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Xu X, Feng J, Cui Y, Li P, Dong J, Liao L. Renal effects and safety between Asian and non-Asian chronic kidney disease and type 2 diabetes treated with nonsteroidal mineralocorticoid antagonists. J Diabetes 2024; 16:e13566. [PMID: 38753662 PMCID: PMC11098447 DOI: 10.1111/1753-0407.13566] [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] [Received: 11/25/2023] [Revised: 03/01/2024] [Accepted: 03/26/2024] [Indexed: 05/18/2024] Open
Abstract
BACKGROUND Asians bear a heavier burden of chronic kidney disease (CKD), a common comorbidity of type 2 diabetes mellitus (T2DM), than non-Asians. Nonsteroidal mineralocorticoid receptor antagonists (MRAs) have garnered attention for their potential advantages in renal outcomes. Nevertheless, the impact on diverse ethnic groups remains unknown. METHODS The PubMed, Embase, Cochrane Library, China National Knowledge Infrastructure (CNKI), Wanfang database, and clinical trial registries were searched through August 2023 with the following keywords: nonsteroidal MRAs (finerenone, apararenone, esaxerenone, AZD9977, KBP-5074), CKD, T2DM, and randomized controlled trial (RCT). A random effects model was used to calculate overall effect sizes. RESULTS Seven RCTs with 14 997 participants were enrolled. Nonsteroidal MRAs reduced urinary albumin to creatinine ratio (UACR) significantly more in Asians than non-Asians: (weighted mean difference [WMD], -0.59, 95% CI, -0.73 to -0.45, p < .01) vs (WMD, -0.29, 95% CI, -0.32 to -0.27, p < .01), respectively. The average decline of estimated glomerular filtration rate (eGFR) was similar in Asians and non-Asians (p > .05). Regarding systolic blood pressure (SBP), nonsteroidal MRAs had a better antihypertension performance in Asians (WMD, -5.12, 95% CI, -5.84 to -4.41, p < .01) compared to non-Asians (WMD, -3.64, 95% CI, -4.38 to -2.89, p < .01). A higher incidence of hyperkalemia and eGFR decrease ≥30% was found in Asians than non-Asians (p < .01). CONCLUSIONS Nonsteroidal MRAs exhibited significant renal benefits by decreasing UACR and lowering SBP in Asian than that of non-Asian patients with CKD and T2DM, without increase of adverse events except hyperkalemia and eGFR decrease ≥30%.
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Affiliation(s)
- Xiaoming Xu
- Department of Endocrinology and Metabology, Shandong Provincial Qianfoshan HospitalShandong UniversityJinanChina
- Department of Endocrinology and MetabologyThe First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan HospitalJinanChina
| | - Jing Feng
- Department of Endocrinology and Metabology, Shandong Provincial Qianfoshan HospitalShandong UniversityJinanChina
- Department of Endocrinology and MetabologyThe First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan HospitalJinanChina
| | - Yuying Cui
- Department of Endocrinology and MetabologyThe First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan HospitalJinanChina
- First Clinical Medical CollegeShandong University of Traditional Chinese MedicineJinanChina
| | - Pingjiang Li
- Department of Endocrinology and MetabologyThe First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan HospitalJinanChina
- Shandong First Medical University and Shandong Academy of Medical SciencesJinanChina
| | - Jianjun Dong
- Department of EndocrinologyQilu Hospital of Shandong UniversityJinanChina
| | - Lin Liao
- Department of Endocrinology and Metabology, Shandong Provincial Qianfoshan HospitalShandong UniversityJinanChina
- Department of Endocrinology and MetabologyThe First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan HospitalJinanChina
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Shu H, Zhang Z, Liu J, Chen P, Yang C, Wu Y, Wu D, Cao Y, Chu Y, Li L. Circular RNAs: An emerging precise weapon for diabetic nephropathy diagnosis and therapy. Biomed Pharmacother 2023; 168:115818. [PMID: 37939612 DOI: 10.1016/j.biopha.2023.115818] [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: 09/03/2023] [Revised: 10/28/2023] [Accepted: 10/31/2023] [Indexed: 11/10/2023] Open
Abstract
Diabetic nephropathy (DN) is a prevalent chronic microvascular complication associated with diabetes mellitus and represents a major cause of chronic kidney disease and renal failure. Current treatment strategies for DN primarily focus on symptom alleviation, lacking effective approaches to halt or reverse DN progression. Circular RNA (circRNA), characterized by a closed-loop structure, has emerged as a novel non-coding RNA regulator of gene expression, attributed to its conservation, stability, specificity, and multifunctionality. Dysregulation of circRNA expression is closely associated with DN progression, whereby circRNA impacts kidney cell injury by modulating cell cycle, differentiation, cell death, as well as influencing the release of inflammatory factors and stromal fibronectin expression. Consequently, circRNA is considered a predictive biomarker and a potential therapeutic target for DN. This review provides an overview of the latest research progress in the classification, functions, monitoring methods, and databases related to circRNA. The paper focuses on elucidating the impact and underlying mechanisms of circRNA on kidney cells under diabetic conditions, aiming to offer novel insights into the prevention, diagnosis, and treatment of DN.
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Affiliation(s)
- Haiying Shu
- Heilongjiang Key Laboratory of Anti-Fibrosis Biotherapy, Mudanjiang Medical University, Mudanjiang, China; College of Life Sciences, Mudanjiang Medical University, Mudanjiang, China
| | - Zhen Zhang
- Heilongjiang Key Laboratory of Anti-Fibrosis Biotherapy, Mudanjiang Medical University, Mudanjiang, China; School of First Clinical Medical College, Mudanjiang Medical University, Mudanjiang, China
| | - Jieting Liu
- College of Life Sciences, Mudanjiang Medical University, Mudanjiang, China.
| | - Peijian Chen
- Heilongjiang Key Laboratory of Anti-Fibrosis Biotherapy, Mudanjiang Medical University, Mudanjiang, China; College of Life Sciences, Mudanjiang Medical University, Mudanjiang, China
| | - Can Yang
- Heilongjiang Key Laboratory of Anti-Fibrosis Biotherapy, Mudanjiang Medical University, Mudanjiang, China; College of Life Sciences, Mudanjiang Medical University, Mudanjiang, China
| | - Yan Wu
- Heilongjiang Key Laboratory of Anti-Fibrosis Biotherapy, Mudanjiang Medical University, Mudanjiang, China; College of Life Sciences, Mudanjiang Medical University, Mudanjiang, China
| | - Dan Wu
- Heilongjiang Key Laboratory of Anti-Fibrosis Biotherapy, Mudanjiang Medical University, Mudanjiang, China; College of Life Sciences, Mudanjiang Medical University, Mudanjiang, China
| | - Yanan Cao
- Heilongjiang Key Laboratory of Anti-Fibrosis Biotherapy, Mudanjiang Medical University, Mudanjiang, China; College of Life Sciences, Mudanjiang Medical University, Mudanjiang, China
| | - Yanhui Chu
- College of Life Sciences, Mudanjiang Medical University, Mudanjiang, China.
| | - Luxin Li
- Heilongjiang Key Laboratory of Anti-Fibrosis Biotherapy, Mudanjiang Medical University, Mudanjiang, China; College of Life Sciences, Mudanjiang Medical University, Mudanjiang, China.
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Zakrocka I, Kocki T, Urbańska E, Załuska W. Effects of Fenofibrate and Gemfibrozil on Kynurenic Acid Production in Rat Kidneys In Vitro: Old Drugs, New Properties. Life (Basel) 2023; 13:2154. [PMID: 38004294 PMCID: PMC10672417 DOI: 10.3390/life13112154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 10/16/2023] [Accepted: 10/31/2023] [Indexed: 11/26/2023] Open
Abstract
Kidney dysfunction significantly increases the cardiovascular risk, even in cases of minor functional declines. Hypertriglyceridemia is the most common lipid abnormality reported in patients with kidney disorders. PPAR-α (peroxisome proliferator-activated receptor-α) agonists called fibrates are the main agents used to lower triglyceride levels. Kynurenic acid (KYNA) is a tryptophan (Trp) derivative directly formed from L-kynurenine (L-KYN) by kynurenine aminotransferases (KATs). KYNA is classified as a uremic toxin, the level of which is correlated with kidney function impairments and lipid abnormalities. The aim of this study was to analyze the effect of the most commonly used triglyceride-lowering drugs, fenofibrate and gemfibrozil, on KYNA production and KAT activity in rat kidneys in vitro. The influence of fenofibrate and gemfibrozil on KYNA formation and KAT activity was tested in rat kidney homogenates in vitro. Fenofibrate and gemfibrozil at 100 µM-1 mM significantly inhibited KYNA synthesis in rat kidney homogenates. Both fibrates directly affected the KAT I and KAT II isoenzyme activities in a dose-dependent manner at similar concentrations. The presented results reveal the novel mechanism of action of fibrates in the kidneys and suggest their potential role in kidney function protection beyond the well-known anti-hyperlipidemic effect.
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Affiliation(s)
- Izabela Zakrocka
- Department of Nephrology, Medical University, Jaczewskiego Street 8, 20-954 Lublin, Poland;
| | - Tomasz Kocki
- Department of Experimental and Clinical Pharmacology, Medical University, Jaczewskiego Street 8b, 20-090 Lublin, Poland; (T.K.); (E.U.)
| | - Ewa Urbańska
- Department of Experimental and Clinical Pharmacology, Medical University, Jaczewskiego Street 8b, 20-090 Lublin, Poland; (T.K.); (E.U.)
| | - Wojciech Załuska
- Department of Nephrology, Medical University, Jaczewskiego Street 8, 20-954 Lublin, Poland;
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Lang L, Zhang J, Zheng D, Gao H. Probucol will become a new model for treating cerebral infarction with a high risk of hemorrhage: A narrative review. Brain Circ 2023; 9:222-227. [PMID: 38284116 PMCID: PMC10821687 DOI: 10.4103/bc.bc_44_23] [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: 05/26/2023] [Revised: 09/07/2023] [Accepted: 09/13/2023] [Indexed: 01/30/2024] Open
Abstract
Lipid-lowering agents are relevant in stroke prevention. Probucol (PU) is an antioxidative and lipid-lowering drug that has been used to treat atherosclerotic cardiovascular diseases and xanthomas. The drug penetrates the core of low-density lipoprotein cholesterol (LDL-C) particles, enhancing the activity of plasma cholesterol l ester transfer protein (CETP) and strengthening the liver scavenger receptor type I, resulting in reducing LDL-C; by increasing the activity of paraoxonase 1, upregulating the antioxidant function of high-density lipoprotein (HDL), and it decreases the serum HDL-cholesterol (HDL-C) level. This drug has been retired from the Western markets for lowering HDL-C levels and Q-interval prolongation. The latter side effect has been rarely reported and may be transient. Recent clinical evidence supports the effectiveness of PU in preventing cardiovascular events and in reducing mortality, irrespective of the reduction of HDL-C. Based on basic research and clinical studies, it appears that PU might be a valuable alternative when statins are ineffective or contraindicated, in patients at high risk of recurrence of cerebral ischemia and hemorrhage.
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Affiliation(s)
- Liguo Lang
- Department of Neurology, The Affiliated Hospital of Qingdao Binhai University, Qingdao, China
- Department of Cardiology, The People's Hospital of Ningxia Hui Autonomous Region, Yinchuan, China
| | - Jianying Zhang
- Department of Neurology, The Affiliated Hospital of Qingdao Binhai University, Qingdao, China
| | - Dongju Zheng
- Department of Oncology Radiotherapy, The People's Hospital of Ningxia Hui Autonomous Region, Yinchuan, China
| | - Huanmin Gao
- Department of Neurology, The Affiliated Hospital of Qingdao Binhai University, Qingdao, China
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de Oliveira E Silva Ullmann T, Ramalho BJ, Laurindo LF, Tofano RJ, Rubira CJ, Guiguer EL, Barbalho SM, Flato UAP, Sloan KP, Araujo AC. Effects of Vitamin D Supplementation in Diabetic Kidney Disease: An Systematic Review. J Ren Nutr 2023; 33:618-628. [PMID: 37302723 DOI: 10.1053/j.jrn.2023.05.006] [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: 10/17/2022] [Revised: 05/05/2023] [Accepted: 05/27/2023] [Indexed: 06/13/2023] Open
Abstract
Diabetes Mellitus is a highly prevalent condition in which Diabetes Mellitus type 2 is the most common. Diabetic Kidney Disease is one of the most relevant complications and affects approximately one-third of patients with Diabetes Mellitus. It is characterized by increased urinary protein excretion and a decrease in glomerular filtration rate, assessed by serum creatinine levels. Recent studies have shown that vitamin D levels are low in these patients. This study aimed to conduct a systematic review of the effects of vitamin D supplementation on proteinuria and creatinine, which are important markers for assessing the severity of kidney disease in patients with Diabetic Kidney Disease. PUBMED, EMBASE, and COCHRANE databases were consulted, Preferred Reporting Items for a Systematic Review and Meta-Analysis guidelines were followed, and the COCHRANE toll for bias assessment was applied. Six papers were quantitative studies and fulfilled the inclusion criteria for this review. The results showed that vitamin D supplementation of 50,000 I.U./week for 8 weeks effectively reduced proteinuria and creatinine in patients with Diabetic Kidney Disease, particularly in patients with Diabetes Mellitus type 2. Vitamin D supplementation is beneficial for patients with Diabetic Kidney Disease by having essential effects on disease-related inflammatory markers, such as the reduction of proteinuria and creatinine. However, more clinical trials must be conducted to evaluate the intervention among more significant numbers of patients.
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Affiliation(s)
- Thais de Oliveira E Silva Ullmann
- Postgraduate Program in Structural and Functional Interactions in Rehabilitation, University of Marília, São Paulo, Brazil; Department of Biochemistry and Pharmacology, University of Marília, São Paulo, Brazil; Hospital Beneficente Unimar - University of Marília, São Paulo, Brazil
| | | | | | - Ricardo José Tofano
- Department of Biochemistry and Pharmacology, University of Marília, São Paulo, Brazil; Hospital Beneficente Unimar - University of Marília, São Paulo, Brazil
| | - Claudio José Rubira
- Department of Biochemistry and Pharmacology, University of Marília, São Paulo, Brazil; Hospital Beneficente Unimar - University of Marília, São Paulo, Brazil
| | - Elen Landgraf Guiguer
- Postgraduate Program in Structural and Functional Interactions in Rehabilitation, University of Marília, São Paulo, Brazil; Department of Biochemistry and Pharmacology, University of Marília, São Paulo, Brazil; Department of Biochemistry, School of Food and Technology of Marília, São Paulo, Brazil
| | - Sandra Maria Barbalho
- Postgraduate Program in Structural and Functional Interactions in Rehabilitation, University of Marília, São Paulo, Brazil; Department of Biochemistry and Pharmacology, University of Marília, São Paulo, Brazil; Department of Biochemistry, School of Food and Technology of Marília, São Paulo, Brazil.
| | - Uri Adrian Prync Flato
- Postgraduate Program in Structural and Functional Interactions in Rehabilitation, University of Marília, São Paulo, Brazil; Department of Biochemistry and Pharmacology, University of Marília, São Paulo, Brazil; Hospital Beneficente Unimar - University of Marília, São Paulo, Brazil
| | | | - Adriano Cressoni Araujo
- Postgraduate Program in Structural and Functional Interactions in Rehabilitation, University of Marília, São Paulo, Brazil; Department of Biochemistry and Pharmacology, University of Marília, São Paulo, Brazil
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Kumar M, Dev S, Khalid MU, Siddenthi SM, Noman M, John C, Akubuiro C, Haider A, Rani R, Kashif M, Varrassi G, Khatri M, Kumar S, Mohamad T. The Bidirectional Link Between Diabetes and Kidney Disease: Mechanisms and Management. Cureus 2023; 15:e45615. [PMID: 37868469 PMCID: PMC10588295 DOI: 10.7759/cureus.45615] [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: 09/10/2023] [Accepted: 09/20/2023] [Indexed: 10/24/2023] Open
Abstract
The complex and mutually influential connection between diabetes mellitus and chronic kidney disease (CKD) is a significant focal point in the current healthcare landscape. Diabetes, a medical condition characterized by elevated blood glucose levels resulting from impaired insulin action or secretion, has become a significant global epidemic. It poses considerable challenges to healthcare systems and affects millions of individuals worldwide. Concurrently, CKD, characterized by the gradual decline of kidney function, has become a persistent health challenge. This narrative review explores the complex relationship between these two conditions, shedding light on their significant implications for public health, clinical practice, and biomedical research. The correlation between diabetes and kidney disease is not merely coincidental. Diabetes is recognized as a significant risk factor for CKD, as individuals with diabetes are considerably more vulnerable to developing renal complications. Diabetic nephropathy, a distinct type of kidney disease closely associated with diabetes, is a significant factor in developing end-stage renal disease. It is imperative to implement efficient diabetes management strategies to regulate blood sugar levels and prevent potential kidney damage. On the other hand, kidney disease may contribute to the development of diabetes. The kidneys regulate glucose levels by filtering the blood and selectively reabsorbing glucose as necessary. In compromised kidney function, such as CKD, impaired glucose metabolism can give rise to insulin resistance and diabetes. As a result, the management of kidney disease plays a dual role in both preserving renal function and preventing diabetes in individuals who are at risk. The coexistence of diabetes and kidney disease in a patient presents complex clinical challenges. Achieving effective management requires a meticulous balance between glycemic control and preservation of renal function. Failing to maintain this delicate equilibrium can lead to cardiovascular complications and subsequent hospitalizations. This comprehensive narrative review aims to thoroughly examine the pathophysiological mechanisms that connect diabetes and kidney disease. It will provide insights into the clinical manifestations and diagnostic methods, explore various approaches to managing the condition, discuss the crucial role of nutrition, delve into pharmacological interventions, emphasize the importance of patient education and self-care, and shed light on emerging research areas. In addition to impacting individual health outcomes, this reciprocal relationship has significant implications for healthcare systems, socioeconomic landscapes, and public health policy. Comprehending this complex interaction is crucial for making well-informed clinical judgments, improving patient care, and developing a more efficient public health approach to address the interconnected issues of diabetes and kidney disease.
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Affiliation(s)
| | - Shah Dev
- Internal Medicine, Jinnah Sindh Medical University, Karachi, PAK
| | | | | | | | - Chris John
- Internal Medicine, University College Dublin, Dublin, IRL
| | | | - Anum Haider
- Internal Medicine, Bahria University Medical and Dental College, Karachi, PAK
| | - Riya Rani
- Internal Medicine, Peoples University of Medical and Health Sciences for Women, Nawabshah, PAK
| | - Maham Kashif
- Medicine, Khawaja Muhammad Safdar Medical College, Sialkot, PAK
| | | | - Mahima Khatri
- Medicine and Surgery, Dow University of Health Sciences, Karachi, PAK
| | - Satesh Kumar
- Medicine and Surgery, Shaheed Mohtarma Benazir Bhutto Medical College, Karachi, PAK
| | - Tamam Mohamad
- Cardiovascular Medicine, Wayne State University, Detroit, USA
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Raj R. Finerenone: a new mineralocorticoid receptor antagonist to beat chronic kidney disease. Curr Opin Nephrol Hypertens 2022; 31:265-271. [PMID: 35165249 DOI: 10.1097/mnh.0000000000000785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE OF REVIEW Clinical trials of the mineralocorticoid receptor antagonist (MRA) finerenone published recently suggest that they improve outcomes in patients with diabetic kidney disease (DKD). This review summarises key research from the last two years to provide clinicians with a synopsis of recent findings. RECENT FINDINGS Large international trials, such as Finerenone in Reducing Kidney Failure and Disease Progression in Diabetic Kidney Disease (5674 participants) and Finerenone in Reducing Cardiovascular Mortality and Morbidity in Diabetic Kidney Disease (7437 participants), suggest that in proteinuric patients with DKD and estimated glomerular filtration rate >25 ml/min/1.73 m2, already on renin-angiotensin-aldosterone system inhibitors, addition of finerenone provided modest further improvement in composite renal and cardiovascular outcomes. Proteinuria was reduced; there was also a small drop in systolic blood pressure. Hyperkalaemia remained a concern, although the incidence is lower with finerenone. Emerging data suggest that newer potassium binding agents may mitigate this risk. Preclinical studies suggest additive benefits when MRA and sodium-glucose co-transporter 2 (SGLT-2) inhibitors are used in combination. SUMMARY The nonsteroidal MRA finerenone could improve renal and cardiac outcomes further in diabetics with kidney disease when added to renin-angiotensin system inhibitors. Hyperkalaemia is probably less worrisome, but real-world data is needed. Combinations with other new nephroprotective agents (such as SGLT2i inhibitors) has the potential to provide increasing benefit. Benefits of finerenone in chronic kidney disease without diabetes remains to be seen.
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Affiliation(s)
- Rajesh Raj
- Clinical Associate Professor, University of Tasmania, Consultant Nephrol-ogist, Launceston General Hospital, Launceston, Australia
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