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Migdalis IN, Papanas N, Raptis AE, Ioannidis IM, Sotiropoulos AE, Dimitriadis GD. The prevalence of diabetic chronic kidney disease in adult Greek subjects with type 2 diabetes mellitus: A series from hospital-based diabetes clinics. Diabetes Res Clin Pract 2020; 166:108243. [PMID: 32502694 DOI: 10.1016/j.diabres.2020.108243] [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: 02/05/2020] [Revised: 05/16/2020] [Accepted: 05/23/2020] [Indexed: 02/06/2023]
Abstract
AIMS To examine the prevalence of diabetic chronic kidney disease (DCKD) and its risk factors in adult Greek subjects with type 2 diabetes mellitus (T2DM) in a population from hospital-based diabetes clinics. METHODS This is a cross-sectional multicentre study based on data collected from Greek hospital-based diabetes clinics from June 2015 to March 2016. DCKD severity was defined according to the Kidney Disease: Improving Global Outcomes (KDIGO) 2012 guidelines. Multivariate analyses assessed the associations between DCKD and its potential risk factors. RESULTS Among the entire population (n = 1759), the overall prevalence of DCKD was 45% including mild, moderate and severe CKD. Older age, male gender, body-mass index, lack of exercise and diabetes duration were significantly associated with DCKD. CONCLUSIONS In Greece, DCKD in T2DM is highly prevalent. It is significantly associated with demographic and lifestyle parameters, as well as T2DM complications, suggesting that further efforts to prevent DCKD should be addressed to subjects with specific characteristics.
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Affiliation(s)
- Ilias N Migdalis
- Second Medical Department and Diabetes Centre, NIMTS Hospital, Monis Petraki 10-12, Athens, Greece.
| | - Nikolaos Papanas
- Diabetes Centre, Second Department of Internal Medicine, Democritus University of Thrace, University Hospital of Alexandroupolis, Alexandroupolis, Greece
| | - Athanasios E Raptis
- Second Department of Internal Medicine, Research Institute and Diabetes Center, Attikon University Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Ioannis M Ioannidis
- Diabetes Centre, First Department of Internal Medicine, General Hospital of Nea Ionia Konstantopoulio-Patision, Athens, Greece
| | - Alexios E Sotiropoulos
- Diabetes Centre, Third Department of Internal Medicine, General Hospital of Nikaia, Piraeus, Greece
| | - George D Dimitriadis
- Second Department of Internal Medicine, Research Institute and Diabetes Center, Attikon University Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
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Gowd V, Kang Q, Wang Q, Wang Q, Chen F, Cheng KW. Resveratrol: Evidence for Its Nephroprotective Effect in Diabetic Nephropathy. Adv Nutr 2020; 11:1555-1568. [PMID: 32577714 PMCID: PMC7666903 DOI: 10.1093/advances/nmaa075] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Revised: 04/08/2020] [Accepted: 05/29/2020] [Indexed: 12/11/2022] Open
Abstract
Diabetic nephropathy (DN) is a severe complication of diabetes mellitus (DM). Dietary habits play a major role in determining the onset and progression of DM-related disorders and a proper diet (rich in fruits and vegetables) can delay or prevent the process of DM pathogenesis. Thus, increasing attention has been paid to polyphenols and polyphenol-rich foods since their increased intake has been associated with a reduced incidence of DM and its associated complications. Resveratrol is a polyphenolic phytoalexin that is mainly found in grapevines and berries. It is available in various pharmaceutical dosages and is widely recommended as a dietary supplement due to its beneficial effects. Remarkably, resveratrol's capability to effectively lower blood glucose levels without any side effects has been amply demonstrated in many in vitro and in vivo studies. Herein, we comprehensively review and discuss the nephroprotective effect of resveratrol during DN and its associated mechanisms. Resveratrol exerts its nephroprotective effects via various mechanisms including reducing oxidative stress and advanced glycation end-product (AGE) production, stimulating autophagy, inhibiting endoplasmic reticulum (ER) stress and inflammation, ameliorating lipotoxicity, activating the AMP kinase (AMPK) pathway, and modulating angiogenesis. Moreover, the use of resveratrol as an adjuvant to conventional antidiabetic therapies could be an effective approach to manage DN in humans. However, evidence is scarce to support whether resveratrol has beneficial effects in humans during DN. Therefore, clinical studies are warranted to elucidate resveratrol's role against DN.
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Affiliation(s)
- Vemana Gowd
- Shenzhen Key Laboratory of Marine Microbiome Engineering, Institute for Advanced Study, Shenzhen University, Shenzhen 518060, China,Key Laboratory of Optoelectronic Devices and Systems of Ministry of Education and Guangdong Province, College of Optoelectronic Engineering, Shenzhen University, Shenzhen 518060, China,Institute for Innovative Development of Food Industry, Shenzhen University, Shenzhen 518060, China
| | - Qingzheng Kang
- Shenzhen Key Laboratory of Marine Microbiome Engineering, Institute for Advanced Study, Shenzhen University, Shenzhen 518060, China,Key Laboratory of Optoelectronic Devices and Systems of Ministry of Education and Guangdong Province, College of Optoelectronic Engineering, Shenzhen University, Shenzhen 518060, China,Institute for Innovative Development of Food Industry, Shenzhen University, Shenzhen 518060, China
| | - Qi Wang
- Shenzhen Key Laboratory of Marine Microbiome Engineering, Institute for Advanced Study, Shenzhen University, Shenzhen 518060, China,Institute for Innovative Development of Food Industry, Shenzhen University, Shenzhen 518060, China,Institute for Food and Bioresource Engineering, College of Engineering, Peking University, Beijing 100871, China
| | - Qiang Wang
- Institute of Food Science and Technology, Chinese Academy of Agricultural Sciences/Key Laboratory of Agro-Products Processing, Ministry of Agriculture, Beijing 100193, Beijing, China
| | - Feng Chen
- Shenzhen Key Laboratory of Marine Microbiome Engineering, Institute for Advanced Study, Shenzhen University, Shenzhen 518060, China,Institute for Innovative Development of Food Industry, Shenzhen University, Shenzhen 518060, China
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Heerspink HJL, de Zeeuw D. Treating diabetic complications; from large randomized clinical trials to precision medicine. Diabetes Obes Metab 2018; 20 Suppl 3:3-5. [PMID: 30294952 PMCID: PMC6221145 DOI: 10.1111/dom.13418] [Citation(s) in RCA: 5] [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: 05/29/2018] [Accepted: 06/08/2018] [Indexed: 12/15/2022]
Abstract
In the last decades, many large randomized controlled trials have been conducted to assess the efficacy and safety of new interventions for the treatment of diabetic kidney disease (DKD). Unfortunately, these trials failed to demonstrate additional kidney or cardiovascular protection. One of the explanations for the failure of these trials appears to be the large variation in drug response between individual patients. All trials to date tested a drug which was targeted to a large heterogeneous population assuming that every individual will show a similar beneficial respond to the drug. Post hoc analyses from the past clinical trials, however, suggest that individual patients show a marked variation in drug response. This highlights the need to personalize treatment taking proper account of the characteristics and preferences of individual patients. Transitioning to a personalized therapy approach will have implications for clinical trial designs, drug registration and its use in clinical practice. Successful implementation of personalized medicine thus requires engagement of multiple stakeholders including academic community, pharmaceutical industry, regulatory agencies, health policy makers, physicians and patients. This supplement of Diabetes Obesity and Metabolism provides a summary on the state-of-the-art of personalized medicine in diabetic kidney disease from the views of various stakeholders.
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Affiliation(s)
- Hiddo J. L. Heerspink
- Department of Clinical Pharmacy and PharmacologyUniversity of Groningen, University Medical Center GroningenGroningenthe Netherlands
| | - Dick de Zeeuw
- Department of Clinical Pharmacy and PharmacologyUniversity of Groningen, University Medical Center GroningenGroningenthe Netherlands
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Robles NR, Villa J, Felix FJ, Fernandez-Berges D, Lozano L. Non-proteinuric diabetic nephropathy is the main cause of chronic kidney disease: Results of a general population survey in Spain. Diabetes Metab Syndr 2017; 11 Suppl 2:S777-S781. [PMID: 28602847 DOI: 10.1016/j.dsx.2017.05.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2017] [Accepted: 05/31/2017] [Indexed: 02/08/2023]
Abstract
BACKGROUND Diabetic nephropathy traditionally produces significant proteinuria prior to the development of renal impairment. However, this clinical paradigm has recently been questioned. The current study evaluated the impact of diabetes mellitus on the prevalence of renal disease in general population. METHODOLOGY Data from of the HERMEX survey, an observational, cross sectional, population based study were used. The final sample included 2813 subjects (mean age 51.2 years, 53.5% female). Four hundred patients have diabetes. Urinary albumin excretion (UAE) rate was analyzed and glomerular filtration rate (GFR) was estimated using the CKD-EPI formula. RESULTS Among participants without diabetes, 2.9%(2.2-3.6) had a GFR < 60 ml/min. Prevalence of abnormal UAE in population without diabetes was 3.3% (2.6-4.0). The global prevalence of renal disease was 5.6%(4.8-6.6). Prevalence of GFR <60 ml/min in subjects with diabetes was 8.8%(6.4-11.9)(p<0.001,Chi-square test). Prevalence of abnormal UAE in population with diabetes was 14.1%(7.7-19.8)(p< 0.001,Chi-square test). CKD prevalence was 20.3%(16.6-24.6)(p<0.001,Chi-square test). The logistic regression analysis showed a positive independent association of CKD with age, high blood pressure and albuminuria. No significant relationship was found with diabetes mellitus CONCLUSIONS: CKD is more prevalent in population with diabetes. Nevertheless, most of patients with diabetes and CKD have no albuminuria. An increased cardiovascular burden seems to produce this clinical presentation.
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Affiliation(s)
- N R Robles
- Cátedra de Riesgo Vascular, Facultad de Medicina, Universidad de Salamanca, Salamanca, Spain; Servicio de Nefrologia, Hospital Infanta Cristina, Badajoz, Spain.
| | - J Villa
- Servicio de Nefrologia, Hospital Infanta Cristina, Badajoz, Spain
| | - F J Felix
- Centro de Salud Villanueva de la Serena-Norte, Villanueva de la Serena, Badajoz, Spain; Unidad de Investigación CIMEX, Programa de Investigación en Enfermedades Cardiovasculares, FUNDESALUD, Badajoz, Spain
| | - D Fernandez-Berges
- Hospital de Don Benito-Villanueva de la Serena, Badajoz, Spain, Spain; Unidad de Investigación CIMEX, Programa de Investigación en Enfermedades Cardiovasculares, FUNDESALUD, Badajoz, Spain
| | - L Lozano
- Centro de Salud Merida, Badajoz, Spain
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Robles NR, Villa J, Gallego RH. Non-Proteinuric Diabetic Nephropathy. J Clin Med 2015; 4:1761-73. [PMID: 26371050 PMCID: PMC4600158 DOI: 10.3390/jcm4091761] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2015] [Revised: 08/11/2015] [Accepted: 08/26/2015] [Indexed: 12/13/2022] Open
Abstract
Diabetic nephropathy patients traditionally show significant macroalbuminuria prior to the development of renal impairment. However, this clinical paradigm has recently been questioned. Epidemiological surveys confirm that chronic kidney disease (CKD) diagnosed by a low glomerular filtration rate (GFR) is more common in diabetic patients than in the non-diabetic population but a low number of patients had levels of proteinuria above that which traditionally defines overt diabetic nephropathy (>500 mg/g). The large number of patients with low levels of proteinuria suggests that the traditional clinical paradigm of overt diabetic nephropathy is changing since it does not seem to be the underlying renal lesion in most of diabetic subjects with CKD.
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Affiliation(s)
- Nicolas Roberto Robles
- Cátedra de Riesgo Vascular, Facultad de Medicina, Universidad de Salamanca, Salamanca 37007, Spain.
| | - Juan Villa
- Servicio de Nefrologia, Hospital Infanta Cristina, Badajoz 06070, Spain.
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Dwyer JP, Lewis JB. Nonproteinuric diabetic nephropathy: when diabetics don't read the textbook. Med Clin North Am 2013; 97:53-8. [PMID: 23290729 DOI: 10.1016/j.mcna.2012.10.006] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Diabetic nephropathy (DN) refers to the structural and functional changes in the kidneys of patients with diabetes mellitus (type 1 or 2). A subset of patients with presumed DN may not have overt proteinuria as a prerequisite to renal failure, contrary to the classical paradigm. No animal model fully recapitulates the human subset. All studies on this subject are observational and most lack biopsy data. Many mechanisms have been postulated, including use of renin-angiotensin system agents, recurrent bouts of acute kidney injury, genetic predisposition, and renal lesions other than DN. A well-designed biopsy study and a series of intervention trials are needed to fully understand this entity.
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Affiliation(s)
- Jamie P Dwyer
- Division of Nephrology and Hypertension, and Nephrology Clinical Trials Center, Vanderbilt University Medical Center, Nashville, TN 37232, USA.
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Freeman JS, Gross B. Potential drug interactions associated with treatments for type 2 diabetes and its comorbidities: a clinical pharmacology review. Expert Rev Clin Pharmacol 2012; 5:31-42. [PMID: 22142157 DOI: 10.1586/ecp.11.64] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Type 2 diabetes is a disease of glucose metabolism that commonly involves multiple comorbidities, including lipid dyscrasias and hypertension. Each concurrent disorder contributes some risk of complications and requires therapeutic intervention. The simultaneous management of so many coexisting illnesses can be complex and commonly results in patients being prescribed multiple medications--referred to as polypharmacy--which may further complicate treatment. To ensure the best patient outcomes, the treating physician must be aware of all the therapeutic agents that a patient is taking to assess possible drug interactions that such a plethora of medications may confer. This article addresses the underlying comorbidites, the drugs commonly used to treat them and the interactions that may arise from concomitant administration.
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Affiliation(s)
- Jeffrey S Freeman
- Division of Endocrinology and Metabolism, Philadelphia College of Osteopathic Medicine 4190 City Avenue, Philadelphia, PA 19131-1626, USA.
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Current world literature. Curr Opin Endocrinol Diabetes Obes 2012; 19:142-7. [PMID: 22374141 DOI: 10.1097/med.0b013e3283520fe6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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