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Mfundo EA, Marealle AI, Nyondo GG, Manguzu MA, Buma D, Kunambi P, Mutagonda RF. Prevalence and determinants of poor glycemic control among diabetic chronic kidney disease patients on maintenance hemodialysis in Tanzania. PLoS One 2025; 20:e0306357. [PMID: 39928652 PMCID: PMC11809847 DOI: 10.1371/journal.pone.0306357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2024] [Accepted: 01/18/2025] [Indexed: 02/12/2025] Open
Abstract
BACKGROUND Poor glycemic control in diabetic chronic kidney disease (CKD) patients on maintenance hemodialysis is of great challenge, resulting in increased risk of morbidity and mortality. This study aimed to determine the prevalence and determinants of poor glycemic control among diabetic CKD patients on maintenance hemodialysis. METHODOLOGY A cross-sectional study was conducted in 12 dialysis centers located in four regions of Tanzania from March to June 2023. The study population was diabetic CKD patients above 18 years on maintenance hemodialysis for three months or more. A consecutive sampling technique was used for patient recruitment, and a semi-structured questionnaire was used to collect data. The primary outcome was poor glycemic control were considered when glycated hemoglobin (HbA1c) levels were < 6% or > 8%. Statistical Package for Social Sciences (SPSS) version 23 was used for data analysis. Univariate and multivariable regression models were used to evaluate the determinants of poor glycemic control. A p-value < 0.05 was considered statistically significant. RESULTS Out of 233 enrolled patients, the overall prevalence of poor glycemic control was 55.4%, whereby 27.0% had HbA1c < 6% and 28.33% had HbA1c > 8%. A high risk of HbA1c > 8% was observed among patients who were on antidiabetic medication (2.16 (95% CI: 1.06-4.41) p = 0.035) and those attending dialysis sessions less than 3 times a week (1.59 (95% CI: 1.02-2.48) p = 0.040). The lower risk of HbA1c < 6% was observed in patients dialyzed using glucose-containing dialysates than those dialyzed with glucose-free dialysate (0.57 (95% CI 0.36-0.87) p = 0.020). CONCLUSION The high prevalence of poor glycemic control among diabetic CKD patients, as revealed by this study, has significant implications. Patients on antidiabetic medication and those with less than three dialysis sessions per week are at a high risk of HbA1c > 8%. Conversely, patients dialyzed using glucose-free dialysates are at a high risk of HbA1c < 6%. Glycemic control in diabetic chronic kidney disease (CKD) patients is a great challenge due to altered glucose homeostasis, gluconeogenesis, tubular glucose reabsorption and inaccuracy of glycemic regulation metrics [1]. Furthermore, changed renal pharmacokinetics of antihyperglycemic agents (AHA), uremic milieu, and dialysis therapy also contribute to this challenge [2]. Based on the severe risk of hyperglycemia and hypoglycemia in patients with diabetic end-stage renal disease (ESRD), glycemic control is of paramount importance.
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Affiliation(s)
- Emmanuel Arthur Mfundo
- Quality Assurance Department, National Health Insurance Fund, Arusha, Tanzania
- Department of Clinical Pharmacy and Pharmacology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Alphonce Ignace Marealle
- Department of Clinical Pharmacy and Pharmacology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Goodluck G. Nyondo
- Department of Medicinal Chemistry, School of Pharmacy, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Martine A. Manguzu
- Department of Clinical Pharmacy and Pharmacology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Deus Buma
- Department of Clinical Research, Training and Consultancy, Muhimbili National Hospital, Dar es Salaam, Tanzania
| | - Peter Kunambi
- Department of Clinical Pharmacology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Ritah F. Mutagonda
- Department of Clinical Pharmacy and Pharmacology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
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Klein KR, Lingvay I, Tuttle KR, Flythe JE. Glycemic Management and Individualized Diabetes Care in Dialysis-Dependent Kidney Failure. Diabetes Care 2025; 48:164-176. [PMID: 39693267 PMCID: PMC11770169 DOI: 10.2337/dci24-0081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2024] [Accepted: 11/22/2024] [Indexed: 12/20/2024]
Abstract
Of the nearly 600,000 people in the U.S. who receive dialysis for chronic kidney failure, >60% have diabetes. People receiving dialysis who have diabetes have worse overall and cardiovascular survival rates than those without diabetes. Diabetes care in the dialysis setting is complicated by kidney failure-related factors that render extrapolation of glycated hemoglobin (HbA1c) targets to the dialysis population unreliable and may change the risk-benefit profiles of glucose-lowering and disease-modifying therapies. No prospective studies have established the optimal glycemic targets in the dialysis population, and few randomized clinical trials of glucose-lowering medications included individuals receiving dialysis. Observational data suggest that both lower and higher HbA1c are associated with mortality in the dialysis population. Existing data suggest the potential for safety and effectiveness of some glucose-lowering medications in the dialysis population, but firm conclusions are hindered by limitations in study design and sample size. While population-specific knowledge gaps about optimal glycemic targets and diabetes medication safety and effectiveness preclude the extension of all general population diabetes guidelines to the dialysis-dependent diabetes population, these uncertainties should not detract from the importance of providing person-centered diabetes care to people receiving dialysis. Diabetes care for individuals with and without dialysis-dependent kidney failure should be holistic, based on individual preferences and prognoses, and tailored to integrate established treatment approaches with proven benefits for glycemic control and cardiovascular risk reduction. Additional research is needed to inform how recent pharmacologic and technological advances can be applied to support such individualized care for people receiving maintenance dialysis.
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Affiliation(s)
- Klara R. Klein
- Division of Endocrinology and Metabolism, University of North Carolina School of Medicine, Chapel Hill, NC
| | - Ildiko Lingvay
- Division of Endocrinology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX
- Peter O’Donnel Jr. School of Public Health, University of Texas Southwestern Medical Center, Dallas, TX
| | - Katherine R. Tuttle
- Division of Nephrology, University of Washington School of Medicine, Seattle, WA
- Providence Medical Research Center, Providence Inland Northwest Health, Spokane, WA
| | - Jennifer E. Flythe
- Division of Nephrology and Hypertension, University of North Carolina School of Medicine, Chapel Hill, NC
- Cecil G. Sheps Center for Health Services Research, University of North Carolina, Chapel Hill, NC
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Rhee CM, Gianchandani RY, Kerr D, Philis-Tsimikas A, Kovesdy CP, Stanton RC, Drincic AT, Galindo RJ, Kalantar-Zadeh K, Neumiller JJ, de Boer IH, Lind M, Kim SH, Ayers AT, Ho CN, Aaron RE, Tian T, Klonoff DC. Consensus Report on the Use of Continuous Glucose Monitoring in Chronic Kidney Disease and Diabetes. J Diabetes Sci Technol 2025; 19:217-245. [PMID: 39611379 PMCID: PMC11607725 DOI: 10.1177/19322968241292041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2024]
Abstract
This report represents the conclusions of 15 experts in nephrology and endocrinology, based on their knowledge of key studies and evidence in the field, on the role of continuous glucose monitors (CGMs) in patients with diabetes and chronic kidney disease (CKD), including those receiving dialysis. The experts discussed issues related to CGM accuracy, indications, education, clinical outcomes, quality of life, research gaps, and barriers to dissemination. Three main goals of management for patients with CKD and diabetes were identified: (1) greater use of CGMs for better glycemic monitoring and management, (2) further research evaluating the accuracy, feasibility, outcomes, and potential value of CGMs in patients with end-stage kidney disease (ESKD) on hemodialysis, and (3) equitable access to CGM technology for patients with CKD. The experts also developed 15 conclusions regarding the use of CGMs in this population related to CGMs' unique delivery of both real-time information that can guide monitoring and management of glycemia and continuous and predictive data in this population, which is at higher risk for hypoglycemia and hyperglycemia. The group noted three major clinical gaps: (1) CGMs are not routinely prescribed for patients with diabetes and CKD; (2) CGMs are not approved by the United States Food and Drug Administration (FDA) for patients with diabetes who are on dialysis; and (3) CGMs are not routinely available to all of those who need them because of structural barriers in the health care system. These gaps can be improved with greater stakeholder collaboration, education, and awareness brought to the use of CGM technology in CKD.
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Affiliation(s)
- Connie M. Rhee
- VA Greater Los Angeles Healthcare System, UCLA David Geffen School of Medicine, Los Angeles, CA, USA
- Cedars-Sinai Health Systems, Los Angeles, CA, USA
| | | | - David Kerr
- Center for Health Systems Research, Sutter Health, Santa Barbara, CA, USA
| | | | - Csaba P. Kovesdy
- The University of Tennessee Health Science Center, Memphis, TN, USA
| | - Robert C. Stanton
- Joslin Diabetes Center, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | | | | | | | | | | | - Marcus Lind
- Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Sun H. Kim
- Stanford University School of Medicine, Stanford, CA, USA
| | | | - Cindy N. Ho
- Diabetes Technology Society, Burlingame, CA, USA
| | | | - Tiffany Tian
- Diabetes Technology Society, Burlingame, CA, USA
| | - David C. Klonoff
- Diabetes Research Institute, Mills-Peninsula Medical Center, San Mateo, CA, USA
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Narasaki Y, Kalantar-Zadeh K, Daza AC, You AS, Novoa A, Peralta RA, Siu MKM, Nguyen DV, Rhee CM. Accuracy of Continuous Glucose Monitoring in Hemodialysis Patients With Diabetes. Diabetes Care 2024; 47:1922-1929. [PMID: 39213372 PMCID: PMC11502529 DOI: 10.2337/dc24-0635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2024] [Accepted: 08/01/2024] [Indexed: 09/04/2024]
Abstract
OBJECTIVE In the general population, continuous glucose monitoring (CGM) provides convenient and less-invasive glucose measurements than conventional self-monitored blood glucose and results in reduced hypoglycemia and hyperglycemia and increased time in target glucose range. However, accuracy of CGM versus blood glucose is not well established in hemodialysis patients. RESEARCH DESIGN AND METHODS Among 31 maintenance hemodialysis patients with diabetes hospitalized from October 2020 to May 2021, we conducted protocolized glucose measurements using Dexcom G6 CGM versus blood glucose, with the latter measured before each meal and at night, plus every 30-min during hemodialysis. We examined CGM-blood glucose correlations and agreement between CGM versus blood glucose using Bland-Altman plots, percentage of agreement, mean and median absolute relative differences (ARDs), and consensus error grids. RESULTS Pearson and Spearman correlations for averaged CGM versus blood glucose levels were 0.84 and 0.79, respectively; Bland-Altman showed the mean difference between CGM and blood glucose was ∼+15 mg/dL. Agreement rates using %20/20 criteria were 48.7%, 47.2%, and 50.2% during the overall, hemodialysis, and nonhemodialysis periods, respectively. Mean ARD (MARD) was ∼20% across all time periods; median ARD was 19.4% during the overall period and was slightly lower during nonhemodialysis (18.2%) versus hemodialysis periods (22.0%). Consensus error grids showed nearly all CGM values were in clinically acceptable zones A (no harm) and B (unlikely to cause significant harm). CONCLUSIONS In hemodialysis patients with diabetes, although MARD values were higher than traditional optimal analytic performance thresholds, error grids showed nearly all CGM values were in clinically acceptable zones. Further studies are needed to determine whether CGM improves outcomes in hemodialysis patients.
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Affiliation(s)
- Yoko Narasaki
- Division of Nephrology, Department of Medicine, David Geffen School of Medicine at the University of California Los Angeles, Los Angeles, CA
- Tibor Rubin Veterans Affairs Medical Center, Long Beach, CA
| | - Kamyar Kalantar-Zadeh
- Division of Nephrology, Department of Medicine, David Geffen School of Medicine at the University of California Los Angeles, Los Angeles, CA
- Tibor Rubin Veterans Affairs Medical Center, Long Beach, CA
- Division of Nephrology, Hypertension, and Kidney Transplantation, Department of Medicine, University of California Irvine School of Medicine, Orange, CA
- The Lundquist Institute at Harbor-UCLA Medical Center, Torrance, CA
| | - Andrea C. Daza
- Division of Nephrology, Department of Medicine, David Geffen School of Medicine at the University of California Los Angeles, Los Angeles, CA
| | - Amy S. You
- Division of Nephrology, Department of Medicine, David Geffen School of Medicine at the University of California Los Angeles, Los Angeles, CA
| | - Alejandra Novoa
- Division of Nephrology, Department of Medicine, David Geffen School of Medicine at the University of California Los Angeles, Los Angeles, CA
| | - Renal Amel Peralta
- Division of Nephrology, Hypertension, and Kidney Transplantation, Department of Medicine, University of California Irvine School of Medicine, Orange, CA
| | - Man Kit Michael Siu
- Division of Nephrology, Department of Medicine, David Geffen School of Medicine at the University of California Los Angeles, Los Angeles, CA
- Nephrology Section, Veterans Affairs Los Angeles Healthcare System, Los Angeles, CA
| | - Danh V. Nguyen
- Division of General Internal Medicine, University of California Irvine School of Medicine, Orange, CA
| | - Connie M. Rhee
- Division of Nephrology, Department of Medicine, David Geffen School of Medicine at the University of California Los Angeles, Los Angeles, CA
- Division of Nephrology, Hypertension, and Kidney Transplantation, Department of Medicine, University of California Irvine School of Medicine, Orange, CA
- Nephrology Section, Veterans Affairs Los Angeles Healthcare System, Los Angeles, CA
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He M, Wu H, Lin G, Wang Y, Shi L, Huang C, Xu Q, Li Z, Huang S, Chen Y, Li N. Towards a Region-Wide Glycaemic Management System: Strategies and Applications for Glycaemic Management of Patients with Diabetes During Hospitalisation. J Multidiscip Healthc 2024; 17:4257-4266. [PMID: 39246566 PMCID: PMC11378989 DOI: 10.2147/jmdh.s468929] [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: 03/14/2024] [Accepted: 08/22/2024] [Indexed: 09/10/2024] Open
Abstract
Objective This study proposes a region-wide blood glucose management system to solve the problem of blood glucose management in patients with diabetes. Methods A professional team of doctors, nurses and dietitians jointly developed a region-wide blood glucose management system. The system operates through a collaborative approach where each team member utilises their specialised role, such as data monitoring, algorithm development or patient support, to contribute to a comprehensive blood glucose management network. This integration ensures accurate glucose tracking, personalised feedback and timely adjustments to treatment plans. The system allows the patient to have a good treatment plan, giving comprehensive medical guidance, and the physician team is responsible for the patient's health status. Results The region-wide blood glucose management system increased the overall blood glucose monitoring rate of patients and reduced the hospitalisation time (from 11.27 days to 9.52 days) and hospitalisation costs (from 12,173.8 yuan to 9502.4 yuan). At the same time, the system effectively counted the incidence and occurrence time of hyperglycaemia and hypoglycaemia adverse events, which can provide a reference for clinical prevention of adverse events. Conclusion A region-wide blood glucose management system can improve medical efficiency, save medical resources and provide a strong guarantee for the health of patients with diabetes. Compared with the traditional diabetes management mode, the region-wide blood glucose management system is more systematic and standardised, meaning it can better meet the needs of patients with diabetes.
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Affiliation(s)
- Min He
- Department of Endocrinology, Shishi General Hospital, Shishi, Fujian, 362700, People's Republic of China
| | - Huinan Wu
- Department of Endocrinology, Shishi General Hospital, Shishi, Fujian, 362700, People's Republic of China
| | - Guanrong Lin
- Department of Endocrinology, Shishi General Hospital, Shishi, Fujian, 362700, People's Republic of China
| | - Yongqin Wang
- Department of Endocrinology, Shishi General Hospital, Shishi, Fujian, 362700, People's Republic of China
| | - Longling Shi
- Department of Endocrinology, Shishi General Hospital, Shishi, Fujian, 362700, People's Republic of China
| | - Chaoling Huang
- Department of Endocrinology, Shishi General Hospital, Shishi, Fujian, 362700, People's Republic of China
| | - Qingyun Xu
- Department of Endocrinology, Shishi General Hospital, Shishi, Fujian, 362700, People's Republic of China
| | - Zhenxing Li
- Department of Endocrinology, Shishi General Hospital, Shishi, Fujian, 362700, People's Republic of China
| | - Shanbo Huang
- Department of Endocrinology, Shishi General Hospital, Shishi, Fujian, 362700, People's Republic of China
| | - Yanni Chen
- Department of Endocrinology, Shishi General Hospital, Shishi, Fujian, 362700, People's Republic of China
| | - Na Li
- Department of Endocrinology, Shishi General Hospital, Shishi, Fujian, 362700, People's Republic of China
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Narasaki Y, Kovesdy CP, You AS, Sumida K, Mallisetty Y, Surbhi S, Thomas F, Amin AN, Streja E, Kalantar-Zadeh K, Rhee CM. Safety of SGLT2 inhibitors, DPP-4 inhibitors, and GLP-1 receptor agonists in US veterans with and without chronic kidney disease: a population-based study. LANCET REGIONAL HEALTH. AMERICAS 2024; 36:100814. [PMID: 38993538 PMCID: PMC11237921 DOI: 10.1016/j.lana.2024.100814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/11/2023] [Revised: 05/27/2024] [Accepted: 05/29/2024] [Indexed: 07/13/2024]
Abstract
Background We examined the real-world comparative safety of sodium-glucose cotransporter-2 inhibitors (SGLT2i) vs. other newer anti-glycemic medications (dipeptidyl peptidase-4 inhibitors [DPP4i], glucagon-like peptide-1 receptor agonists [GLP1a]) in patients with and without chronic kidney disease (CKD). Methods Among US Veterans with diabetes receiving care from the Veterans Affairs (VA) healthcare system over 2004-19, we identified incident users of SGLT2i vs. DPP4i vs. GLP1a monotherapy. In analyses stratified by CKD status, defined by estimated glomerular filtration rate and albuminuria, we examined associations of SGLT2i vs. DPP4i vs. GLP1a use with risk of infection-related (primary outcome) and genitourinary infection hospitalizations (secondary outcome) using multivariable Cox models. Findings Among 92,269 patients who met eligibility criteria, 52% did not have CKD, whereas 48% had CKD. In the overall and non-CKD cohorts, compared to DPP4i use, SGLT2i use was associated with lower infection-related hospitalization risk (HRs [95% CIs] 0.74 [0.67-0.81] and 0.77 [0.67, 0.88], respectively), whereas GLP1a use demonstrated comparable risk. However, in the CKD cohort SGLT2i and GLP1a use were each associated with lower risk (HRs [95% CIs] 0.70 [0.61, 0.81] and 0.91 [0.84, 0.99], respectively). Propensity score-matched analyses showed similar findings in the non-CKD and CKD cohorts. In the overall, non-CKD, and CKD cohorts, SGLT2i use was associated with lower genitourinary infection hospitalization risk whereas GLP1a use showed comparable risk vs. DPP4i use. Interpretation In a national cohort of Veterans with diabetes, compared with DPP4i use, SGLT2i use was associated with lower infection-related and genitourinary infection hospitalization risk. Funding VA Health Services Research and Development, USA.
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Affiliation(s)
- Yoko Narasaki
- Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
- Nephrology Section, Tibor Rubin Veterans Affairs Medical Center, Long Beach, CA, USA
| | - Csaba P Kovesdy
- Division of Nephrology, Department of Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
- Nephrology Section, Memphis Veterans Affairs Medical Center, Memphis, TN, USA
| | - Amy S You
- Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
- Nephrology Section, Tibor Rubin Veterans Affairs Medical Center, Long Beach, CA, USA
| | - Keiichi Sumida
- Division of Nephrology, Department of Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Yamini Mallisetty
- Division of Nephrology, Department of Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Satya Surbhi
- Division of Nephrology, Department of Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Fridtjof Thomas
- Division of Nephrology, Department of Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Alpesh N Amin
- Division of Hospital Medicine, Department of Medicine, University of California Irvine School of Medicine, Orange, CA, USA
| | - Elani Streja
- Nephrology Section, Tibor Rubin Veterans Affairs Medical Center, Long Beach, CA, USA
- Division of Nephrology, Hypertension, and Kidney Transplantation, University of California Irvine, Orange, CA, USA
| | - Kamyar Kalantar-Zadeh
- Nephrology Section, Tibor Rubin Veterans Affairs Medical Center, Long Beach, CA, USA
- Division of Nephrology, Hypertension, and Kidney Transplantation, University of California Irvine, Orange, CA, USA
- The Lundquist Institute at Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Connie M Rhee
- Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
- Division of Nephrology, Hypertension, and Kidney Transplantation, University of California Irvine, Orange, CA, USA
- Nephrology Section, Veterans Affairs Greater Los Angeles Health Care System, Los Angeles, CA, USA
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Mallappallil M, Sasidharan S, Sabu J, John S. Treatment of Type 2 Diabetes Mellitus in Advanced Chronic Kidney Disease for the Primary Care Physician. Cureus 2024; 16:e64663. [PMID: 39149651 PMCID: PMC11326530 DOI: 10.7759/cureus.64663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/16/2024] [Indexed: 08/17/2024] Open
Abstract
Diabetes mellitus (DM) is a common cause of chronic kidney disease (CKD), leading to the need for renal replacement therapy (RRT). RRT includes hemodialysis (HD), peritoneal dialysis (PD), kidney transplantation (KT), and medical management. As CKD advances, the management of DM may change as medication clearance, effectiveness, and side effects can be altered due to decreasing renal clearance. Medications like metformin that were safe to use early in CKD may build up toxic levels of metabolites in advanced CKD. Other medications, like sodium-glucose co-transporter 2 inhibitors, which work by excreting glucose in the urine, may not be able to work effectively in advanced CKD due to fewer working nephrons. Insulin breakdown may take longer, and both formulation and dosing may need to be changed to avoid hypoglycemia. While DM control contributes to CKD progression, effective DM control continues to be important even after patients have been placed on RRT. Patients on RRT are frequently taken care of by a team of providers, including the primary care physician, both in and outside the hospital. Non-nephrologists who are involved with the care of a patient treated with RRT need to be adept at managing DM in this population. This paper aims to outline the management of type 2 DM in advanced CKD.
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Affiliation(s)
- Mary Mallappallil
- Internal Medicine and Nephrology, New York City (NYC) Health + Hospitals/Kings County Hospital Center, Brooklyn, USA
- Internal Medicine and Nephrology, State University of New York (SUNY) Downstate University of Health Sciences, Brooklyn, USA
| | - Sandeep Sasidharan
- Internal Medicine and Nephrology, State University of New York (SUNY) Downstate University of Health Sciences, Brooklyn, USA
- Internal Medicine and Nephrology, New York City (NYC) Health + Hospitals/Kings County Hospital Center, Brooklyn, USA
| | - Jacob Sabu
- Internal Medicine, State University of New York (SUNY) Downstate Health Sciences University, Brooklyn, USA
| | - Sabu John
- Internal Medicine and Cardiology, New York City (NYC) Health + Hospitals/Kings County Hospital Center, Brooklyn, USA
- Internal Medicine and Cardiology, State University of New York (SUNY) Downstate University of Health Sciences, Brooklyn, USA
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Silva Almodóvar A, Donneyong M, Seiber E, Nahata MC. Potentially Inappropriately Prescribed Medication Prescriptions Among Medicare Patients Receiving Hemodialysis. Am J Kidney Dis 2024; 84:132-134. [PMID: 38266971 DOI: 10.1053/j.ajkd.2023.11.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 11/06/2023] [Accepted: 11/19/2023] [Indexed: 01/26/2024]
Affiliation(s)
- Armando Silva Almodóvar
- Institute of Therapeutic Innovations and Outcomes (ITIO), College of Pharmacy, Ohio State University, Columbus, Ohio.
| | - Macarius Donneyong
- College of Pharmacy, Ohio State University, Columbus, Ohio; College of Public Health, Ohio State University, Columbus, Ohio
| | - Eric Seiber
- College of Public Health, Ohio State University, Columbus, Ohio
| | - Milap C Nahata
- Institute of Therapeutic Innovations and Outcomes (ITIO), College of Pharmacy, Ohio State University, Columbus, Ohio; College of Medicine, Ohio State University, Columbus, Ohio
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Cheng XBJ, Bargman J. Complications of Peritoneal Dialysis Part II: Nonmechanical Complications. Clin J Am Soc Nephrol 2024; 19:791-799. [PMID: 38190143 PMCID: PMC11168822 DOI: 10.2215/cjn.0000000000000418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2023] [Accepted: 12/21/2023] [Indexed: 01/09/2024]
Abstract
Peritoneal dialysis (PD) is a form of KRT that offers flexibility and autonomy to patients with ESKD. It is associated with lower costs compared with hemodialysis in many countries. Unlike mechanical complications that typical arise early in the course of treatment, noninfectious, nonmechanical complications often present late in patients who are established on PD. In this review, we first discuss abnormal-appearing drained dialysate, including hemoperitoneum, chyloperitoneum, and noninfectious cloudy dialysate. The underlying cause is frequently unrelated to PD. We then discuss encapsulating peritoneal sclerosis, a rare complication of PD. Finally, we review metabolic changes associated with PD and methods to mitigate its effects.
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Affiliation(s)
- Xin Bo Justin Cheng
- University Health Network, Toronto, Ontario, Canada
- Vancouver General Hospital, Vancouver, British Columbia, Canada
| | - Joanne Bargman
- University Health Network, Toronto, Ontario, Canada
- University of Toronto, Toronto, Ontario, Canada
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10
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Kato K, Kageyama S, Nakashima K, Ito H, Ito Y, Miyake T. End-stage Renal Disease in Which Diazoxide Was Effective in Treating Hypoglycemia Caused by Late Dumping Syndrome after Gastrectomy. Intern Med 2024; 63:1421-1427. [PMID: 37813619 PMCID: PMC11157299 DOI: 10.2169/internalmedicine.1704-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Accepted: 08/20/2023] [Indexed: 10/11/2023] Open
Abstract
We herein report a case in which diazoxide was effective in treating reactive hypoglycemia caused by late dumping syndrome in a patient with end-stage renal disease (ESRD). A 50-year-old man with ESRD and a history of gastrectomy underwent hemodialysis. Although he was administered voglibose to treat recurrent reactive hypoglycemia caused by late dumping syndrome, he had difficulty continuing treatment because of gastrointestinal side effects. When he began diazoxide treatment, the reactive hypoglycemia improved. The dose was gradually increased with no apparent side effects, and the hypoglycemic attacks disappeared one year after the start of treatment.
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Affiliation(s)
- Kosuke Kato
- Department of Internal Medicine, Meinan Hospital, Japan
| | | | | | - Harumi Ito
- Department of Internal Medicine, Meinan Hospital, Japan
| | - Yuji Ito
- Department of Internal Medicine, Meinan Hospital, Japan
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11
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Kang DH, Streja E, You AS, Lee Y, Narasaki Y, Torres S, Novoa-Vargas A, Kovesdy CP, Kalantar-Zadeh K, Rhee CM. Hypoglycemia and Mortality Risk in Incident Hemodialysis Patients. J Ren Nutr 2024; 34:200-208. [PMID: 37918644 DOI: 10.1053/j.jrn.2023.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 08/14/2023] [Accepted: 09/10/2023] [Indexed: 11/04/2023] Open
Abstract
OBJECTIVE Hypoglycemia is a frequent occurrence in chronic kidney disease patients due to alterations in glucose and insulin metabolism. However, there are sparse data examining the predictors and clinical implications of hypoglycemia including mortality risk among incident hemodialysis patients. DESIGN AND METHODS Among 58,304 incident hemodialysis patients receiving care from a large national dialysis organization over 2007-2011, we examined clinical characteristics associated with risk of hypoglycemia, defined as a blood glucose concentration <70 mg/dL, in the first year of dialysis using expanded case-mix + laboratory logistic regression models. We then examined the association between hypoglycemia during the first year of dialysis with all-cause mortality using expanded case-mix + laboratory Cox models. RESULTS In the first year of dialysis, hypoglycemia was observed among 16.8% of diabetic and 6.9% of nondiabetic incident hemodialysis patients. In adjusted logistic regression models, clinical characteristics associated with hypoglycemia included younger age, female sex, African-American race, presence of a central venous catheter, lower residual renal function, and longer dialysis session length. In the overall cohort, patients who experienced hypoglycemia had a higher risk of all-cause mortality risk (reference: absence of hypoglycemia): adjusted hazard ratio (95% confidence interval) 1.08 (1.04, 1.13). In stratified analyses, hypoglycemia was also associated with higher mortality risk in the diabetic and nondiabetic subgroups: adjusted hazard ratios (95% confidence interval's) 1.08 (1.04-1.13), and 1.17 (0.94-1.45), respectively. CONCLUSIONS Hypoglycemia was a frequent occurrence among both diabetic and nondiabetic hemodialysis patients and was associated with a higher mortality risk. Further studies are needed to identify approaches that reduce hypoglycemia risk in the hemodialysis population.
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Affiliation(s)
- Duk-Hee Kang
- Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology, Hypertension, and Kidney Transplantation, University of California Irvine School of Medicine, Orange, California; Division of Nephrology, Department of Internal Medicine, Ewha Womans University School of Medicine, Ewha Medical Research Center, Seoul, South Korea
| | - Elani Streja
- Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology, Hypertension, and Kidney Transplantation, University of California Irvine School of Medicine, Orange, California; Nephrology Section, Tibor Rubin Veterans Affairs Medical Center, Long Beach, California
| | - Amy S You
- Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology, Hypertension, and Kidney Transplantation, University of California Irvine School of Medicine, Orange, California
| | - Yongkyu Lee
- Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology, Hypertension, and Kidney Transplantation, University of California Irvine School of Medicine, Orange, California; Nephrology Division, Department of Internal Medicine, NHIS Ilsan Hospital, Goyang-si, Gyeonggi-do, South Korea
| | - Yoko Narasaki
- Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology, Hypertension, and Kidney Transplantation, University of California Irvine School of Medicine, Orange, California
| | - Silvina Torres
- Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology, Hypertension, and Kidney Transplantation, University of California Irvine School of Medicine, Orange, California
| | - Alejandra Novoa-Vargas
- Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology, Hypertension, and Kidney Transplantation, University of California Irvine School of Medicine, Orange, California
| | - Csaba P Kovesdy
- Division of Nephrology, University of Tennessee Health Science Center, Memphis, Tennessee; Nephrology Section, Memphis Veterans Affairs Medical Center, Memphis, Tennessee
| | - Kamyar Kalantar-Zadeh
- Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology, Hypertension, and Kidney Transplantation, University of California Irvine School of Medicine, Orange, California; Nephrology Section, Tibor Rubin Veterans Affairs Medical Center, Long Beach, California
| | - Connie M Rhee
- Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology, Hypertension, and Kidney Transplantation, University of California Irvine School of Medicine, Orange, California.
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12
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Rope R, Ryan E, Weinhandl ED, Abra GE. Home-Based Dialysis: A Primer for the Internist. Annu Rev Med 2024; 75:205-217. [PMID: 38039393 DOI: 10.1146/annurev-med-050922-051415] [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] [Indexed: 12/03/2023]
Abstract
Home-based dialysis modalities offer both clinical and practical advantages to patients. The use of the home-based modalities, peritoneal dialysis and home hemodialysis, has been increasing over the past decade after a long period of decline. Given the increasing frequency of use of these types of dialysis, it is important for clinicians to be familiar with how these types of dialysis are performed and key clinical aspects of care related to their use in patients with end-stage kidney disease.
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Affiliation(s)
- Robert Rope
- Division of Nephrology and Hypertension, Oregon Health & Science University, Portland, Oregon, USA;
| | - Eric Ryan
- Division of Nephrology and Hypertension, Oregon Health & Science University, Portland, Oregon, USA;
| | - Eric D Weinhandl
- DaVita Clinical Research, Minneapolis, Minnesota, USA
- Department of Pharmaceutical Care and Health Systems, University of Minnesota, Minneapolis, Minnesota, USA
| | - Graham E Abra
- Division of Nephrology, Department of Medicine, Stanford University, Stanford, California, USA;
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13
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Lau L, Wiebe N, Ramesh S, Ahmed S, Klarenbach S, Carrero JJ, Stenvinkel P, Thorand B, Senior P, Tonelli M, Bello AK. Associations of Estradiol With Mortality and Health Outcomes in Patients Undergoing Hemodialysis: A Prospective Cohort Study. Can J Kidney Health Dis 2023; 10:20543581231209233. [PMID: 37928249 PMCID: PMC10624074 DOI: 10.1177/20543581231209233] [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: 05/30/2023] [Accepted: 09/16/2023] [Indexed: 11/07/2023] Open
Abstract
Background Both lower and higher estradiol (E2) levels have been associated with increased mortality among women with kidney failure. However, robust data are still lacking. Objective We investigated the interaction of diabetes and age on linear and nonlinear associations between E2 levels, adverse outcomes, and health-related quality of life (HRQOL) in Canadian women undergoing hemodialysis (HD). Design Population-based cohort study; data from Canadian Kidney Disease Cohort Study (CKDCS). Setting & patients A total of 427 women undergoing HD enrolled in the CKDCS. Measurements Baseline E2 (in pmol/L) and E2 tertiles (<38 pmol/L, 38-95 pmol/L, >95 pmol/L). Methods Cox-proportional hazards used for all-cause and cardiovascular disease (CVD) mortality. Fine-Gray models used for incident CVD. Mixed models used for Health Utilities Index Mark 3 (HUI3), Kidney Disease Quality of Life Physical Component Scores (KDQOL12-PCS), and Mental Component Scores (KDQOL12-MCS). Results Over a median follow-up of 3.6 (interquartile range [IQR]: 1.6-7.5) years, 250 (58.6%) participants died; 74 deaths (29.6%) were CV-related. Among 234 participants without prior CV events, 80 (34.2%) had an incident CVD event. There were no significant linear associations between E2 and all-cause mortality, CVD mortality, and incident CVD. However, E2 showed a significant concave association with all-cause mortality, but not with CVD mortality and incident CVD. Among patients aged ≥63 years, higher E2 levels were associated with lower HUI3 scores, mean difference (MD) = -0.062 per 1 - SD pmol/L, 95% confidence interval (CI) = -0.112 to -0.012, but the opposite was observed in younger patients (<63 years) in whom higher E2 levels were associated with higher HUI3 scores (MD = 0.032 per 1 - SD pmol/L, 95% CI = 0.008-0.055), Pinteraction = .045. No associations were observed among E2, KDQOL12-PCS (MD = -0.15 per 1 - SD pmol/L, 95% CI = -1.15 to 0.86), and KDQOL12-MCS (MD = -0.63 per 1 - SD pmol/L, 95% CI = -1.82 to 0.57). Limitations Unmeasured confounding and small sample size. Conclusions The association between E2 and all-cause mortality may be nonlinear, while no association was observed for CVD mortality, incident CVD, KDQOL12-PCS, and KDQOL12-MCS. Furthermore, the association between serum E2 and HUI3 was modified by age: Higher levels were associated with higher utility among women aged <63 years and the converse observed among older women.
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Affiliation(s)
- Lina Lau
- Institute of Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany
- International Helmholtz Research School for Diabetes, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany
- Institute for Medical Information Processing, Biometry, and Epidemiology, Ludwig Maximilians Universität München, Germany
- Department of Medicine, University of Alberta, Edmonton, Canada
| | - Natasha Wiebe
- Department of Medicine, University of Alberta, Edmonton, Canada
| | | | - Sofia Ahmed
- Department of Medicine, University of Calgary, AB, Canada
| | | | - Juan-Jesus Carrero
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Peter Stenvinkel
- Renal Unit, Department of Clinical Sciences and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Barbara Thorand
- Institute of Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany
- Institute for Medical Information Processing, Biometry, and Epidemiology, Ludwig Maximilians Universität München, Germany
- German Center for Diabetes Research, Neuherberg, Germany
| | - Peter Senior
- Department of Medicine, University of Alberta, Edmonton, Canada
| | | | - Aminu K. Bello
- Department of Medicine, University of Alberta, Edmonton, Canada
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Echefu G, Stowe I, Burka S, Basu-Ray I, Kumbala D. Pathophysiological concepts and screening of cardiovascular disease in dialysis patients. FRONTIERS IN NEPHROLOGY 2023; 3:1198560. [PMID: 37840653 PMCID: PMC10570458 DOI: 10.3389/fneph.2023.1198560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Accepted: 08/10/2023] [Indexed: 10/17/2023]
Abstract
Dialysis patients experience 10-20 times higher cardiovascular mortality than the general population. The high burden of both conventional and nontraditional risk factors attributable to loss of renal function can explain higher rates of cardiovascular disease (CVD) morbidity and death among dialysis patients. As renal function declines, uremic toxins accumulate in the blood and disrupt cell function, causing cardiovascular damage. Hemodialysis patients have many cardiovascular complications, including sudden cardiac death. Peritoneal dialysis puts dialysis patients with end-stage renal disease at increased risk of CVD complications and emergency hospitalization. The current standard of care in this population is based on observational data, which has a high potential for bias due to the paucity of dedicated randomized clinical trials. Furthermore, guidelines lack specific guidelines for these patients, often inferring them from non-dialysis patient trials. A crucial step in the prevention and treatment of CVD would be to gain better knowledge of the influence of these predisposing risk factors. This review highlights the current evidence regarding the influence of advanced chronic disease on the cardiovascular system in patients undergoing renal dialysis.
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Affiliation(s)
- Gift Echefu
- Division of Cardiovascular Medicine, The University of Tennessee Health Science Center, Memphis, TN, United States
| | - Ifeoluwa Stowe
- Department of Internal Medicine, Baton Rouge General Medical Center, Baton Rouge, LA, United States
| | - Semenawit Burka
- Department of Internal Medicine, University of Texas Rio Grande Valley, McAllen, TX, United States
| | - Indranill Basu-Ray
- Department of Cardiology, Memphis Veterans Affairs (VA) Medical Center, Memphis, TN, United States
| | - Damodar Kumbala
- Nephrology Division, Renal Associates of Baton Rouge, Baton Rouge, LA, United States
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15
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Folgueras García A, Corte Arboleya Z, Venta Obaya R. [Alternative strategies to the use of glycosylated hemoglobin in monitoring the glycemic status of diabetic patients with end-stage renal disease]. Med Clin (Barc) 2023; 160:145-150. [PMID: 35945057 DOI: 10.1016/j.medcli.2022.05.014] [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: 12/17/2021] [Revised: 05/11/2022] [Accepted: 05/13/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Diabetes mellitus (DM) is one of the leading causes of end-stage renal disease. Glycosylated hemoglobin (HbA1c) is the recommended glycemic marker to achieve an optimal glycemic control that is essential to prevent comorbidities associated with the disease. However, in patients on haemodialysis (HD) this marker has important limitations, this reason has led us to search alternative markers such as glycosylated albumin (AG), labile fraction of glycosylated hemoglobin (LHbA1c) or glycation indices. PATIENTS AND METHODS We enrolled 47 patients in HD, 23 with DM, obtaining samples for the determination of de AG, HbA1c y LHbA1c. Glycation indices, which allow estimated the HbA1c using glucose, AG or LHbA1c, were calculated including a control group composed of 75 diabetic patients without kidney disease. RESULTS Diabetic patients in HD had significantly higher mean values than patients without DM for glucose [160 (44) vs 96 (12)mg/dL], HbA1c [6,4 (1,0) vs 4,9 (0,3)%], AG [16,0 (5,1) vs 12,9 (1,6)%] and LHbA1c [2,0 (0,3) vs 1,7 (0,2)%]. HbA1c calculated using glycation indices was significantly higher than measured in all HD patients, regardless of the marker used for the estimation. CONCLUSIONS The glycemic markers evaluated (glucose, AG and LHbA1c), could reflect a possible underestimation of the real glycemic state by HbA1c because of the limitations of this marker in HD patients. The use of alternative markers, knowing their limitations, could improve the monitoring of patients on HD and, therefore, reduce the risk of developing DM2 complications.
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Affiliation(s)
- Andrés Folgueras García
- Servicio de Análisis Clínicos, Hospital Universitario San Agustín, Avilés. Asturias, España.
| | - Zoraida Corte Arboleya
- Servicio de Análisis Clínicos, Hospital Universitario San Agustín, Avilés. Asturias, España
| | - Rafael Venta Obaya
- Servicio de Análisis Clínicos, Hospital Universitario San Agustín, Avilés. Asturias, España; Departamento de Bioquímica y Biología Molecular, Universidad de Oviedo, Oviedo, Asturias, España
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16
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ALATAŞ H, ARSLAN N, PEMBEGÜL İ. The relationship of dietary antioxidant capacity with laboratory and anthropometric measurements in hemodialysis patients. JOURNAL OF HEALTH SCIENCES AND MEDICINE 2023. [DOI: 10.32322/jhsm.1218704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
Aim: Dietary antioxidant intake correlates with blood antioxidant content and protects against oxidative damage and related inflammatory complications. This study was conducted to examine the relationship between total antioxidant capacity of diet and effective factors with laboratory and anthropometric parameters in patients undergoing hemodialysis. Material and Method: The present case-control study consisted of 62 cases and 59 controls individuals who received hemodialysis treatment between the ages of 35-75. Dietary intake, sociodemographic data, medical history, and anthropometric measurements were collected from participants using a validated questionnaire. Results: Examining the association between dietary components and diet's total antioxidant capacity (dTAC) reveals a positive correlation between dietary protein (kg/avg), beta carotene (mcg/day), vitamin C (mg/day), vitamin E (mg/day), and polyunsaturated fatty acids (PUFA) (g/day) (p=0.002). The serum albumin, serum neutrophil to lymphocyte ratio and HDL-cholesterol have been reported to have a positive relationship with dTAC. And body mass ındex (BMI) and other anthropometric parameters were found to have a negative connection with dTAC (p=0.007). Conclusion: Total dietary antioxidant capacity is effective on anthropometric measurements and serum laboratory values. Increasing the antioxidant capacity of the diet in hemodialysis patients is important to prevent complications related to inflammation.
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17
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Zanchi A, Jehle AW, Lamine F, Vogt B, Czerlau C, Bilz S, Seeger H, de Seigneux S. Diabetic kidney disease in type 2 diabetes: a consensus statement from the Swiss Societies of Diabetes and Nephrology. Swiss Med Wkly 2023; 153:40004. [PMID: 36652726 DOI: 10.57187/smw.2023.40004] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
Diabetic kidney disease is highly prevalent in patients with type 2 diabetes and is a major cause of end-stage renal disease in Switzerland. Patients with diabetic kidney disease are among the most complex patients in diabetes care. They require a multifactorial and multidisciplinary approach with the goal to slow the decline in glomerular filtration rate (GFR) and cardiovascular morbidity. With this consensus we propose an evidence-based guidance to health care providers involved in the care of type 2 diabetic patients with diabetic kidney disease.First, there is a need to increase physician awareness and improve screening for diabetic kidney disease as early intervention may improve clinical outcomes and the financial burden. Evaluation of estimated GFR (eGFR) and spot urine albumin/creatinine ratio is recommended at least annually. Once it is diagnosed, glucose control and optimisation of blood pressure control with renin-angiotensin system blockers have been recommended as mainstay management of diabetic kidney disease for more than 20 years. Recent, high quality randomised controlled trials have shown that sodium-glucose cotransporter-2 (SGLT2) inhibition slows eGFR decline and cardiovascular events beyond glucose control. Likewise, mineralocorticoid receptor antagonism with finerenone has cardiorenal protective effects in diabetic kidney disease. Glucagon-like peptide-1 (GLP1) receptor agonists improve weight loss if needed, and decrease albuminuria and cardiovascular morbidity. Lipid control is also important to decrease cardiovascular events. All these therapies are included in the treatment algorithms proposed in this consensus. With advancing kidney failure, other challenges may rise, such as hyperkalaemia, anaemia and metabolic acidosis, as well as chronic kidney disease-mineral and bone disorder. These different topics and treatment strategies are discussed in this consensus. Finally, an update on diabetes management in renal replacement therapy such as haemodialysis, peritoneal dialysis and renal transplantation is provided. With the recent developments of efficient therapies for diabetic kidney disease, it has become evident that a consensus document is necessary. We are optimistic that it will significantly contribute to a high-quality care for patients with diabetic kidney disease in Switzerland in the future.
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Affiliation(s)
- Anne Zanchi
- Service of Nephrology and Hypertension, Department of Medicine, Lausanne University Hospital, Lausanne, Switzerland.,Service of Endocrinology, Diabetes and Metabolism, Department of Medicine, Lausanne University Hospital, Lausanne, Switzerland
| | - Andreas W Jehle
- Department of Internal Medicine, Hirslanden Klinik St. Anna, Lucerne, Switzerland.,Transplantation Immunology and Nephrology, University Hospital Basel, Basel, Switzerland
| | - Faiza Lamine
- Service of Endocrinology, Diabetes and Metabolism, Department of Medicine, Lausanne University Hospital, Lausanne, Switzerland.,Unit of Diabetes and Endocrinology, Department of Internal Medicine, Riviera-Chablais Hospital (HRC), Rennaz, Switzerland
| | - Bruno Vogt
- Department of Nephrology and Hypertension, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Cecilia Czerlau
- Department of Nephrology and Hypertension, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Stefan Bilz
- Internal Medicine and Endocrinology, Kantonsspital St Gallen, Switzerland
| | - Harald Seeger
- Division of Nephrology, University Hospital Zurich, Switzerland
| | - Sophie de Seigneux
- Service of Nephrology and Hypertension, Department of Medicine, Geneva University Hospital, Switzerland
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18
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Wu J, Zhan X, Wen Y, Wang X, Feng X, Peng F, Wang N, Wu X, Wu J. Preexisting Cardiovascular Disease, Hypertension, and Mortality in Peritoneal Dialysis. Rev Cardiovasc Med 2023; 24:30. [PMID: 39076863 PMCID: PMC11270473 DOI: 10.31083/j.rcm2401030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Revised: 11/14/2022] [Accepted: 11/15/2022] [Indexed: 07/31/2024] Open
Abstract
Background Preexisting cardiovascular disease (CVD) and hypertension are each associated with poor prognosis in peritoneal dialysis (PD) patients. Joint associations of preexisting CVD and hypertension have not been comprehensively evaluated in this population. Methods We conducted a retrospective cohort study of 3073 Chinese incident PD patients from five dialysis centres between January 1, 2005, and December 31, 2018. The joint associations between preexisting CVD, hypertension, and mortality were analysed using Cox regression models. Results Over a median of 33.7 months of follow-up, 581 (18.6%) patients died, with 286 (9.3%) deaths due to CVD. After adjusting for confounding factors, the preexisting CVD coexisting with hypertension, preexisting CVD, and hypertension groups had higher risks of all-cause mortality (hazard ratio [HR]: 3.97, 95% confidence interval [CI]: 3.06 to 5.15; HR: 2.21, 95% CI: 1.29 to 3.79; and HR: 1.83, 95% CI: 1.47 to 2.29, respectively) and CVD mortality (HR: 4.68, 95% CI: 3.27 to 6.69; HR: 2.10, 95% CI: 0.95 to 4.62; and HR: 1.86, 95% CI: 1.36 to 2.54, respectively) than the control group without preexisting CVD or hypertension (p for trend < 0.001). There was no interaction between subgroup analyses (p > 0.05). The joint associations showed similar patterns using the Fine-Gray competing risk models. Conclusions Preexisting CVD and hypertension at the start of PD were additive prognostic utilities for mortality, and preexisting CVD was more strongly associated with mortality than hypertension.
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Affiliation(s)
- Juan Wu
- Urology & Nephrology Center, Department of Nephrology, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), 310014 Hangzhou, Zhejiang, China
| | - Xiaojiang Zhan
- Department of Nephrology, the First Affiliated Hospital of Nanchang University, 330209 Nanchang, Jiangxi, China
| | - Yueqiang Wen
- Department of Nephrology, the Second Affiliated Hospital of Guangzhou Medical University, 510260 Guangzhou, Guangdong, China
| | - Xiaoyang Wang
- Department of Nephrology, the First Affiliated Hospital of Zhengzhou University, 450052 Zhengzhou, Henan, China
| | - Xiaoran Feng
- Department of Nephrology, Jiujiang No. 1 People's Hospital, 332000 Jiujiang, Jiangxi, China
| | - Fenfen Peng
- Department of Nephrology, Zhujiang Hospital of Southern Medical University, 510280 Guangzhou, Guangdong, China
| | - Niansong Wang
- Department of Nephrology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 200233 Shanghai, China
- Clinical Research Center for Chronic Kidney Disease, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 200233 Shanghai, China
| | - Xianfeng Wu
- Department of Nephrology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 200233 Shanghai, China
- Clinical Research Center for Chronic Kidney Disease, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 200233 Shanghai, China
| | - Junnan Wu
- Department of Nephrology, Zhejiang University Medical College Affiliated Sir Run Run Shaw Hospital, 310016 Hangzhou, Zhejiang, China
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Williams ME, Steenkamp D, Wolpert H. Making sense of glucose sensors in end-stage kidney disease: A review. FRONTIERS IN CLINICAL DIABETES AND HEALTHCARE 2022; 3:1025328. [PMID: 36992784 PMCID: PMC10012164 DOI: 10.3389/fcdhc.2022.1025328] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 10/27/2022] [Indexed: 12/23/2022]
Abstract
Diabetes mellitus remains the leading cause of end-stage kidney disease worldwide. Inadequate glucose monitoring has been identified as one of the gaps in care for hemodialysis patients with diabetes, and lack of reliable methods to assess glycemia has contributed to uncertainty regarding the benefit of glycemic control in these individuals. Hemoglobin A1c, the standard metric to evaluate glycemic control, is inaccurate in patients with kidney failure, and does not capture the full range of glucose values for patients with diabetes. Recent advances in continuous glucose monitoring have established this technology as the new gold standard for glucose management in diabetes. Glucose fluctuations are uniquely challenging in patients dependent on intermittent hemodialysis, and lead to clinically significant glycemic variability. This review evaluates continuous glucose monitoring technology, its validity in the setting of kidney failure, and interpretation of glucose monitoring results for the nephrologist. Continuous glucose monitoring targets for patients on dialysis have yet to be established. While continuous glucose monitoring provides a more complete picture of the glycemic profile than hemoglobin A1c and can mitigate high-risk hypoglycemia and hyperglycemia in the context of the hemodialysis procedure itself, whether the technology can improve clinical outcomes merits further investigation.
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Affiliation(s)
| | - Devin Steenkamp
- Section of Endocrinology, Diabetes, and Nutrition, Department of Medicine, Boston Medical Center, Boston, MA, United States
| | - Howard Wolpert
- Boston University School of Medicine, Boston, MA, United States
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20
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Abe M, Matsuoka T, Kawamoto S, Miyasato K, Kobayashi H. Toward Revision of the ‘Best Practice for Diabetic Patients on Hemodialysis 2012’. KIDNEY AND DIALYSIS 2022; 2:495-511. [DOI: 10.3390/kidneydial2040045] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2025]
Abstract
Diabetic nephropathy is the leading cause of dialysis therapy worldwide. The number of diabetes patients on dialysis in clinical settings has been increasing in Japan. In 2013, the Japanese Society for Dialysis Therapy (JSDT) published the “Best Practice for Diabetic Patients on Hemodialysis 2012”. While glycated hemoglobin (HbA1c) is used mainly as a glycemic control index for dialysis patients overseas, Japan is the first country in the world to use glycated albumin (GA) for assessment. According to a survey conducted by the JSDT in 2018, the number of facilities measuring only HbA1c has decreased compared with 2013, while the number of facilities measuring GA or both has significantly increased. Ten years have passed since the publication of the first edition of the guidelines, and several clinical studies regarding the GA value and mortality of dialysis patients have been reported. In addition, novel antidiabetic agents have appeared, and continuous glucose monitoring of dialysis patients has been adopted. On the other hand, Japanese dialysis patients are rapidly aging, and the proportion of patients with malnutrition is increasing. Therefore, there is great variation among diabetes patients on dialysis with respect to their backgrounds and characteristics. This review covers the indices and targets of glycemic control, the treatment of hyperglycemia, and diet recommendations for dialysis patients with diabetes.
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Affiliation(s)
- Masanori Abe
- Division of Nephrology, Hypertension and Endocrinology, Department of Medicine, Nihon University School of Medicine, Tokyo 173-8610, Japan
| | - Tomomi Matsuoka
- Division of Nephrology, Hypertension and Endocrinology, Department of Medicine, Nihon University School of Medicine, Tokyo 173-8610, Japan
| | - Shunsuke Kawamoto
- Division of Nephrology, Hypertension and Endocrinology, Department of Medicine, Nihon University School of Medicine, Tokyo 173-8610, Japan
| | - Kota Miyasato
- Division of Nephrology, Hypertension and Endocrinology, Department of Medicine, Nihon University School of Medicine, Tokyo 173-8610, Japan
| | - Hiroki Kobayashi
- Division of Nephrology, Hypertension and Endocrinology, Department of Medicine, Nihon University School of Medicine, Tokyo 173-8610, Japan
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Banimfreg BH, Alshraideh H, Shamayleh A, Guella A, Semreen MH, Al Bataineh MT, Soares NC. Untargeted Metabolomic Plasma Profiling of Emirati Dialysis Patients with Diabetes versus Non-Diabetic: A Pilot Study. Biomolecules 2022; 12:962. [PMID: 35883517 PMCID: PMC9313445 DOI: 10.3390/biom12070962] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 06/29/2022] [Accepted: 07/04/2022] [Indexed: 12/14/2022] Open
Abstract
Diabetic kidney disease (DKD) is a severe irreversible complication of diabetes mellitus that further disturbs glucose metabolism. Identifying metabolic changes in the blood may provide early insight into DKD pathogenesis. This study aims to determine blood biomarkers differentiating DKD from non-diabetic kidney disease in the Emirati population utilizing the LC-MS/MS platform. Blood samples were collected from hemodialysis subjects with and without diabetes to detect indicators of pathological changes using an untargeted metabolomics approach. Metabolic profiles were analyzed based on clinically confirmed diabetic status and current HbA1c values. Five differentially significant metabolites were identified based on the clinically confirmed diabetic status, including hydroxyprogesterone and 3,4-Dihydroxymandelic acid. Similarly, we identified seven metabolites with apparent differences between Dialysis Diabetic (DD) and Dialysis non-Diabetic (DND) groups, including isovalerylglycine based on HbA1c values. Likewise, the top three metabolic pathways, including Tyrosine metabolism, were identified following the clinically confirmed diabetic status. As a result, nine different metabolites were enriched in the identified metabolic pathways, such as 3,4-Dihydroxymandelic acid. As a result, eleven different metabolites were enriched, including Glycerol. This study provides an insight into blood metabolic changes related to DKD that may lead to more effective management strategies.
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Affiliation(s)
- Bayan Hassan Banimfreg
- Department of Industrial Engineering, College of Engineering, American University of Sharjah, Sharjah P.O. Box 26666, United Arab Emirates; (B.H.B.); (H.A.)
| | - Hussam Alshraideh
- Department of Industrial Engineering, College of Engineering, American University of Sharjah, Sharjah P.O. Box 26666, United Arab Emirates; (B.H.B.); (H.A.)
| | - Abdulrahim Shamayleh
- Department of Industrial Engineering, College of Engineering, American University of Sharjah, Sharjah P.O. Box 26666, United Arab Emirates; (B.H.B.); (H.A.)
| | - Adnane Guella
- Nephrology Department, University Hospital Sharjah, Sharjah P.O. Box 72772, United Arab Emirates;
| | - Mohammad Harb Semreen
- Department of Medicinal Chemistry, College of Pharmacy, University of Sharjah, Sharjah P.O. Box 27272, United Arab Emirates; (M.H.S.); (N.C.S.)
- Sharjah Institute for Medical Research, University of Sharjah, Sharjah P.O. Box 27272, United Arab Emirates
| | - Mohammad Tahseen Al Bataineh
- College of Medicine, University of Sharjah, Sharjah P.O. Box 27272, United Arab Emirates
- College of Medicine and Health Sciences, Department of Genetics and Molecular Biology, Khalifa University of Science and Technology, Abu Dhabi P.O. Box 127788, United Arab Emirates
- Center for Biotechnology, Khalifa University of Science and Technology, Abu Dhabi P.O. Box 127788, United Arab Emirates
| | - Nelson C. Soares
- Department of Medicinal Chemistry, College of Pharmacy, University of Sharjah, Sharjah P.O. Box 27272, United Arab Emirates; (M.H.S.); (N.C.S.)
- Sharjah Institute for Medical Research, University of Sharjah, Sharjah P.O. Box 27272, United Arab Emirates
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Al-Ghamdi SM, Bieber B, AlRukhaimi M, AlSahow A, Al Salmi I, Al Ali F, Al Aradi A, Pecoits-Filho R, Robinson BM, Pisoni RL. Diabetes Prevalence, Treatment, Control, and Outcomes Among Hemodialysis Patients in the Gulf Cooperation Council Countries. Kidney Int Rep 2022; 7:1093-1102. [PMID: 35570992 PMCID: PMC9091610 DOI: 10.1016/j.ekir.2022.02.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 02/02/2022] [Accepted: 02/07/2022] [Indexed: 02/08/2023] Open
Abstract
INTRODUCTION Diabetes mellitus (DM) is a leading cause of end-stage kidney disease (ESKD). We provide the first description of DM prevalence, related outcomes, and the hemoglobin A1c (HbA1c)/mortality relationship in national hemodialysis (HD) patient samples across the Gulf Cooperation Council (GCC) countries. METHODS We analyzed data from the prospective Dialysis Outcomes and Practice Patterns Study (DOPPS) in the GCC (2012-2018, N = 2274 HD patients ≥18 years old). Descriptive statistics were calculated, and all-cause mortality was analyzed for patients with DM versus without DM and by HbA1c levels in patients with DM by Cox regression with progressive confounder adjustments. RESULTS DM in the GCC ranged from 45% to 74% in patients with HD by country. Patients with DM were 13 years older (59.9 vs. 46.7 years) and had greater body mass index (BMI), shorter median years on dialysis (1.5 vs. 3.0 years), and higher comorbidity burden. In patients with DM, insulin use was 26% to 50% across countries, with variable oral antidiabetic drug use (2%-32%); median HbA1c levels were 6.1% to 7.5% across countries. Patients with DM (vs. without DM) had higher crude death rates (15.6 vs. 6.2 deaths per 100 patient-years, mean follow-up 1.3 years) and adjusted mortality (hazard ratio [HR] = 1.72 [95% CI 1.23-2.39]). In patients with DM, mortality was lowest at HbA1c 6.5% to 7.5%, with mortality particularly elevated at high HbA1c >9% (HR = 2.13 [95% CI 1.10-4.10]). CONCLUSION Patients with DM in the GCC have high comorbidity burden and mortality rates despite a relatively young mean age. In GCC countries, a holistic strategy for improving diabetes care and outcomes for HD patients is needed at the primary, secondary, and tertiary levels.
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Affiliation(s)
- Saeed M.G. Al-Ghamdi
- Department of Medicine, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
- Correspondence: Saeed M.G. Al-Ghamdi, Department of Medicine, Faculty of Medicine, King Abdulaziz University, P.O. Box 80215, Jeddah, Saudi Arabia 21589.
| | - Brian Bieber
- Arbor Research Collaborative for Health, Ann Arbor, Michigan, USA
| | - Mona AlRukhaimi
- Department of Medicine, Dubai Medical College, Dubai, United Arab Emirates
| | - Ali AlSahow
- Division of Nephrology, Jahra Hospital, Jahra, Kuwait
| | - Issa Al Salmi
- Department of Nephrology, The Royal Hospital, Ministry of Health, Muscat, Oman
| | - Fadwa Al Ali
- Department of Nephrology, Hamad General Hospital, Doha, Qatar
| | - Ali Al Aradi
- Nephrology, Salmaniya Medical Complex, Manama, Bahrain
| | - Roberto Pecoits-Filho
- Department of Medicine, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Bruce M. Robinson
- Department of Medicine, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Ronald L. Pisoni
- Department of Medicine, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
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23
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Rahmani A, Niknafs B, Naseri M, Nouri M, Tarighat-Esfanjani A. Effect of Nigella Sativa Oil on Oxidative Stress, Inflammatory, and Glycemic Control Indices in Diabetic Hemodialysis Patients: A Randomized Double-Blind, Controlled Trial. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE : ECAM 2022; 2022:2753294. [PMID: 35463059 PMCID: PMC9033343 DOI: 10.1155/2022/2753294] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 03/18/2022] [Indexed: 12/13/2022]
Abstract
Background and Aims Diabetes is a leading cause of renal failure. High levels of oxidative stress and inflammation in patients with renal diabetes lead to various disorders and mortality. This study was performed to determine the effect of Nigella sativa (NS) supplementation on superoxide dismutase (SOD), malondialdehyde (MDA), total antioxidant capacity (TAC), high-sensitivity C-reactive protein (hs-CRP), glycosylated hemoglobin (HbA1c), fasting blood sugar (FBS), and insulin (INS) in patients with diabetes mellitus undergoing hemodialysis (HD). Methods In this randomized, double-blind, placebo-controlled clinical trial, a total of 46 diabetic HD patients were randomly divided into NS (n = 23) and placebo (n = 23) groups. NS group received 2 g/day of NS oil, and the placebo group received paraffin oil for 12 weeks. Serum levels of SOD, MDA, TAC, hs-CRP, HbA1C, FBS, and INS were measured before and after the study. Results Compared to baseline values, SOD, TAC, and INS levels increased, whereas MDA, hs-CRP, HbA1c, and FBS significantly decreased. After adjusting for covariates using the ANCOVA test, changes in the concentrations of SOD (p = .040), MDA (p = .025), TAC (p=<.001), hs-CRP (p = .017), HbA1c (p = .014), and FBS (p = .027) were statistically significant compared to the placebo group. Intergroup changes in INS were not significant. Additionally, there were no notable side effects during the research. Conclusions This study found that NS supplementation significantly enhanced the levels of SOD, MDA, TAC, hs-CRP, HbA1c, and FBS in diabetic HD patients.
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Affiliation(s)
- Alireza Rahmani
- Student Research Committee, Student Research Center, Tabriz University of Medical Sciences, Tabriz, IR, Iran
| | - Bahram Niknafs
- Department of Internal Medicine, School of Medicine, Imam Reza Medical Research and Training Hospital, Tabriz University of Medical Sciences, Tabriz, IR, Iran
| | - Mohsen Naseri
- Traditional Medicine Clinical Trial Research Center, Shahed University, Tehran, Iran
| | - Maryam Nouri
- Student Research Committee, Student Research Center, Tabriz University of Medical Sciences, Tabriz, IR, Iran
- Department of Nutrition Sciences, Varastegan Institute for Medical Sciences, Mashhad, IR, Iran
| | - Ali Tarighat-Esfanjani
- Nutrition Research Center, Clinical Nutrition Department, Faculty of Nutrition and Food Sciences, Tabriz University of Medical Sciences, Tabriz, Iran
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24
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Rhee CM, Kalantar-Zadeh K, Tuttle KR. Novel approaches to hypoglycemia and burnt-out diabetes in chronic kidney disease. Curr Opin Nephrol Hypertens 2022; 31:72-81. [PMID: 34750332 PMCID: PMC8684381 DOI: 10.1097/mnh.0000000000000756] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
PURPOSE OF REVIEW Diabetes mellitus is a leading cause of chronic kidney disease (CKD) that confers faster kidney disease progression, higher mortality, and various metabolic derangements including hypoglycemia. RECENT FINDINGS Even in the absence of diabetes mellitus, growing research demonstrates that CKD patients are at heightened risk for hypoglycemia via multiple pathways. In CKD patients transitioning to end-stage renal disease (ESRD), spontaneous resolution of hyperglycemia and frequent hypoglycemia resulting in reduction and/or cessation of glucose-lowering medications are frequently observed in a phenomenon described as 'burnt-out diabetes'. In non-CKD patients, it is well established that hypoglycemia is causally associated with mortality, with pathways including arrhythmias, sudden cardiac death, stroke, and seizures. Increasing evidence shows that, in CKD and ESRD patients with and without diabetes mellitus, hypoglycemia is associated with cardiovascular complications and mortality risk. SUMMARY Given the high prevalence of hypoglycemia in CKD patients and the morbidity and mortality associated with this metabolic complication, a multimodal strategy is needed to prevent dysglycemia, including individualization of glycemic targets, selection of glucose-lowering medications less likely to induce hypoglycemia, medical nutrition therapy administered by trained dietitians, and accurate and precise hypoglycemia detection methods, such as self-monitored blood glucose or continuous glucose monitoring including during dialysis treatment.
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Affiliation(s)
- Connie M. Rhee
- Harold Simmons Center for Kidney Disease Research and Epidemiology, University of California Irvine School of Medicine, Orange, California
- Tibor Rubin Veterans Affairs Long Beach Healthcare System, Long Beach, California
| | - Kamyar Kalantar-Zadeh
- Harold Simmons Center for Kidney Disease Research and Epidemiology, University of California Irvine School of Medicine, Orange, California
- Tibor Rubin Veterans Affairs Long Beach Healthcare System, Long Beach, California
| | - Katherine R. Tuttle
- Providence Health Care, Spokane, Washington
- Nephrology Division and Kidney Research Institute, University of Washington, Seattle, Washington
- Institute of Translational Health Sciences, University of Washington, Seattle, Washington
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25
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Ou SH, Chen HY, Fang NW, Yin CH, Chen CL, Chen JS. Effect of anti-diabetic drugs in dialysis patients with diabetes: a nationwide retrospective cohort study. Cardiovasc Diabetol 2021; 20:179. [PMID: 34496858 PMCID: PMC8424811 DOI: 10.1186/s12933-021-01364-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 08/15/2021] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Type 2 diabetes mellitus is common in patients undergoing dialysis. However, the association between anti-diabetic drug use and survival outcomes is rarely discussed. We aimed to investigate whether continued anti-diabetic medication use affects the survival of diabetic dialysis patients and whether different hypoglycemic drug use influences prognosis. METHODS Using a nationwide database, we enrolled patients with incident end-stage renal disease under maintenance dialysis during 2011-2015 into the pre-existing diabetes dialysis (PDD), incident diabetes after dialysis (IDD), and non-diabetic dialysis (NDD) groups. The PDD group was further subclassified into patients who continued (PDD-M) and discontinued (PDD-NM) anti-diabetic drug use after dialysis. RESULTS A total of 5249 dialysis patients were examined. The PDD-NM group displayed a significantly higher mortality rate than the IDD, PDD-M, and NDD groups (log-rank test P < 0.001). The PDD-M group had a significantly lower risk of death, regardless of insulin (P < 0.001) or oral hypoglycemic agent (OHA) (P < 0.001) use. Initial insulin administration or OHA had no statistically significant effect on overall mortality in the IDD group. But OHA use had better survival trends than insulin administration for the older (P = 0.02) and male subgroups (P = 0.05). CONCLUSIONS For dialysis patients with diabetes, continuous administration of anti-diabetic drugs after dialysis and choice of medication may affect outcomes.
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Affiliation(s)
- Shih-Hsiang Ou
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
- Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Graduate Institute of Clinical Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Hsin-Yu Chen
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Nai-Wen Fang
- Department of Pediatrics, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Chun-Hao Yin
- Department of Medical Education and Research, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Chien-Liang Chen
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
- Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Jin-Shuen Chen
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.
- Department of Medical Education and Research, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.
- Faculty of Medicine, School of Medicine, National Defense Medicine, Taipei, Taiwan.
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26
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Narasaki Y, Park E, You AS, Daza A, Peralta RA, Guerrero Y, Novoa A, Amin AN, Nguyen DV, Price D, Kalantar-Zadeh K, Rhee CM. Continuous glucose monitoring in an end-stage renal disease patient with diabetes receiving hemodialysis. Semin Dial 2021; 34:388-393. [PMID: 34378258 DOI: 10.1111/sdi.13009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 07/05/2021] [Accepted: 07/18/2021] [Indexed: 12/29/2022]
Abstract
Diabetes is the leading cause of end-stage renal disease (ESRD) and contributes to heightened morbidity and mortality in dialysis patients. Given that ESRD patients are susceptible to hypoglycemia and hyperglycemia via multiple pathways, adequate glycemic monitoring and control is a cornerstone in diabetic kidney disease management. In ESRD, existing glycemic metrics such as glycated hemoglobin, self-monitored blood glucose, fructosamine, and glycated albumin have limitations in accuracy, convenience, and accessibility. In contrast, continuous glucose monitoring (CGM) provides automated, less invasive glucose measurements and more comprehensive glycemic data versus conventional metrics. Here, we report a 48-year-old male with ESRD due to diabetes receiving thrice-weekly hemodialysis who experienced decreased patient-burden, greater glucose monitoring adherence, improved glycemic parameters, and reduction in hypoglycemia after transitioning to CGM. Through this case, we discuss how CGM is a practical, convenient patient-centered tool that may improve metabolic outcomes and quality of life in ESRD patients with diabetes.
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Affiliation(s)
- Yoko Narasaki
- Harold Simmons Center for Chronic Disease Research and Epidemiology, Division of Nephrology, Hypertension and Kidney Transplantation, University of California Irvine School of Medicine, Orange, California, USA
| | - Elisa Park
- Harold Simmons Center for Chronic Disease Research and Epidemiology, Division of Nephrology, Hypertension and Kidney Transplantation, University of California Irvine School of Medicine, Orange, California, USA
| | - Amy S You
- Harold Simmons Center for Chronic Disease Research and Epidemiology, Division of Nephrology, Hypertension and Kidney Transplantation, University of California Irvine School of Medicine, Orange, California, USA
| | - Andrea Daza
- Harold Simmons Center for Chronic Disease Research and Epidemiology, Division of Nephrology, Hypertension and Kidney Transplantation, University of California Irvine School of Medicine, Orange, California, USA
| | - Rene Amel Peralta
- Harold Simmons Center for Chronic Disease Research and Epidemiology, Division of Nephrology, Hypertension and Kidney Transplantation, University of California Irvine School of Medicine, Orange, California, USA
| | - Yalitzi Guerrero
- Harold Simmons Center for Chronic Disease Research and Epidemiology, Division of Nephrology, Hypertension and Kidney Transplantation, University of California Irvine School of Medicine, Orange, California, USA
| | - Alejandra Novoa
- Harold Simmons Center for Chronic Disease Research and Epidemiology, Division of Nephrology, Hypertension and Kidney Transplantation, University of California Irvine School of Medicine, Orange, California, USA
| | - Alpesh N Amin
- Department of Medicine, University of California Irvine School of Medicine, Orange, California, USA
| | - Danh V Nguyen
- Department of Medicine, University of California Irvine School of Medicine, Orange, California, USA
| | | | - Kamyar Kalantar-Zadeh
- Harold Simmons Center for Chronic Disease Research and Epidemiology, Division of Nephrology, Hypertension and Kidney Transplantation, University of California Irvine School of Medicine, Orange, California, USA
| | - Connie M Rhee
- Harold Simmons Center for Chronic Disease Research and Epidemiology, Division of Nephrology, Hypertension and Kidney Transplantation, University of California Irvine School of Medicine, Orange, California, USA
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27
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Al-Saleh Y, Sabico S, Al-Furqani A, Jayyousi A, Alromaihi D, Ba-Essa E, Alawadi F, Alkaabi J, Hassanein M, Al-Sifri S, Saleh S, Alessa T, Al-Daghri NM. Sulfonylureas in the Current Practice of Type 2 Diabetes Management: Are They All the Same? Consensus from the Gulf Cooperation Council (GCC) Countries Advisory Board on Sulfonylureas. Diabetes Ther 2021; 12:2115-2132. [PMID: 33983614 PMCID: PMC8342668 DOI: 10.1007/s13300-021-01059-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 04/09/2021] [Indexed: 12/22/2022] Open
Abstract
Since their inception in the commercial market in the mid-twentieth century, sulfonylureas (SUs) have remained a therapeutic option in the management of type 2 diabetes (T2D). Despite their established glucose-lowering effects, there is no consensus among global experts and modern guidelines regarding the priority of SUs in relation to other therapeutic options, given the lack of evidence that SUs are associated with a low risk of macrovascular events and excess mortality. However, findings from recent trials and real-time observations have resolved this contentious issue somewhat, albeit to varying degrees. The present consensus discusses the role of SUs in contemporary diabetes management in the Gulf Cooperation Council (GCC) countries. Regional experts from these countries gathered virtually to formulate a consensus following presentations of topics relevant to SU therapy with an emphasis on gliclazide, including long-term efficacy, cost, end-organ benefits, and side effects, based on up-to-date evidence. The present narrative review reflects the conclusions of this assembly and provides a platform upon which future guidelines for the use of SUs in the GCC can be tailored.
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Affiliation(s)
- Yousef Al-Saleh
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, 22490, Saudi Arabia.
- King Abdullah International Medical Research Center, Riyadh, 11481, Saudi Arabia.
- Department of Medicine, King Abdulaziz Medical City, Riyadh, Ministry of National Guard-Health Affairs, Riyadh, 14611, Saudi Arabia.
- Chair for Biomarkers of Chronic Diseases, Biochemistry Department, College of Science, King Saud University, Riyadh, 11451, Saudi Arabia.
| | - Shaun Sabico
- Chair for Biomarkers of Chronic Diseases, Biochemistry Department, College of Science, King Saud University, Riyadh, 11451, Saudi Arabia
| | | | - Amin Jayyousi
- Endocrine and Diabetes Section, Hamad Medical Corporation, Doha, Qatar
- Weill Cornell Medical College, Doha, Qatar
| | - Dalal Alromaihi
- King Hamad University Hospital, Busaiteen, Bahrain
- Medical University of Bahrain, Busaiteen, Bahrain
- Bahrain Diabetes Society, Manama, Bahrain
| | | | - Fatheya Alawadi
- Endocrine Department, Dubai Hospital, Dubai Health Authority, Dubai, United Arab Emirates
| | - Juma Alkaabi
- Department of Internal Medicine, College of Medicine, and Health Sciences, UAE University, Al Ain, United Arab Emirates
| | - Mohamed Hassanein
- Endocrine Department, Dubai Hospital, Dubai Health Authority, Dubai, United Arab Emirates
| | | | - Seham Saleh
- Prince Sultan Cardiac Center, Riyadh, Saudi Arabia
| | - Thamer Alessa
- Division of Endocrinology, Diabetes and Metabolism, Jaber Al-Ahmad Hospital, Kuwait City, Kuwait
- Dasman Diabetes Institute, Kuwait City, Kuwait
| | - Nasser M Al-Daghri
- Chair for Biomarkers of Chronic Diseases, Biochemistry Department, College of Science, King Saud University, Riyadh, 11451, Saudi Arabia
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Yusof Khan AHK, Zakaria NF, Zainal Abidin MA, Kamaruddin NA. Prevalence of glycemic variability and factors associated with the glycemic arrays among end-stage kidney disease patients on chronic hemodialysis. Medicine (Baltimore) 2021; 100:e26729. [PMID: 34397709 PMCID: PMC8322551 DOI: 10.1097/md.0000000000026729] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Accepted: 06/29/2021] [Indexed: 01/04/2023] Open
Abstract
Glycemic variability (GV) confers a significantly higher risk of diabetic-related complications, especially cardiovascular. Despite extensive research in this area, data on end-stage kidney disease (ESKD) patients on chronic hemodialysis are scarce. This study aims to determine the magnitude of GV among ESKD (diabetic vs nondiabetic) patients and its associated factors on hemodialysis days (HDD) and non-hemodialysis days (NHDD) where postulation of a higher GV observed among diabetic on HDD.We recruited 150 patients on hemodialysis, 93 patients with type 2 diabetic (DM-ESKD), and 57 with nondiabetic (NDM-ESKD). The GV indices (standard deviation [SD] and percentage coefficient variant [%CV]) were obtained from 11-point and 7-point self-monitoring blood glucose (fasting to post-meal) (SMBG) profiles on HDD and NHDD. The GV indices and its associated factors of both DM-ESKD and NDM-ESKD were analyzed to compare HDD vs NHDD.Mean blood glucose on HDD was 9.33 [SD 2.7, %CV 30.6%] mmol/L in DM-ESKD compared with 6.07 [SD 0.85, %CV 21.3%] mmol/L in NDM-ESKD (P = <.01). The DM-ESKD group experienced significantly above target GV indices compared to NDM-ESKD on both HDD and NHDD, particularly in the subgroup with HbA1c 8-10% (P = <.01). Presence of diabetes, older age, hyperlipidemia, HbA1c, ferritin levels, and albumin were identified as factors associated with GV.DM-ESKD patients have above-target GV indices, especially on HDD, therefore increasing their risk of developing future complications. We identified high HbA1c, older age group, presence of hyperlipidemia, ferritin levels, and albumin as factors associated with GV indices that may be used as surrogate markers for GV. Since these groups of patients are vulnerable to CVD mortality, urgent attention is needed to rectify it.
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Affiliation(s)
- Abdul Hanif Khan Yusof Khan
- Department of Neurology, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia (UPM), Serdang, Selangor, Malaysia
| | - Nor Fadhlina Zakaria
- Department of Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia (UPM), Serdang, Selangor, Malaysia
| | - Muhammad Adil Zainal Abidin
- Kuliyyah of Medicine, International Islamic University Malaysia (IIUM), Jalan Hospital Campus, Kuantan, Pahang, Malaysia
| | - Nor Azmi Kamaruddin
- Department of Medicine, The National University of Malaysia (HUKM), Jalan Yaacob Latif, Bandar Tun Razak, Cheras, Wilayah Persekutuan Kuala Lumpur, Malaysia
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29
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Liao K, Lin KC, Chiou SJ. Self-efficacy remains a vital factor in reducing the risk of dialysis in type 2 diabetes care. Medicine (Baltimore) 2021; 100:e26644. [PMID: 34260563 PMCID: PMC8284740 DOI: 10.1097/md.0000000000026644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 06/25/2021] [Indexed: 01/04/2023] Open
Abstract
Studies have provided promising outcomes of the pay-for-performance (P4P) program or with good continuity of care levels in diabetes control.We investigate the different exposures in continuity of care (COC) with their providers and those who participate in the P4P program and its effects on the risk of diabetes diabetic nephropathy in the future.We obtained COC and P4P information from the annual database, to which we applied a hierarchical linear modeling (HLM) in 3 levels adjusted to account for other covariates as well as the effects of hospital clustering and accumulating time.Newly diagnosed type 2 diabetes in 2003At the individual level, those with a higher Diabetes Complications Severity Index (DCSI) score have a higher likelihood of diabetic nephropathy than those with a lower DCSI (OR, 1.46), whereas contrasting results were obtained for the Charlson Comorbidity Index (CCI) (odds ratio[OR], 0.88). Patients who visited family physicians, endocrinologists, and gastroenterologists showed a lower likelihood of diabetic nephropathy (OR, 0.664, 0.683, and 0.641, respectively), whereas those who continued to visit neurologists showed an increased risk of diabetic nephropathy by 4 folds. At the hospital level, patients with diabetes visiting primary care clinics had a lower risk of diabetic nephropathy with an OR of 0.584 than those visiting hospitals of other higher levels. Regarding the repeat time level, the patients who had a higher COC score and participated in the P4P program had a reduced diabetic nephropathy risk with an OR of 0.339 and 0.775, respectively.Diabetes control necessitates long-term care involving the patients' healthcare providers for the management of their conditions to reduce the risk of diabetic nephropathy. Indeed, most contributing factors are related to patients, but we cannot eliminate the optimal outcomes related to good relationships with healthcare providers and participation in the P4P program.
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Affiliation(s)
- Kuomeng Liao
- Department of endocrinology and metabolism, Zhongxiao Branch, Taipei City Hospital, Taipei, Taiwan
| | - Kuan-Chia Lin
- Preventive Medicine Center, National Yang Ming University, Taipei, Taiwan, R.O.C
- Institute of Hospital and Health Care Administration, National Yang-Ming University, Taipei, Taiwan, R.O.C
| | - Shang-Jyh Chiou
- Department of Health Care Management, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan, R.O.C
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30
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Rhee CM, Kalantar-Zadeh K, Moore LW. Medical Nutrition Therapy for Diabetic Kidney Disease. J Ren Nutr 2021; 31:229-232. [PMID: 33990265 DOI: 10.1053/j.jrn.2021.03.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Accepted: 03/13/2021] [Indexed: 12/22/2022] Open
Affiliation(s)
- Connie M Rhee
- University of California Irvine, Orange, California.
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Pomposelli T, Schuetz C, Wang P, Yamada K. A Strategy to Simultaneously Cure Type 1 Diabetes and Diabetic Nephropathy by Transplant of Composite Islet-Kidney Grafts. Front Endocrinol (Lausanne) 2021; 12:632605. [PMID: 34054721 PMCID: PMC8153710 DOI: 10.3389/fendo.2021.632605] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 04/16/2021] [Indexed: 11/13/2022] Open
Abstract
In recent years islet cell transplant has proven itself to be a viable clinical option for a select group of diabetic patients. Graft loss after transplant however continues to hinder the long-term success of the procedure. Transplanting the islets as a pre-vascularized composite islet-kidney graft has emerged as a relevant solution. Much groundbreaking research has been done utilizing this model in conjunction with strategies aimed towards islet cell survival and prolongation of function in the host. Transplanting the islet cells as a prevascularized graft under the capsule of the donor kidney as a composite islet-kidney graft has been shown to provide long term durable blood glucose control in large animal studies by limiting graft apoptosis as well as providing a physical barrier against the host immune response. While promising, this technique is limited by long term immunosuppression requirements of the host with its well-known adverse sequelae. Research into tolerance inducing strategies of the host to the allogeneic and xenogeneic islet-kidney graft has shown much promise in the avoidance of long-term immunosuppression. In addition, utilizing xenogeneic tissue grafts could provide a near-limitless supply of organs. The islet-kidney model could provide a durable and long-term cure for diabetes. Here we summarize the most recent data, as well as groundbreaking strategies to avoid long term immunosuppression and promote graft acceptance.
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Affiliation(s)
- Thomas Pomposelli
- Columbia Center for Translational Immunology, Department of Medicine, Columbia University Irving Medical Center, New York, NY, United States
- Department of Surgery, Columbia University Irving Medical Center, New York, NY, United States
| | - Christian Schuetz
- Columbia Center for Translational Immunology, Department of Medicine, Columbia University Irving Medical Center, New York, NY, United States
| | - Ping Wang
- Precision Health Program, Michigan State University, East Lansing, MI, United States
- Department of Radiology, College of Human Medicine, Michigan State University, East Lansing, MI, United States
| | - Kazuhiko Yamada
- Columbia Center for Translational Immunology, Department of Medicine, Columbia University Irving Medical Center, New York, NY, United States
- Department of Surgery, Columbia University Irving Medical Center, New York, NY, United States
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32
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Chiou S, Liao K, Huang Y, Lin W, Hsieh C. Synergy between the pay-for-performance scheme and better physician-patient relationship might reduce the risk of retinopathy in patients with type 2 diabetes. J Diabetes Investig 2021; 12:819-827. [PMID: 33025682 PMCID: PMC8089022 DOI: 10.1111/jdi.13422] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 09/19/2020] [Accepted: 09/24/2020] [Indexed: 12/16/2022] Open
Abstract
AIMS/INTRODUCTION This study investigated whether participation by patients with type 2 diabetes in Taiwan's pay-for-performance (P4P) program and maintaining good continuity of care (COC) with their healthcare provider reduced the likelihood of future complications, such as retinopathy. MATERIALS AND METHODS The analysis used longitudinal panel data for newly diagnosed type 2 diabetes from the National Health Insurance claims database in Taiwan. COC was measured annually from 2003 to 2013, and was used to allocate the patients to low, medium and high groups. Cox regression analysis was used with time-dependent (time-varying) covariates in a reduced model (with only P4P or COC), and the full model was adjusted with other covariates. RESULTS Despite the same significant effects of treatment at primary care, the Diabetes Complications Severity Index scores were significantly associated with the development of retinopathy. After adjusting for these, the hazard ratios for developing retinopathy among P4P participants in the low, medium and high COC groups were 0.594 (95% confidence interval [CI] 0.398-0.898, P = 0.012), 0.676 (95% CI 0.520-0.867, P = 0.0026) and 0.802 (95% CI 0.603-1.030, P = 0.1062), respectively. Thus, patients with low or median COC who participated in the P4P program had a significantly lower risk of retinopathy than those who did not. CONCLUSIONS Diabetes care requires a long-term relationship between patients and their care providers. Besides encouraging patients to participate in P4P programs, health authorities should provide more incentives for providers or patients to regularly survey patients' lipid profiles and glucose levels, and reward the better interpersonal relationship to prevent retinopathy.
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Affiliation(s)
- Shang‐Jyh Chiou
- Department of Health Care ManagementNational Taipei University of Nursing and Health SciencesTaipeiTaiwan
| | - Kuomeng Liao
- Department of Endocrinology and MetabolismZhongxiao BranchTaipei City HospitalTaipeiTaiwan
| | - Yu‐Tung Huang
- Center for Big Data Analytics and StatisticsChang Gung Memorial HospitalTaoyuan CityTaiwan
| | - Wender Lin
- Department of Health Care AdministrationChang Jung Christian UniversityTainan CityTaiwan
| | - Chi‐Jeng Hsieh
- Department of Health Care AdministrationOriental Institute of TechnologyNew Taipei CityTaipeiTaiwan
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Alalawi F, Bashier A. Management of diabetes mellitus in dialysis patients: Obstacles and challenges. Diabetes Metab Syndr 2021; 15:1025-1036. [PMID: 34000713 DOI: 10.1016/j.dsx.2021.05.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 04/30/2021] [Accepted: 05/02/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND AIMS Diabetic kidney disease (DKD) is a major health issue that is associated with an increased risk of morbidity and mortality. The treatment of DKD is challenging given changes in blood glucose homeostasis, unclear accuracy of glucose metrics, and altered kinetics of the blood glucose-lowering medications. There is uncertainty surrounding the optimal glycemic target in this population although recent epidemiologic data suggest that HbA1c ranges of 6-8%, as well as 7-9%, are associated with increased survival rates among diabetic dialysis patients. Furthermore, the treatment of diabetes in patients maintained on dialysis is challenging, and many blood glucose-lowering medications are renally metabolized and excreted hence requiring dose adjustment or avoidance in dialysis patients. METHOD ology: PubMed, Google Scholar, and Medline were searched for all literature discussing the management of diabetes in dialysis patients. RESULTS The literature was discussed under many subheadings providing the latest evidence in the treatment of diabetes in dialysis patients. CONCLUSION The management of diabetes in dialysis is very complex requiring a multi-disciplinary team involving endocrinologists and nephrologists to achieve targets and reduce morbidity and mortality.
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Affiliation(s)
- Fakhriya Alalawi
- Nephrology Department, Dubai Hospital. Dubai Health Authority, United Arab Emirates
| | - Alaaeldin Bashier
- Endocrine Department, Dubai Hospital. Dubai Health Authority, United Arab Emirates.
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Rosa TS, Corrêa HL, Deus LA, Stone W, Reis AL, Gadelha AB, de Araújo TB, Silva Junior PR, Moraes MR, Silva JAB, Tzanno-Martins C, Simões HG, Prestes J, Neves RVP. Effects of dynamic and isometric resistance training protocols on metabolic profile in hemodialysis patients: a randomized controlled trial. Appl Physiol Nutr Metab 2021; 46:1029-1037. [PMID: 33651633 DOI: 10.1139/apnm-2020-0900] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
The aim of this study was to compare the effect of dynamic (DRT) and isometric (IRT) resistance training on glycemic homeostasis, lipid profile, and nitric oxide (NO) in hemodialysis (HD) patients. Patients were randomly distributed into 3 groups: control (n = 65), DRT (n = 65), and IRT (n = 67). Patients assessed before and after the intervention period were tested for fasting blood glucose, glycated hemoglobin, oral glucose tolerance test, insulin resistance, lipid profile, leptin, insulin, adiponectin, C-reactive protein, and NO . Patients underwent to strength and body composition assessments. Subjects allocated in both DRT and IRT groups took part in a 24-week resistance training program, 3 times per week. Each training session was approximately 1 hour before dialysis and consisted of 3 sets of 8-12 repetitions at low intensity. Total workload was higher in the DRT as compared with the IRT. This heightened workload related to better glycemic homeostasis in HD patients as measured by regulation of insulin, adiponectin, and leptin, while improveing triglycerides, free-fat mass, and muscle strength. Additionally, NO levels were increased in the DRT group. NO was significantly correlated with glucose intolerance (r = -0.42, p = 0.0155) and workload (r = 0.46, p = 0.0022). The IRT group only improved strength (p < 0.05). Twenty-four weeks of DRT improved glycemic homeostasis, lipid profile, and NO in HD patients. Although IRT seems to play an important role in increasing strength, DRT might be a better choice to promote metabolic adjustments in HD patients. Clinical trial: http://www.ensaiosclinicos.gov.br/rg/RBR-3gpg5w. Novelty: DRT might be a better choice for metabolic improvements in patients with chronic kidney disease (CKD). Exercise-training might treat metabolic imbalance in CKD patients.
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Affiliation(s)
- Thiago Santos Rosa
- Graduate Program of Physical Education, Catholic University of Brasilia, Brazil
| | - Hugo Luca Corrêa
- Graduate Program of Physical Education, Catholic University of Brasilia, Brazil
| | - Lysleine Alves Deus
- Graduate Program of Physical Education, Catholic University of Brasilia, Brazil
| | - Whitley Stone
- School of Kinesiology, Recreation, and Sport, Western Kentucky University, KY, USA
| | - Andrea Lucena Reis
- Graduate Program of Physical Education, Catholic University of Brasilia, Brazil
| | - André Bonadias Gadelha
- Graduate Program of Physical Education, Catholic University of Brasilia, Brazil.,Seção de Educação Física, Colégio Militar de Brasília
| | | | | | - Milton Rocha Moraes
- Graduate Program of Physical Education, Catholic University of Brasilia, Brazil
| | | | | | | | - Jonato Prestes
- Graduate Program of Physical Education, Catholic University of Brasilia, Brazil
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Abstract
Chronic kidney disease (CKD) is among the most prevalent and dire complications of diabetes mellitus in adults across the world. Diabetes substantially contributes to the burden of kidney disease, such that one third to one half of CKD in the United States and many other countries is attributable to diabetic kidney disease (DKD). As DKD progresses to end-stage renal disease (ESRD), patients are at heightened risk for atypical glycemic complications, including the development of burnt-out diabetes, manifested by hypoglycemic bouts and poor outcomes. Furthermore, even in the absence of diabetes, hypoglycemia is a frequent occurrence in CKD patients that may contribute to their high burden of cardiovascular disease and death. Extrapolation of data from clinical trials in high-cardiovascular-risk populations and observational studies in patients with non-dialysis-dependent (NDD) CKD and ESRD suggest that moderate glycemic targets defined by glycated hemoglobin levels of 6% to 8% and glucose levels of 100 to 150 mg/dL are associated with better survival in DKD patients. However, given the imprecision of glycated hemoglobin levels in kidney disease, further research is needed to determine the optimal glycemic metric and target in diabetic NDD-CKD and ESRD patients. Given their exceedingly high cardiovascular morbidity and mortality, there is a compelling need for further investigation of how to optimally manage dysglycemia in the NDD-CKD and ESRD populations.
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36
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Burton JO, Corbett RW, Kalra PA, Vas P, Yiu V, Chrysochou C, Kirmizis D. Recent advances in treatment of haemodialysis. J R Soc Med 2021; 114:30-37. [PMID: 33269971 PMCID: PMC8173362 DOI: 10.1177/0141076820972669] [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: 03/19/2020] [Accepted: 10/21/2020] [Indexed: 11/15/2022] Open
Abstract
Haemodialysis remains the most widely used treatment for patients with end-stage renal disease. Despite the progress that has occurred in the treatment of end-stage renal disease over the last six decades, there has been a failure to translate this into the desired clinical benefits, with morbidity and mortality rates among patients on haemodialysis remaining unacceptably high. Recently, however, there have been expectations that the significant advances that took place over the last few years may result in improved outcomes. New medications for the treatment of anaemia and secondary hyperparathyroidism, as well as novel trends in the areas of iron therapy, diabetes management and physical exercise are among the most important advances which, taken together, are changing the standards of care for patients on haemodialysis. The latest advances, of relevance not only to specialists in Renal Medicine but also to general practitioners caring for these patients, are reviewed in this collaborative paper.
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Affiliation(s)
- James O. Burton
- Department of Cardiovascular Sciences, University of Leicester, Leicester LE1 7RH, UK
- Department of Renal Medicine, University Hospitals of Leicester NHS Trust, Leicester LE1 5WW, UK
| | - Richard W. Corbett
- Hammersmith Hospital, Imperial College Healthcare NHS Trust, London W12 0HS, UK
| | - Philip A. Kalra
- University of Manchester, Manchester M13 9PL, UK
- Department of Nephrology, Salford Royal Hospital NHS Foundation Trust, Salford M6 8HD, UK
| | - Prashanth Vas
- King’s College Hospital, London SE5 9RS, UK
- Institute of Diabetes, Endocrinology and Obesity, King’s Health Partners, London SE1 9RT, UK
| | - Vivian Yiu
- Cambridge University Hospitals NHS Foundation Trust, Cambridge CB2 0QQ, UK
| | - Constantina Chrysochou
- Department of Nephrology, Salford Royal Hospital NHS Foundation Trust, Salford M6 8HD, UK
| | - Dimitrios Kirmizis
- Department of Nephrology, Colchester General Hospital, East Suffolk and North Essex NHS Foundation Trust, Colchester CO4 5JL, UK
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Martynov SA, Severina AS, Larina II, Shamhalova MS, Arzumanov SV, Pinchuk AV, Shestakova MV. [Preparation of the dialysis patient with type 1 diabetes mellitus for kidney transplantation]. ACTA ACUST UNITED AC 2020; 66:18-30. [PMID: 33481364 DOI: 10.14341/probl12686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 12/14/2020] [Accepted: 12/20/2020] [Indexed: 11/06/2022]
Abstract
Kidney transplantation is unique method of renal replacement therapy, allowing to improve quality and duration of life for patients with diabetes mellitus type 1 (DM1) and end-stage renal disease (ESRD) on dialysis therapy. Recently using of innovation technologies for diabetes management and modern immunosuppression enable achieving better results of posttransplant rehabilitation for patients with DM1, especially if kidney transplantation is performed early after initiation of dialysis. Detailed examination of patient with DM1 before potential kidney transplantation is very important to reduce of early and late postoperative complications. Kidney transplantation preparation includes effective glycemic control, adequate dialysis therapy, treatment of diabetes and ESRD complications and concomitant conditions, especially cardiovascular diseases, accounting for kidney transplantation perspective. Furthermore, diagnostics and treatment of any infectious process, timely vaccination, cancer screening are basic approaches of kidney transplantation preparation program, providing the best survival rate of kidney graft and patient.
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Affiliation(s)
| | | | | | | | - S V Arzumanov
- N.A. Lopatkin Research Institute of Urology and Interventional Radiology - branch of the National Medical Radiological Research Centre
| | - A V Pinchuk
- Sklifosovsky Research Institute for Emergency Medicine
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38
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Schexnayder CD, Agbahiwe S, Emelogu O. Burnt Out? The Phenomenon of Type 2 Diabetes Mellitus in End-Stage Renal Disease. Fed Pract 2020; 37:580-585. [PMID: 33424218 PMCID: PMC7789851 DOI: 10.12788/fp.0076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
In patients with T2DM and ESRD, insulin is the antidiabetic medication of choice with a hemoglobin A1c target of 6 to 8%, using fructosamine levels or other measures for better assessment of glycemic control.
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Affiliation(s)
- Chandler D Schexnayder
- is a Home-Based Primary Care Clinical Pharmacy Specialist, and is a Primary Care Clinical Pharmacy Specialist, both at the Michael E. DeBakey Veteran Affairs Medical Center in Houston, Texas. is a Primary Care Clinical Pharmacy Specialist at the Audie L. Murphy Memorial Veterans' Hospital in San Antonio, Texas
| | - Sylvester Agbahiwe
- is a Home-Based Primary Care Clinical Pharmacy Specialist, and is a Primary Care Clinical Pharmacy Specialist, both at the Michael E. DeBakey Veteran Affairs Medical Center in Houston, Texas. is a Primary Care Clinical Pharmacy Specialist at the Audie L. Murphy Memorial Veterans' Hospital in San Antonio, Texas
| | - Oluchi Emelogu
- is a Home-Based Primary Care Clinical Pharmacy Specialist, and is a Primary Care Clinical Pharmacy Specialist, both at the Michael E. DeBakey Veteran Affairs Medical Center in Houston, Texas. is a Primary Care Clinical Pharmacy Specialist at the Audie L. Murphy Memorial Veterans' Hospital in San Antonio, Texas
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39
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Wei X, Wen Y, Zhou Q, Feng X, Peng FF, Wang N, Wang X, Wu X. Hyperlipidemia and mortality associated with diabetes mellitus co-existence in Chinese peritoneal dialysis patients. Lipids Health Dis 2020; 19:234. [PMID: 33160371 PMCID: PMC7648430 DOI: 10.1186/s12944-020-01405-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2020] [Accepted: 10/19/2020] [Indexed: 11/27/2022] Open
Abstract
Background To evaluate associations between diabetes mellitus (DM) coexisting with hyperlipidemia and mortality in peritoneal dialysis (PD) patients. Methods This was a retrospective cohort study with 2939 incident PD patients in China from January 2005 to December 2018. Associations between the DM coexisting with hyperlipidemia and mortality were evaluated using the Cox regression. Results Of 2939 patients, with a median age of 50.0 years, 519 (17.7%) died during the median of 35.1 months. DM coexisting with hyperlipidemia, DM, and hyperlipidemia were associated with 1.93 (95% CI 1.45 to 2.56), 1.86 (95% CI 1.49 to 2.32), and 0.90 (95% CI 0.66 to 1.24)-time higher risk of all-cause mortality, compared with without DM and hyperlipidemia, respectively (P for trend < 0.001). Subgroup analyses showed a similar pattern. Among DM patients, hyperlipidemia was as a high risk of mortality as non-hyperlipidemia (hazard ratio 1.02, 95%CI 0.73 to 1.43) during the overall follow-up period, but from 48-month follow-up onwards, hyperlipidemia patients had 3.60 (95%CI 1.62 to 8.01)-fold higher risk of all-cause mortality than those non-hyperlipidemia (P interaction = 1.000). Conclusions PD patients with DM coexisting with hyperlipidemia were at the highest risk of all-cause mortality, followed by DM patients and hyperlipidemia patients, and hyperlipidemia may have an adverse effect on long-term survival in DM patients.
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Affiliation(s)
- Xin Wei
- Department of Nephrology, the First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Yueqiang Wen
- Department of Nephrology, the Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Qian Zhou
- Department of Medical Statistics, Clinical Trials Unit, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Xiaoran Feng
- Department of Nephrology, Jiujiang No. 1 People's Hospital, Jiujiang, China
| | - Fen Fen Peng
- Department of Nephrology, Zhujiang Hospital of Southern Medical University, Guangzhou, China
| | - Niansong Wang
- Department of Nephrology, Affiliated Sixth People's Hospital, Shanghai Jiao Tong University, No.600, Yi Shan Road, Shanghai, China
| | - Xiaoyang Wang
- Department of Nephrology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Xianfeng Wu
- Department of Nephrology, Affiliated Sixth People's Hospital, Shanghai Jiao Tong University, No.600, Yi Shan Road, Shanghai, China.
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Pioglitazone Is Associated with Lower Major Adverse Cardiovascular and Cerebrovascular Events than DPP4-Inhibitors in Diabetic Patients with End-Stage Renal Disease: A Taiwan Nationwide Cohort Study, 2006-2016. J Clin Med 2020; 9:jcm9113578. [PMID: 33172034 PMCID: PMC7694655 DOI: 10.3390/jcm9113578] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 10/30/2020] [Accepted: 11/03/2020] [Indexed: 12/19/2022] Open
Abstract
While pioglitazone reduces insulin resistance and hepatic gluconeogenesis effectively in patients with type 2 diabetes mellitus (T2DM), these benefits remained controversial in patients with end stage renal disease (ESRD). We compared major adverse cardiac cerebrovascular events (MACCEs) and mortality (overall, infection-related, and MACCE-related) of pioglitazone to that of dipeptidyl peptidase 4 inhibitors (DPP4-inhibitors) in patients with T2DM and ESRD. From Taiwan’s national health insurance research database (NHIRD), 647 pioglitazone users and 6080 DPP4-inhibitors users between 1 April 2006 and 31 December 2016 were followed from the 91th date after the ESRD certification until the study outcomes, independently; withdraw from the NHI program, death, or 31 December 2017, whichever came first. After weighting, risks of MACCEs (10.48% vs. 12.62% per person-years, hazard ratio (HR): 0.85, 95% (CI): 0.729–0.985) and all-cause mortality (12.86% vs. 13.22% per person-years, (HR): 0.88, 95% (CI): 0.771–0.995) are significantly lower in pioglitazone group. Subgroup analysis found lower MACCEs risk in the pioglitazone users without insulin therapy (6.44% vs. 10.04% (HR): 0.59, 95% (CI): 0.42–0.82) and lower MACCEs related death (2.76% vs. 3.84% (HR): 0.61, 95% (CI): 0.40–0.95) in the pioglitazone group with dyslipidemia, when comparing with DPP4-inhibitors users. Pioglitazone is associated with lower all-cause mortality and MACCEs in diabetic patients with ESRD, compared to DPP4-inhibitors. These benefits were even more significant in the non-insulin users and patients with dyslipidemia.
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41
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Eroglu E, Heimbürger O, Lindholm B. Peritoneal dialysis patient selection from a comorbidity perspective. Semin Dial 2020; 35:25-39. [PMID: 33094512 DOI: 10.1111/sdi.12927] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 09/27/2020] [Accepted: 09/30/2020] [Indexed: 12/17/2022]
Abstract
Despite many medical and socioeconomic advantages, peritoneal dialysis (PD) is an underutilized dialysis modality that in most countries is used by only 5%-20% of dialysis patients, while the vast majority are treated with in-center hemodialysis. Several factors may explain this paradox, such as lack of experience and infrastructure for training and monitoring of PD patients, organizational issues, overcapacity of hemodialysis facilities, and lack of economic incentives for dialysis centers to use PD instead of HD. In addition, medical conditions that are perceived (rightly or wrongly) as contraindications to PD represent barriers for the use of PD because of their purported potential negative impact on clinical outcomes in patients starting PD. While there are few absolute contraindications to PD, high age, comorbidities such as diabetes mellitus, obesity, polycystic kidney disease, heart failure, and previous history of abdominal surgery and renal allograft failure, may be seen (rightly or wrongly) as relative contraindications and thus barriers to initiation of PD. In this brief review, we discuss how the presence of these conditions may influence the strategy of selecting patients for PD, focusing on measures that can be taken to overcome potential problems.
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Affiliation(s)
- Eray Eroglu
- Division of Nephrology, Department of Internal Medicine, Erciyes University School of Medicine, Kayseri, Turkey.,Division of Renal Medicine and Baxter Novum, Department of Clinical Science Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Olof Heimbürger
- Division of Renal Medicine and Baxter Novum, Department of Clinical Science Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Bengt Lindholm
- Division of Renal Medicine and Baxter Novum, Department of Clinical Science Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
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42
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Kaiafa G, Veneti S, Polychronopoulos G, Pilalas D, Daios S, Kanellos I, Didangelos T, Pagoni S, Savopoulos C. Is HbA1c an ideal biomarker of well-controlled diabetes? Postgrad Med J 2020; 97:380-383. [PMID: 32913038 DOI: 10.1136/postgradmedj-2020-138756] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Accepted: 08/15/2020] [Indexed: 12/16/2022]
Abstract
HbA1c is a biomarker with a central role in the diagnosis and follow-up of patients with diabetes, although not a perfect one. Common comorbidities encountered in patients with diabetes mellitus, such as renal insufficiency, high output states (iron deficiency anaemia, haemolytic anaemia, haemoglobinopathies and pregnancy) and intake of specific drugs could compromise the sensitivity and specificity of the biomarker. COVID-19 pandemic poses a pressing challenge for the diabetic population, since maintaining optimal blood glucose control is key to reduce morbidity and mortality rates. Alternative methods for diabetes management, such as fructosamine, glycosylated albumin and device-based continuous glucose monitoring, are discussed.
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Affiliation(s)
- Georgia Kaiafa
- First Propedeutic Department of Internal Medicine, AHEPA University Hospital, Medical School, Aristotle University of Thessaloniki, Greece
| | - Stavroula Veneti
- First Propedeutic Department of Internal Medicine, AHEPA University Hospital, Medical School, Aristotle University of Thessaloniki, Greece
| | - George Polychronopoulos
- First Propedeutic Department of Internal Medicine, AHEPA University Hospital, Medical School, Aristotle University of Thessaloniki, Greece
| | - Dimitrios Pilalas
- First Propedeutic Department of Internal Medicine, AHEPA University Hospital, Medical School, Aristotle University of Thessaloniki, Greece
| | - Stylianos Daios
- Internal Medicine Department, General Hospital of Serres, Greece
| | - Ilias Kanellos
- First Propedeutic Department of Internal Medicine, AHEPA University Hospital, Medical School, Aristotle University of Thessaloniki, Greece
| | - Triantafyllos Didangelos
- First Propedeutic Department of Internal Medicine, AHEPA University Hospital, Medical School, Aristotle University of Thessaloniki, Greece
| | - Stamatina Pagoni
- 3rd Department of Internal Medicine, "G. Gennimatas" General Hospital of Athens, Greece.,Hellenic Society of Internal Medicine, Athens, Greece
| | - Christos Savopoulos
- First Propedeutic Department of Internal Medicine, AHEPA University Hospital, Medical School, Aristotle University of Thessaloniki, Greece
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Attri B, Goyal A, Gupta Y, Tandon N. Basal-Bolus Insulin Regimen for Hospitalised Patients with COVID-19 and Diabetes Mellitus: A Practical Approach. Diabetes Ther 2020; 11:2177-2194. [PMID: 32683660 PMCID: PMC7368619 DOI: 10.1007/s13300-020-00873-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND AND AIM The coronavirus disease 2019 (COVID-19) outbreak has rapidly crossed international boundaries and placed increasing demands on healthcare facilities worldwide. Patients with diabetes and uncontrolled blood glucose levels are at increased risk for poor clinical outcomes and in-hospital mortality related to COVID-19. Therefore, achieving good glycaemic control is of paramount importance among hospitalised patients with COVID-19. Basal-bolus insulin therapy is a safe and effective intervention for the management of hyperglycaemia in hospitalised patients. The aim of this article is to provide a practical guidance for the use of the basal-bolus insulin regimen in hospitalised patients with COVID-19 and diabetes mellitus. METHODS This guidance document was formulated based on the review of available literature and the combined personal experiences of the authors. We provide a comprehensive review on the use of the basal-bolus insulin regimen, including its principles, rationale, indications, prerequisites, initiation, and dose titration, and also suggest targets for blood glucose control and different levels of capillary blood glucose monitoring. Various case scenarios are used to illustrate how optimal glucose control can be achieved, such as through adjustments in doses of prandial and basal insulin, the use of correctional insulin dosing and changes in the timing and content of major and minor meals. CONCLUSION The practical guidance for the use of the basal-bolus insulin regimen in hospitalised patients with COVID-19 and diabetes mellitus presented here can be used for patients admitted to hospital for indications other than COVID-19 and for those in ambulatory care.
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Affiliation(s)
- Bhawna Attri
- Department of Endocrinology and Metabolism, All India Institute of Medical Sciences, New Delhi, India
| | - Alpesh Goyal
- Department of Endocrinology and Metabolism, All India Institute of Medical Sciences, New Delhi, India
| | - Yashdeep Gupta
- Department of Endocrinology and Metabolism, All India Institute of Medical Sciences, New Delhi, India.
| | - Nikhil Tandon
- Department of Endocrinology and Metabolism, All India Institute of Medical Sciences, New Delhi, India.
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Varikasuvu SR, Sulekar H, Aloori S, Thangappazham B. The association of non-invasive skin autofluorescence measurements with cardiovascular and all-cause mortality in hemodialysis patients: a meta-analysis. Int Urol Nephrol 2020; 52:1757-1769. [PMID: 32661621 DOI: 10.1007/s11255-020-02543-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Accepted: 06/15/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND This systematic review and meta-analysis were aimed to study the association of tissue accumulation of advanced glycation end products (AGEs) measured as skin autofluorescence (SAF) with cardiovascular disease (CVD), cardiovascular mortality (CVM) and all-cause mortality (ACM) in hemodialysis (HD) patients. METHODS All major databases were searched for relevant studies reporting SAF in dialysis patients. Data for meta-analyses were extracted in the form of odds ratios (OR) and/or hazard ratios (HR) and the pooled overall outcomes were computed for the association of SAF with CVD, CVM, ACM in HD patients using either fixed or random effects meta-analysis based on the between-study heterogeneity. The sensitivity and meta-regression analyses were performed. RESULTS We included nine studies in this meta-analysis. The SAF levels were associated with higher risk for cardiovascular morbidity (pooled OR = 2.59, Z = 2.30, P = 0.02), cardiovascular (pooled HR = 3.03, Z = 3.13, P = 0.002) and overall mortalities (pooled HR = 2.23, Z = 6.30, P < 0.001) in HD patients. CONCLUSION In HD patients, the novel and non-invasive measurement of tissue AGEs as SAF levels could be useful for risk estimating the cardiovascular and all-cause mortalities.
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Affiliation(s)
- Seshadri Reddy Varikasuvu
- Department of Biochemistry, All India Institute of Medical Sciences (AIIMS), Deoghar, Jharkhand, 814152, India.
| | - Harish Sulekar
- Department of Urology, M. Ch Resident, Vijayanagara Institute of Medical Sciences, Ballary, Karnataka, 583104, India
| | - Sowjanya Aloori
- Department of Health Education, Telangana State Residential School and College, Choutuppal, Telangana, 508252, India
| | - Balachandar Thangappazham
- Department of Internal Medicine, All India Institute of Medical Sciences (AIIMS), Bibinagar, Telangana, 508126, India
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Okazaki M, Inaguma D, Imaizumi T, Hishida M, Kurasawa S, Kubo Y, Kato S, Yasuda Y, Katsuno T, Kaneda F, Maruyama S. Impact of old age on the association between in-center extended-hours hemodialysis and mortality in patients on incident hemodialysis. PLoS One 2020; 15:e0235900. [PMID: 32649701 PMCID: PMC7351168 DOI: 10.1371/journal.pone.0235900] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Accepted: 06/25/2020] [Indexed: 11/18/2022] Open
Abstract
With the global problem of aging, it has become more difficult to improve the prognosis of older dialysis patients. Extended-hours hemodialysis offers longer treatment time compared to conventional hemodialysis regimen and provides favorable metabolic status, hemodynamic stability, and increased dietary intake. Despite prior studies reporting that in-center extended-hours hemodialysis can reduce the mortality rate, the treatment impact on elderly patients remains unclear. Therefore, we examined the association between extended-hours hemodialysis compared to conventional hemodialysis and all-cause mortality. Survival analyses using Cox proportional hazard model with multivariable adjustments and propensity-score based method were performed to compare mortality risk between 198 consecutive patients who started in-center extended-hours hemodialysis (Extended-HD) and 1407 consecutive patients who initiated conventional hemodialysis. The median age was 67.1 years in the Extended-HD group and 70.7 years in the conventional hemodialysis group. Extended-HD was associated with lower all-cause mortality in overall patients and the subgroup >70 years (adjusted hazard ratios of 0.60 [95% CI, 0.39–0.91] and 0.35 [95% CI, 0.18–0.69], respectively). There was a significant interaction between age >70 years and Extended-HD. In conclusion, extended-hours hemodialysis was associated with a lower mortality rate, especially in elderly patients.
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Affiliation(s)
- Masaki Okazaki
- Department of Nephrology, Nagoya University Graduate School of Medicine, Nagoya, Japan
- Department of Clinical Trials and Research, National Hospital Organization Nagoya Medical Center, Nagoya, Japan
| | - Daijo Inaguma
- Department of Nephrology, Fujita Health University School of Medicine, Toyoake, Japan
| | - Takahiro Imaizumi
- Department of Nephrology, Nagoya University Graduate School of Medicine, Nagoya, Japan
- Department of Advanced Medicine, Nagoya University Hospital, Nagoya, Japan
- Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
| | - Manabu Hishida
- Department of Nephrology, Nagoya University Graduate School of Medicine, Nagoya, Japan
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Shimon Kurasawa
- Department of Nephrology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yoko Kubo
- Department of Preventive Medicine, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Sawako Kato
- Department of Nephrology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yoshinari Yasuda
- Department of Nephrology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Takayuki Katsuno
- Department of Nephrology and Rheumatology, Aichi Medical University School of Medicine, Nagakute, Japan
| | | | - Shoichi Maruyama
- Department of Nephrology, Nagoya University Graduate School of Medicine, Nagoya, Japan
- * E-mail:
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Varikasuvu SR, Aloori S, Bhongir AV. Higher skin autofluorescence detection using AGE-Reader™ technology as a measure of increased tissue accumulation of advanced glycation end products in dialysis patients with diabetes: a meta-analysis. J Artif Organs 2020; 24:44-57. [PMID: 32613473 DOI: 10.1007/s10047-020-01189-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Accepted: 06/23/2020] [Indexed: 12/18/2022]
Abstract
This meta-analysis was conducted to compare skin autofluorescence (SAF) levels as a measure of advanced glycation end products (AGEs) accumulation between diabetic and non-diabetic dialysis patients. Relevant studies were identified primarily by searching PubMed/MEDLINE and other online databases and manual searching of cross-references. Random-effects model was used to obtain standardized mean differences (SMD) as a summary statistic. Heterogeneity was tested with meta-regression and sub-group analyses. Publication bias and robustness of this meta-analysis were tested using funnel plot and sensitivity analyses. A total of 11 reports comparing SAF between diabetic and non-diabetic dialysis patients were finally included in this meta-analysis. Dialysis patients with diabetes showed significantly higher circulatory SAF levels than their non-diabetic counterparts (SMD = 0.39; P < 0.0001). The difference was more evident in hemodialysis modality (SMD = 0.40; P < 0.0001). A one-study leave-out sensitivity analysis validated the robustness of this meta-analysis. The presence of diabetes in dialysis patients is associated with increased AGEs accumulation reflected through SAF measurements using a novel and non-invasive AGE-Reader™ technology. Our findings are in support of considering anti-AGE therapeutic strategies in addition to standard glycemic management in dialysis patients with diabetes.
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Affiliation(s)
- Seshadri Reddy Varikasuvu
- Department of Biochemistry, All India Institute of Medical Sciences (AIIMS), Deoghar, Jharkhand, 814152, India.
| | - Sowjanya Aloori
- Department of Health Education, Telangana State Residential School and College, Choutuppal, Telangana, 508252, India
| | - Aparna Varma Bhongir
- Department of Biochemistry, All India Institute of Medical Sciences (AIIMS), Bibinagar, Telangana, 508126, India
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Min MS, Siemsen AW, Chutaro E, Musgrave JE, Wong RL, Palafox NA. Hemodialysis in the Compact Nations of the US Affiliated Pacific: History and Health Care Implications. HAWAI'I JOURNAL OF HEALTH & SOCIAL WELFARE 2020; 79:113-119. [PMID: 32596688 PMCID: PMC7311944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Background: The epidemic of non-communicable disease in the Compact nations of the US Affiliated Pacific Islands and the associated renal complications drive the demand for hemodialysis. Limited healthcare budgets and a lack of trained human health resources in these areas make hemodialysis a challenging undertaking that may require significant sacrifices in competing health care priorities. Methods: Two nephrologists who developed hemodialysis in the US Affiliated Pacific Islands provide its history. Cost estimates of hemodialysis for the Compact nations are collected from a 2014 hemodialysis feasibility report. The experiences and outcomes of current hemodialysis centers in the United States and other island nations provide a framework by which to assess the potential benefit and impact of hemodialysis in the Compact nations. Discussion: A consideration of how and why different stakeholders value hemodialysis will be crucial because they will drive the public's response to the institutionalization of any new intervention or the cessation of any existing intervention like hemodialysis. Conclusion: Updated cost estimates for dialysis clinics and data on renal disease rates in the Compact nations will be necessary to make informed decisions about hemodialysis in the current health systems. In the meantime, it is essential to enhance current medical interventions and public health strategies to prevent kidney disease and decrease the risks for kidney failure. Such preventive interventions must be culturally appropriate, effective, cost-efficient, and sustainable in the unique context of the Pacific.
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Affiliation(s)
- Margaret S. Min
- Department of Family Medicine and Community Health, John A. Burns School of Medicine, University of Hawai‘i, Honolulu, HI (MSM, NAP)
| | - Arnold W. Siemsen
- St. Francis Medical Center, Renal Institute of the Pacific, Honolulu, HI (AWS)
- Department of Medicine, John A. Burns School of Medicine, University of Hawai‘i, Honolulu, HI (AWS)
| | - Emi Chutaro
- Pacific Island Health Officers Association, Honolulu, HI (EC)
| | - James E. Musgrave
- Department of Pediatrics, John A. Burns School of Medicine, University of Hawai‘i, Honolulu, HI (JEM)
| | | | - Neal A. Palafox
- Department of Family Medicine and Community Health, John A. Burns School of Medicine, University of Hawai‘i, Honolulu, HI (MSM, NAP)
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The use of diazoxide in the management of spontaneous hypoglycemia in patients with ESRD. CEN Case Rep 2020; 9:271-277. [PMID: 32274651 DOI: 10.1007/s13730-020-00471-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Accepted: 03/25/2020] [Indexed: 01/10/2023] Open
Abstract
Although diabetes remains the number one cause of renal failure nationwide, spontaneous hypoglycemia in patients with CKD has also been described in the absence of exogenous insulin or any other diabetes treatment. Decreased renal gluconeogenesis and impaired renal insulin clearance are underlying mechanisms of hypoglycemia in individuals with ESRD. Diazoxide was originally approved as an anti-hypertensive medication, but also is known to bind ATP-sensitive K channels in the beta cells of the pancreas, ultimately leading to inhibition of insulin release. We detail six cases of ESRD-associated hypoglycemia which responded to treatment with diazoxide therapy.
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Zhang LS, Li J, Jia-Ping L. Rhein-8-O-β-D-glucopyranoside inhibited high glucose-induced apoptosis of human mesangial cells by regulating the lincRNA ANRIL/let-7a/TGF-β1/Smad signaling pathway. Exp Ther Med 2020; 19:2871-2878. [PMID: 32256771 PMCID: PMC7086228 DOI: 10.3892/etm.2020.8544] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2017] [Accepted: 11/22/2019] [Indexed: 01/10/2023] Open
Abstract
Diabetic nephropathy is one of most frequent complications of diabetes, and is the major cause of end-stage disease in diabetic patients. The present study investigated the roles and mechanisms of Rhein-8-O-β-D-glucopyranoside (Rg) protecting human mesangial cells (HMCs) from high glucose (HG)-induced apoptosis. Using a Cell Counting Kit-8 assay the proliferation of HMCs was analyzed, and flow cytometry was applied to detect apoptosis. The apoptosis-associated protein Bcl-2, caspase-3 and members of the transforming growth factor-β1 (TGF-β1)/Smad signaling pathway were analyzed using a western blotting assay. HG significantly induced HMC apoptosis, and Rg markedly attenuated the HG-induced apoptosis. HG decreased the Bcl-2 expression and increased the caspase-3 expression, and Rg treatment recovered the expressions of Bcl-2 and caspase-3 affected by HG. The underlying mechanisms were further analyzed, and it was demonstrated that HG significantly upregulated the long intervening non-coding RNA (lincRNA) ANRIL expression level, downregulated let-7a expression and activated the TGF-β1/Smad signaling pathway; Rg treatment recovered the expressions of lincRNA ANRIL and let-7a, and inhibited the TGF-β1/Smad signaling pathway in the condition of HG. In conclusion, the present results suggested that Rg attenuated HG-induced apoptosis of HMCs by regulating the lincRNA ANRIL/let-7a/TGF-β1/Smad signaling pathway.
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Affiliation(s)
- Lan-Sheng Zhang
- School of Pharmacy and Chemistry, Dali University, Dali, Yunnan 671000, P.R. China
| | - Jing Li
- School of Pharmacy and Chemistry, Dali University, Dali, Yunnan 671000, P.R. China
| | - Liu Jia-Ping
- School of Pharmacy and Chemistry, Dali University, Dali, Yunnan 671000, P.R. China
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50
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Dawwas GK, Leonard CE, Garg M, Vouri SM, Smith SM, Flory JH, Genuardi MV, Park H. Twelve-year trends in pharmacologic treatment of type 2 diabetes among patients with heart failure in the United States. Diabetes Obes Metab 2020; 22:705-710. [PMID: 31903713 DOI: 10.1111/dom.13949] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Revised: 12/16/2019] [Accepted: 12/26/2019] [Indexed: 12/19/2022]
Abstract
We conducted a cross-sectional analysis using a database from commercial health plans in the United States to describe trends in the use of antidiabetic medications among patients with type 2 diabetes and heart failure (HF) from 2006 through 2017. We used loop diuretic dose as a surrogate for HF severity (mild HF 0-40 mg/day, moderate-severe HF >40 mg/day). We assessed antidiabetic medication dispensing in the 90 days following HF diagnosis. Over the 12-year period, we identified an increase in the use of metformin (39.2% vs. 62.6%), dipeptidyl peptidase-4 inhibitors (DPP-4i) (0.5% vs. 17.1%) and sodium-glucose co-transporter-2 inhibitors (SGLT-2i) (0.0% vs. 9.0%), but a decrease in the use of sulphonylureas (47.8% vs. 27.8%) and thiazolidinediones (TZDs) (31.7% vs. 5.3%). In 2017, patients with moderate-severe HF more commonly used insulin (43.1%); a majority of mild HF patients used metformin (62.8%). A proportion of patients with moderate-severe HF used TZDs (4.4%). Among patients with diabetes and HF, the use of metformin and DPP-4i rapidly increased, but a proportion of patients with moderate-severe HF continued to use TZDs. Despite their promising cardiovascular safety profile, SGLT-2i use remains limited.
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Affiliation(s)
- Ghadeer K Dawwas
- Center for Pharmacoepidemiology Research and Training, Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Charles E Leonard
- Center for Pharmacoepidemiology Research and Training, Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Mahek Garg
- Department of Pharmaceutical Outcomes and Policy, Center for Drug Evaluation and Safety, College of Pharmacy, University of Florida, Gainesville, Florida
| | - Scott M Vouri
- Department of Pharmaceutical Outcomes and Policy, Center for Drug Evaluation and Safety, College of Pharmacy, University of Florida, Gainesville, Florida
| | - Steven M Smith
- Department of Pharmaceutical Outcomes and Policy, Center for Drug Evaluation and Safety, College of Pharmacy, University of Florida, Gainesville, Florida
- Department of Pharmacotherapy and Translational Research, College of Pharmacy, University of Florida, Gainesville, Florida
| | - James H Flory
- Center for Pharmacoepidemiology Research and Training, Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
- Endocrinology Service, Department of Subspecialty Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Michael V Genuardi
- Cardiovascular Division, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Haesuk Park
- Department of Pharmaceutical Outcomes and Policy, Center for Drug Evaluation and Safety, College of Pharmacy, University of Florida, Gainesville, Florida
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