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Gui Y, Palanza Z, Fu H, Zhou D. Acute kidney injury in diabetes mellitus: Epidemiology, diagnostic, and therapeutic concepts. FASEB J 2023; 37:e22884. [PMID: 36943403 PMCID: PMC10602403 DOI: 10.1096/fj.202201340rr] [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: 08/15/2022] [Revised: 02/16/2023] [Accepted: 03/08/2023] [Indexed: 03/23/2023]
Abstract
Acute kidney injury (AKI) and diabetes mellitus (DM) are public health problems that cause a high socioeconomic burden worldwide. In recent years, the landscape of AKI etiology has shifted: Emerging evidence has demonstrated that DM is an independent risk factor for the onset of AKI, while an alternative perspective considers AKI as a bona fide complication of DM. Therefore, it is necessary to systematically characterize the features of AKI in DM. In this review, we summarized the epidemiology of AKI in DM. While focusing on circulation- and tissue-specific microenvironment changes after DM, we described the active cellular and molecular mechanisms of increased kidney susceptibility to AKI under DM stress. We also reviewed the current diagnostic and therapeutic strategies for AKI in DM recommended in the clinic. Updated recognition of the epidemiology, pathophysiology, diagnosis, and medications of AKI in DM is believed to reveal a path to mitigate the frequency of AKI and DM comorbidity that will ultimately improve the quality of life in DM patients.
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Affiliation(s)
- Yuan Gui
- Division of Nephrology, Department of Medicine, University of Connecticut School of Medicine, Farmington, CT, 06030, USA
| | - Zachary Palanza
- Division of Nephrology, Department of Medicine, University of Connecticut School of Medicine, Farmington, CT, 06030, USA
| | - Haiyan Fu
- State Key Laboratory of Organ Failure Research, National Clinical Research Center of Kidney Disease, Division of Nephrology, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China
- Department of Pathology, University of Pittsburgh School of Medicine, Pittsburgh, PA, 15261, USA
| | - Dong Zhou
- Division of Nephrology, Department of Medicine, University of Connecticut School of Medicine, Farmington, CT, 06030, USA
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A Simple Nomogram to Predict Contrast-Induced Acute Kidney Injury in Patients with Congestive Heart Failure Undergoing Coronary Angiography. Cardiol Res Pract 2021; 2021:9614953. [PMID: 33859840 PMCID: PMC8009707 DOI: 10.1155/2021/9614953] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 02/12/2021] [Accepted: 03/10/2021] [Indexed: 11/30/2022] Open
Abstract
Background Patients with congestive heart failure (CHF) are vulnerable to contrast-induced kidney injury (CI-AKI), but few prediction models are currently available. Therefore, we aimed to establish a simple nomogram for CI-AKI risk assessment for patients with CHF undergoing coronary angiography. Methods A total of 1876 consecutive patients with CHF (defined as New York Heart Association functional class II-IV or Killip class II-IV) were enrolled and randomly (2:1) assigned to a development cohort and a validation cohort. The endpoint was CI-AKI defined as serum creatinine elevation of ≥0.3 mg/dL or 50% from baseline within the first 48–72 hours following the procedure. Predictors for the simple nomogram were selected by multivariable logistic regression with a stepwise approach. The discriminative power was assessed using the area under the receiver operating characteristic (ROC) curve and was compared with the classic Mehran score in the validation cohort. Calibration was assessed using the Hosmer–Lemeshow test and 1000 bootstrap samples. Results The incidence of CI-AKI was 9.06% (170) in the total sample, 8.64% (n = 109) in the development cohort, and 9.92% (n = 61) in the validation cohort (P=0.367). The simple nomogram including four predictors (age, intra-aortic balloon pump, acute myocardial infarction, and chronic kidney disease) demonstrated a similar predictive power as the Mehran score (area under the curve: 0.80 vs. 0.75, P=0.061), as well as a well-fitted calibration curve. Conclusions The present simple nomogram including four predictors is a simple and reliable tool to identify CHF patients at risk of CI-AKI, whereas further external validations are needed.
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Lun Z, Lei L, Zhou D, Ying M, Liu L, Chen G, Liu J, He Y, Li H, Huang Z, Yang Y, Ye J, Liu Y. A comparison between two different definitions of contrast-associated acute kidney injury for long-term mortality in patients with diabetes undergoing coronary angiography: a prospective cohort study. BMC Cardiovasc Disord 2020; 20:485. [PMID: 33198639 PMCID: PMC7670693 DOI: 10.1186/s12872-020-01778-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 11/09/2020] [Indexed: 01/22/2023] Open
Abstract
Background The definitions of contrast-associated acute kidney injury (CA-AKI) are diverse and have different predictive effects for prognosis, which are adverse for clinical practice. Few articles have discussed the relationship between these definitions and long-term prognosis in patients with diabetes. Methods A total of 1154 diabetic patients who were undergoing coronary angiography (CAG) were included in this study. Two definitions of CA-AKI were used: CA-AKIA was defined as an increase ≥ 0.3 mg/dl or > 50% in serum creatinine (SCr) from baseline within 72 h after CAG, and CA-AKIB was defined as an increase ≥ 0.5 mg/dl or > 25% in SCr from baseline within 72 h after CAG. We used Cox regression to evaluate the association of these two CA-AKI definitions with long-term mortality and calculate the population attributable risks (PARs) of different definitions for long-term prognosis. Results During the median follow-up period of 7.4 (6.2–8.2) years, the overall long-term mortality was 18.84%, and the long-term mortality in patients with CA-AKI according to both CA-AKIA and CA-AKIB criteria were 36.73% and 28.86%, respectively. We found that CA-AKIA (HR: 2.349, 95% CI 1.570–3.517, p = 0.001) and CA-AKIB (HR: 1.608, 95% CI 1.106–2.339, p = 0.013) were associated with long-term mortality. The PARs were the highest for CA-AKIA (31.14%), followed by CA-AKIB (14.93%). Conclusions CA-AKI is a common complication in diabetic patients receiving CAG. The two CA-AKI definitions are significantly associated with a poor long-term prognosis, and CA-AKIA, with the highest PAR, needs more clinical attention.
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Affiliation(s)
- Zhubin Lun
- The First School of Clinical Medicine, Guangdong Medical University, Zhanjiang, 523808, China.,Department of Cardiology, Dongguan TCM Hospital, Dongguan, 523000, China.,Department of Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, The Affiliated Guangdong Provincial People's Hospital of South China University of Technology, Guangdong Academy of Medical Sciences, Guangzhou, 510080, China
| | - Li Lei
- Department of Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, The Affiliated Guangdong Provincial People's Hospital of South China University of Technology, Guangdong Academy of Medical Sciences, Guangzhou, 510080, China.,The Second School of Clinical Medicine, Southern Medical University, Guangzhou, 510515, China
| | - Dianhua Zhou
- Department of Cardiology, Dongguan TCM Hospital, Dongguan, 523000, China
| | - Ming Ying
- Department of Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, The Affiliated Guangdong Provincial People's Hospital of South China University of Technology, Guangdong Academy of Medical Sciences, Guangzhou, 510080, China
| | - Liwei Liu
- Department of Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, The Affiliated Guangdong Provincial People's Hospital of South China University of Technology, Guangdong Academy of Medical Sciences, Guangzhou, 510080, China.,The Second School of Clinical Medicine, Southern Medical University, Guangzhou, 510515, China
| | - Guanzhong Chen
- Department of Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, The Affiliated Guangdong Provincial People's Hospital of South China University of Technology, Guangdong Academy of Medical Sciences, Guangzhou, 510080, China
| | - Jin Liu
- Department of Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, The Affiliated Guangdong Provincial People's Hospital of South China University of Technology, Guangdong Academy of Medical Sciences, Guangzhou, 510080, China
| | - Yibo He
- Department of Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, The Affiliated Guangdong Provincial People's Hospital of South China University of Technology, Guangdong Academy of Medical Sciences, Guangzhou, 510080, China
| | - Huanqiang Li
- Department of Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, The Affiliated Guangdong Provincial People's Hospital of South China University of Technology, Guangdong Academy of Medical Sciences, Guangzhou, 510080, China
| | - Zhidong Huang
- Department of Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, The Affiliated Guangdong Provincial People's Hospital of South China University of Technology, Guangdong Academy of Medical Sciences, Guangzhou, 510080, China
| | - Yongquan Yang
- Department of Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, The Affiliated Guangdong Provincial People's Hospital of South China University of Technology, Guangdong Academy of Medical Sciences, Guangzhou, 510080, China
| | - Jianfeng Ye
- Department of Cardiology, Dongguan TCM Hospital, Dongguan, 523000, China.
| | - Yong Liu
- Department of Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, The Affiliated Guangdong Provincial People's Hospital of South China University of Technology, Guangdong Academy of Medical Sciences, Guangzhou, 510080, China.
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Izkhakov E, Rozenbaum Z, Margolis G, Khoury S, Keren G, Shacham Y. Prolonged Hyperglycemia and Renal Failure after Primary Percutaneous Coronary Intervention. Cardiorenal Med 2019; 9:92-99. [PMID: 30636246 DOI: 10.1159/000495704] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Accepted: 11/13/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND There are limited data regarding the effect of long-standing hyperglycemia on the occurrence of acute kidney injury (AKI) in ST segment elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary intervention (PCI). METHODS We retrospectively studied 723 STEMI patients undergoing primary PCI. Patients were stratified into two groups according to glycated hemoglobin (HbA1c) levels as a marker of prolonged hyperglycemia: those with HbA1c < 7% and those with HbA1c ≥7%. Medical records were reviewed for the occurrence of AKI. RESULTS HbA1c levels ≥7% were found in 225/723 (31%) of patients. The occurrence of AKI was significantly higher among patients with HbA1c levels ≥7% (32/225, 14%) compared to patients with HbA1c levels < 7% (32/498, 6%; p = 0.001). Patients with chronic kidney disease (CKD) and HbA1c ≥7% had an eight-fold increase in the incidence of AKI compared to patients with HbA1c < 7% and no CKD (32 vs. 4%). In a multivariable regression model, HbA1c ≥7% was independently associated with AKI (OR 1.92, 95% CI 1.09-3.36, p = 0.02). CONCLUSION HbA1c ≥7% was associated with a higher likelihood of AKI in STEMI patients treated with primary PCI.
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Affiliation(s)
- Elena Izkhakov
- Institute of Endocrinology, Metabolism, and Hypertension, Tel Aviv Sourasky Medical Center affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Zach Rozenbaum
- Department of Cardiology, Tel Aviv Sourasky Medical Center affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Gilad Margolis
- Department of Cardiology, Tel Aviv Sourasky Medical Center affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shafik Khoury
- Department of Cardiology, Tel Aviv Sourasky Medical Center affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Gad Keren
- Department of Cardiology, Tel Aviv Sourasky Medical Center affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yacov Shacham
- Department of Cardiology, Tel Aviv Sourasky Medical Center affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel,
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Qian T, Tian L, Li Y, Zhang Z, Tian X, Sun D. Value of the combined examination of Cys-C and HbA1c for diagnosis of early renal injury in pediatric diabetes. Exp Ther Med 2016; 13:515-518. [PMID: 28352324 PMCID: PMC5348714 DOI: 10.3892/etm.2016.3967] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Accepted: 12/06/2016] [Indexed: 02/05/2023] Open
Abstract
The objective of the present study was to evaluate the combined application of measuring cystatin C (Cys-C) and hemoglobin A1c (HbA1c) levels for early renal injury in pediatric patients with type 2 diabetes. A total of 130 children with type 2 diabetes admitted to our hospital from May 2013 to July 2015 were selected. Patients were divided according to whether there was complication of renal injury. In group A (n=65), the patients had renal injury and in group B (n=65), the patients did not have renal injury. The levels of Cys-C and HbA1c in the two groups were examined. The results showed that the levels of Cys-C and HbA1c of patients in group A were significantly higher than those in group B (P<0.05), and the positive rate of the combined examination of Cys-C and HbA1c in group A was 92.3%, and was higher than that of the individual examinations of either Cys-C or HbA1c (P<0.05). The Spearman's correlation coefficient analysis was applied to group B and showed that Cys-C was positively correlated with HbA1c (r=0.842, P<0.05). From analysis of the receiver operating characteristic curves, the combined examination of Cys-C and HbA1c surpassed the individual examinations of Cys-C or HbA1c in sensitivity and specificity (P<0.05). In conclusion, the positive detection rate of early renal injury was significantly increased by the combined examination of Cys-C and HbA1c in pediatric patients with type 2 diabetes, which is beneficial for early identification and diagnosis of this diseases and is worthy of clinical application.
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Affiliation(s)
- Tong Qian
- Clinical Laboratory, Xuzhou Chlidren's Hospital, Xuzhou, Jiangsu 221002, P.R. China
| | - Lijun Tian
- Clinical Laboratory, Xuzhou Chlidren's Hospital, Xuzhou, Jiangsu 221002, P.R. China
| | - Yanyan Li
- Clinical Laboratory, Xuzhou Chlidren's Hospital, Xuzhou, Jiangsu 221002, P.R. China
| | - Zhenru Zhang
- Clinical Laboratory, Xuzhou Chlidren's Hospital, Xuzhou, Jiangsu 221002, P.R. China
| | - Xiuying Tian
- Clinical Laboratory, Xuzhou Chlidren's Hospital, Xuzhou, Jiangsu 221002, P.R. China
| | - Dan Sun
- Clinical Laboratory, Xuzhou Chlidren's Hospital, Xuzhou, Jiangsu 221002, P.R. China
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An Elevated Glycemic Gap is Associated with Adverse Outcomes in Diabetic Patients with Acute Myocardial Infarction. Sci Rep 2016; 6:27770. [PMID: 27291987 PMCID: PMC4904212 DOI: 10.1038/srep27770] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2015] [Accepted: 05/24/2016] [Indexed: 02/07/2023] Open
Abstract
Acute hyperglycemia is a frequent finding in patients presenting to the emergency department (ED) with acute myocardial infarction (AMI). The prognostic role of hyperglycemia in diabetic patients with AMI remains controversial. We retrospectively reviewed patients' medical records to obtain demographic data, clinical presentation, major adverse cardiac events (MACEs), several clinical scores and laboratory data, including the plasma glucose level at initial presentation and HbA1c levels. The glycemic gap, which represents changes in serum glucose levels during the index event, was calculated from the glucose level upon ED admission minus the HbA1c-derived average glucose (ADAG). We enrolled 331 patients after the review of medical records. An elevated glycemic gap between admission serum glucose levels and ADAG were associated with an increased risk of mortality in patients. The glycemic gap showed superior discriminative power regarding the development of MACEs when compared with the admission glucose level. The calculation of the glycemic gap may increase the discriminative powers of established clinical scoring systems in diabetic patients presenting to the ED with AMI. In conclusion, the glycemic gap could be used as an adjunct parameter to assess the severity and prognosis of diabetic patients presenting with AMI. However, the usefulness of the glycemic gap should be further explored in prospective longitudinal studies.
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