Effects of CCR5 59029G/A polymorphism on the risk to diabetic nephropathy

T cells and their products in diabetic kidney disease

Diabetic kidney disease (DKD) is the most common cause of end-stage renal disease and has gradually become a public health problem worldwide. DKD is increasingly recognized as a comprehensive inflammatory disease that is largely regulated by T cells. Given the pivotal role of T cells and T cells-producing cytokines in DKD, we summarized recent advances concerning T cells in the progression of type 2 diabetic nephropathy and provided a novel perspective of immune-related factors in diabetes. Specific emphasis is placed on the classification of T cells, process of T cell recruitment, function of T cells in the development of diabetic kidney damage, and potential treatments and therapeutic strategies involving T cells.

Construction of a Prediction Model for the Mortality of Elderly Patients with Diabetic Nephropathy

To construct a prediction model for all-cause mortality in elderly diabetic nephropathy (DN) patients, in this cohort study, the data of 511 DN patients aged ≥65 years were collected and the participants were divided into the training set (n = 358) and the testing set (n = 153). The median survival time of all participants was 2 years. The data in the training set were grouped into the survival group (n = 203) or the death group (n = 155). Variables with P ≤ 0.1 between the two groups were selected as preliminary predictors and involved into the multivariable logistic regression model and the covariables were gradually adjusted. The receiver operator characteristic (ROC), Kolmogorov-Smirnov (KS), and calibration curves were plotted for evaluating the predictive performance of the model. Internal validation of the performance of the model was verified in the testing set. The predictive values of the model were also conducted in terms of people with different genders and ages or accompanied with chronic kidney disease (CKD) or cardiovascular diseases (CVD), respectively. In total, 216 (42.27%) elderly DN patients were dead within 2 years. The prediction model for the 2-year mortality of elderly patients with DN was established based on length of stay (LOS), temperature, heart rate, peripheral oxygen saturation (SpO₂), serum creatinine (Scr), red cell distribution width (RDW), the simplified acute physiology score-II (SAPS-II), hyperlipidemia, and the Chronic Kidney Disease Epidemiology Collaboration equation for estimated glomerular filtration rate (eGFR-CKD-EPI). The AUC of the model was 0.78 (95% CI: 0.73–0.83) in the training set and 0.72 (95% CI: 0.63–0.80) in the testing set. The AUC of the model was 0.78 (95% CI: 0.65–0.91) in females and 0.78 (95%CI: 0.68–0.88) in patients ≤75 years. The AUC of the model was 0.74 (95% CI: 0.64–0.84) in patients accompanied with CKD. The model had good predictive value for the mortality of elderly patients with DN within 2 years. In addition, the model showed good predictive values for female DN patients, DN patients ≤75 years, and DN patients accompanied with CKD.

Development of Biomarkers and Molecular Therapy Based on Inflammatory Genes in Diabetic Nephropathy

Diabetic Nephropathy (DN) is a debilitating consequence of both Type 1 and Type 2 diabetes affecting the kidney and renal tubules leading to End Stage Renal Disease (ESRD). As diabetes is a world epidemic and almost half of diabetic patients develop DN in their lifetime, a large group of people is affected. Due to the complex nature of the disease, current diagnosis and treatment are not adequate to halt disease progression or provide an effective cure. DN is now considered a manifestation of inflammation where inflammatory molecules regulate most of the renal physiology. Recent advances in genetics and genomic technology have identified numerous susceptibility genes that are associated with DN, many of which have inflammatory functions. Based on their role in DN, we will discuss the current aspects of developing biomarkers and molecular therapy for advancing precision medicine.

Probiotics ameliorates glycemic control of patients with diabetic nephropathy: A randomized clinical study

OBJECTIVE

This research aimed to explore the effects of probiotic administration on glycemic control and renal function in patients with diabetic nephropathy (DN).

METHODS

The 101 participants were randomly divided into two treatment groups and 76 patients were included in the final analysis. In 76 patients with diabetic nephropathy of type 2 diabetes, a randomized double-blind and placebo-controlled clinical trial was conducted to evaluate the administration of 3.2 × 109  CFU probiotic supplements per day (Bifidobacterium bifidum, 1.2 × 109  CFU, Lactobacillus acidophilus 4.2 × 109  CFU, Streptococcus thermophilus 4.3 × 109  CFU) for 12 weeks on glycemic control of patients, including fasting blood glucose, 2 h postprandial blood glucose, glycosylated hemoglobin (HbA1c), microalbuminuria/creatinine (mAlb/Cr) and estimated glomerular filtration rate (eGFR) levels. The placebo group daily received empty capsules filled with starch.

RESULTS

After 12 weeks, the administration of probiotics demonstrated a significant reduction in fasting blood glucose (10.68 ± 3.24 mmol/L before vs. 7.81 ± 2.77 mmol/L after, p < 0.05), HbA1c (8.19 ± 1.60% before vs. 7.32 ± 1.20% after, p < 0.05) and mAlb/Cr (101.60 ± 22.17 mg/g before vs. 67.53 ± 20.11 mg/g after, p < 0.05), while only mAlb/Cr level was significantly lower in the probiotic group than in the placebo group after intervention (67.53 ± 20.11 mg/g vs. 87.71 ± 23.01, p < 0.05). Meanwhile, there was no significant reduction of 2 h postprandial blood glucose level (18.95 ± 5.23 mmol/L vs. 17.35 ± 6.28 mmol/L, p = 0.24) and eGFR (84.34 ± 6.97 ml/min vs. 82.8 ± 8.72 ml/min, p = 0.45) in patients before and after probiotic intake. In addition, the placebo group failed to show any significant change of these parameters.

CONCLUSION

This clinical study revealed probiotic administration could ameliorate glycemic control of patients with diabetic nephropathy, potentiating its therapeutic potential in clinical application.