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Tu L, Hu H, Zhou X, Zhang H, Liu X, Yang D, He Y. Association between estimated glomerular filtration rate and reversion to normoglycemia in people with impaired fasting glucose: a 5-year retrospective cohort study. Eur J Med Res 2024; 29:140. [PMID: 38388456 PMCID: PMC10882936 DOI: 10.1186/s40001-024-01669-y] [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: 07/24/2023] [Accepted: 01/12/2024] [Indexed: 02/24/2024] Open
Abstract
OBJECTIVES The present body of evidence regarding the correlation between the estimated glomerular filtration rate (eGFR) and the reversal of impaired fasting glucose (IFG) to normoglycemia remains constrained. Consequently, the objective of our study is to examine the relationship between eGFR and the restoration of normoglycemia in individuals with IFG. METHODS This retrospective cohort study consecutively collected data from 24,541 non-selective participants with IFG at Rich Healthcare Group in China from January 2010 to 2016. We aimed to investigate the association between baseline eGFR and reversion to normoglycemia using the Cox proportional-hazards regression model. Through the utilization of a Cox proportional hazards regression model featuring cubical spline smoothing, we were able to ascertain the non-linear correlation between eGFR and the return to normoglycemia. Furthermore, various sensitivity and subgroup analyses were carried out, and a competing risk multivariate Cox regression was employed to examine the progression to diabetes as a competing risk for the reversal of normoglycemic events. RESULTS In our study, comprising 24,541 participants, the average age was 49.25 ± 13.77 years, with 66.28% being male. The baseline eGFR mean was 104.16 ± 15.78 ml/min per 1.73 m2. During a median follow-up period of 2.89 years, we observed a reversion rate to normoglycemia of 45.50%. Upon controlling for covariates, our findings indicated a positive correlation between eGFR and the probability of returning to normoglycemia (HR = 1.008, 95% CI 1.006-1.009). In addition, a non-linear association was observed between eGFR and the likelihood of transitioning from IFG to normoglycemia. The inflection point of eGFR was found to be 111.962 ml/min per 1.73 m2, with HRs of 1.003 (95% CI 1.001, 1.005) on the left side of the point and 1.019 (95% CI 1.015, 1.022) on the right side. Our robust results were supported by competing risks multivariate Cox's regression and sensitivity analysis. CONCLUSIONS The findings of our investigation indicate a favorable and non-linear correlation between eGFR and the restoration of normoglycemia in Chinese individuals with IFG. Specifically, a reduction in renal function at an early stage in these patients may considerably diminish the likelihood of attaining normoglycemia.
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Affiliation(s)
- Lirong Tu
- Department of Nephrology, Affiliated Hospital of North Sichuan Medical College, No.1 Maoyuan South Rd, Nanchong, 637000, Sichuan Province, China
| | - Haofei Hu
- Department of Nephrology, The First Affiliated Hospital of Shenzhen University, Shenzhen, 518000, Guangdong Province, China
- Department of Nephrology, Shenzhen Second People's Hospital, Shenzhen, 518000, Guangdong Province, China
| | - Xinglei Zhou
- Department of Nephrology, Second Affiliated Hospital of Xuzhou Medical University, Xuzhou, 221006, Jiangsu Province, China
| | - Heping Zhang
- Department of Nephrology, Affiliated Hospital of North Sichuan Medical College, No.1 Maoyuan South Rd, Nanchong, 637000, Sichuan Province, China
| | - Xiaohui Liu
- Department of Nephrology, Affiliated Hospital of North Sichuan Medical College, No.1 Maoyuan South Rd, Nanchong, 637000, Sichuan Province, China.
| | - Dehua Yang
- Department of Pediatrics, Shenzhen Hengsheng Hospital, No. 20 Yintian Road, Baoan District, Shenzhen, 518103, Guangdong Province, China.
| | - Yongcheng He
- Department of Nephrology, Affiliated Hospital of North Sichuan Medical College, No.1 Maoyuan South Rd, Nanchong, 637000, Sichuan Province, China.
- Department of Nephrology, Shenzhen Hengsheng Hospital, Shenzhen, 518103, Guangdong Province, China.
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Li T, Cao C, Xuan X, Liu W, Xiao X, Wei C. The association between creatinine to body weight ratio and the risk of progression to diabetes from pre-diabetes: a 5-year cohort study in Chinese adults. BMC Endocr Disord 2023; 23:266. [PMID: 38044422 PMCID: PMC10694873 DOI: 10.1186/s12902-023-01518-9] [Citation(s) in RCA: 1] [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: 12/16/2022] [Accepted: 11/21/2023] [Indexed: 12/05/2023] Open
Abstract
OBJECTIVE Evidence on the association between the creatinine to body weight (Cre/BW) ratio and the risk of pre-diabetes to diabetes development remains limited. Our study aimed to examine the association between the Cre/BW ratio and incident diabetes in pre-diabetic patients. METHODS This retrospective cohort study included 24,506 pre-diabetic participants who underwent health checks from 2010 to 2016 in China. We used the Cox proportional-hazards regression model to explore the relationship between baseline Cre/BW ratio and diabetes risk in pre-diabetes patients. Using a Cox proportional hazards regression with cubic spline function and smooth curve fitting (cubical spline smoothing), we were able to determine the non-linear relationship between them. We also carried out a number of subgroup and sensitivity analyses. RESULTS The age range of the participants included in this study was 20-99 years, with a majority of 16,232 individuals (66.24%) being men. The mean baseline Cre/BW ratio was 1.06 (SD 0.22) umol/L/kg. 2512 (10.25%) participants received a diabetes final diagnosis over a median follow-up period of 2.89 years. After adjusting for covariates, the Cre/BW ratio had a negative association with incident diabetes in participants with pre-diabetes, per umol/L/kg increase in Cre/BM ratio was accompanied by a 55.5% decrease in diabetes risk (HR = 0.445, 95%CI 0.361 to 0.548). The Cre/BW ratio and risk of diabetes had a non-linear connection, with 1.072 umol/L/kg serving as the ratio's inflection point. The HR were 0.294 (95%CI:0.208-0.414) and 0.712 (95%CI:0.492-1.029), respectively, on the left and right sides of the inflection point. The sensitivity analysis demonstrated the robustness of these results. Subgroup analyses indicated that the Cre/BW ratio was strongly associated with the risk of diabetes among participants who were younger than 50 years, as well as among those with diastolic blood pressure (DBP) < 90 mmHg and triglyceride (TG) < 1.7 mmol/L. In contrast, among participants 50 years of age or older, those with DBP ≥ 90 mmHg, and those with TG ≥ 1.7 mmol/L, the relationship between the Cre/BW ratio and the risk of diabetes was attenuated. CONCLUSION This study demonstrates a negative, non-linear relationship between the Cre/BW ratio and the risk of diabetes among the Chinese population with pre-diabetes. From a therapeutic standpoint, it is clinically meaningful to maintain the Cre/BW ratio levels above the inflection point of 1.072 umol/L/kg.
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Affiliation(s)
- Tong Li
- Department of Nephrology, Shenzhen Second People's Hospital, Shenzhen, Guangdong Province, 518000, China
- Department of Nephrology, The First Affiliated Hospital of Shenzhen University, Shenzhen, Guangdong Province, 518000, China
| | - Changchun Cao
- Department of Rehabilitation, Shenzhen Dapeng New District Nan'ao People's Hospital, Shenzhen, Guangdong Province, 518000, China
| | - Xuan Xuan
- Department of Rheumatology, Shenzhen Second People's Hospital, Shenzhen, Guangdong Province, 518000, China
- Department of Rheumatology, The First Affiliated Hospital of Shenzhen University, Shenzhen, Guangdong Province, 518000, China
| | - Wenjing Liu
- Department of Geriatrics, Shenzhen Second People's Hospital, No.3002 Sungang Road, Futian District, Shenzhen, Guangdong Province, 518000, China
- Department of Geriatrics, The First Affiliated Hospital of Shenzhen University, Shenzhen, Guangdong Province, 518000, China
| | - Xiaohua Xiao
- Department of Geriatrics, Shenzhen Second People's Hospital, No.3002 Sungang Road, Futian District, Shenzhen, Guangdong Province, 518000, China.
- Department of Geriatrics, The First Affiliated Hospital of Shenzhen University, Shenzhen, Guangdong Province, 518000, China.
| | - Cuimei Wei
- Department of Geriatrics, Shenzhen Second People's Hospital, No.3002 Sungang Road, Futian District, Shenzhen, Guangdong Province, 518000, China.
- Department of Geriatrics, The First Affiliated Hospital of Shenzhen University, Shenzhen, Guangdong Province, 518000, China.
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Duan S, Zhou M, Lu F, Chen C, Chen S, Geng L, Zhang C, Guo H, Zeng M, Sun B, Mao H, Zhang B, Xing C, Yuan Y. Triglyceride-glucose index is associated with the risk of chronic kidney disease progression in type 2 diabetes. Endocrine 2023:10.1007/s12020-023-03357-z. [PMID: 37004636 DOI: 10.1007/s12020-023-03357-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Accepted: 03/17/2023] [Indexed: 04/04/2023]
Abstract
OBJECTIVE The study aimed to investigate the association of TyG index with chronic kidney disease (CKD) progression in type 2 diabetes mellitus (T2DM). METHODS A total of 179 T2DM patients with CKD were retrospectively included. CKD progression was defined as a doubling of baseline serum creatinine or onset of end-stage kidney disease (ESKD). Internal validation was performed by the Kidney Failure Risk Equation (KFRE) model and Net reclassification improvement (NRI). RESULTS The optimal cut-off value of the TyG index was 9.17. The cumulative incidence of kidney outcomes was significantly higher in the high-TyG group (v.s low-TyG group, P = 0.019). In addition, the high-TyG index was associated with a greater risk of CKD progression (HR 1.794, 95% CI 1.026-3.137, P = 0.040). And reclassification analyses confirmed the final adjusted model improved NRI (61.90% v.s model 2, 43.80% v.s model 1). The further RCS curves presented an inverted S-shaped relationship between the TyG index and the risk of CKD progression. Internal validation verified that a higher TyG index was associated with 2.10-fold increased odds of 2-year ESKD risk >10% (95% CI 1.82-8.21). Moreover, subgroup analysis suggested that the association was more pronounced in those at relatively early CKD stages (higher than stage 2) and with no medication history of oral hypoglycemic agents. CONCLUSION An elevated TyG index was associated with a higher risk of CKD progression in T2DM patients. Our findings suggested that timely targeting insulin sensitivity at the early stages of T2DM might be associated with declined future risk of CKD development.
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Affiliation(s)
- Suyan Duan
- Department of Nephrology, the First Affiliated Hospital of Nanjing Medical University, Nanjing Medical University, Nanjing, China
| | - Meng Zhou
- Department of Nephrology, the First Affiliated Hospital of Nanjing Medical University, Nanjing Medical University, Nanjing, China
| | - Fang Lu
- Department of Nephrology, the First Affiliated Hospital of Nanjing Medical University, Nanjing Medical University, Nanjing, China
| | - Chen Chen
- Department of Nephrology, the First Affiliated Hospital of Nanjing Medical University, Nanjing Medical University, Nanjing, China
| | - Si Chen
- Department of Nephrology, the First Affiliated Hospital of Nanjing Medical University, Nanjing Medical University, Nanjing, China
| | - Luhan Geng
- Department of Nephrology, the First Affiliated Hospital of Nanjing Medical University, Nanjing Medical University, Nanjing, China
| | - Chengning Zhang
- Department of Nephrology, the First Affiliated Hospital of Nanjing Medical University, Nanjing Medical University, Nanjing, China
| | - Honglei Guo
- Department of Nephrology, the First Affiliated Hospital of Nanjing Medical University, Nanjing Medical University, Nanjing, China
| | - Ming Zeng
- Department of Nephrology, the First Affiliated Hospital of Nanjing Medical University, Nanjing Medical University, Nanjing, China
| | - Bin Sun
- Department of Nephrology, the First Affiliated Hospital of Nanjing Medical University, Nanjing Medical University, Nanjing, China
| | - Huijuan Mao
- Department of Nephrology, the First Affiliated Hospital of Nanjing Medical University, Nanjing Medical University, Nanjing, China
| | - Bo Zhang
- Department of Nephrology, the First Affiliated Hospital of Nanjing Medical University, Nanjing Medical University, Nanjing, China.
| | - Changying Xing
- Department of Nephrology, the First Affiliated Hospital of Nanjing Medical University, Nanjing Medical University, Nanjing, China.
| | - Yanggang Yuan
- Department of Nephrology, the First Affiliated Hospital of Nanjing Medical University, Nanjing Medical University, Nanjing, China.
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Alqallaf A, Swan P, Docherty NG. Renal insulin resistance in type 2 diabetes mellitus and progression of chronic kidney disease: potential pathogenic mechanisms. Expert Rev Endocrinol Metab 2022; 17:523-532. [PMID: 36203374 DOI: 10.1080/17446651.2022.2131534] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 09/28/2022] [Indexed: 01/06/2023]
Abstract
INTRODUCTION A bidirectional association exists between insulin resistance (IR) and chronic kidney disease (CKD) in Type 2 Diabetes Mellitus (T2DM). Baseline measures of IR are predictive of CKD progression, and uremia in progressive CKD is itself, in turn, associated with a worsening of IR. Pre-clinical research reveals that intrinsic IR in glomerular podocytes and the renal tubule may serve as a pathogenic driver of CKD in T2DM. AREAS COVERED The present manuscript takes as its point of departure, the recently identified prognostic utility of severe insulin resistance as a predictor of CKD in T2DM. Findings from a series of studies describing the association of IR with pathological alterations in both established, and less commonly assessed dynamic measures of renal impairment are discussed. Drawing upon the pre-clinical mechanistic evidence base, the cellular and molecular basis of intrinsic renal IR as a promoter of CKD is considered. EXPERT OPINION Measurement of insulin sensitivity may add value to profiling of renal risk in T2DM. Rational selection of therapeutic strategies targeting the enhancement of insulin sensitivity merits special attention regarding the personalized management of CKD in insulin resistance predominant T2DM.
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Affiliation(s)
- Alrataj Alqallaf
- Diabetes Complications Research Centre, Conway Institute of Biomolecular and Biomedical Research, School of Medicine, University College Dublin, Dublin, Ireland
| | - Patrick Swan
- Diabetes Complications Research Centre, Conway Institute of Biomolecular and Biomedical Research, School of Medicine, University College Dublin, Dublin, Ireland
| | - Neil G Docherty
- Diabetes Complications Research Centre, Conway Institute of Biomolecular and Biomedical Research, School of Medicine, University College Dublin, Dublin, Ireland
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Harada KH, Harada Sassa M. Potential confounders in the association between per- and polyfluoroalkyl substance exposure and diabetes. Diabetologia 2022; 65:1745-1746. [PMID: 35840662 DOI: 10.1007/s00125-022-05758-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Accepted: 05/24/2022] [Indexed: 11/30/2022]
Affiliation(s)
- Kouji H Harada
- Department of Health and Environmental Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan.
| | - Mariko Harada Sassa
- Department of Health and Environmental Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
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Alicic RZ, Neumiller JJ, Galindo RJ, Tuttle KR. Use of Glucose-Lowering Agents in Diabetes and CKD. Kidney Int Rep 2022; 7:2589-2607. [PMID: 36506243 PMCID: PMC9727535 DOI: 10.1016/j.ekir.2022.09.018] [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: 05/13/2022] [Revised: 08/31/2022] [Accepted: 09/19/2022] [Indexed: 12/15/2022] Open
Abstract
Diabetes is the most common cause of kidney failure worldwide. Patients with diabetes and chronic kidney disease (CKD) are also at markedly higher risk of cardiovascular disease, particularly heart failure (HF), and death. Through the processes of gluconeogenesis and glucose reabsorption, the kidney plays a central role in glucose homeostasis. Insulin resistance is an early alteration observed in CKD, worsened by the frequent presence of hypertension, obesity, and ongoing chronic inflammation, and oxidative stress. Management of diabetes in moderate to severe CKD warrants special consideration because of changes in glucose and insulin homeostasis and altered metabolism of glucose-lowering therapies. Kidney failure and initiation of kidney replacement therapy by dialysis adds to management complexity by further limiting therapeutic options, and predisposing individuals to hypoglycemia and hyperglycemia. Glycemic goals should be individualized, considering CKD severity, presence of macrovascular and microvascular complications, and life expectancy. A general hemoglobin A1c (HbA1c) goal of approximately 7% may be appropriate in earlier stages of CKD, with more relaxed targets often appropriate in later stages. Use of sodium glucose cotransporter2 (SGLT2) inhibitors and glucagon like peptide-1 receptor agonists (GLP-1RAs) meaningfully improves kidney and heart outcomes for patients with diabetes and CKD, irrespective of HbA1c targets, and are now part of guideline-directed medical therapy in this high-risk population. Delivery of optimal care for patients with diabetes and CKD will require collaboration across health care specialties and disciplines.
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Affiliation(s)
- Radica Z. Alicic
- Providence Medical Research Center, Providence Health Care, Spokane, Washington, USA
- Department of Medicine, University of Washington School of Medicine, Spokane and Seattle, Washington, USA
- Correspondence: Radica Z. Alicic, Providence Medical Research Center, 105 West 8th Avenue, Suite 250E, Spokane, Washington 99204, USA.
| | - Joshua J. Neumiller
- Providence Medical Research Center, Providence Health Care, Spokane, Washington, USA
- Department of Pharmacotherapy, College of Pharmacy and Pharmaceutical Sciences, Washington State University, Spokane, Washington, USA
| | - Rodolfo J. Galindo
- Department of Medicine, Division of Endocrinology, Emory University School of Medicine
| | - Katherine R. Tuttle
- Providence Medical Research Center, Providence Health Care, Spokane, Washington, USA
- Department of Medicine, University of Washington School of Medicine, Spokane and Seattle, Washington, USA
- Nephrology Division, Kidney Research Institute and Institute of Translational Health Sciences, University of Washington, Spokane and Seattle, Washington, USA
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Kaka N, Sethi Y, Patel N, Kaiwan O, Al-Inaya Y, Manchanda K, Uniyal N. Endocrine manifestations of chronic kidney disease and their evolving management: A systematic review. Dis Mon 2022; 68:101466. [PMID: 35965104 DOI: 10.1016/j.disamonth.2022.101466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Chronic Kidney Disease (CKD) shows a wide range of renal abnormalities including the excretory, metabolic, endocrine, and homeostatic function of the kidney. The prognostic impact of the 'endocrine manifestations' which are often overlooked by clinicians cannot be overstated. METHODS AND OBJECTIVES A systematic review was attempted to provide a comprehensive overview of all endocrine abnormalities of CKD and their evolving principles of management, searching databases of PubMed, Embase, and Scopus and covering the literature between 2002 and 2022. RESULTS The endocrine derangements in CKD can be attributed to a myriad of pathologic processes, in particular decreased clearance, impaired endogenous hormone production, uremia-induced cellular dysfunction, and activation of systemic inflammatory pathways. The major disorders include anemia, hyperprolactinemia, insulin resistance, reproductive hormone deficiency, thyroid hormone deficiency, and serum FGF (Fibroblast Growth Factor) alteration. Long-term effects of CKD also include malnutrition and increased cardiovascular risk. The recent times have unveiled their detailed pathogenesis and have seen an evolution in the principles of management which necessitates a revision of current guidelines. CONCLUSION Increased advertence regarding the pathology, impact, and management of these endocrine derangements can help in reducing morbidity as well as mortality in the CKD patients by allowing prompt individualized treatment. Moreover, with timely and appropriate intervention, a long-term reduction in complications, as well as an enhanced quality of life, can be achieved in patients with CKD.
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Affiliation(s)
- Nirja Kaka
- GMERS Medical College, Himmatnagar, Gujarat 382007, India
| | - Yashendra Sethi
- Department of Medicine, Government Doon Medical College, Dehradun, Uttarakhand, India
| | - Neil Patel
- GMERS Medical College, Himmatnagar, Gujarat 382007, India.
| | | | | | | | - Nidhi Uniyal
- Department of Medicine, Government Doon Medical College, Dehradun, Uttarakhand, India
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Cen J, Han Y, Liu Y, Hu H. Evaluated Glomerular Filtration Rate Is Associated With Non-alcoholic Fatty Liver Disease: A 5-Year Longitudinal Cohort Study in Chinese Non-obese People. Front Nutr 2022; 9:916704. [PMID: 35782950 PMCID: PMC9244698 DOI: 10.3389/fnut.2022.916704] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Accepted: 05/30/2022] [Indexed: 12/12/2022] Open
Abstract
ObjectiveEvidence regarding the association between evaluated glomerular filtration rate (eGFR) and non-alcoholic fatty liver disease (NAFLD) is still limited. On that account, the purpose of our research is to survey the link of evaluated eGFR on NAFLD.MethodsThis study is a retrospective cohort study. Which consecutively and non-selectively collected a total of 16,138 non-obese participants in a Chinese hospital from January 2010 to December 2014. We then used the Cox proportional-hazards regression model to explore the relationship between baseline eGFR and NAFLD risk. A Cox proportional hazards regression with cubic spline functions and smooth curve fitting (the cubic spline smoothing) was used to identify the non-linear relationship between eGFR and NAFLD. Additionally, we also performed a series of sensitivity analyses and subgroup analyses. Data had been uploaded to the DATADRYAD website.ResultsThe mean age of the included individuals was 43.21 ± 14.95 years old, and 8,467 (52.47%) were male. The mean baseline eGFR was 98.83 ± 22.80 mL/min per 1.73m2. During a median follow-up time of 35.8 months, 2,317 (14.36%) people experienced NAFLD. After adjusting covariates, the results showed that eGFR was negatively associated with incident NAFLD (HR = 0.983, 95%CI: 0.980, 0.985). There was also a non-linear relationship between eGFR and NAFLD, and the inflection point of eGFR was 103.489 mL/min per 1.73 m2. The effect sizes (HR) on the left and right sides of the inflection point were 0.988 (0.984, 0.991) and 0.971 (0.963, 0.979), respectively. And the sensitive analysis demonstrated the robustness of our results. Subgroup analysis showed that eGFR was more strongly associated with incident NAFLD in diastolic blood pressure (DBP) < 90 mmHg, fasting plasma glucose (FPG) ≤ 6.1 mmol/L, high-density lipoprotein cholesterol (HDL-c) < 1 mmol/L, and alanine aminotransferase (ALT) ≥ 40 U/L participants. In contrast, the weaker association was probed in those with DBP ≥ 90 mmHg, ALT < 40 U/L, FPG > 6.1 mmol/L, and HDL-c ≥ 1 mmol/L.ConclusionThis study demonstrates a negative and non-linear association between eGFR and incident NAFLD in the Chinese non-obese population. eGFR is strongly related to NAFLD when eGFR is above 103 mL/min per 1.73 m2. From a therapeutic perspective, it makes sense to maintain eGFR levels within the inflection point to 130 mL/min/1.73 m2.
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Affiliation(s)
- Ji Cen
- Department of Nephrology, Hechi People’s Hospital, Hechi, China
| | - Yong Han
- Department of Emergency, Shenzhen Second People’s Hospital, Shenzhen, China
- Department of Emergency, The First Affiliated Hospital of Shenzhen University, Shenzhen, China
- Shenzhen University Health Science Center, Shenzhen, China
| | - Yufei Liu
- Shenzhen University Health Science Center, Shenzhen, China
- Department of Neurosurgery, Shenzhen Second People’s Hospital, Shenzhen, China
- Department of Neurosurgery, The First Affiliated Hospital of Shenzhen University, Shenzhen, China
| | - Haofei Hu
- Shenzhen University Health Science Center, Shenzhen, China
- Department of Nephrology, Shenzhen Second People’s Hospital, Shenzhen, China
- Department of Nephrology, The First Affiliated Hospital of Shenzhen University, Shenzhen, China
- *Correspondence: Haofei Hu,
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Association between Sarcopenia and Insulin-Like Growth Factor-1, Myostatin, and Insulin Resistance in Elderly Patients Undergoing Hemodialysis. J Aging Res 2022; 2022:1327332. [PMID: 35371569 PMCID: PMC8967580 DOI: 10.1155/2022/1327332] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 02/17/2022] [Indexed: 12/21/2022] Open
Abstract
Sarcopenia is common in hemodialysis patients, especially in the elderly patients undergoing hemodialysis. Various factors may contribute to the occurrence of sarcopenia, such as anabolic and catabolic imbalance. This study aims to investigate the correlation of insulin-like growth factor-1 (IGF-1) levels as an anabolic factor, myostatin levels, and insulin resistance as catabolic factors with sarcopenia in the pathogenesis of sarcopenia in elderly patients undergoing hemodialysis. A total of 40 subjects aged 60 years or more who undergoing hemodialysis in Dr. Soetomo Hospital Surabaya were included in this cross-sectional study. Sarcopenia was diagnosed according to Asian Working Group Sarcopenia 2019 criteria. IGF-1, myostatin, and insulin resistance levels were measured once before hemodialysis. Subjects with sarcopenia diagnosis were 33 (82.5%), that is, 19 (47.5%) men and 14 (35%) women. There were 28 (70%) of the subjects diagnosed with severe sarcopenia. Furthermore, there were significant differences in the characteristics and geriatric parameters between the sarcopenia and nonsarcopenia groups. There were differences between the two groups in hemoglobin levels, IGF-1 levels, myostatin levels, homeostasis model assessment-insulin resistance (HOMA-IR) levels, muscle mass, handgrip strength, body mass index status, mini nutritional assessment status, and physical activity scale for elderly status (all p < 0.05). Correlation analyses showed that IGF-1 levels negatively correlated with sarcopenia status in elderly patients undergoing hemodialysis (p < 0.05). On the contrary, myostatin and HOMA-IR levels were positively correlated with sarcopenia status in elderly patients undergoing hemodialysis (all p < 0.05). Based on this recent study, IGF-1, myostatin, and insulin resistance were significantly correlated with sarcopenia in elderly patients undergoing hemodialysis.
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Mo Z, Hu H, Du X, Huang Q, Chen P, Lai L, Yu Z. Association of Evaluated Glomerular Filtration Rate and Incident Diabetes Mellitus: A Secondary Retrospective Analysis Based on a Chinese Cohort Study. Front Med (Lausanne) 2022; 8:724582. [PMID: 35174179 PMCID: PMC8841619 DOI: 10.3389/fmed.2021.724582] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 12/24/2021] [Indexed: 02/04/2023] Open
Abstract
BackgroundPrevious studies have revealed that chronic kidney disease (CKD) is a significant risk factor for insulin resistance and diabetes. However, few studies are on the association between estimated glomerular filtration rate (eGFR) and incident diabetes, especially in the Chinese population with eGFR>60 mL/min·1.73 m2. This study explored the relationship between eGFR and incident diabetes in a large cohort in the Chinese community.MethodsThis study was a retrospective cohort study. A total of 1,99,435 adults from Rich Healthcare Group in China were studied, including all medical records for participants who received a health check from 2010 to 2016. The target-independent and target-dependent variables were eGFR measured at baseline, and incident diabetes mellitus appeared during the follow-up. After testing the proportion hypothesis, Cox proportional hazards regression was used to investigate the association between eGFR and incident diabetes. A Cox proportional hazards regression with cubic spline functions and smooth curve fitting (the cubic spline smoothing) was used to identify non-linear relationships between eGFR and the risk of diabetes. Additionally, we also performed subgroup analysis and a series sensitivity analysis. It was stated that the data had been uploaded to the DATADRYAD website.ResultAfter adjusting gender, body mass index (BMI), systolic blood pressure (SBP), diastolic blood pressure (DBP), fasting plasma glucose (FPG), total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), triglyceride (TG), alanine aminotransferase (ALT), aspartate aminotransferase (AST), smoking and drinking status, and family history of diabetes, the result showed that eGFR was negatively associated with incident diabetes [HR = 0.986, 95% CI (0.984, 0.988)]. A non-linear relationship was detected between eGFR and incident diabetes, with an inflection point of eGFR of 98.034 mL/min·1.73 m2. The effect sizes and the confidence intervals (Cis) on the left and right sides of the inflection point were 0.998 (0.993, 1.003) and 0.976 (0.972, 0.980), respectively. Subgroup analysis showed a stronger association in the population with FPG <6.1 mmol/L, BMI <24 kg/m2, SBP <140 mmHg, DBP <90 mmHg and family history without diabetes. The same trend was also seen in women and the population who never smoke.ConclusionEstimated glomerular filtration rate is independently associated with incident diabetes. The relationship between eGFR and incident diabetes is also non-linear. eGFR is strongly related to incident diabetes when eGFR was above 98.034 mL/min·1.73 m2.
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Affiliation(s)
- Zihe Mo
- Department of Physical Examination, DongGuan Tungwah Hospital, Dongguan, China
| | - Haofei Hu
- Department of Nephrology, The First Affiliated Hospital of Shenzhen University, Shenzhen, China
- Department of Nephrology, Shenzhen Second People's Hospital, Shenzhen, China
| | - Xiaoqing Du
- Department of Physical Examination, DongGuan Tungwah Hospital, Dongguan, China
| | - Qingli Huang
- Department of Physical Examination, DongGuan Tungwah Hospital, Dongguan, China
| | - Ping Chen
- Department of Physical Examination, DongGuan Tungwah Hospital, Dongguan, China
| | - Linjing Lai
- Department of Physical Examination, DongGuan Tungwah Hospital, Dongguan, China
| | - Zhiqun Yu
- Department of Physical Examination, DongGuan Tungwah Hospital, Dongguan, China
- *Correspondence: Zhiqun Yu
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11
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Wang X, Huang C, Liu Y, Han Y, Hu H. Association of estimated glomerular filtration rate and incident pre-diabetes: A secondary 5-year longitudinal cohort study in Chinese people. Front Endocrinol (Lausanne) 2022; 13:965545. [PMID: 36387884 PMCID: PMC9648615 DOI: 10.3389/fendo.2022.965545] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 10/14/2022] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE There is still limited evidence regarding the relationship between the estimated glomerular filtration rate (eGFR) and pre-diabetes. For that reason, our research aims to survey the association of eGFR with pre-diabetes. METHODS This study was a retrospective cohort study, which consecutively and non-selectively collected a total of 173301 participants from Rich Healthcare Group in China from January 2010 to 2016. We then used the Cox proportional-hazards regression model to explore the relationship between baseline eGFR and pre-diabetes risk. Using a Cox proportional hazards regression with cubic spline function and smooth curve fitting (cubical spline smoothing), we were able to determine the non-linear relationship between eGFR and pre-diabetes. Additionally, we also conducted a series of sensitivity analyses and subgroup analyses. The DATADRYAD website was updated with data. RESULTS The mean age of the included individuals was 40.95 ± 11.94 years old, and 92318 (53.27%) were male. The mean baseline eGFR was 111.40 ± 14.77 ml/min per 1.73 m2. During a median follow-up time of 3.0 years, 18333 (10.58%) people experienced pre-diabetes. As a result of adjusting for covariates, eGFR had a negative association with incident pre-diabetes (HR=0.993, 95%CI: 0.992-0.995). There was also a U-shaped curve relationship between eGFR and pre-diabetes, and the inflection point of eGFR was 129.793 ml/min per 1.73 m2. HRs on the left and right sides of the inflection point were respectively 0.993 (0.991-0.994) and 1.023 (1.010- 1.037). Our results were robust in the sensitivity analysis. Subgroup analyses indicated that eGFR was strongly associated with the risk of pre-diabetes among participants who were younger than 30 years and 40-70 years, as well as among those who had never smoked. In contrast, the association of eGFR with the risk of pre-diabetes was attenuated among participants who were 30-40 years of age and 70 years of age or older, and among those who currently smoked. CONCLUSION This study demonstrates a negative and U-shaped curve association between eGFR and the risk of pre-diabetes among the general Chinese population. Either reduced renal function or glomerular hyperperfusion status may be associated with an increased risk of prediabetes.
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Affiliation(s)
- Xiaoyu Wang
- Department of Nephrology, Hechi People’s Hospital, Hechi, Guangxi Zhuang Autonomous Region, China
| | - Cheng Huang
- Department of Nephrology, Hechi People’s Hospital, Hechi, Guangxi Zhuang Autonomous Region, China
| | - Yufei Liu
- Department of Neurosurgery, Shenzhen Second People’s Hospital, Shenzhen, Guangdong, China
- Department of Neurosurgery, The First Affiliated Hospital of Shenzhen University, Shenzhen, Guangdong, China
- Shenzhen University Health Science Center, Shenzhen University, Shenzhen, Guangdong, China
| | - Yong Han
- Shenzhen University Health Science Center, Shenzhen University, Shenzhen, Guangdong, China
- Department of Emergency, Shenzhen Second People’s Hospital, Shenzhen, Guangdong, China
- Department of Emergency, The First Affiliated Hospital of Shenzhen University, Shenzhen, Guangdong, China
- *Correspondence: Yong Han, ; Haofei Hu,
| | - Haofei Hu
- Shenzhen University Health Science Center, Shenzhen University, Shenzhen, Guangdong, China
- Department of Nephrology, Shenzhen Second People’s Hospital, Shenzhen, Guangdong, China
- Department of Nephrology, The First Affiliated Hospital of Shenzhen University, Shenzhen, Guangdong, China
- *Correspondence: Yong Han, ; Haofei Hu,
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12
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Zhang Z, He P, Zhou C, Liu M, Liu C, Li H, Zhang Y, Li Q, Zhang Y, Wang G, Liang M, Qin X. Association of estimated glomerular filtration rate from serum creatinine and cystatin C with new-onset diabetes: a nationwide cohort study in China. Acta Diabetol 2021; 58:1269-1276. [PMID: 33909121 DOI: 10.1007/s00592-021-01719-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Accepted: 04/11/2021] [Indexed: 12/22/2022]
Abstract
AIMS The association between estimated glomerular filtration rate (eGFR) and the risk of diabetes remains uncertain. We aimed to examine the association between eGFR based on creatinine (eGFRcr), cystatin C (eGFRcys), or a combination of both (eGFRcr-cys) and new-onset diabetes, using data from the China Health and Retirement Longitudinal Study (CHARLS), a nationally representative cohort study. METHODS A total of 4,775 participants with pertinent measurements and without diabetes at baseline from CHARLS were included in the final analysis. The eGFR was calculated by creatinine, cystatin C or a combination of both using the Chronic Kidney Disease Epidemiology Collaboration equations. The study outcome was new-onset diabetes, defined as physician-diagnosed diabetes or use of glucose-lowering drugs during follow-up, or fasting glucose ≥ 126 mg/dL, random glucose ≥ 200 mg/dL, or HbA1c ≥ 6.5% (48 mmol/mol) at the exit visit. RESULTS The mean age of the study population was 59.6 years. The mean values for the eGFRcr, eGFRcys, and eGFRcr-cys were 92.4, 78.9 and 85.9 mL/min/1.73m2, respectively. Over 4 years of follow-up, 612 (12.8%) participants experienced diabetes. Participants with lower eGFRcr-cys (< 60 mL/min/1.73m2) had a significantly higher risk of new-onset diabetes (adjusted OR, 1.46; 95%CI: 1.02, 2.09), compared to those with eGFRcr-cys ≥ 60 mL/min/1.73m2. However, there was no significant association between eGFRcr (< 60 vs. ≥ 60 mL/min/1.73m2; adjusted OR, 1.27; 95%CI: 0.75, 2.17) or eGFRcys (adjusted OR, 1.04; 95%CI: 0.80, 1.36) and new-onset diabetes. CONCLUSIONS Lower eGFRcr-cys (< 60 mL/min/1.73m2), but not eGFRcr or eGFRcys, was significantly associated with an increased risk of new-onset diabetes in Chinese adults.
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Affiliation(s)
- Zhuxian Zhang
- National Clinical Research Center for Kidney Disease, State Key Laboratory for Organ Failure Research, Guangdong Provincial Key Laboratory of Renal Failure Research, Guangzhou Regenerative Medicine and Health Guangdong Laboratory, Guangdong Provincial Clinical Research Center for Kidney Disease, Division of Nephrology, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China
| | - Panpan He
- National Clinical Research Center for Kidney Disease, State Key Laboratory for Organ Failure Research, Guangdong Provincial Key Laboratory of Renal Failure Research, Guangzhou Regenerative Medicine and Health Guangdong Laboratory, Guangdong Provincial Clinical Research Center for Kidney Disease, Division of Nephrology, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China
| | - Chun Zhou
- National Clinical Research Center for Kidney Disease, State Key Laboratory for Organ Failure Research, Guangdong Provincial Key Laboratory of Renal Failure Research, Guangzhou Regenerative Medicine and Health Guangdong Laboratory, Guangdong Provincial Clinical Research Center for Kidney Disease, Division of Nephrology, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China
| | - Mengyi Liu
- National Clinical Research Center for Kidney Disease, State Key Laboratory for Organ Failure Research, Guangdong Provincial Key Laboratory of Renal Failure Research, Guangzhou Regenerative Medicine and Health Guangdong Laboratory, Guangdong Provincial Clinical Research Center for Kidney Disease, Division of Nephrology, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China
| | - Chengzhang Liu
- National Clinical Research Center for Kidney Disease, State Key Laboratory for Organ Failure Research, Guangdong Provincial Key Laboratory of Renal Failure Research, Guangzhou Regenerative Medicine and Health Guangdong Laboratory, Guangdong Provincial Clinical Research Center for Kidney Disease, Division of Nephrology, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China
- Institute of Biomedicine, Anhui Medical University, Hefei, 230032, China
| | - Huan Li
- National Clinical Research Center for Kidney Disease, State Key Laboratory for Organ Failure Research, Guangdong Provincial Key Laboratory of Renal Failure Research, Guangzhou Regenerative Medicine and Health Guangdong Laboratory, Guangdong Provincial Clinical Research Center for Kidney Disease, Division of Nephrology, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China
| | - Yuanyuan Zhang
- National Clinical Research Center for Kidney Disease, State Key Laboratory for Organ Failure Research, Guangdong Provincial Key Laboratory of Renal Failure Research, Guangzhou Regenerative Medicine and Health Guangdong Laboratory, Guangdong Provincial Clinical Research Center for Kidney Disease, Division of Nephrology, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China
| | - Qinqin Li
- Institute of Biomedicine, Anhui Medical University, Hefei, 230032, China
| | - Yan Zhang
- Spine Disease Research Institute, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, 200032, China
| | - Guobao Wang
- National Clinical Research Center for Kidney Disease, State Key Laboratory for Organ Failure Research, Guangdong Provincial Key Laboratory of Renal Failure Research, Guangzhou Regenerative Medicine and Health Guangdong Laboratory, Guangdong Provincial Clinical Research Center for Kidney Disease, Division of Nephrology, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China
| | - Min Liang
- National Clinical Research Center for Kidney Disease, State Key Laboratory for Organ Failure Research, Guangdong Provincial Key Laboratory of Renal Failure Research, Guangzhou Regenerative Medicine and Health Guangdong Laboratory, Guangdong Provincial Clinical Research Center for Kidney Disease, Division of Nephrology, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China
| | - Xianhui Qin
- National Clinical Research Center for Kidney Disease, State Key Laboratory for Organ Failure Research, Guangdong Provincial Key Laboratory of Renal Failure Research, Guangzhou Regenerative Medicine and Health Guangdong Laboratory, Guangdong Provincial Clinical Research Center for Kidney Disease, Division of Nephrology, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China.
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13
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Mahmoud T, Borgi L. The Interplay Between Nutrition, Metabolic, and Endocrine Disorders in Chronic Kidney Disease. Semin Nephrol 2021; 41:180-188. [PMID: 34140096 DOI: 10.1016/j.semnephrol.2021.03.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
The kidneys are responsible for maintaining our bodies' homeostasis through excretion, biodegradation, and synthesis of different hormones. Therefore, a decline in renal function often results in significant derangements in hormone levels. The most common metabolic and endocrine abnormalities seen in patients with chronic kidney disease include deficiencies in erythropoietin, calcitriol, triiodothyronine, testosterone, and estrogen. In addition, accumulation of hormones such as adiponectin, leptin, triglycerides, and prolactin also is seen. Subsequently, this can lead to the development of a wide range of clinical consequences including but not limited to anemia, hyperparathyroidism, insulin resistance, anorexia-cachexia, infertility, bone disorders, and cardiovascular diseases. These disorders can negatively affect the prognosis and quality of life of patients with chronic kidney disease, and, thus, early diagnosis, nutritional intervention, and pharmacologic treatment is imperative.
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Affiliation(s)
- Tala Mahmoud
- Faculty of Medicine, University of Balamand, Beirut, Lebanon
| | - Lea Borgi
- Renal Division, Brigham and Women's Hospital, Boston, MA.
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14
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Huber MP, Zelnick LR, Utzschneider KM, Kahn SE, de Boer IH, Kestenbaum BR. Tubular Secretory Clearance Is Associated With Whole-Body Insulin Clearance. J Clin Endocrinol Metab 2020; 105:5891787. [PMID: 32785690 PMCID: PMC7500476 DOI: 10.1210/clinem/dgaa522] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 08/06/2020] [Indexed: 12/17/2022]
Abstract
CONTEXT The kidneys eliminate insulin via glomerular and peritubular mechanisms; consequently, the kidney contribution to insulin clearance may be underestimated by the glomerular filtration rate (GFR) alone. OBJECTIVE To determine associations of tubular secretory clearance with whole-body insulin clearance and sensitivity in a dedicated study of glucose and insulin metabolism. DESIGN, SETTING, AND PARTICIPANTS We performed an ancillary, cross-sectional study of tubular secretion in the Study of Glucose and Insulin in Renal Disease (SUGAR). Hyperinsulinemic-euglycemic clamps were performed in 57 nondiabetic persons with chronic kidney disease and 38 persons without kidney disease. INTERVENTION We measured plasma and 24-hour urine concentrations of endogenous solutes primarily eliminated by tubular secretion. Kidney clearances of secretory solutes were calculated as the amount of blood fully cleared of that solute per minute. MAIN OUTCOME MEASURES Whole-body insulin clearance, insulin sensitivity. RESULTS Mean whole-body insulin clearance was 924 ± 228 mL/min. After adjustment for age, sex, Black race, fat and fat-free mass, each 20% lower estimated GFR was associated with a 13 mL/min lower insulin clearance (95% confidence interval [CI], 2-24 mL/min lower). Each 20% lower clearance of isovalerylglycine and xanthosine were associated with a 16 mL/min lower (95% CI, 5-26 mL/min lower) and 19 mL/min lower (95% CI, 7-31 mL/min lower) insulin clearance, respectively. Neither estimated GFR nor secretory solute clearances were associated with insulin sensitivity after adjustment. CONCLUSIONS These results highlight the importance of tubular secretory pathways to insulin elimination but suggest that kidney functions in aggregate contribute only modestly to systemic insulin clearance.
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Affiliation(s)
- Matthew P Huber
- University of Washington, Department of Medicine, Seattle, Washington
- Kidney Research Institute, Seattle, Washington
- Correspondence and Reprint Requests: Matthew P. Huber, MD, University of Washington, Department of Medicine, Seattle, WA; Kidney Research Institute, Seattle, WA, USA. E-mail:
| | - Leila R Zelnick
- Kidney Research Institute, Seattle, Washington
- University of Washington, Department of Medicine, Division of Nephrology, Seattle, Washington
| | - Kristina M Utzschneider
- VA Puget Sound Health Care System, Seattle, Washington
- University of Washington, Department of Medicine, Division of Metabolism, Endocrinology and Nutrition, Seattle, Washington
| | - Steven E Kahn
- VA Puget Sound Health Care System, Seattle, Washington
- University of Washington, Department of Medicine, Division of Metabolism, Endocrinology and Nutrition, Seattle, Washington
| | - Ian H de Boer
- Kidney Research Institute, Seattle, Washington
- University of Washington, Department of Medicine, Division of Nephrology, Seattle, Washington
| | - Bryan R Kestenbaum
- Kidney Research Institute, Seattle, Washington
- University of Washington, Department of Medicine, Division of Nephrology, Seattle, Washington
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15
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Kim HR. The Relationship between the Progression of Chronic Kidney Disease and Beta Cell Function in Non-Diabetic Korean Adults. KOREAN JOURNAL OF CLINICAL LABORATORY SCIENCE 2020. [DOI: 10.15324/kjcls.2020.52.3.165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Affiliation(s)
- Hyung Rag Kim
- Department of Laboratory Medicine, St. Galloro Hospital, Suncheon, Korea
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16
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Liu L, Xia R, Song X, Zhang B, He W, Zhou X, Li S, Yuan G. Association between the triglyceride-glucose index and diabetic nephropathy in patients with type 2 diabetes: A cross-sectional study. J Diabetes Investig 2020; 12:557-565. [PMID: 33319507 PMCID: PMC8015837 DOI: 10.1111/jdi.13371] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 06/27/2020] [Accepted: 07/17/2020] [Indexed: 12/12/2022] Open
Abstract
Aims/Introduction The triglyceride–glucose (TyG) index has been proposed as a reliable and simple marker of insulin resistance. We investigated the association between TyG index and diabetic nephropathy (DN) in patients with type 2 diabetes. Materials and Methods A consecutive case series of 682 adult patients with type 2 diabetes hospitalized in the Department of Endocrinology at the Tongji Hospital (Wuhan, Hubei, China) from January 2007 to December 2009 was included in this cross‐sectional analysis. Receiver operating characteristics curve analysis, correlation analysis and multiple logistic regression analysis were carried out. Results A total of 232 (34.0%) participants were identified with DN. Compared with the non‐DN group, the DN group had longer disease duration, and higher bodyweight, systolic blood pressure, diastolic blood pressure, glycated hemoglobin, triglycerides, total cholesterol, serum uric acid, 24 h‐urinary albumin, TyG index and homeostasis model assessment 2 estimates for insulin resistance (HOMA2‐IR; P < 0.05 for each). The TyG index with an optimal cut‐off point >9.66 showed a higher area under the receiver operating characteristic curve of 0.67 (P = 0.002) than HOMA2‐IR (area under the curve 0.61, P = 0.029) on receiver operating characteristic curve analysis for DN identification. Additionally, the TyG index positively correlated with the levels of metabolic indicators (bodyweight, glycated hemoglobin, triglycerides, total cholesterol, serum uric acid, fasting glucose and HOMA2‐IR) and natural logarithmic 24 h‐urinary albumin (P < 0.05 for each), but not natural logarithm of estimated glomerular filtration rate. On multiple regression analysis, an increased TyG index was shown to be an independent risk factor (odds ratio 1.91, P = 0.001) for DN. Conclusions The TyG index was independently associated with DN in patients with type 2 diabetes, and was a better marker than HOMA2‐IR for identification of DN in type 2 diabetes patients.
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Affiliation(s)
- Li Liu
- Department of Endocrinology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Rui Xia
- Department of Endocrinology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Xiaoqing Song
- Department of Endocrinology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Benping Zhang
- Department of Endocrinology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Wentao He
- Department of Endocrinology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Xinrong Zhou
- Department of Endocrinology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Shengzhong Li
- Department of Surgery, Wuhan Jinyintan Hospital, Wuhan, Hubei, China
| | - Gang Yuan
- Department of Endocrinology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
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17
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Han MM, Song W, Conti T, Conti FF, Greenlee T, Hom G, Briskin IN, Singh RP, Talcott KE. Visual Acuity Outcomes after Cataract Extraction with Intraocular Lens Implantation in Eyes with Diabetic Retinopathy. Ophthalmol Retina 2020; 4:351-360. [PMID: 32111544 DOI: 10.1016/j.oret.2019.12.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Revised: 12/26/2019] [Accepted: 12/27/2019] [Indexed: 01/19/2023]
Abstract
PURPOSE To evaluate change in best-corrected visual acuity (BCVA) in patients with diabetes and diabetic retinopathy (DR) after cataract extraction (CE). DESIGN Retrospective cohort study. PARTICIPANTS Diabetic eyes of patients 18 years of age or older that underwent CE at the Cleveland Clinic from 2012 through 2018. METHODS Chart review examining visual acuities from patient visits before and after surgery, as well as OCT images. Statistical analysis was carried out using multiple linear regression models. MAIN OUTCOME MEASURES The primary end point was change in BCVA during the first postoperative year. The secondary end point was the association of central subfield thickness at baseline with change in BCVA. Additional preoperative factors examined were age, race, gender, laterality, insulin use, hemoglobin A1c, creatinine, blood urea nitrogen, and estimated glomerular filtration rate. RESULTS Diabetic eyes without DR (n = 138) and eyes with mild/moderate nonproliferative DR (NPDR; n = 125), severe NPDR (n = 20), and proliferative DR (PDR; n = 72) were included. A year after surgery, eyes without DR gained a median of 11.0 Early Treatment Diabetic Retinopathy Study (ETDRS) letters (interquartile range [IQR], 5.0-20.0) from 65.0 (IQR, 58.0-70.0) before surgery, eyes with mild or moderate DR gained 10.0 letters (IQR, 5.0-22.0) from 65.0 (IQR, 58.0-76.0), eyes with severe NPDR gained 20.5 letters (IQR, 8.0-28.5) from 55.0 (IQR, 26.0-65.0), and eyes with PDR gained 15.0 letters (IQR, 6.0-29.5) from 55.0 (IQR, 35.0-61.0). Eyes without DR or mild or moderate NPDR showed significantly greater improvements in VA 1 year after surgery compared with eyes with severe NPDR or PDR when controlling for baseline visual acuity (VA), with eyes with more severe DR showing less expected VA gain (P < 0.001). Length of disease most strongly related to baseline DR severity (ρ = 0.431; P < 0.001). CONCLUSIONS Cataract surgery is beneficial in most patients with DR without severe concurrent macular pathologic features. However, preoperative VA and the severity of DR can limit visual outcomes.
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Affiliation(s)
- Michael M Han
- Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Weilin Song
- Cleveland Clinic Lerner College of Medicine, Cleveland, Ohio
| | - Thais Conti
- Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio; Center for Ophthalmic Bioinformatics, Cole Eye Institute, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Felipe F Conti
- Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio; Center for Ophthalmic Bioinformatics, Cole Eye Institute, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Tyler Greenlee
- Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio; Center for Ophthalmic Bioinformatics, Cole Eye Institute, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Grant Hom
- Case Western Reserve University School of Medicine, Cleveland, Ohio; Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio; Center for Ophthalmic Bioinformatics, Cole Eye Institute, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Isaac N Briskin
- Department of Quantitative Health Sciences, Cleveland Clinic Lerner Research Institute, Cleveland, Ohio
| | - Rishi P Singh
- Case Western Reserve University School of Medicine, Cleveland, Ohio; Cleveland Clinic Lerner College of Medicine, Cleveland, Ohio; Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio; Center for Ophthalmic Bioinformatics, Cole Eye Institute, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Katherine E Talcott
- Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio; Center for Ophthalmic Bioinformatics, Cole Eye Institute, Cleveland Clinic Foundation, Cleveland, Ohio.
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Roumie CL, Hung AM, Russell GB, Basile J, Kreider KE, Nord J, Ramsey TM, Rastogi A, Sweeney ME, Tamariz L, Kostis WJ, Williams JS, Zias A, Cushman WC. Blood Pressure Control and the Association With Diabetes Mellitus Incidence: Results From SPRINT Randomized Trial. Hypertension 2019; 75:331-338. [PMID: 31865790 DOI: 10.1161/hypertensionaha.118.12572] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
The SPRINT (Systolic Blood Pressure Intervention Trial) demonstrated reduced cardiovascular outcomes. We evaluated diabetes mellitus incidence in this randomized trial that compared intensive blood pressure strategy (systolic blood pressure <120 mm Hg) versus standard strategy (<140 mm Hg). Participants were ≥50 years of age, with systolic 130 to 180 mm Hg and increased cardiovascular risk. Participants were excluded if they had diabetes mellitus, polycystic kidney disease, proteinuria >1 g/d, heart failure, dementia, or stroke. Postrandomization exclusions included participants missing blood glucose or ≥126 mg/dL (6.99 mmol/L) or on hypoglycemics. The outcome was incident diabetes mellitus: fasting blood glucose ≥126 mg/dL (6.99 mmol/L), diabetes mellitus self-report, or new use of hypoglycemics. The secondary outcome was impaired fasting glucose (100-125 mg/dL [5.55-6.94 mmol/L]) among those with normoglycemia (<100 mg/dL [5.55 mmol/L]). There were 9361 participants randomized and 981 excluded, yielding 4187 and 4193 participants assigned to intensive and standard strategies. There were 299 incident diabetes mellitus events (2.3% per year) for intensive and 251 events (1.9% per year) for standard, rates of 22.6 (20.2-25.3) versus 19.0 (16.8-21.5) events per 1000 person-years of treatment, respectively (adjusted hazard ratio, 1.19 [95% CI, 0.95-1.49]). Impaired fasting glucose rates were 26.4 (24.9-28.0) and 22.5 (21.1-24.1) per 100 person-years for intensive and standard strategies (adjusted hazard ratio, 1.17 [1.06-1.30]). Intensive treatment strategy was not associated with increased diabetes mellitus but was associated with more impaired fasting glucose. The risks and benefits of intensive blood pressure targets should be factored into individualized patient treatment goals. Clinical Trial Registration- URL: http://www.clinicaltrials.gov. Unique identifier: NCT01206062.
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Affiliation(s)
- Christianne L Roumie
- From the VA Tennessee Valley Healthcare System Geriatric Research and Education Clinical Center, Nashville, TN (C.L.R., A.M.H.)
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN (C.L.R., A.M.H.)
| | - Adriana M Hung
- From the VA Tennessee Valley Healthcare System Geriatric Research and Education Clinical Center, Nashville, TN (C.L.R., A.M.H.)
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN (C.L.R., A.M.H.)
| | - Gregory B Russell
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, NC (G.B.R.)
| | - Jan Basile
- Ralph H Johnson VA Medical Center and Medical University of South Carolina, Charleston (J.B.)
| | - Kathryn Evans Kreider
- Division of Endocrinology, Metabolism and Nutrition, Department of Medicine, Duke University School of Nursing, Duke University Medical Center, NC (K.E.K.)
| | - John Nord
- Salt Lake City VA Medical Center, Salt Lake City, UT (J.N.)
| | - Thomas M Ramsey
- School of Nursing Office of Research and Scholarship, The University of Alabama at Birmingham (T.M.R.)
| | - Anjay Rastogi
- Division of Nephrology, Department of Medicine David Geffen School of Medicine UCLA, Los Angeles, CA (A.R.)
| | - Mary Ellen Sweeney
- Division of Endocrinology, Diabetes and Lipids, Department of Medicine, Emory University and Atlanta VA Medical Center (M.E.S.)
| | - Leonardo Tamariz
- Miami Veterans Healthcare and Division of Population Health and Computational Medicine, University of Miami, FL (L.T.)
| | - William J Kostis
- The Cardiovascular Institute at Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ (W.J.K.)
| | - Jonathan S Williams
- Endocrine Unit, VA Boston Healthcare System, Jamaica Plain, MA (J.S.W.)
- Division of Endocrinology, Diabetes, and Hypertension Harvard Medical School, Brigham and Women's Hospital, Boston, MA (J.S.W.)
| | - Athena Zias
- Northport Veterans Affairs Medical Center, Northport, NY Renaissance School of Medicine at Stony Brook University (A.Z.)
| | - William C Cushman
- Memphis Veterans Affairs Medical Center and University of Tennessee Health Science Center, Memphis (W.C.C.)
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19
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Li Q, Wang X, Ni Y, Hao H, Liu Z, Wen S, Shao X, Wu X, Yu W, Hu W. Epidemiological characteristics and risk factors of T2DM in Chinese premenopausal and postmenopausal women. Lipids Health Dis 2019; 18:155. [PMID: 31315681 PMCID: PMC6637604 DOI: 10.1186/s12944-019-1091-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2018] [Accepted: 06/20/2019] [Indexed: 12/26/2022] Open
Abstract
Objective This study was to analyse the prevalence of type 2 diabetes mellitus (T2DM) in premenopausal and postmenopausal women. Methods A total of 3227 women met the requirements from June to December in 2014, including 207 cases of premenopausal women and 3020 cases of postmenopausal women. The prevalence of T2DM and the associated risk factors in the two groups were analysed. Results The prevalence of premenopausal women with T2DM was 12.1%, while the prevalence in postmenopausal women was 19.4% (P < 0.05). Total serum protein (TP) (OR = 1.164 95% CI = 1.023–1.324) (P = 0.021) is a major risk factor for premenopausal women with T2DM. The prevalence of T2DM increased with the increase in TP. In postmenopausal groups, the prevalence of T2DM was associated with age (OR = 1.037 95% CI = 1.024–1.051) (P < 0.001), BMI (OR = 1.076 95% CI = 1.044–1.109) (P < 0.001), blood pressure (OR = 1.521 95% CI = 1.234–1.875) (P < 0.001), triglycerides (TG) (OR = 1.106 95% CI = 1.027–1.190) (P = 0.008), blood urea nitrogen (BUN) (OR = 1.065 95% CI = 1.004–1.129) (P = 0.036), alanine aminotransferase (ALT) (OR = 1.009 95% CI = 1.003–1.016) (P = 0.004) and TP (OR = 1.031 95% CI = 1.005–1.057) (P = 0.018). Conclusions Postmenopausal women have a higher rate of type 2 diabetes than premenopausal women. TP is a major risk factor for premenopausal women with T2DM. TP, ALT, and BUN are postmenopausal risk factors in addition to traditional risk factors such as obesity, lipidaemia and blood pressure. We should monitor risk factors and take early prevention and intervention measures to reduce the prevalence of diabetes and improve the quality of life of postmenopausal women. Trial registration ChiCTR, ChiCTR-TRC-14005029. Registered 29 July 2014,http://www.chictr.org.cn/showproj.aspx?proj=4545
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Affiliation(s)
- Qingjun Li
- Department of Endocrinology and Metabolism, Huai'an Hospital Affiliated to Xuzhou Medical College and Huai'an Second People's Hospital, Huai'an, 223001, China
| | - Xiaoqing Wang
- Department of Endocrinology and Metabolism, Huai'an Hospital Affiliated to Xuzhou Medical College and Huai'an Second People's Hospital, Huai'an, 223001, China
| | - Yaojun Ni
- Department of Cardiothoracic Surgery, Hospital Affiliated to Nanjing Medical College and Huai'an First People's Hospital, Huai'an, 223001, China
| | - Hairong Hao
- Department of Endocrinology and Metabolism, Huai'an Hospital Affiliated to Xuzhou Medical College and Huai'an Second People's Hospital, Huai'an, 223001, China
| | - Ziyu Liu
- Department of Endocrinology and Metabolism, Huai'an Hospital Affiliated to Xuzhou Medical College and Huai'an Second People's Hospital, Huai'an, 223001, China
| | - Surong Wen
- Department of Endocrinology and Metabolism, Huai'an Hospital Affiliated to Xuzhou Medical College and Huai'an Second People's Hospital, Huai'an, 223001, China
| | - Xiaojuan Shao
- Department of Endocrinology and Metabolism, Huai'an Hospital Affiliated to Xuzhou Medical College and Huai'an Second People's Hospital, Huai'an, 223001, China
| | - Xiaojuan Wu
- Department of Endocrinology and Metabolism, Huai'an Hospital Affiliated to Xuzhou Medical College and Huai'an Second People's Hospital, Huai'an, 223001, China
| | - Weinan Yu
- Department of Endocrinology and Metabolism, Huai'an Hospital Affiliated to Xuzhou Medical College and Huai'an Second People's Hospital, Huai'an, 223001, China.
| | - Wen Hu
- Department of Endocrinology and Metabolism, Huai'an Hospital Affiliated to Xuzhou Medical College and Huai'an Second People's Hospital, Huai'an, 223001, China.
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Lin CY, Hsieh MC, Kor CT, Hsieh YP. Association and risk factors of chronic kidney disease and incident diabetes: a nationwide population-based cohort study. Diabetologia 2019; 62:438-447. [PMID: 30607465 DOI: 10.1007/s00125-018-4788-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Accepted: 11/15/2018] [Indexed: 12/26/2022]
Abstract
AIMS/HYPOTHESIS Chronic kidney disease (CKD) is a known complication of diabetes mellitus, and insulin resistance is a well-known complication of CKD. However, there is no consensus in the published data on the association of CKD with incident diabetes. METHODS A total of 15,403 people with CKD were identified from the Taiwan National Health Insurance Research Database to determine their risk of incident diabetes compared with that of 15,403 matched individuals without CKD. Fine and Gray regression models using death as a competing risk were performed to calculate adjusted HRs and 95% CIs. Risk factors for incident diabetes in people with CKD were also determined. RESULTS The CKD cohort had a higher incidence rate of diabetes compared with the non-CKD cohort (11.23/1000 person-years vs 8.93/1000 person-years). In the fully adjusted model, CKD was a significant and independent predictor of incident diabetes (adjusted HR 1.204; 95% CI 1.11, 1.31). The influence of CKD on incident diabetes showed consistent results in three levels of sensitivity analysis. In the CKD cohort, the significant risk factors for incident diabetes included increased age, geographical location, hypertension, hyperlipidaemia and gout. Of these, hypertension was associated with the highest risk of developing incident diabetes (adjusted HR 1.682; 95% CI 1.47, 1.93). CONCLUSIONS/INTERPRETATION People with CKD were at higher risk of developing incident diabetes. People with CKD and hypertension, hyperlipidaemia, increased age or gout and who lived in certain geographical regions of Taiwan were more likely to develop diabetes as a complication compared with people without those characteristics.
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Affiliation(s)
- Ching-Yeh Lin
- Department of Internal Medicine, Changhua Christian Hospital, 135 Nanxiao Street, Changhua City, 500, Taiwan
| | - Ming-Chia Hsieh
- Department of Internal Medicine, Changhua Christian Hospital, 135 Nanxiao Street, Changhua City, 500, Taiwan
| | - Chew-Teng Kor
- Department of Internal Medicine, Changhua Christian Hospital, 135 Nanxiao Street, Changhua City, 500, Taiwan
| | - Yao-Peng Hsieh
- Department of Internal Medicine, Changhua Christian Hospital, 135 Nanxiao Street, Changhua City, 500, Taiwan.
- School of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
- School of Medicine, Chung Shan Medical University, Taichung, Taiwan.
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21
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Wang IK, Tsai TH, Hung YC, Wang TY, Yen TH, Lin CL, Sung FC. Increased risk of new-onset type 2 diabetes in people with chronic kidney disease. Int Urol Nephrol 2019; 51:707-712. [PMID: 30689178 DOI: 10.1007/s11255-019-02075-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2018] [Accepted: 01/03/2019] [Indexed: 11/30/2022]
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22
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Sagmeister MS, Taylor AE, Fenton A, Wall NA, Chanouzas D, Nightingale PG, Ferro CJ, Arlt W, Cockwell P, Hardy RS, Harper L. Glucocorticoid activation by 11β-hydroxysteroid dehydrogenase enzymes in relation to inflammation and glycaemic control in chronic kidney disease: A cross-sectional study. Clin Endocrinol (Oxf) 2019; 90:241-249. [PMID: 30358903 PMCID: PMC6334281 DOI: 10.1111/cen.13889] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Revised: 10/02/2018] [Accepted: 10/22/2018] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Patients with chronic kidney disease (CKD) have dysregulated cortisol metabolism secondary to changes in 11β-hydroxysteroid dehydrogenase (11β-HSD) enzymes. The determinants of this and its clinical implications are poorly defined. METHODS We performed a cross-sectional study to characterize shifts in cortisol metabolism in relation to renal function, inflammation and glycaemic control. Systemic activation of cortisol by 11β-HSD was measured as the metabolite ratio (tetrahydrocortisol [THF]+5α-tetrahydrocortisol [5αTHF])/tetrahydrocortisone (THE) in urine. RESULTS The cohort included 342 participants with a median age of 63 years, median estimated glomerular filtration rate (eGFR) of 28 mL/min/1.73 m2 and median urine albumin-creatinine ratio of 35.5 mg/mmol. (THF+5αTHF)/THE correlated negatively with eGFR (Spearman's ρ = -0.116, P = 0.032) and positively with C-reactive protein (ρ = 0.208, P < 0.001). In multivariable analysis, C-reactive protein remained a significant independent predictor of (THF+5αTHF)/THE, but eGFR did not. Elevated (THF+5αTHF)/THE was associated with HbA1c (ρ = 0.144, P = 0.008) and diabetes mellitus (odds ratio for high vs low tertile of (THF+5αTHF)/THE 2.57, 95% confidence interval 1.47-4.47). Associations with diabetes mellitus and with HbA1c among the diabetic subgroup were independent of eGFR, C-reactive protein, age, sex and ethnicity. CONCLUSIONS In summary, glucocorticoid activation by 11β-HSD in our cohort comprising a spectrum of renal function was associated with inflammation and impaired glucose control.
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Affiliation(s)
- Michael S. Sagmeister
- Institute of Inflammation and AgeingUniversity of BirminghamBirminghamUK
- Department of Renal MedicineUniversity Hospitals Birmingham NHS Foundation TrustBirminghamUK
| | - Angela E. Taylor
- Institute of Metabolism and Systems ResearchUniversity of BirminghamBirminghamUK
| | - Anthony Fenton
- Institute of Inflammation and AgeingUniversity of BirminghamBirminghamUK
- Department of Renal MedicineUniversity Hospitals Birmingham NHS Foundation TrustBirminghamUK
| | - Nadezhda A. Wall
- Institute of Clinical SciencesUniversity of BirminghamBirminghamUK
| | - Dimitrios Chanouzas
- Institute of Inflammation and AgeingUniversity of BirminghamBirminghamUK
- Department of Renal MedicineUniversity Hospitals Birmingham NHS Foundation TrustBirminghamUK
| | - Peter G. Nightingale
- Institute of Translational MedicineUniversity Hospitals Birmingham NHS Foundation TrustBirminghamUK
| | - Charles J. Ferro
- Department of Renal MedicineUniversity Hospitals Birmingham NHS Foundation TrustBirminghamUK
| | - Wiebke Arlt
- Institute of Metabolism and Systems ResearchUniversity of BirminghamBirminghamUK
| | - Paul Cockwell
- Department of Renal MedicineUniversity Hospitals Birmingham NHS Foundation TrustBirminghamUK
| | - Rowan S. Hardy
- Institute of Metabolism and Systems ResearchUniversity of BirminghamBirminghamUK
- Institute of Inflammation and Ageing, ARUK Rheumatoid Arthritis Centre of Excellence, and MRC ARUK Centre for Musculoskeletal AgeingUniversity of BirminghamBirminghamUK
| | - Lorraine Harper
- Department of Renal MedicineUniversity Hospitals Birmingham NHS Foundation TrustBirminghamUK
- Institute of Clinical SciencesUniversity of BirminghamBirminghamUK
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de Boer IH, Utzschneider KM. The kidney's role in systemic metabolism-still much to learn. Nephrol Dial Transplant 2018; 32:588-590. [PMID: 28407131 DOI: 10.1093/ndt/gfx027] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Accepted: 01/30/2017] [Indexed: 11/13/2022] Open
Affiliation(s)
- Ian H de Boer
- Division of Nephrology, Department of Medicine, University of Washington, Seattle, WA, USA.,Kidney Research Institute, Seattle, WA, USA.,VA Puget Sound Health Care System and University of Washington, Seattle, WA, USA
| | - Kristina M Utzschneider
- VA Puget Sound Health Care System and University of Washington, Seattle, WA, USA.,Division of Metabolism, Endocrinology and Nutrition, Department of Medicine, University of Washington, Seattle, WA, USA
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Abstract
PURPOSE OF REVIEW Chronic kidney disease (CKD) is characterized by the accumulation of uremic retention solutes (URS) and is associated with perturbations of glucose homeostasis even in absence of diabetes. The underlying mechanisms of insulin resistance, β cell failure, and increase risk of diabetes in CKD, however, remain unclear. Metabolomic studies reported that some metabolites are similar in CKD and diabetic kidney disease (DKD) and contribute to the progression to end-stage renal disease. We attempted to discuss the mechanisms involved in the disruption of carbohydrate metabolism in CKD by focusing on the specific role of URS. RECENT FINDINGS Recent clinical data have demonstrated a defect of insulin secretion in CKD. Several studies highlighted the direct role of some URS (urea, trimethylamine N-oxide (TMAO), p-cresyl sulfate, 3-carboxylic acid 4-methyl-5-propyl-2-furan propionic (CMPF)) in glucose homeostasis abnormalities and diabetes incidence. Gut dysbiosis has been identified as a potential contributor to diabetes and to the production of URS. The complex interplay between the gut microbiota, kidney, pancreas β cell, and peripheral insulin target tissues has brought out new hypotheses for the pathogenesis of CKD and DKD. The characterization of intestinal microbiota and its associated metabolites are likely to fill fundamental knowledge gaps leading to innovative research, clinical trials, and new treatments for CKD and DKD.
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Affiliation(s)
- Laetitia Koppe
- Department Nephrology, Centre Hospitalier Lyon Sud, 69495, Pierre-Benite, France.
- Univ. Lyon, CarMeN lab, INSA-Lyon, INSERM U1060, INRA, Université Claude Bernard Lyon 1, 69621, Villeurbanne, France.
| | - Denis Fouque
- Department Nephrology, Centre Hospitalier Lyon Sud, 69495, Pierre-Benite, France
- Univ. Lyon, CarMeN lab, INSA-Lyon, INSERM U1060, INRA, Université Claude Bernard Lyon 1, 69621, Villeurbanne, France
| | - Christophe O Soulage
- Univ. Lyon, CarMeN lab, INSA-Lyon, INSERM U1060, INRA, Université Claude Bernard Lyon 1, 69621, Villeurbanne, France
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25
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Xu H, Carrero JJ. Insulin resistance in chronic kidney disease. Nephrology (Carlton) 2018; 22 Suppl 4:31-34. [PMID: 29155496 DOI: 10.1111/nep.13147] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/30/2017] [Indexed: 11/27/2022]
Abstract
This review provides an overview of insulin resistance (IR) in patients with chronic kidney disease (CKD). IR is a pathological state in which target tissues fail to respond normally to insulin. IR is understood as a consequence of CKD and its prevalence rises particularly in advanced CKD stages. Mechanisms leading to IR are complex and multifactorial, involving post-receptor signaling defects, unhealthy lifestyles, metabolic acidosis, inflammation, oxidative stress, vitamin D deficiency, anemia, and uremic toxicity, as shown by human and experimental studies over the last 30 years. Whereas hyperinsulinemic euglycemic clamp is the gold standard, it is unpractical at the bedside, and either estimated IR indices by fasting glucose or insulin and oral glucose tolerance tests (OGTT) provide satisfactory estimates of IR also in patients with CKD. IR is likely to play a key role in the development of cardiometabolic complications, but not all studies associate IR with the risk of cardiovascular events and death. Various interventions at the level of lifestyle modifications, adaptations in dialysis therapy (such as use of icodextrin based solutions) and pharmacological strategies such as thiazolidinediones or vitamin D therapy may improve IR in patient with CKD.
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Affiliation(s)
- Hong Xu
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Juan J Carrero
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
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26
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Siméon S, Massy Z, Højlund K, Lalic K, Porcellati F, Dekker J, Petrie J, Currie G, Balkau B. Renal function markers and insulin sensitivity after 3 years in a healthy cohort, the EGIR-RISC study. BMC Nephrol 2018; 19:124. [PMID: 29855339 PMCID: PMC5984396 DOI: 10.1186/s12882-018-0918-1] [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: 09/14/2017] [Accepted: 05/14/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND People with chronic renal disease are insulin resistant. We hypothesized that in a healthy population, baseline renal function is associated with insulin sensitivity three years later. METHODS We studied 405 men and 528 women from the European Group for the study of Insulin Resistance - Relationship between Insulin Sensitivity and Cardiovascular disease cohort. Renal function was characterized by the estimated glomerular filtration rate (eGFR) and by the urinary albumin-creatinine ratio (UACR). At baseline only, insulin sensitivity was quantified using a hyperinsulinaemic-euglycaemic clamp; at baseline and three years, we used surrogate measures: the Matsuda insulin sensitivity index (ISI), the HOmeostasis Model Assessment of Insulin Sensitivity (HOMA-IS). Associations between renal function and insulin sensitivity were studied cross-sectionally and longitudinally. RESULTS In men at baseline, no associations were seen with eGFR, but there was some evidence of a positive association with UACR. In women, all insulin sensitivity indices showed the same negative trend across eGFR classes, albeit not always statistically significant; for UACR, women with values above the limit of detection, had higher clamp measured insulin sensitivity than other women. After three years, in men only, ISI and HOMA-IS showed a U-shaped relation with baseline eGFR; women with eGFR> 105 ml/min/1.73m2 had a significantly higher insulin sensitivity than the reference group (eGFR: 90-105 ml/min/1.73m2). For both men and women, year-3 insulin sensitivity was higher in those with higher baseline UACR. All associations were attenuated after adjusting on significant covariates. CONCLUSIONS There was no evidence to support our hypothesis that markers of poorer renal function are associated with declining insulin sensitivity in our healthy population.
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Affiliation(s)
- Soline Siméon
- CESP team5, Faculty of Medicine - University Paris-South, Faculty of Medicine - University Versailles-St Quentin, INSERM U1018, University Paris-Saclay, Villejuif, France
| | - Ziad Massy
- CESP team5, Faculty of Medicine - University Paris-South, Faculty of Medicine - University Versailles-St Quentin, INSERM U1018, University Paris-Saclay, Villejuif, France.,Division of Nephrology, Ambroise Paré Hospital APHP (Z.M.), Boulogne-Billancourt, Paris, France
| | - Kurt Højlund
- Department of Endocrinology (K.H.) Odense University Hospital, DK-5000, Odense, Denmark.,The Section of Molecular Diabetes & Metabolism, Department of Clinical Research and Institute of Molecular Medicine, University of Southern Denmark, DK-5000, Odense, Denmark
| | - Katarina Lalic
- Faculty of Medicine, University of Belgrade, Clinic for Endocrinology, Diabetes and Metabolic Diseases, Belgrade, Serbia
| | - Francesca Porcellati
- Section of Internal Medicine, Endocrinology and Metabolism, Department of Medicine, Perugia University School of Medicine, Perugia, Italy
| | - Jacqueline Dekker
- Department of Epidemiology and Biostatistics, Amsterdam Public Health research institute, VU University Medical Center, Amsterdam, the Netherlands
| | - John Petrie
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, Scotland, UK
| | - Gemma Currie
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, Scotland, UK
| | - Beverley Balkau
- CESP team5, Faculty of Medicine - University Paris-South, Faculty of Medicine - University Versailles-St Quentin, INSERM U1018, University Paris-Saclay, Villejuif, France. .,CESP, INSERM U1018 Equipe 5, 16 Avenue Paul Vaillant Couturier, 94807, Villejuif cedex, France.
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Joyce T, Chirino YI, Natalia MT, Jose PC. Renal damage in the metabolic syndrome (MetSx): Disorders implicated. Eur J Pharmacol 2018; 818:554-568. [DOI: 10.1016/j.ejphar.2017.11.032] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Revised: 11/14/2017] [Accepted: 11/16/2017] [Indexed: 02/08/2023]
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28
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Kim GS, Kim SG, Kim HS, Hwang EY, Lee JH, Yoon H. The relationship between chronic kidney function and homeostasis model assessment of insulin resistance and beta cell function in Korean adults with or without type 2 diabetes mellitus. Endocr J 2017; 64:1181-1190. [PMID: 28890482 DOI: 10.1507/endocrj.ej17-0274] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
The present study was conducted to assess the relationship between chronic kidney disease (CKD) and the homeostasis model assessment of insulin resistance (HOMA-IR) and beta cell function (HOMA-B) in Korean adults with or without type 2 diabetes mellitus (T2DM). This study included 5,188 adults aged 20 or older using the 2015 Korea National Health and Nutrition Examination Survey (KNHANES) data, which represents national data in Korea. A covariance test adjusted for covariates was performed for HOMA-IR and HOMA-B in relation to CKD. The present study has several key findings. First, in T2DM, HOMA-IR (p = 0.035) was higher in the CKD group than in the non-CKD group after adjusting for the related variables but HOMA-B (p = 0.141) was not significant. Second, in non-T2DM, HOMA-IR (p = 0.163) and HOMA-B (p = 0.658) were not associated with CKD after adjusting for the related variables (except age). However, when further adjusted for age, HOMA-IR (p = 0.020) and HOMA-B (p = 0.006) were higher in the CKD group than in the non-CKD group. In conclusion, insulin resistance was positively associated CKD with in Korean adults with or without T2DM. Beta cell function was positively associated CKD with in Korean adults without T2DM but not in Korean adults with T2DM.
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Affiliation(s)
- Gwang Seok Kim
- Department of Emergency Medical Technology, Chungbuk Health and Science University, Cheongju-si 28150, South Korea
| | - Sung Gil Kim
- Department of Radiological Science, Hanlyo University, Gwangyang-si, 57764, South Korea
| | - Han Soo Kim
- Department of Health Science Graduate School, Chosun University, Gwangju 61457, South Korea
| | - Eun Young Hwang
- Department of Nursing Graduate School, Chosun University, Gwangju 61457, South Korea
| | - Jun Ho Lee
- Department of Biomedical Laboratory Science, Wonkwang Health Science University, Iksan-si, 54538, South Korea
| | - Hyun Yoon
- Department of Biomedical Laboratory Science, Hanlyo University, Gwangyang-si 57764, South Korea
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The prevalence and association of chronic kidney disease and diabetes in liver cirrhosis using different estimated glomerular filtration rate equation. Oncotarget 2017; 9:2236-2248. [PMID: 29416767 PMCID: PMC5788635 DOI: 10.18632/oncotarget.23368] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Accepted: 08/29/2017] [Indexed: 12/13/2022] Open
Abstract
Background Chronic kidney disease (CKD) in cirrhosis is one of the dreaded complications associated with a steep rise in mortality and morbidity, including diabetes. There are limited data on the prevalence of CKD and the association with diabetes in outpatients with cirrhosis. Methodology This is a cross-sectional study of 7,440 adult liver cirrhosis patients enrolled from August 2001 to April 2010 in a medical center. Case control matching by age and sex with 1,967 pairs, and conditional logistic regression for odds of diabetes was analyzed using adjusted model. Results CKD was present in 46.0%, 45.7% and 45.6% of the study population using the MDRD-6, CKD-EPI and MDRD-4 estimated glomerular filtration rate (eGFR) equations, respectively. Using a conditional logistic regression model after adjusting for other risk factors, odds for diabetes increased significantly compared with non-CKD in CKD stage 3 to 5 (stage 3~5) based on MDRD-6–adjusted model, ORs were: stage 3~5, 2.34 (95% CI, 1.78-3.01); MDRD-4–adjusted model, ORs were: stage 3~5, 8.51 (95% CI, 5.63-11.4); CKD-EPI–adjusted model, ORs were: stage 3~5, 8.61 (95% CI, 5.13-13.9). Conclusion In cirrhosis patients, prevalence of diabetes was higher in patients with advanced stage of CKD. For patients with cirrhosis, patients with CKD stages 3~5 defined by MDRD-4, MDRD-6, and CKD-EPI eGFR equations had increased risk for diabetes. More severe cirrhosis, indicated by the Child-Turcott-Pugh classification was also accompanied by an increased risk for diabetes.
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Xie Y, Bowe B, Li T, Xian H, Yan Y, Al-Aly Z. Higher blood urea nitrogen is associated with increased risk of incident diabetes mellitus. Kidney Int 2017; 93:741-752. [PMID: 29241622 DOI: 10.1016/j.kint.2017.08.033] [Citation(s) in RCA: 97] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Revised: 08/26/2017] [Accepted: 08/31/2017] [Indexed: 01/05/2023]
Abstract
Experimental evidence suggests that higher levels of urea may increase insulin resistance and suppress insulin secretion. However, whether higher levels of blood urea nitrogen (BUN) are associated with increased risk of incident diabetes mellitus in humans is not known. To study this, we built a national cohort of 1,337,452 United States Veterans without diabetes to characterize the association of BUN and risk of incident diabetes. Over a median follow-up of 4.93 years, there were 172,913 cases of incident diabetes. In joint risk models of estimated glomerular filtration rate (eGFR) and BUN. there was no association between eGFR and the risk of incident diabetes in those with a BUN of 25 mg/dl or less. However, the risk was significantly increased in those with a BUN over 25 mg/dl at all eGFR levels, even in those with an eGFR of 60 ml/min/1.73m2 or more (hazard ratio 1.27; confidence interval 1.24-1.31). The risk of incident diabetes was highest in those with BUN over 25 mg/dL and an eGFR under 15 ml/min/1.73m2 (1.68; 1.51-1.87). Spline analyses of the relationship between BUN and risk of incident diabetes showed that risk was progressively higher as BUN increased. In models where eGFR was included as a continuous covariate, compared to a BUN of 25 mg/dl or less, a BUN over 25 mg/dl was associated with increased risk of incident diabetes (1.23; 1.21-1.25). Every 10 ml/min/1.73m2 decrease in eGFR was not associated with risk of incident diabetes (1.00; 1.00-1.01). Two-stage residual inclusion analyses showed that, independent of the impact of eGFR, every 10 mg/dL increase in BUN concentration was associated with increased risk of incident diabetes (1.15; 1.14-1.16). Thus, higher levels of BUN are associated with increased risk of incident diabetes mellitus.
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Affiliation(s)
- Yan Xie
- Clinical Epidemiology Center, Research and Education Service, VA Saint Louis Health Care System, St. Louis, Missouri, USA
| | - Benjamin Bowe
- Clinical Epidemiology Center, Research and Education Service, VA Saint Louis Health Care System, St. Louis, Missouri, USA
| | - Tingting Li
- Clinical Epidemiology Center, Research and Education Service, VA Saint Louis Health Care System, St. Louis, Missouri, USA; Department of Medicine, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Hong Xian
- Clinical Epidemiology Center, Research and Education Service, VA Saint Louis Health Care System, St. Louis, Missouri, USA; Department of Epidemiology and Biostatistics, College for Public Health and Social Justice, Saint Louis University, St. Louis, Missouri, USA
| | - Yan Yan
- Clinical Epidemiology Center, Research and Education Service, VA Saint Louis Health Care System, St. Louis, Missouri, USA; Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Ziyad Al-Aly
- Clinical Epidemiology Center, Research and Education Service, VA Saint Louis Health Care System, St. Louis, Missouri, USA; Department of Medicine, Washington University School of Medicine, St. Louis, Missouri, USA; Renal Section, Medicine Service, VA St. Louis Health Care System, St. Louis, Missouri, USA; Institute for Public Health, Washington University in St. Louis, St. Louis, Missouri, USA.
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Guthoff M, Wagner R, Vosseler D, Peter A, Nadalin S, Häring HU, Fritsche A, Heyne N. Impact of end-stage renal disease on glucose metabolism—a matched cohort analysis. Nephrol Dial Transplant 2017; 32:670-676. [DOI: 10.1093/ndt/gfx018] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2016] [Accepted: 01/12/2017] [Indexed: 12/13/2022] Open
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Ahmad I, Zelnick LR, Robinson NR, Hung AM, Kestenbaum B, Utzschneider KM, Kahn SE, de Boer IH. Chronic kidney disease and obesity bias surrogate estimates of insulin sensitivity compared with the hyperinsulinemic euglycemic clamp. Am J Physiol Endocrinol Metab 2017; 312:E175-E182. [PMID: 28073780 PMCID: PMC5374297 DOI: 10.1152/ajpendo.00394.2016] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2016] [Revised: 12/12/2016] [Accepted: 01/02/2017] [Indexed: 12/27/2022]
Abstract
Insulin sensitivity can be measured by procedures such as the hyperinsulinemic euglycemic clamp or by using surrogate indices. Chronic kidney disease (CKD) and obesity may differentially affect these measurements because of changes in insulin kinetics and organ-specific effects on insulin sensitivity. In a cross-sectional study of 59 subjects with nondiabetic CKD [estimated glomerular filtration rate: (GFR) <60 ml·min-1·1.73 m2] and 39 matched healthy controls, we quantified insulin sensitivity by clamp (SIclamp), oral glucose tolerance test, and fasting glucose and insulin. We compared surrogate insulin sensitivity indices to SIclamp using descriptive statistics, graphical analyses, correlation coefficients, and linear regression. Mean age was 62.6 yr; 48% of the participants were female, and 77% were Caucasian. Insulin sensitivity indices were 8-38% lower in participants with vs. without CKD and 13-59% lower in obese compared with nonobese participants. Correlations of surrogate indices with SIclamp did not differ significantly by CKD or obesity status. Adjusting for SIclamp in addition to demographic factors, Matsuda index was 15% lower in participants with vs. without CKD (P = 0.09) and 36% lower in participants with vs. without obesity (P = 0.0001), whereas 1/HOMA-IR was 23% lower in participants with vs. without CKD (P = 0.02) and 46% lower in participants with vs. without obesity (P < 0.0001). We conclude that CKD and obesity do not significantly alter correlations of surrogate insulin sensitivity indices with SIclamp, but they do bias surrogate measurements of insulin sensitivity toward lower values. This bias may be due to differences in insulin kinetics or organ-specific responses to insulin.
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Affiliation(s)
- Iram Ahmad
- Division of Metabolism, Endocrinology, and Nutrition, Department of Medicine, University of Washington, Seattle, Washington;
- Division of Nephrology, Department of Medicine, Kidney Research Institute, University of Washington, Seattle, Washington
| | - Leila R Zelnick
- Division of Nephrology, Department of Medicine, Kidney Research Institute, University of Washington, Seattle, Washington
| | - Nicole R Robinson
- Division of Nephrology, Department of Medicine, Kidney Research Institute, University of Washington, Seattle, Washington
| | - Adriana M Hung
- Division of Nephrology and Hypertension, Vanderbilt University School of Medicine, Nashville, Tennessee; and
| | - Bryan Kestenbaum
- Division of Nephrology, Department of Medicine, Kidney Research Institute, University of Washington, Seattle, Washington
| | - Kristina M Utzschneider
- Division of Metabolism, Endocrinology, and Nutrition, Department of Medicine, University of Washington, Seattle, Washington
- Veterans Affairs Puget Sound Health Care System, Seattle, Washington
| | - Steven E Kahn
- Division of Metabolism, Endocrinology, and Nutrition, Department of Medicine, University of Washington, Seattle, Washington
- Veterans Affairs Puget Sound Health Care System, Seattle, Washington
| | - Ian H de Boer
- Division of Nephrology, Department of Medicine, Kidney Research Institute, University of Washington, Seattle, Washington
- Veterans Affairs Puget Sound Health Care System, Seattle, Washington
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Spoto B, Pisano A, Zoccali C. Insulin resistance in chronic kidney disease: a systematic review. Am J Physiol Renal Physiol 2016; 311:F1087-F1108. [DOI: 10.1152/ajprenal.00340.2016] [Citation(s) in RCA: 173] [Impact Index Per Article: 21.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2016] [Accepted: 09/28/2016] [Indexed: 01/07/2023] Open
Abstract
Insulin resistance (IR) is an early metabolic alteration in chronic kidney disease (CKD) patients, being apparent when the glomerular filtration rate is still within the normal range and becoming almost universal in those who reach the end stage of kidney failure. The skeletal muscle represents the primary site of IR in CKD, and alterations at sites beyond the insulin receptor are recognized as the main defect underlying IR in this condition. Estimates of IR based on fasting insulin concentration are easier and faster but may not be adequate in patients with CKD because renal insufficiency reduces insulin catabolism. The hyperinsulinemic euglycemic clamp is the gold standard for the assessment of insulin sensitivity because this technique allows a direct measure of skeletal muscle sensitivity to insulin. The etiology of IR in CKD is multifactorial in nature and may be secondary to disturbances that are prominent in renal diseases, including physical inactivity, chronic inflammation, oxidative stress, vitamin D deficiency, metabolic acidosis, anemia, adipokine derangement, and altered gut microbiome. IR contributes to the progression of renal disease by worsening renal hemodynamics by various mechanisms, including activation of the sympathetic nervous system, sodium retention, and downregulation of the natriuretic peptide system. IR has been solidly associated with intermediate mechanisms leading to cardiovascular (CV) disease in CKD including left ventricular hypertrophy, vascular dysfunction, and atherosclerosis. However, it remains unclear whether IR is an independent predictor of mortality and CV complications in CKD. Because IR is a modifiable risk factor and its reduction may lower CV morbidity and mortality, unveiling the molecular mechanisms responsible for the pathogenesis of CKD-related insulin resistance is of importance for the identification of novel therapeutic targets aimed at reducing the high CV risk of this condition.
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Affiliation(s)
- Belinda Spoto
- Consiglio Nazionale delle Ricerche-Istituto di Fisiologia Clinica, Clinical Epidemiology and Physiopathology of Renal Diseases and Hypertension, Reggio di Calabria, Italy
| | - Anna Pisano
- Consiglio Nazionale delle Ricerche-Istituto di Fisiologia Clinica, Clinical Epidemiology and Physiopathology of Renal Diseases and Hypertension, Reggio di Calabria, Italy
| | - Carmine Zoccali
- Consiglio Nazionale delle Ricerche-Istituto di Fisiologia Clinica, Clinical Epidemiology and Physiopathology of Renal Diseases and Hypertension, Reggio di Calabria, Italy
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Bowlby W, Zelnick LR, Henry C, Himmelfarb J, Kahn SE, Kestenbaum B, Robinson-Cohen C, Utzschneider KM, de Boer IH. Physical activity and metabolic health in chronic kidney disease: a cross-sectional study. BMC Nephrol 2016; 17:187. [PMID: 27876008 PMCID: PMC5120456 DOI: 10.1186/s12882-016-0400-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2016] [Accepted: 11/15/2016] [Indexed: 12/30/2022] Open
Abstract
Background Patients with chronic kidney disease (CKD) are at high risk of progression to end stage renal disease and cardiovascular events. Physical activity may reduce these risks by improving metabolic health. We tested associations of physical activity with central components of metabolic health among people with moderate-severe non-diabetic CKD. Methods We performed a cross-sectional study of 47 people with CKD (estimated GFR <60 ml/min/1.73 m2) and 29 healthy control subjects. Accelerometry was used to measured physical activity over 7 days, the hyperinsulinemic-euglycemic clamp was used to measure insulin sensitivity, and DXA was used to measured fat mass. We tested associations of physical activity with insulin sensitivity, fat mass, blood pressure, serum lipid concentrations, and serum high sensitivity C-reactive protein concentration using multivariable linear regression, adjusting for possible confounding factors. Results Participants with CKD were less active than participants without CKD (mean (SD) 468.1 (233.1) versus 662.3 (292.5) counts per minute) and had lower insulin sensitivity (4.1 (2.1) versus 5.2 (2.0 (mg/min)/(μU/mL)), higher fat mass (32.0 (11.4) versus 29.4 (14.8) kg), and higher triglyceride concentrations (153.2 (91.6) versus 99.6 (66.8) mg/dL). With adjustment for demographics, comorbidity, medications, and estimated GFR, each two-fold higher level of physical activity was associated with a 0.9 (mg/min)/(μU/mL) higher insulin sensitivity (95% CI 0.2, 1.5, p = 0.006), an 8.0 kg lower fat mass (−12.9, −3.1, p = 0.001), and a 37.9 mg/dL lower triglyceride concentration (−71.9, −3.9, p = 0.03). Associations of physical activity with insulin sensitivity and triglycerides did not differ significantly by CKD status (p-values for interaction >0.3). Conclusions Greater physical activity is associated with multiple manifestations of metabolic health among people with moderate-severe CKD. Electronic supplementary material The online version of this article (doi:10.1186/s12882-016-0400-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Wilson Bowlby
- University of Washington School of Medicine, Seattle, WA, USA
| | - Leila R Zelnick
- Division of Nephrology and Kidney Research Institute, University of Washington, Seattle, WA, USA
| | - Connor Henry
- Division of Nephrology and Kidney Research Institute, University of Washington, Seattle, WA, USA
| | - Jonathan Himmelfarb
- Division of Nephrology and Kidney Research Institute, University of Washington, Seattle, WA, USA
| | - Steven E Kahn
- VA Puget Sound Health Care System, Seattle, WA, USA.,Division of Metabolism, Endocrinology, and Nutrition, University of Washington, Seattle, WA, USA
| | - Bryan Kestenbaum
- Division of Nephrology and Kidney Research Institute, University of Washington, Seattle, WA, USA
| | - Cassianne Robinson-Cohen
- Division of Nephrology and Kidney Research Institute, University of Washington, Seattle, WA, USA
| | - Kristina M Utzschneider
- VA Puget Sound Health Care System, Seattle, WA, USA.,Division of Metabolism, Endocrinology, and Nutrition, University of Washington, Seattle, WA, USA
| | - Ian H de Boer
- Division of Nephrology and Kidney Research Institute, University of Washington, Seattle, WA, USA. .,VA Puget Sound Health Care System, Seattle, WA, USA.
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Ikizler HO, Zelnick L, Ruzinski J, Curtin L, Utzschneider KM, Kestenbaum B, Himmelfarb J, de Boer IH. Dietary Acid Load is Associated With Serum Bicarbonate but not Insulin Sensitivity in Chronic Kidney Disease. J Ren Nutr 2016; 26:93-102. [PMID: 26508542 PMCID: PMC4762747 DOI: 10.1053/j.jrn.2015.08.008] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2015] [Revised: 08/05/2015] [Accepted: 08/16/2015] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVE In chronic kidney disease (CKD), dietary acid may promote metabolic acidosis and insulin resistance, which in turn may contribute to adverse clinical health outcomes. We examined associations between dietary acid load, serum bicarbonate, and insulin sensitivity in CKD. DESIGN In a cross-sectional study, we collected 3-day prospective food diaries to quantify dietary acid load as net endogenous acid production (NEAP, the nonvolatile acid load produced by the diet's acid balance) and potential renal acid load (PRAL). We measured urine net acid excretion (NAE) in 24-hour urine samples. Insulin sensitivity was measured by hyperinsulinemic euglycemic clamp. SUBJECTS Forty-two patients with CKD Stages 3 to 5 attending nephrology clinics in the Pacific Northwest and 21 control subjects (estimated glomerular filtration rate [eGFR] ≥ 60 mL/minute/1.73 m(2)). MAIN OUTCOME MEASURES Serum bicarbonate and insulin sensitivity (SIclamp). RESULTS Mean age was 60.8 ± 13.6 years, and 54% of participants were men. Mean eGFR and serum bicarbonate concentrations were 34.4 ± 13.1 mL/minute/1.73 m(2) and 24.1 ± 2.9 mEq/L for participants with CKD and 88.6 ± 14.5 mL/minute/1.73 m(2) and 26.3 ± 1.8 mEq/L for control subjects, respectively. Mean NEAP, PRAL, and NAE were 58.2 ± 24.3, 9.7 ± 18.4, and 32.1 ± 19.8 mEq/day, respectively. Considering all participants, dietary acid load was significantly, inversely associated with serum bicarbonate, adjusting for age, gender, race, eGFR, body mass index, and diuretic use: -1.2 mEq/L per standard deviation (SD) NEAP (95% confidence interval [CI] -1.8 to -0.6, P < .0001); -0.9 mEq/L bicarbonate per SD PRAL (95% CI -1.5 to -0.4, P = .0005); -0.7 mEq/L bicarbonate per SD NAE (95% CI -1.2 to -0.1, P = .01). These associations were similar in participants with and without CKD. However, neither NEAP and PRAL nor NAE was significantly associated with SIclamp. Serum bicarbonate was also not significantly associated with SIclamp. CONCLUSIONS In CKD, dietary acid load is associated with serum bicarbonate, suggesting that acidosis may be improved by dietary changes, but not with insulin sensitivity.
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Affiliation(s)
- Halil O Ikizler
- University of Vermont College of Medicine, Burlington, Vermont; Kidney Research Institute, University of Washington, Seattle, Washington
| | - Leila Zelnick
- Kidney Research Institute, University of Washington, Seattle, Washington
| | - John Ruzinski
- Kidney Research Institute, University of Washington, Seattle, Washington
| | - Laura Curtin
- Kidney Research Institute, University of Washington, Seattle, Washington
| | - Kristina M Utzschneider
- Division of Metabolism, Endocrinology and Nutrition, Department of Medicine, VA Puget Sound Health Care System and University of Washington, Seattle, Washington
| | - Bryan Kestenbaum
- Kidney Research Institute, University of Washington, Seattle, Washington; Division of Nephrology, Department of Medicine, University of Washington, Seattle, Washington; Department of Epidemiology, University of Washington, Seattle, Washington
| | - Jonathan Himmelfarb
- Kidney Research Institute, University of Washington, Seattle, Washington; Division of Nephrology, Department of Medicine, University of Washington, Seattle, Washington
| | - Ian H de Boer
- Kidney Research Institute, University of Washington, Seattle, Washington; Division of Nephrology, Department of Medicine, University of Washington, Seattle, Washington; Department of Epidemiology, University of Washington, Seattle, Washington.
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de Boer IH, Zelnick L, Afkarian M, Ayers E, Curtin L, Himmelfarb J, Ikizler TA, Kahn SE, Kestenbaum B, Utzschneider K. Impaired Glucose and Insulin Homeostasis in Moderate-Severe CKD. J Am Soc Nephrol 2016; 27:2861-71. [PMID: 26823551 DOI: 10.1681/asn.2015070756] [Citation(s) in RCA: 71] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2015] [Accepted: 12/08/2015] [Indexed: 12/16/2022] Open
Abstract
Kidney disease leads to clinically relevant disturbances in glucose and insulin homeostasis, but the pathophysiology in moderate-severe CKD remains incompletely defined. In a cross-sectional study of 59 participants with nondiabetic CKD (mean eGFR =37.6 ml/min per 1.73 m(2)) and 39 healthy control subjects, we quantified insulin sensitivity, clearance, and secretion and glucose tolerance using hyperinsulinemic-euglycemic clamp and intravenous and oral glucose tolerance tests. Participants with CKD had lower insulin sensitivity than participants without CKD (mean[SD] 3.9[2.0] versus 5.0 [2.0] mg/min per µU/ml; P<0.01). Insulin clearance correlated with insulin sensitivity (r=0.72; P<0.001) and was also lower in participants with CKD than controls (876 [226] versus 998 [212] ml/min; P<0.01). Adjustment for physical activity, diet, fat mass, and fatfree mass in addition to demographics and smoking partially attenuated associations of CKD with insulin sensitivity (adjusted difference, -0.7; 95% confidence interval, -1.4 to 0.0 mg/min per µU/ml) and insulin clearance (adjusted difference, -85; 95% confidence interval, -160 to -10 ml/min). Among participants with CKD, eGFR did not significantly correlate with insulin sensitivity or clearance. Insulin secretion and glucose tolerance did not differ significantly between groups, but 65% of participants with CKD had impaired glucose tolerance. In conclusion, moderate-severe CKD associated with reductions in insulin sensitivity and clearance that are explained, in part, by differences in lifestyle and body composition. We did not observe a CKD-specific deficit in insulin secretion, but the combination of insulin resistance and inadequate augmentation of insulin secretion led to a high prevalence of impaired glucose tolerance.
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Affiliation(s)
- Ian H de Boer
- Division of Nephrology and Kidney Research Institute and Veterans Affairs Puget Sound Health Care System, Seattle, Washington; and
| | - Leila Zelnick
- Division of Nephrology and Kidney Research Institute and
| | | | - Ernest Ayers
- Division of Nephrology and Kidney Research Institute and
| | - Laura Curtin
- Division of Nephrology and Kidney Research Institute and
| | | | - T Alp Ikizler
- Division of Nephrology and Vanderbilt Center for Kidney Disease, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Steven E Kahn
- Veterans Affairs Puget Sound Health Care System, Seattle, Washington; and Division of Metabolism, Endocrinology, and Nutrition, University of Washington, Seattle, Washington
| | | | - Kristina Utzschneider
- Veterans Affairs Puget Sound Health Care System, Seattle, Washington; and Division of Metabolism, Endocrinology, and Nutrition, University of Washington, Seattle, Washington
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Noh H, Yu MR, Kim HJ, Jang EJ, Hwang ES, Jeon JS, Kwon SH, Han DC. Uremic toxin p-cresol induces Akt-pathway-selective insulin resistance in bone marrow-derived mesenchymal stem cells. Stem Cells 2015; 32:2443-53. [PMID: 24805773 DOI: 10.1002/stem.1738] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2013] [Revised: 04/04/2014] [Accepted: 04/11/2014] [Indexed: 11/06/2022]
Abstract
We reported a functional incompetence in mesenchymal stem cells (MSCs) under uremia, but the mechanisms have not been explored. To study the mechanisms of dysfunctional MSCs induced by uremia, we characterized insulin signaling in MSCs and investigated the effect of uremic toxin, p-cresol, on the proangiogenic actions of insulin. In MSCs, insulin induced hypoxia-inducible factor (HIF)-1α, vascular endothelial growth factor, and stromal cell-derived factor 1α expressions via PI3K/Akt-dependent pathway. MSCs treated with p-cresol exhibited altered insulin signaling in a selective manner for insulin receptor substrate-1/PI3K/Akt pathway, whereas ERK pathway remained active. The insulin-induced increase of HIF-1α was blunted by p-cresol treatment. This Akt-selective insulin resistance was also observed in MSCs isolated from chronic kidney disease (CKD) mice. In mice model of hindlimb ischemia, blood flow recovery, capillary density, and local production of angiogenic factors in the ischemic limb treated with CKD MSCs were significantly inferior to those promoted by control MSCs. However, modifying CKD MSCs by overexpression of HIF-1α restored all of these changes. Taken together, these data suggest that p-cresol contributes to insulin resistance in a selective manner for Akt pathway. This might be a biological explanation for the functional incompetence of MSCs under uremia through defects in the insulin-induced elevation of HIF-1α protein expression.
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Affiliation(s)
- Hyunjin Noh
- Department of Internal Medicine, Soon Chun Hyang University, Seoul, Korea; Hyonam Kidney Laboratory, Soon Chun Hyang University, Seoul, Korea
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Hu J, Yang S, Wang Y, Goswami R, Peng C, Gao R, Zhou H, Zhang Y, Cheng Q, Zhen Q, Li Q. Serum bisphenol A and progression of type 2 diabetic nephropathy: a 6-year prospective study. Acta Diabetol 2015; 52:1135-41. [PMID: 26321107 DOI: 10.1007/s00592-015-0801-5] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2015] [Accepted: 07/23/2015] [Indexed: 12/14/2022]
Abstract
AIMS Bisphenol A (BPA) is associated with diabetes and cardiovascular diseases. The aim of our study was to evaluate whether serum BPA could predict the progression of chronic kidney disease (CKD) in patients with type 2 diabetes (T2D). METHODS In this prospective study, a total of 121 patients with T2D and estimated glomerular filtration rate (eGFR) ≥ 60 mL/min/1.73 m(2) were followed up for 6 years. The baseline values of serum BPA were measured. Renal function was measured as eGFR calculated by the Chronic Kidney Disease Epidemiology Collaboration creatinine-cystatin C equation. Development of CKD was defined as eGFR < 60 mL/min/1.73 m(2) at the last follow-up. Regression models were used to analyze the associations of serum BPA with the change in eGFR and the risk of CKD development. RESULTS Baseline serum BPA concentration was 0.40 (0.17, 1.40) ng/mL. Duration of T2D, baseline waist circumference, systolic blood pressure, diastolic blood pressure, fasting plasma glucose, and serum BPA level were significantly negatively associated with the annual change and percentage change in eGFR. After adjusting for clinical factors, baseline serum BPA level had a significant negative association with the annual change in eGFR (β = -0.371, P < 0.001) and percentage change in eGFR (β = -0.391, P = <0.001). Multivariate logistic regression analysis showed that patients with high levels of serum BPA exhibited about a sevenfold increased risk of developing CKD compared to patients with low levels of serum BPA [odds ratio (OR) 6.65 (95 % CI 1.47, 30.04), P = 0.014]. CONCLUSION Serum BPA may be a predictor of CKD in patients with T2D.
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Affiliation(s)
- Jinbo Hu
- Department of Endocrinology, The First Affiliated Hospital of Chongqing Medical University, No.1 Youyi Street, Yuzhong District, Chongqing, 400016, China
| | - Shumin Yang
- Department of Endocrinology, The First Affiliated Hospital of Chongqing Medical University, No.1 Youyi Street, Yuzhong District, Chongqing, 400016, China
| | - Yue Wang
- Department of Endocrinology, The First Affiliated Hospital of Chongqing Medical University, No.1 Youyi Street, Yuzhong District, Chongqing, 400016, China
| | - Richa Goswami
- Department of Endocrinology, The First Affiliated Hospital of Chongqing Medical University, No.1 Youyi Street, Yuzhong District, Chongqing, 400016, China
| | - Chuan Peng
- Department of Endocrinology, The First Affiliated Hospital of Chongqing Medical University, No.1 Youyi Street, Yuzhong District, Chongqing, 400016, China
| | - Rufei Gao
- Department of Endocrinology, The First Affiliated Hospital of Chongqing Medical University, No.1 Youyi Street, Yuzhong District, Chongqing, 400016, China
| | - Huang Zhou
- Department of Endocrinology, The First Affiliated Hospital of Chongqing Medical University, No.1 Youyi Street, Yuzhong District, Chongqing, 400016, China
| | - Yi Zhang
- Hospital of Chongqing University, Chongqing, 400044, China
| | - Qingfeng Cheng
- Department of Endocrinology, The First Affiliated Hospital of Chongqing Medical University, No.1 Youyi Street, Yuzhong District, Chongqing, 400016, China
| | - Qianna Zhen
- Department of Endocrinology, The First Affiliated Hospital of Chongqing Medical University, No.1 Youyi Street, Yuzhong District, Chongqing, 400016, China
| | - Qifu Li
- Department of Endocrinology, The First Affiliated Hospital of Chongqing Medical University, No.1 Youyi Street, Yuzhong District, Chongqing, 400016, China.
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Jing C, Xu S, Ming J, Cai J, Zhang R, Shen H, Yang W, Ji Q. Insulin resistance is not independently associated with chronic kidney disease in Chinese population: A population-based cross-sectional study. Clin Chim Acta 2015; 448:232-7. [DOI: 10.1016/j.cca.2015.07.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2015] [Revised: 07/08/2015] [Accepted: 07/13/2015] [Indexed: 11/25/2022]
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de Boer IH, Mehrotra R. Insulin resistance in chronic kidney disease: a step closer to effective evaluation and treatment. Kidney Int 2015; 86:243-5. [PMID: 25079023 PMCID: PMC4119606 DOI: 10.1038/ki.2014.123] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Accurate measurements are needed to target insulin resistance in CKD. Among older men with and without moderate CKD, Jia and colleagues compared insulin resistance estimated from glucose and insulin concentrations obtained while fasting or during an oral glucose tolerance test to insulin resistance measured by the gold standard hyperinsulinemic euglycemic clamp and tested associations of each with mortality. These findings move forward the study of insulin resistance in CKD and generate new questions for future work.
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Affiliation(s)
- Ian H de Boer
- Division of Nephrology and Kidney Research Institute, Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Rajnish Mehrotra
- Division of Nephrology and Kidney Research Institute, Department of Medicine, University of Washington, Seattle, Washington, USA
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Jia T, Risérus U, Xu H, Lindholm B, Ärnlöv J, Sjögren P, Cederholm T, Larsson TE, Ikizler TA, Carrero JJ. Kidney function, β-cell function and glucose tolerance in older men. J Clin Endocrinol Metab 2015; 100:587-93. [PMID: 25429626 PMCID: PMC4318901 DOI: 10.1210/jc.2014-3313] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
CONTEXT Kidney dysfunction induces insulin resistance, but it is unknown if β cell function is affected. OBJECTIVE To investigate insulin release (β cell function) and glucose tolerance following a standardized oral glucose tolerance test (OGTT) across kidney function strata. SETTING AND DESIGN Community-based cohort study from the Uppsala Longitudinal Study of Adult Men (ULSAM). PARTICIPANTS AND MAIN OUTCOME MEASURE: Included were 1015 nondiabetic Swedish men aged 70-71 years. All participants underwent OGTT and euglycaemic hyperinsulinaemic clamp (HEGC) tests, allowing determination of insulin sensitivity, β cell function, and glucose tolerance. Kidney function was estimated by cystatin C-algorithms. Mixed models were used to identify determinants of insulin secretion after the hyperglycemic load. RESULTS As many as 466 (46%) of participants presented moderate-advanced kidney disease. Insulin sensitivity (by HEGC) decreased across decreasing kidney function quartiles. After the OGTT challenge, however, β cell function indices (area under the curve for insulin release, the estimated first phase insulin release, and the insulinogenic index) were incrementally higher. Neither the oral disposition index nor the 2-h postload glucose tolerance differed across the kidney function strata. Mixed models showed that dynamic insulin release during the OGTT was inversely associated with kidney function, despite the correction for each individual's insulin sensitivity or its risk factors. CONCLUSIONS In older men, β cell function after a hyperglycemic load appropriately compensated the loss in insulin sensitivity that accompanies kidney dysfunction. As a result, the net balance between insulin sensitivity and β cell function was preserved.
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Affiliation(s)
- Ting Jia
- Divisions of Renal Medicine and Baxter Novum, Departments of Clinical Science, Intervention and Technology (T.J., H.X., B.L., T.E.L., J.J.C.), Public Health Sciences (T.J.), and Center for Molecular Medicine (J.J.C.), Karolinska Institutet, Stockholm, Sweden; Department of Public Health and Caring Sciences, Section of Geriatrics (J.A.), Clinical Nutrition and Metabolism (U.R., P.S., T.C.), Uppsala University, Uppsala, Sweden; School of Health and Social Studies (J.A.), Dalarna University, Falun, Sweden; and Department of Medicine (T.A.I.), Division of Nephrology, Vanderbilt University Medical Center, Nashville, Tennessee
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Teta D. Insulin resistance as a therapeutic target for chronic kidney disease. J Ren Nutr 2014; 25:226-9. [PMID: 25511524 DOI: 10.1053/j.jrn.2014.10.019] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2014] [Accepted: 10/29/2014] [Indexed: 12/15/2022] Open
Abstract
Insulin resistance (IR) is a prevalent metabolic feature in chronic kidney disease (CKD). Postreceptor insulin-signaling defects have been observed in uremia. A decrease in the activity of phosphatidylinositol 3-kinase appears critical in the pathophysiology of CKD-associated IR. Lipotoxicity due to ectopic accumulation of lipid moieties has recently emerged as another mechanism by which CKD and/or associated metabolic disorders may lead to IR through impairment of various insulin-signaling molecules. Metabolic acidosis, anemia, excess of fat mass, inflammation, vitamin D deficiency, adipokine imbalance, physical inactivity, and the accumulation of nitrogenous compounds of uremia all contribute to CKD-associated IR. The clinical impacts of IR in this setting are numerous, including endothelial dysfunction, increased cardiovascular mortality, muscle wasting, and possibly initiation and progression of CKD. This is why IR may be a therapeutic target in the attempt to improve outcomes in CKD. General measures to improve IR are directed to counteract causal factors. The use of pharmaceutical agents such as inhibitors of the renin-angiotensin system may improve IR in hypertensive and CKD patients. Pioglitazone appears a safe and promising therapeutic agent to reduce IR and uremic-associated abnormalities. However, interventional studies are needed to test if the reduction and/or normalization of IR may actually improve outcomes in these patients.
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Affiliation(s)
- Daniel Teta
- Service of Nephrology, Department of Medicine, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland.
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Chang YT, Liu CC, Tsai LM, Li CY, Sung JM. Separate and joint effects of diabetes mellitus and chronic kidney disease on the risk of acute coronary syndrome: a population-based cohort study. Medicine (Baltimore) 2014; 93:e261. [PMID: 25526451 PMCID: PMC4603129 DOI: 10.1097/md.0000000000000261] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Patient with diabetes (DM) and chronic kidney disease (CKD) are at a higher risk of developing acute coronary syndrome (ACS). However, only a few studies have investigated the separate and joint effects of DM and CKD on the risk of ACS, especially population-based studies under age-, sex- and various cardiovascular risk factor-stratifications. By using a national diabetes cohort derived from the Taiwan National Health Insurance Research Database, we identified a total of 416,143 DM and 541,724 non-DM patients, including 51,208 DM/CKD and 8,894 non-DM/CKD patients, in 2000 who did not have a history of ACS (ICD-9: 410.X, 413.9, 411.1) before 2000. We then prospectively investigated the incidence of ACS by linking to inpatient claims data from 2000 to 2007. A Cox proportional hazard model was used to estimate the relative risk of ACS in individuals with DM and/or CKD under various stratifications. Age- and sex-specific incidence rates were similar between the non-DM/CKD and DM/non-CKD groups, except for female patients under 45 years, in whom DM was associated with a higher risk of ACS than CKD (8.21 vs. 3.82 per 1000 person-years). In the group aged <45 years, the DM/non-CKD patients were associated with a higher relative hazard of ACS than those in the non-DM/CKD group when compared with the non-DM/non-CKD group (men: adjusted hazard ratios [AHR]:1.77; 95% confidence interval [CI]:1.61-1.93 vs. 1.42 [95% CI: 0.73-2.73]; women 1.97 [95% CI: 1.76-2.20] vs. 1.13 [95% CI: 0.36-3.52]). This discrepancy in AHR was reduced with increasing age. The co-existence of DM and CKD further enhanced the AHR in a multiplicative independent manner. A significant age-modification effect was noted in the DM individuals regardless of their CKD status, but not in the non-DM/CKD group. In stratification by various cardiovascular risk factors, diabetes had a higher risk of ACS than CKD in patients with ≤2 selected risk factors, with the exception of the hyperlipidemia and hypertension subgroup. When all three selected risk factors were included, CKD was associated with a higher risk of ACS than DM (AHR: 1.43 [1.27-1.60] vs. 1.25 [1.22-1.29]). In conclusion, DM and CKD were associated with different levels of risk for ACS according to age, sex and certain cardiovascular risk factors. Strategies aimed at preventing ACS should therefore be individualized according to the presence of DM, CKD and various cardiovascular risk factors.
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Affiliation(s)
- Yu-Tzu Chang
- From the Department of Internal Medicine, National Cheng Kung University Hospital, Tainan (Y-TC, L-MT, J-MS); Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan (Y-TC); Health Promotion Administration, Ministry of Health and Welfare, Taipei, Taiwan (C-CL); Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan (C-CL, C-YL, J-MS); and Department of Public Health, College of Public Health, China Medical University, Taichung, Taiwan (C-YL)
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Rhee CM, Kalantar-Zadeh K, Streja E, Carrero JJ, Ma JZ, Lu JL, Kovesdy CP. The relationship between thyroid function and estimated glomerular filtration rate in patients with chronic kidney disease. Nephrol Dial Transplant 2014; 30:282-7. [PMID: 25246335 DOI: 10.1093/ndt/gfu303] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Recent studies have shown an increasing risk of hypothyroidism with incrementally lower estimated glomerular filtration rate (eGFR) in cohorts comprised of patients with normal to mildly impaired kidney function. We sought to confirm these findings in a nationally representative cohort of Veterans Affairs patients with moderate-to-severe chronic kidney disease (CKD). METHODS This study examined the association between kidney function and hypothyroidism among 461 607 veterans with Stage 3 to 5 CKD who underwent repeated measurements of serum creatinine and thyrotropin (TSH) at identical time points between October 2004 and September 2006. Kidney function was defined by eGFR using the Chronic Kidney Disease Epidemiology Collaboration formula. In primary analyses, the association between eGFR and hypothyroidism (defined as serum TSH > 5 mIU/L and/or receipt of thyroid hormone supplementation) was estimated using multivariable random effects logistic regression. In secondary analyses, the association between eGFR and serum TSH level was estimated using multivariable random effects linear regression. RESULTS At baseline, 68.9, 25.5, 5.3 and 0.3% of patients had Stage 3A, 3B, 4 and 5 CKD, respectively. For every 10 mL/min/1.73 m(2) lower eGFR, there was an 18% higher risk of hypothyroidism: adjusted odds ratio 1.18 [95% confidence interval (CI) 1.17-1.20, P < 0.001]. In secondary analyses, we observed that a 10 mL/min/1.73 m(2) lower eGFR was associated with a 0.11 mIU/L higher serum TSH (95% CI 0.10-0.11 mIU/L higher serum TSH, P < 0.001). CONCLUSIONS In a nationally representative cohort of patients with moderate-to-severe CKD, there is an inverse association between eGFR and risk of hypothyroidism.
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Affiliation(s)
- Connie M Rhee
- Harold Simmons Center for Chronic Disease Research and Epidemiology, Division of Nephrology and Hypertension, University of California Irvine Medical Center, Orange, CA, USA
| | - Kamyar Kalantar-Zadeh
- Harold Simmons Center for Chronic Disease Research and Epidemiology, Division of Nephrology and Hypertension, University of California Irvine Medical Center, Orange, CA, USA
| | - Elani Streja
- Harold Simmons Center for Chronic Disease Research and Epidemiology, Division of Nephrology and Hypertension, University of California Irvine Medical Center, Orange, CA, USA
| | | | - Jennie Z Ma
- Division of Nephrology, University of Virginia, Charlottesville, VA, USA
| | - Jun L Lu
- Division of Nephrology, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Csaba P Kovesdy
- Division of Nephrology, University of Tennessee Health Science Center, Memphis, TN, USA Division of Nephrology, Memphis Veterans Affairs Medical Center, Memphis, TN, USA
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McGill JB. Anti-diabetes therapy: safety considerations for patients with impaired kidney function. Postgrad Med 2014; 126:161-71. [PMID: 24918801 DOI: 10.3810/pgm.2014.05.2765] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
The presence of type 2 diabetes mellitus (T2DM) is a common risk factor for the development of chronic kidney disease, but appropriate glycemic control can slow the progression of kidney dysfunction in patients with T2DM. The kidney plays a role in insulin resistance and gluconeogenesis, therefore, impaired kidney function alters glucose dynamics compared with normal kidney function, thus affecting antihyperglycemic treatment strategies. Glycemic management is further complicated by reduced drug clearance and a greater risk of hypoglycemia with use of certain medications, notably the sulfonylureas. Of the classes of antihyperglycemic drugs discussed in this review, caution is advised when using some classes in patients with T2DM and kidney disease.
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Affiliation(s)
- Janet B McGill
- Professor of Medicine, Division of Endocrinology, Metabolism and Lipid Research, Washington University School of Medicine, St Louis, MO.
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Chatterjee R, Biggs ML, de Boer IH, Brancati FL, Svetkey LP, Barzilay J, Djoussé L, Ix JH, Kizer JR, Siscovick DS, Mozaffarian D, Edelman D, Mukamal KJ. Potassium and glucose measures in older adults: the Cardiovascular Health Study. J Gerontol A Biol Sci Med Sci 2014; 70:255-61. [PMID: 24895271 DOI: 10.1093/gerona/glu071] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND We sought to determine the impacts of serum and dietary potassium measures on glucose metabolism and diabetes risk in older adults. METHODS Among participants of the Cardiovascular Health Study, a community-based cohort of older American adults, we examined a) cross-sectional associations between potassium and measures of insulin sensitivity and secretion estimated from oral glucose tolerance tests and b) longitudinal associations of serum and dietary potassium with diabetes risk. RESULTS Among 4,754 participants aged ≥65 years at baseline, there were 445 cases of incident diabetes during a median follow-up of 12 years. In multivariate models, baseline serum and dietary potassium were both associated with lower insulin sensitivity and greater insulin secretion. Compared with those with a serum potassium ≥4.5 mEq/L, participants with a serum potassium <4.0mEq/L had an adjusted mean difference in Matsuda insulin sensitivity index of -0.18 (-0.39, 0.02). Compared with those in the highest quartile, participants in the lowest quartile of dietary potassium intake had a corresponding adjusted mean difference in Matsuda insulin sensitivity index of -0.61 (-0.94, -0.29). In multivariate models, neither serum nor dietary potassium intake was associated with long-term diabetes risk. CONCLUSIONS Although we did not identify serum and dietary potassium as risk factors for incident diabetes in older adults, results from cross-sectional analyses suggest that both may be associated with increased insulin resistance. This relationship with insulin resistance needs to be confirmed, and its importance on diabetes risk, cardiovascular risk, and conditions specific to older adults should be determined as well.
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Affiliation(s)
- Ranee Chatterjee
- Department of Medicine, Duke University, Durham, North Carolina.
| | - Mary L Biggs
- Department of Biostatistics, Collaborative Studies Coordinating Center
| | - Ian H de Boer
- Department of Medicine, and Department of Epidemiology, University of Washington, Seattle
| | | | - Laura P Svetkey
- Department of Medicine, Duke University, Durham, North Carolina
| | - Joshua Barzilay
- Kaiser Permanente of Georgia and Department of Medicine, Emory University School of Medicine, Atlanta
| | - Luc Djoussé
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, and Boston Veterans Affairs Healthcare System, Massachusetts
| | - Joachim H Ix
- Department of Medicine, University of California, San Diego and Veterans Affairs San Diego Healthcare System
| | - Jorge R Kizer
- Department of Medicine, Albert Einstein College of Medicine, Bronx, New York
| | - David S Siscovick
- Department of Medicine, and Department of Epidemiology, University of Washington, Seattle
| | - Dariush Mozaffarian
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - David Edelman
- Department of Medicine, Duke University, Durham, North Carolina
| | - Kenneth J Mukamal
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
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Chronic kidney disease and nonalcoholic Fatty liver disease-is there a link? Gastroenterol Res Pract 2014; 2014:847539. [PMID: 24729784 PMCID: PMC3963366 DOI: 10.1155/2014/847539] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2013] [Accepted: 02/04/2014] [Indexed: 01/12/2023] Open
Abstract
Research in recent years has led to the recognition of the importance of nonalcoholic fatty liver disease (NAFLD) and its relationship to the metabolic syndrome (MS). This has led to a growing interest in the potential prognostic value of NAFLD for adverse cardiovascular disease (CVD) outcome. On the other hand, searching for new risk factors for chronic kidney disease (CKD) development and progression is very important. Growing evidence suggests that the MS is an important factor in the pathogenesis of CKD. The best confirmation of this pathogenic link is hypertensive and diabetic nephropathy as the main causes of CKD. Furthermore, the possible link between NAFLD and CKD has also attracted research interest and recent data suggest an association between these two conditions. These findings have fuelled concerns that NAFLD may be a new and added risk factor for the development and progression of CKD. NAFLD and CKD share some important cardiometabolic risk factors and possible common pathophysiological mechanisms, and both are linked to an increased risk of incident CVD events. Therefore, common factors underlying the pathogenesis of NAFLD and CKD may be insulin resistance, oxidative stress, activation of rennin-angiotensin system, and inappropriate secretion of inflammatory cytokines by steatotic and inflamed liver.
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Xu H, Huang X, Arnlöv J, Cederholm T, Stenvinkel P, Lindholm B, Risérus U, Carrero JJ. Clinical correlates of insulin sensitivity and its association with mortality among men with CKD stages 3 and 4. Clin J Am Soc Nephrol 2014; 9:690-7. [PMID: 24436478 DOI: 10.2215/cjn.05230513] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
BACKGROUND AND OBJECTIVES Insulin resistance participates in the pathogenesis of multiple metabolic and cardiovascular diseases. CKD patients have impaired insulin sensitivity, but the clinical correlates and outcome associations of impaired insulin sensitivity in this vulnerable population are not well defined. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS The prospective cohort study was from the third examination cycle of the Uppsala Longitudinal Study of Adult Men, a population-based survey of elderly men ages 70-71 years; insulin sensitivity was assessed by glucose disposal rate as measured with euglycemic clamps. Inclusion criterion was eGFR<60 ml/min per 1.73 m(2) (n=543). Exclusion criteria were incomplete data on euglycemic clamp and diabetes (n=97), leaving 446 men with CKD stages 3 and 4 (eGFR median=51.9 ml/min per 1.73 m(2); range=20.2-59.5 ml/min per 1.73 m(2)). RESULTS The mean of glucose disposal rate was 5.4 ± 1.9 mg/kg per minute. In multivariable analysis, the independent clinical correlates of glucose disposal rate were eGFR (slope, 0.02; 95% confidence interval, 0.01 to 0.04), hypertension (-0.48; 95% confidence interval, -0.86 to -0.11), hyperlipidemia (-0.51; 95% confidence interval, -0.84 to -0.18), and body mass index (-0.32; 95% confidence interval, -0.37 to -0.27). During follow-up (median=10.0 years; interquartile range=8.7-11.0 years), 149 participants died. In Cox regression models, glucose disposal rate was not associated with all-cause or cardiovascular mortality. Multiplicative interactions (P<0.05) were observed between glucose disposal rate and physical activity or smoking in total mortality association. After subsequent stratification, glucose disposal rate was an independent correlate of all-cause mortality in smokers (adjusted hazard ratio, 0.72; 95% confidence interval, 0.54 to 0.96 per 1 mg/kg per minute glucose disposal rate increase) and physically inactive individuals (hazard ratio, 0.77; 95% confidence interval, 0.61 to 0.97) but not their counterparts. CONCLUSION eGFR, together with various components of the metabolic syndrome, contributed to explain the variance of insulin sensitivity in men with CKD stages 3 and 4. Insulin sensitivity was associated with a lower mortality risk in individuals who smoked and individuals who were physically inactive.
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Affiliation(s)
- Hong Xu
- Divisions of Renal Medicine and Baxter Novum, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden;, †Department of Nephrology, Peking Union Medical College Hospital, Chinese Academy of Medical Science, Beijing, China;, ‡Division of Nephrology, Peking University Shenzhen Hospital, Peking University, Shenzhen, China;, §Department of Public Health and Caring Sciences, Section of Geriatrics, and, ¶Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism, Uppsala University, Uppsala, Sweden;, ‖School of Health and Social Studies, Dalarna University, Falun, Sweden, *Center for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden
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Park JH, Oh SW, Ahn SY, Kim S, Na KY, Chae DW, Kim S, Chin HJ. Decreased estimated glomerular filtration rate is not directly related to increased insulin resistance. Diabetes Res Clin Pract 2013; 99:366-71. [PMID: 23298661 DOI: 10.1016/j.diabres.2012.12.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2012] [Revised: 12/01/2012] [Accepted: 12/13/2012] [Indexed: 10/27/2022]
Abstract
AIMS Insulin resistance (IR) is associated with chronic kidney disease (CKD) but little is known about the possible causal relationship and differences in IR based on estimated glomerular filtration rate (eGFR) groups. The objective of this study was to identify a possible association between the level of renal dysfunction and IR. METHODS We measured eGFR and calculated the Homeostasis Model Assessment IR (HOMA-IR) index value. The study included 17,157 subjects ≥20years old without diabetes who underwent voluntary health check-ups. We classified subjects into four groups according to eGFR: Group 1, eGFR ≥90; Group 2, eGFR 75-89; Group 3, eGFR 60-74; Group 4, eGFR <60mL/min/1.73m(2). RESULTS While HOMA-IR index values were higher in lower eGFR groups compared with higher eGFR groups (P<0.001), multivariate analysis revealed that the relationship was not significant. HOMA-IR index values in eGFR groups estimated by analysis of covariance (ANCOVA) adjusted for related factors were not significantly higher in lower eGFR groups. When we stratified the subjects by the number of MS components, there were no meaningful differences in HOMA-IR values according to eGFR group. The frequency of high HOMA-IR index (≥2.5) among eGFR groups stratified with number of MS components was not significantly different. CONCLUSION Decreased kidney function is not associated with IR.
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Affiliation(s)
- Jung Hwan Park
- Department of Internal Medicine, Konkuk University School of Medicine, Republic of Korea
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Hamad AA, Khalil AA, Connolly V, Ahmed MH. Relationship between non-alcoholic fatty liver disease and kidney function: A communication between two organs that needs further exploration. Arab J Gastroenterol 2012; 13:161-5. [DOI: 10.1016/j.ajg.2012.06.010] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2012] [Revised: 05/19/2012] [Accepted: 06/21/2012] [Indexed: 01/22/2023]
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