An in-depth analysis shows a hidden atherogenic lipoprotein profile in non-diabetic chronic kidney disease patients. Expert Opin Ther Targets 2019; 23:619-630. [PMID: 31100024 DOI: 10.1080/14728222.2019.1620206] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Background: Chronic kidney disease (CKD) is an independent risk factor for atherosclerotic disease. We hypothesized that CKD promotes a proatherogenic lipid profile modifying lipoprotein composition and particle number. Methods: Cross-sectional study in 395 non-diabetic individuals (209 CKD patients and 186 controls) without statin therapy. Conventional lipid determinations were combined with advanced lipoprotein profiling by nuclear magnetic resonance, and their discrimination ability was assessed by machine learning. Results: CKD patients showed an increase of very-low-density (VLDL) particles and a reduction of LDL particle size. Cholesterol and triglyceride content of VLDLs and intermediate-density (IDL) particles increased. However, low-density (LDL) and high-density (HDL) lipoproteins gained triglycerides and lost cholesterol. Total-Cholesterol, HDL-Cholesterol, LDL-Cholesterol, non-HDL-Cholesterol and Proprotein convertase subtilisin-kexin type (PCSK9) were negatively associated with CKD stages, whereas triglycerides, lipoprotein(a), remnant cholesterol, and the PCSK9/LDL-Cholesterol ratio were positively associated. PCSK9 was positively associated with total-Cholesterol, LDL-Cholesterol, LDL-triglycerides, LDL particle number, IDL-Cholesterol, and remnant cholesterol. Machine learning analysis by random forest revealed that new parameters have a higher discrimination ability to classify patients into the CKD group, compared to traditional parameters alone: area under the ROC curve (95% CI), .789 (.711, .853) vs .687 (.611, .755). Conclusions: non-diabetic CKD patients have a hidden proatherogenic lipoprotein profile.
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Affiliation(s)
- Marcelino Bermudez-Lopez
- a Vascular & Renal Translational Research Group , IRBLleida, Spain and Spanish Research Network for Renal Diseases (RedInRen. ISCIII) , Lleida , Spain
| | - Carles Forne
- b Biostatistics Unit , IRBLleida , Lleida , Spain.,c Department of Basic Medical Sciences , University of Lleida , Lleida , Spain
| | | | - Milica Bozic
- a Vascular & Renal Translational Research Group , IRBLleida, Spain and Spanish Research Network for Renal Diseases (RedInRen. ISCIII) , Lleida , Spain
| | - David Arroyo
- a Vascular & Renal Translational Research Group , IRBLleida, Spain and Spanish Research Network for Renal Diseases (RedInRen. ISCIII) , Lleida , Spain.,e Servicio de nefrología , Hospital Universitario Severo Ochoa , Leganés , Spain
| | - Teresa Bretones
- f Department of Cardiology , Hospital Universitario Puerta del Mar , Cádiz , Spain
| | - Nuria Alonso
- g Endocrinology and Nutrition Department , Hospital Universitari Germans Trias i Pujol , Badalona , Spain.,h Center for Biomedical Research on Diabetes and Associated Metabolic Diseases (CIBERDEM) , Barcelona , Spain
| | - Serafi Cambray
- a Vascular & Renal Translational Research Group , IRBLleida, Spain and Spanish Research Network for Renal Diseases (RedInRen. ISCIII) , Lleida , Spain
| | | | - Didac Mauricio
- a Vascular & Renal Translational Research Group , IRBLleida, Spain and Spanish Research Network for Renal Diseases (RedInRen. ISCIII) , Lleida , Spain.,h Center for Biomedical Research on Diabetes and Associated Metabolic Diseases (CIBERDEM) , Barcelona , Spain.,j Endocrinology and Nutrition Department , Hospital de la Santa Creu i Sant Pau , Barcelona , Spain
| | - Jose Luis Gorriz
- k Hospital Clínico Universitario Valencia , Universitat de Valencia, INCLIVA , Lleida , Spain
| | - Elvira Fernandez
- a Vascular & Renal Translational Research Group , IRBLleida, Spain and Spanish Research Network for Renal Diseases (RedInRen. ISCIII) , Lleida , Spain
| | - Jose Manuel Valdivielso
- a Vascular & Renal Translational Research Group , IRBLleida, Spain and Spanish Research Network for Renal Diseases (RedInRen. ISCIII) , Lleida , Spain
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27
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Lu J, Sun M, Wu X, Yuan X, Liu Z, Qu X, Ji X, Merriman TR, Li C. Urate-lowering therapy alleviates atherosclerosis inflammatory response factors and neointimal lesions in a mouse model of induced carotid atherosclerosis. FEBS J 2019; 286:1346-1359. [PMID: 30690853 PMCID: PMC6849826 DOI: 10.1111/febs.14768] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Revised: 11/10/2018] [Accepted: 01/23/2019] [Indexed: 12/18/2022]
Abstract
Hyperuricemia (HU) is a cause of gout. Clinical studies show a link between HU and cardiovascular disease. However, the role of soluble serum urate (SU) on atherosclerosis development remains elusive. We aimed to use a new HU mouse model [Uricase/Uox knockout (KO)] to further investigate the relationship between HU and atherosclerosis. A mouse model by perivascular collar placement of induced carotid atherosclerosis was established in male Uox-KO mice. The Uox-KO mice had elevated SU levels and enhanced levels of atherosclerosis inflammatory response proteins. In contrast, Uox-KO mice with carotid atherosclerosis showed severe neointimal changes in histology staining consistent with increases in intimal area and increases in proliferating cell nuclear antigen (PCNA)- and F4/80-positive cells. Allopurinol reduced neointimal areas induced by the perivascular collar in hyperuricemic mice, accompanied by decreased expression of PCNA- and F4/80-positive cells. Urate-lowering treatment alleviated atherosclerosis inflammatory response factors and reactive oxygen species (ROS) intensities in both collar placement Uox-KO mice and urate-stimulated human umbilical vein endothelial cells (HUVECs). In vitro results using HUVECs showed ROS was induced by urate and ROS induction was abrogated using antioxidants. These data demonstrate that urate per se does not trigger atherosclerosis intima lesions in male mice. Urate worsens carotid neointimal lesions induced by the perivascular collar and urate-lowering therapy partially abrogates the effects. The current study warrants clinical studies on the possible benefits of urate-lowering therapy in atherosclerosis patients with HU.
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Affiliation(s)
- Jie Lu
- Institute of Metabolic Diseases, Qingdao University, China.,Shandong Provincial Key Laboratory of Metabolic Diseases and Qingdao Key Laboratory of Gout, The Affiliated Hospital of Qingdao University, China.,Department of Endocrinology and Metabolic Diseases, The Affiliated Hospital of Qingdao University, China
| | - Mingshu Sun
- Institute of Metabolic Diseases, Qingdao University, China.,Shandong Provincial Key Laboratory of Metabolic Diseases and Qingdao Key Laboratory of Gout, The Affiliated Hospital of Qingdao University, China.,Department of Rheumatology and Clinical Immunology, The Affiliated Hospital of Qingdao University, China
| | - Xinjiang Wu
- Institute of Metabolic Diseases, Qingdao University, China
| | - Xuan Yuan
- Institute of Metabolic Diseases, Qingdao University, China
| | - Zhen Liu
- Institute of Metabolic Diseases, Qingdao University, China.,Shandong Provincial Key Laboratory of Metabolic Diseases and Qingdao Key Laboratory of Gout, The Affiliated Hospital of Qingdao University, China
| | - Xiaojie Qu
- Institute of Metabolic Diseases, Qingdao University, China.,Shandong Provincial Key Laboratory of Metabolic Diseases and Qingdao Key Laboratory of Gout, The Affiliated Hospital of Qingdao University, China.,Department of Endocrinology and Metabolic Diseases, The Affiliated Hospital of Qingdao University, China
| | - Xiaopeng Ji
- Institute of Metabolic Diseases, Qingdao University, China.,Shandong Provincial Key Laboratory of Metabolic Diseases and Qingdao Key Laboratory of Gout, The Affiliated Hospital of Qingdao University, China
| | - Tony R Merriman
- Department of Biochemistry, University of Otago, Dunedin, New Zealand
| | - Changgui Li
- Institute of Metabolic Diseases, Qingdao University, China.,Shandong Provincial Key Laboratory of Metabolic Diseases and Qingdao Key Laboratory of Gout, The Affiliated Hospital of Qingdao University, China.,Department of Endocrinology and Metabolic Diseases, The Affiliated Hospital of Qingdao University, China
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28
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Barrios C, Zierer J, Würtz P, Haller T, Metspalu A, Gieger C, Thorand B, Meisinger C, Waldenberger M, Raitakari O, Lehtimäki T, Otero S, Rodríguez E, Pedro-Botet J, Kähönen M, Ala-Korpela M, Kastenmüller G, Spector TD, Pascual J, Menni C. Circulating metabolic biomarkers of renal function in diabetic and non-diabetic populations. Sci Rep 2018; 8:15249. [PMID: 30323304 PMCID: PMC6189123 DOI: 10.1038/s41598-018-33507-7] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Accepted: 09/26/2018] [Indexed: 01/18/2023] Open
Abstract
Using targeted NMR spectroscopy of 227 fasting serum metabolic traits, we searched for novel metabolic signatures of renal function in 926 type 2 diabetics (T2D) and 4838 non-diabetic individuals from four independent cohorts. We furthermore investigated longitudinal changes of metabolic measures and renal function and associations with other T2D microvascular complications. 142 traits correlated with glomerular filtration rate (eGFR) after adjusting for confounders and multiple testing: 59 in diabetics, 109 in non-diabetics with 26 overlapping. The amino acids glycine and phenylalanine and the energy metabolites citrate and glycerol were negatively associated with eGFR in all the cohorts, while alanine, valine and pyruvate depicted opposite association in diabetics (positive) and non-diabetics (negative). Moreover, in all cohorts, the triglyceride content of different lipoprotein subclasses showed a negative association with eGFR, while cholesterol, cholesterol esters (CE), and phospholipids in HDL were associated with better renal function. In contrast, phospholipids and CEs in LDL showed positive associations with eGFR only in T2D, while phospholipid content in HDL was positively associated with eGFR both cross-sectionally and longitudinally only in non-diabetics. In conclusion, we provide a wide list of kidney function-associated metabolic traits and identified novel metabolic differences between diabetic and non-diabetic kidney disease.
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Affiliation(s)
- Clara Barrios
- Department for Twin Research, King's College London, London, UK
- Department of Nephrology, Hospital del Mar, Institut Mar d'Investigacions Mediques, Barcelona, Spain
| | - Jonas Zierer
- Department for Twin Research, King's College London, London, UK.
- Institute of Bioinformatics and Systems Biology, Helmholtz Zentrum München - German Research Center for Environmental Health, Neuherberg, Germany.
- Weill Cornell Medical College, New York City, USA.
| | - Peter Würtz
- Research Programs Unit, Diabetes and Obesity, University of Helsinki, Helsinki, Finland
- Nightingale Health Ltd, Helsinki, Finland
| | - Toomas Haller
- Estonian Genome Center, University of Tartu, Tartu, Estonia
| | | | - Christian Gieger
- Institute of Epidemiology II, Helmholtz Zentrum München - German Research Center for Environmental Health, Neuherberg, Germany
- Research Unit Molecular Epidemiology, Helmholtz Zentrum München - German Research Center for Environmental Health, Neuherberg, Germany
| | - Barbara Thorand
- Institute of Epidemiology II, Helmholtz Zentrum München - German Research Center for Environmental Health, Neuherberg, Germany
| | - Christa Meisinger
- Institute of Epidemiology II, Helmholtz Zentrum München - German Research Center for Environmental Health, Neuherberg, Germany
- Chair of Epidemiology, Ludwig-Maximilians-Universität München, UNIKA-T, Augsburg, Germany
| | - Melanie Waldenberger
- Institute of Epidemiology II, Helmholtz Zentrum München - German Research Center for Environmental Health, Neuherberg, Germany
- Research Unit Molecular Epidemiology, Helmholtz Zentrum München - German Research Center for Environmental Health, Neuherberg, Germany
| | - Olli Raitakari
- Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland
- Department of Clinical Physiology and Nuclear Medicine, Turku University Hospital, Turku, Finland
| | - Terho Lehtimäki
- Department of Clinical Chemistry, Fimlab Laboratories and Finnish Cardiovascular Research Center-Tampere, Faculty of Medicine and Life Sciences, University of Tampere, Tampere, Finland
| | - Sol Otero
- Department of Nephrology, Hospital del Mar, Institut Mar d'Investigacions Mediques, Barcelona, Spain
- Department of Nephrology, Consorci Sanitari del Garraf, Barcelona, Spain
| | - Eva Rodríguez
- Department of Nephrology, Hospital del Mar, Institut Mar d'Investigacions Mediques, Barcelona, Spain
| | - Juan Pedro-Botet
- Department of Endocrinology and Nutrition, Hospital del Mar, Institut Mar d'Investigacions Mediques, Barcelona, Spain
| | - Mika Kähönen
- Department of Clinical Physiology, University of Tampere and Tampere University Hospital, Tampere, Finland
| | - Mika Ala-Korpela
- Systems Epidemiology, Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
- Population Health Science, Bristol Medical School, University of Bristol, Bristol, UK
- Medical Research Council Integrative Epidemiology Unit at the University of Bristol, Bristol, UK
- Computational Medicine, Faculty of Medicine, University of Oulu and Biocenter Oulu, Oulu, Finland
- NMR Metabolomics Laboratory, School of Pharmacy, University of Eastern Finland, Kuopio, Finland
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, The Alfred Hospital, Monash University, Melbourne, Victoria, Australia
| | - Gabi Kastenmüller
- Institute of Bioinformatics and Systems Biology, Helmholtz Zentrum München - German Research Center for Environmental Health, Neuherberg, Germany
| | - Tim D Spector
- Department for Twin Research, King's College London, London, UK
| | - Julio Pascual
- Department of Nephrology, Hospital del Mar, Institut Mar d'Investigacions Mediques, Barcelona, Spain
| | - Cristina Menni
- Department for Twin Research, King's College London, London, UK.
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29
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Richardson T, Aslibekyan S, Ashraf AP. Clinical Characteristics and Sequelae of Severe Hypertriglyceridemia in Pediatrics. Endocr Pract 2018; 24:789-795. [PMID: 30084679 DOI: 10.4158/ep-2018-0106] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
OBJECTIVE Severe hypertriglyceridemia (HTG) (i.e., plasma triglycerides [TGs] >1,000 mg/dL) in children is a rare but pernicious and understudied condition. Our objective was to evaluate the etiology, characteristics, and sequelae of severe pediatric HTG. METHODS This was a retrospective electronic medical record review of pediatric patients with severe HTG at a tertiary referral Children's hospital over a 17-year period. RESULTS There were a total of 124 patients with severe HTG. The etiology varied: hemato-oncologic (n = 48), diabetes and insulin resistance-related (n = 46), total parenteral nutrition (TPN)-related (n = 6), renal (n = 12), and miscellaneous (n = 12). There was considerable variability in the number of days for the plasma TGs to decrease to <1,000 mg/dL (147.7 ± 567.3 days) and to further decrease to <500 mg/dL (136.84 ± 230.9 days). Patients with diabetes required the longest time to improve their plasma TGs (165.8 ± 305.7 days) compared to other groups. There were 11 cases of pancreatitis, comorbid with diabetes (n = 5), hemato-oncologic conditions (n = 3), and TPN (n = 3). Sixty-seven patients (54%) had persistent HTG. CONCLUSION Severe HTG in pediatrics is commonly due to secondary causes. Patients with diabetes tend to have a longer course of dyslipidemia. A substantial number of patients had persistent dyslipidemia, indicating underlying genetic susceptibility to HTG that is phenotypically expressed consequent to a secondary metabolic insult. ABBREVIATIONS DKA = diabetic ketoacidosis; EMR = electronic medical record; GSD = glycogen storage disorder; HbA1c = hemoglobin A1c; HIV = human immunodeficiency virus; HTG = hypertriglyceridemia; ICD-9 = International Classification of Diseases-Ninth Revision; IV = intravenous; LCHAD = long-chain 3-hydroxyacyl coenzyme A dehydrogenase deficiency; LPL = lipoprotein lipase; NPO = nothing by mouth; PCOS = polycystic ovary syndrome; T1DM = type 1 diabetes mellitus; T2DM = type 2 diabetes mellitus; TG = triglyceride; TPN = total parenteral nutrition; VLDL = very-low-density lipoprotein.
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30
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Chang CY, Chang HR, Lin HC, Chang HH. Comparison of Renal Function and Other Predictors in Lacto–Ovo Vegetarians and Omnivores With Chronic Kidney Disease. J Am Coll Nutr 2018. [DOI: 10.1080/07315724.2018.1424588] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
- Chou-Yueh Chang
- Department of Nutrition, Chung Shan Medical University Hospital, Taichung, Taiwan
- Department of Nutrition, Chung Shan Medical University, Taichung, Taiwan
| | - Horng-Rong Chang
- Department of Nephrology, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Hsing-Chun Lin
- Department of Nutrition, Chung Shan Medical University Hospital, Taichung, Taiwan
- Department of Nutrition, Chung Shan Medical University, Taichung, Taiwan
| | - Han-Hsin Chang
- Department of Nutrition, Chung Shan Medical University Hospital, Taichung, Taiwan
- Department of Nutrition, Chung Shan Medical University, Taichung, Taiwan
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31
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Lin YH, Huang JC, Wu PY, Chen SC, Chiu YW, Chang JM, Chen HC. Greater low-density lipoprotein cholesterol variability is associated with increased progression to dialysis in patients with chronic kidney disease stage 3. Oncotarget 2017; 9:3242-3253. [PMID: 29423043 PMCID: PMC5790460 DOI: 10.18632/oncotarget.23228] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2017] [Accepted: 11/16/2017] [Indexed: 02/06/2023] Open
Abstract
Increasing evidence suggests that lipid variability may be a predictor of cardiovascular events. However, few studies have evaluated the association between lipid variability and renal outcomes in patients with moderate-to-advanced chronic kidney disease (CKD). Therefore, the aims of this study were to assess whether lipid variability is associated with progression to dialysis in patients with CKD stage 3–5, and to evaluate the risk factors of lipid variability. This longitudinal study enrolled 725 patients with CKD stage 3–5. Intra-individual lipid variability was defined as the standard deviations (SDs) of lipid levels. The renal end-point was defined as commencing dialysis. During a mean follow-up period of 3.2 years, 208 patients (28.7%) started dialysis. The patients with CKD stage 3 with high low-density lipoprotein (LDL) cholesterol SD (per 1 mg/dL; hazard ratio, 1.035; 95% confidence interval, 1.003 to 1.067; p = 0.003) were associated with an increased risk of progression to dialysis, however this association was not seen in the patients with CKD stage 4 or 5. Furthermore, in the patients with CKD stage 3, a high urine protein-to-creatinine ratio (p < 0.001) and the use of statins (p < 0.001) were significantly associated with an increased LDL-cholesterol SD. Greater LDL-cholesterol variability was associated with an increased risk of progression to dialysis in patients with CKD stage 3, but not in those with CKD stage 4 or 5. These findings support the potential role of aggressive lipid control on clinical outcomes and highlight its importance in patients with CKD stage 3.
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Affiliation(s)
- Yu-Hsuan Lin
- School of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Jiun-Chi Huang
- Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.,Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Internal Medicine, Kaohsiung Municipal Hsiao-Kang Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.,Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Pei-Yu Wu
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Internal Medicine, Kaohsiung Municipal Hsiao-Kang Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Szu-Chia Chen
- Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.,Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Internal Medicine, Kaohsiung Municipal Hsiao-Kang Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.,Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Yi-Wen Chiu
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.,Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Jer-Ming Chang
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Internal Medicine, Kaohsiung Municipal Cijin Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.,Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Hung-Chun Chen
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.,Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
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