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Zhang M, Wang Y, Fu W, Sun L. The effect of a methylxanthine vasodilator: pentoxifylline on the treatment of diabetic nephropathy-a meta-analysis. NAUNYN-SCHMIEDEBERG'S ARCHIVES OF PHARMACOLOGY 2024; 397:2777-2791. [PMID: 37987795 DOI: 10.1007/s00210-023-02842-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 11/08/2023] [Indexed: 11/22/2023]
Abstract
This meta-analysis aimed to comprehensively evaluate the efficacy and safety of pentoxifylline (PTF) in the treatment of diabetic nephropathy (DN) and to offer fresh perspectives and evidence-based references for this condition. Meta-analysis. Relevant randomized controlled trials (RCTs) were searched from PubMed, Embase, Cochrane Library, China Knowledge Network (CNKI), Wanfang, and China Biomedical Literature Database. All trials were screened for compliance with the inclusion and exclusion criteria, and relevant data were extracted after quality evaluation. Eighteen studies with a total of 1280 patients were finally included. Compared to the control group, high sensitivity C-reactive protein (hsCRP) was improved (MD = - 0.23. 95% CI = [- 0.41, - 0.05], P = 0.01); urinary albumin excretion (UAE) rate was reduced (MD = - 16.50, 95% CI = [- 18.87, - 14.13], P<0.00001); the change of serum creatinine (Scr) from baseline was reduced (MD = - 0.05, 95%CI = [- 0.08, - 0.01], P = 0.009); fasting plasma glucose (FPG) was decreased (MD = - 5.66, 95% CI = [- 9.79, - 1.53], P = 0.007); and the improvement of glomerular filtration rate (eGFR) from baseline was increased (MD = 4.38, 95% CI = [3.28, 5.48], P<0.00001) in the treatment group. No significant difference was observed between the two groups concerning systolic blood pressure, diastolic blood pressure, total cholesterol, and triglycerides. And in terms of safety, the use of PTF was relatively safe with some self-limiting adverse events. FPG was decreased by PTF more effectively, but there was no effect of PTF on glycated hemoglobin (HbA1c). PTF could improve hsCRP, decrease UAE and Scr, and raise eGFR in the treatment of DN.
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Affiliation(s)
- Mingyu Zhang
- Department of Nephrology, The First Hospital of China Medical University, Shenyang, 110001, Liaoning Province, People's Republic of China
| | - Yaqing Wang
- Department of Nephrology, The First Hospital of China Medical University, Shenyang, 110001, Liaoning Province, People's Republic of China
| | - Wenjing Fu
- Department of Nephrology, The First Hospital of China Medical University, Shenyang, 110001, Liaoning Province, People's Republic of China
| | - Li Sun
- Department of Nephrology, The First Hospital of China Medical University, Shenyang, 110001, Liaoning Province, People's Republic of China.
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Ou SH, Chang WC, Wu LY, Wang SI, Wei JCC, Lee PT. Diabetic Macular Edema Is Predictive of Renal Failure in Patients With Diabetes Mellitus and Chronic Kidney Disease. J Clin Endocrinol Metab 2024; 109:761-770. [PMID: 37804118 DOI: 10.1210/clinem/dgad581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 09/16/2023] [Accepted: 09/27/2023] [Indexed: 10/08/2023]
Abstract
CONTEXT Chronic hyperglycemia in patients with diabetes mellitus (DM) causes retinal damage and leakage, resulting in vision loss. Although diabetic retinopathy (DR) and diabetic kidney disease (DKD) are usually correlated, the relationship between diabetic macular edema (DME) and DKD remains unknown. OBJECTIVE To assess whether DME presence can predict renal failure in patients with DM and chronic kidney disease (CKD). METHODS This retrospective cohort study used data from 120 healthcare organizations in the TriNetX network. Electronic medical records of approximately 90 million patients were reviewed. The study population was classified into DME and non-DME cohorts. Primary and secondary outcomes were new-onset end-stage renal disease (ESRD) and all-cause mortality, respectively. Covariate factors were incorporated to reduce confounding effects. RESULTS Before matching, the DME cohort used more medication and had poorer renal function and blood sugar control than the non-DME cohort. Subsequently, the 2 groups were well-matched in demographics, socioeconomic status, lifestyle, comorbidities, and medication usage. The DME cohort had a significantly higher risk of ESRD, dialysis, and renal transplantation than the non-DME cohort. Subgroup analyses showed consistent results irrespective of follow-up duration, initial estimated glomerular filtration rate, or glycated hemoglobin levels. Additionally, the DME cohort had a lower risk of all-cause mortality than the non-DME cohort. CONCLUSION Statistically significant 5-year increased risks of ESRD, dialysis, and renal transplantation were observed in patients with concurrent DME. Therefore, close monitoring and follow-up of the renal function in DM patients with DME are necessary and strongly recommended.
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Affiliation(s)
- Shih-Hsiang Ou
- Division of Nephrology, Department of Internal Medicine, Pingtung Veterans General Hospital, Pingtung 900, Taiwan
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung 813414, Taiwan
- Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei 112304, Taiwan
| | - Wei-Che Chang
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung 813414, Taiwan
| | - Ling-Ying Wu
- Department of Obstetrics and Gynecology, Kaohsiung Municipal Feng Shan Hospital-Under the management of Chang Gung Medical Foundation, Kaohsiung 830, Taiwan
| | - Shiow-Ing Wang
- Center for Health Data Science, Department of Medical Research, Chung Shan Medical University Hospital, Taichung 40201, Taiwan
- Institute of Medicine, Chung Shan Medical University, Taichung 40201, Taiwan
- Department of Nursing, Jen-Teh Junior College of Medicine, Nursing and Management, Miaoli 356006, Taiwan
| | - James Cheng-Chung Wei
- Institute of Medicine, Chung Shan Medical University, Taichung 40201, Taiwan
- Division of Allergy, Immunology and Rheumatology, Department of Internal Medicine, Chung Shan Medical University Hospital, Taichung 40201, Taiwan
- Department of Nursing, Chung Shan Medical University, Taichung 40201, Taiwan
- Graduate Institute of Integrated Medicine, China Medical University, Taichung 413, Taiwan
| | - Po-Tsang Lee
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung 813414, Taiwan
- Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei 112304, Taiwan
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Zhao Y, Liu L, Zuo L, Zhou X, Wang S, Gao H, Yu F, Zhang X, Wang M, Chen L, Zhang R, Zhang F, Bi S, Bai Q, Ding J, Yang Q, Xin S, Chai S, Chen M, Zhang J. A Novel Risk Score Model for the Differential Diagnosis of Type 2 Diabetic Nephropathy: A Multicenter Study. J Diabetes Res 2023; 2023:5514767. [PMID: 38155834 PMCID: PMC10754636 DOI: 10.1155/2023/5514767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 11/20/2023] [Accepted: 12/09/2023] [Indexed: 12/30/2023] Open
Abstract
Introduction DN is a common complication of diabetes. However, diabetes combined with renal injury may involve DN or NDKD, with different treatment schemes. The purpose of our study was to determine the independent risk factors of DN and establish a risk score model to help differentiate DN and NDKD, providing a reference for clinical treatment. Methods A total of 678 T2D patients who had undergone renal biopsy in four affiliated hospitals of Peking University were consecutively enrolled. Patients were assigned to the DN group and NDKD group according to histopathological results. Seventy percent of patients from PKUFH were randomly assigned to the training group, and the remaining 30% were assigned to the internal validation group. Patients from the other three centers were assigned to the external validation group. We used univariate and multivariate logistic regression analyses to identify independent risk factors of DN in the training group and conducted multivariate logistic regression analysis with these independent risk factors in the training group to find regression coefficients "β" to establish a risk score model. Finally, we conducted internal and external validation of the model with ROC curves. Results Diabetic retinopathy, diabetes duration ≥ 5 years, eGFR < 30 ml/min/1.73 m2, 24 h UTP ≥ 3 g, and no hematuria were independent risk factors (P < 0.05), and each factor scored 2, 1, 1, 1, and 1. We assigned the patients to a low-risk group (0-1 points), a medium-risk group (2-3 points), and a high-risk group (4-6 points), representing unlikely DN, possibly DN, and a high probability of DN, respectively. The AUCs were 0.860, 0.924, and 0.855 for the training, internal validation, and external validation groups, respectively. Conclusion The risk score model could help differentiate DN and NDKD in a noninvasive manner, reduce the number of renal biopsies, and provide a reference for clinical treatment.
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Affiliation(s)
- Yuetong Zhao
- Department of Endocrinology, Peking University First Hospital, Beijing, China
- Department of Clinical Nutrition, Peking University First Hospital, Beijing, China
| | - Lin Liu
- Department of Endocrinology, Peking University First Hospital, Beijing, China
| | - Li Zuo
- Department of Nephrology, Peking University People's Hospital, Beijing, China
| | - Xianghai Zhou
- Department of Endocrinology, Peking University People's Hospital, Beijing, China
| | - Song Wang
- Department of Nephrology, Peking University Third Hospital, Beijing, China
| | - Hongwei Gao
- Department of Endocrinology, Peking University Third Hospital, Beijing, China
| | - Feng Yu
- Department of Nephrology, Peking University International Hospital, Beijing, China
| | - Xiaomei Zhang
- Department of Endocrinology, Peking University International Hospital, Beijing, China
| | - Mi Wang
- Department of Nephrology, Peking University People's Hospital, Beijing, China
| | - Ling Chen
- Department of Endocrinology, Peking University People's Hospital, Beijing, China
| | - Rui Zhang
- Department of Endocrinology, Peking University People's Hospital, Beijing, China
| | - Fang Zhang
- Department of Endocrinology, Peking University People's Hospital, Beijing, China
| | - Shuhong Bi
- Department of Nephrology, Peking University Third Hospital, Beijing, China
| | - Qiong Bai
- Department of Nephrology, Peking University Third Hospital, Beijing, China
| | - Jiaxiang Ding
- Department of Nephrology, Peking University International Hospital, Beijing, China
| | - Qinghua Yang
- Department of Nephrology, Peking University International Hospital, Beijing, China
| | - Sixu Xin
- Department of Endocrinology, Peking University International Hospital, Beijing, China
| | - Sanbao Chai
- Department of Endocrinology, Peking University International Hospital, Beijing, China
| | - Min Chen
- Department of Nephrology, Peking University First Hospital, Beijing, China
- Institute of Nephrology, Peking University, Beijing, China
| | - Junqing Zhang
- Department of Endocrinology, Peking University First Hospital, Beijing, China
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Kim CH, Kang HY, Kim G, Park J, Nam BY, Park JT, Han SH, Kang SW, Yoo TH. Soluble receptors for advanced glycation end-products prevent unilateral ureteral obstruction-induced renal fibrosis. Front Pharmacol 2023; 14:1172269. [PMID: 37261287 PMCID: PMC10227196 DOI: 10.3389/fphar.2023.1172269] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 05/09/2023] [Indexed: 06/02/2023] Open
Abstract
Introduction: The receptor for advanced glycation end products (RAGE) and its ligands, such as high-mobility group protein box 1 (HMGB1), play an important role in the accumulation of extracellular matrix in chronic kidney diseases with tubulointerstitial fibrosis. Blocking RAGE signaling with soluble RAGE (sRAGE) is a therapeutic candidate for renal fibrosis. Methods: NRK-52E cells were stimulated with or without HMGB1 and incubated with sRAGE in vitro. Sprague-Dawley rats were intraperitoneally treated with sRAGE after unilateral ureteral obstruction (UUO) operation in vivo. Results: HMBG1-stimulated NRK-52E cells showed increased fibronectin expression, type I collagen, α-smooth muscle actin, and connective tissue growth factor, which were attenuated by sRAGE. The mitogen-activated protein kinase (MAPK) pathway and nuclear translocation of nuclear factor kappa B (NF-κB) were enhanced in NRK-52E cells exposed to HMBG1, and sRAGE treatment alleviated the activation of the MAPK and NF-κB pathways. In the UUO rat models, sRAGE significantly ameliorated the increased renal fibronectin, type I collagen, and α-smooth muscle actin expressions. Masson's trichrome staining confirmed the anti-fibrotic effect of sRAGE in the UUO rat model. RAGE also significantly attenuated the activation of the MAPK pathway and NF-κB, as well as the increased number of infiltrated macrophages within the tubulointerstitium in the kidney of the UUO rat models. Conclusion: These findings suggest that RAGE plays a pivotal role in the pathogenesis of renal fibrosis and that its inhibition by sRAGE may be a potential therapeutic approach for renal fibrosis.
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Affiliation(s)
- Chan Ho Kim
- Department of Internal Medicine, International St. Mary’s Hospital, Catholic Kwandong University College of Medicine, Incheon, Republic of Korea
| | - Hye-Young Kang
- Department of Internal Medicine, College of Medicine, Severance Biomedical Science Institute, Brain Korea 21 Project for Medical Science, Yonsei University, Seoul, Republic of Korea
| | - Gyuri Kim
- Department of Internal Medicine, College of Medicine, Severance Biomedical Science Institute, Institute of Kidney Disease Research, Yonsei University, Seoul, Republic of Korea
| | - Jimin Park
- Department of Internal Medicine, College of Medicine, Severance Biomedical Science Institute, Institute of Kidney Disease Research, Yonsei University, Seoul, Republic of Korea
| | - Bo Young Nam
- Department of Internal Medicine, College of Medicine, Severance Biomedical Science Institute, Institute of Kidney Disease Research, Yonsei University, Seoul, Republic of Korea
| | - Jung Tak Park
- Department of Internal Medicine, College of Medicine, Severance Biomedical Science Institute, Institute of Kidney Disease Research, Yonsei University, Seoul, Republic of Korea
| | - Seung Hyeok Han
- Department of Internal Medicine, College of Medicine, Severance Biomedical Science Institute, Institute of Kidney Disease Research, Yonsei University, Seoul, Republic of Korea
| | - Shin-Wook Kang
- Department of Internal Medicine, College of Medicine, Severance Biomedical Science Institute, Institute of Kidney Disease Research, Yonsei University, Seoul, Republic of Korea
| | - Tae-Hyun Yoo
- Department of Internal Medicine, College of Medicine, Severance Biomedical Science Institute, Institute of Kidney Disease Research, Yonsei University, Seoul, Republic of Korea
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Ram C, Gairola S, Verma S, Mugale MN, Bonam SR, Murty US, Sahu BD. Biochanin A Ameliorates Nephropathy in High-Fat Diet/Streptozotocin-Induced Diabetic Rats: Effects on NF-kB/NLRP3 Axis, Pyroptosis, and Fibrosis. Antioxidants (Basel) 2023; 12:antiox12051052. [PMID: 37237918 DOI: 10.3390/antiox12051052] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Revised: 04/29/2023] [Accepted: 05/03/2023] [Indexed: 05/28/2023] Open
Abstract
Nephropathy is the most prevalent microvascular disorder in diabetes mellitus. Oxidative stress and inflammatory cascade provoked by the persistent hyperglycemic milieu play integral roles in the aggravation of renal injury and fibrosis. We explored the impact of biochanin A (BCA), an isoflavonoid, on the inflammatory response, nod-like receptor protein 3 (NLRP3) inflammasome activation, oxidative stress, and fibrosis in diabetic kidneys. A high-fat-diet/streptozotocin (HFD/STZ)-induced experimental model of diabetic nephropathy (DN) was established in Sprague Dawley rats, and in vitro studies were performed in high-glucose-induced renal tubular epithelial (NRK-52E) cells. Persistent hyperglycemia in diabetic rats was manifested by perturbation of renal function, marked histological alterations, and oxidative and inflammatory renal damage. Therapeutic intervention of BCA mitigated histological changes, improved renal function and antioxidant capacity, and suppressed phosphorylation of nuclear factor-kappa B (NF-κB) and nuclear factor-kappa B inhibitor alpha (IκBα) proteins. Our in vitro data reveal excessive superoxide generation, apoptosis, and altered mitochondrial membrane potential in NRK-52E cells that were cultured in a high-glucose (HG) environment were subsided by BCA intervention. Meanwhile, the upregulated expressions of NLRP3 and its associated proteins, the pyroptosis-indicative protein gasdermin-D (GSDMD) in the kidneys, and HG-stimulated NRK-52E cells were significantly ameliorated by BCA treatment. Additionally, BCA blunted transforming growth factor (TGF)-β/Smad signaling and production of collagen I, collagen III, fibronectin, and alfa-smooth muscle actin (α-SMA) in diabetic kidneys. Our results indicate the plausible role of BCA in attenuating DN, presumably through modulation of the apoptotic cascade in renal tubular epithelial cells and the NF-κB/NLRP3 axis.
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Affiliation(s)
- Chetan Ram
- Department of Pharmacology & Toxicology, National Institute of Pharmaceutical Education and Research (NIPER), Guwahati 781101, India
| | - Shobhit Gairola
- Department of Pharmacology & Toxicology, National Institute of Pharmaceutical Education and Research (NIPER), Guwahati 781101, India
| | - Shobhit Verma
- Toxicology & Experimental Medicine, CSIR-Central Drug Research Institute (CDRI), Lucknow 226031, India
| | - Madhav Nilakanth Mugale
- Toxicology & Experimental Medicine, CSIR-Central Drug Research Institute (CDRI), Lucknow 226031, India
| | - Srinivasa Reddy Bonam
- Department of Microbiology and Immunology, University of Texas Medical Branch, Galveston, TX 77555, USA
| | | | - Bidya Dhar Sahu
- Department of Pharmacology & Toxicology, National Institute of Pharmaceutical Education and Research (NIPER), Guwahati 781101, India
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Han SY, Han SH, Ghee JY, Cha JJ, Kang YS, Cha DR. SH3YL1 Protein Predicts Renal Outcomes in Patients with Type 2 Diabetes. Life (Basel) 2023; 13:life13040963. [PMID: 37109492 PMCID: PMC10141384 DOI: 10.3390/life13040963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Revised: 03/28/2023] [Accepted: 04/04/2023] [Indexed: 04/29/2023] Open
Abstract
NADPH oxidase (NOX)-derived oxidative stress is an important factor in renal progression, with NOX4 being the predominant NOX in the kidney. Recently, Src homology 3 (SH3) domain-containing YSC84-like 1 (SH3YL1) was reported to be a regulator of NOX4. In this study, we tested whether the SH3YL1 protein could predict 3-year renal outcomes in patients with type 2 diabetes. A total of 131 patients with type 2 diabetes were enrolled in this study. Renal events were defined as a 15% decline in the estimated glomerular filtration rate (eGFR) from the baseline, the initiation of renal replacement therapy, or death during the 3 years. The levels of the urinary SH3YL1-to-creatinine ratio (USCR) were significantly different among the five stages of chronic kidney disease (CKD) and the three groups, based on albuminuria levels. The USCR levels showed a significant negative correlation with eGFR and a positive correlation with the urinary albumin-to-creatinine ratio (UACR). Plasma SH3YL1 levels were significantly correlated with UACR. The highest tertile group of USCR and plasma SH3YL1 had a significantly lower probability of renal event-free survival. Furthermore, the highest tertile group of USCR showed a significant association with the incidence of renal events after full adjustment: adjusted hazard ratio (4.636: 95% confidence interval, 1.416-15.181, p = 0.011). This study suggests that SH3YL1 is a new diagnostic biomarker for renal outcomes in patients with type 2 diabetes.
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Affiliation(s)
- Sang Youb Han
- Department of Internal Medicine, Inje University, Ilsan-Paik Hospital, Goyang 10380, Republic of Korea
| | - Seung Hyun Han
- Department of Internal Medicine, Inje University, Ilsan-Paik Hospital, Goyang 10380, Republic of Korea
| | - Jung Yeon Ghee
- Department of Internal Medicine, Korea University, Ansan Hospital, Ansan 15368, Republic of Korea
| | - Jin Joo Cha
- Department of Internal Medicine, Korea University, Ansan Hospital, Ansan 15368, Republic of Korea
| | - Young Sun Kang
- Department of Internal Medicine, Korea University, Ansan Hospital, Ansan 15368, Republic of Korea
| | - Dae Ryong Cha
- Department of Internal Medicine, Korea University, Ansan Hospital, Ansan 15368, Republic of Korea
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Hanai K, Mori T, Yamamoto Y, Yoshida N, Murata H, Babazono T. Association of Estimated Glomerular Filtration Rate With Progression of Albuminuria in Individuals With Type 2 Diabetes. Diabetes Care 2023; 46:183-189. [PMID: 36399781 DOI: 10.2337/dc22-1582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 10/24/2022] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To elucidate the association of glomerular filtration rate (GFR) at baseline with subsequent progression of albuminuria in individuals with type 2 diabetes. RESEARCH DESIGN AND METHODS This was a single-center retrospective cohort study of 6,618 Japanese adults with type 2 diabetes and urinary albumin-to-creatinine ratio of <300 mg/g, comprising 2,459 women and 4,159 men with a mean (± SD) age of 60 ± 12 years. The exposure was baseline estimated GFR (eGFR) (mL/min/1.73 m2), treated as a categorical variable and classified into five categories: ≥90, 75-90, 60-75, 45-60, and <45, as well as a continuous variable. The outcome was progression of albuminuria category (i.e., from normoalbuminuria to micro- or macroalbuminuria or from micro- to macroalbuminuria). Hazard ratios (HRs) for the outcome were estimated using the multivariable Cox proportional hazards model. In the analysis treating baseline eGFR as a continuous variable, the multivariable-adjusted restricted cubic spline model was used. RESULTS During the median follow-up period of 6.3 years, 1,190 individuals reached the outcome. When those with a baseline eGFR of 75-90 mL/min/1.73 m2 were considered the reference group, HRs (95% CIs) for the outcome in those with a baseline eGFR of ≥90, 60-75, 45-60, or <45 mL/min/1.73 m2 were 1.38 (1.14-1.66), 1.34 (1.14-1.58), 1.81 (1.50-2.20), or 2.37 (1.84-3.05), respectively. Furthermore, the inverse J-shaped curve was more clearly shown by the spline model. CONCLUSIONS This study of Japanese adults with type 2 diabetes suggests that both high and low GFRs are implicated in the pathogenesis of albuminuria progression.
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TGF-β Inhibitors for Therapeutic Management of Kidney Fibrosis. Pharmaceuticals (Basel) 2022; 15:ph15121485. [PMID: 36558936 PMCID: PMC9783223 DOI: 10.3390/ph15121485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 11/22/2022] [Accepted: 11/26/2022] [Indexed: 11/30/2022] Open
Abstract
Kidney fibrosis is a common pathophysiological mechanism of chronic kidney disease (CKD) progression caused by several underlying kidney diseases. Among various contributors to kidney fibrosis, transforming growth factor-β1 (TGF-β1) is the major factor driving fibrosis. TGF-β1 exerts its profibrotic attributes via the activation of canonical and non-canonical signaling pathways, which induce proliferation and activation of myofibroblasts and subsequent accumulation of extracellular matrix. Over the past few decades, studies have determined the TGF-β1 signaling pathway inhibitors and evaluated whether they could ameliorate the progression of CKD by hindering kidney fibrosis. However, therapeutic strategies that block TGF-β1 signaling have usually demonstrated unsatisfactory results. Herein, we discuss the therapeutic concepts of the TGF-β1 signaling pathway and its inhibitors and review the current state of the art regarding regarding TGF-β1 inhibitors in CKD management.
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Cha DR. Diabetic kidney disease, revisited: where do we stand? Kidney Res Clin Pract 2022; 41:S31-S32. [DOI: 10.23876/j.krcp.22.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 08/17/2022] [Indexed: 11/04/2022] Open
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Han SY, Ghee JY, Cha JJ, Kang YS, Hur DY, Kim HS, Cha DR. Upregulation of VSIG4 in Type 2 Diabetic Kidney Disease. Life (Basel) 2022; 12:life12071031. [PMID: 35888119 PMCID: PMC9318196 DOI: 10.3390/life12071031] [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: 06/16/2022] [Revised: 07/06/2022] [Accepted: 07/07/2022] [Indexed: 12/01/2022] Open
Abstract
Fibrosis is the final common finding in patients with advanced diabetic kidney disease. V-set Ig domain containing 4 (VSIG4) is related to fibrosis in several diseases. It also contributes to fibrosis under high-glucose conditions in renal tubule cells. To determine the role of VSIG4 in type 2 diabetes, we examined VSIG4 expression in a type 2 diabetic animal model and podocyte. Urinary excretion of albumin and VSIG4 was significantly higher in db/db mice than in the control group. Urine VSIGs levels for 6 h were about three-fold higher in db/db mice than in db/m mice at 20 weeks of age: 55.2 ± 37.8 vs. 153.1 ± 74.3 ng, p = 0.04. Furthermore, urinary VSIG4 levels were significantly correlated with urinary albumin levels (r = 0.77, p < 0.01). Intrarenal VSIG4 mRNA expression was significantly higher in db/db mice than in control mice (1.00 ± 0.35 vs. 1.69 ± 0.77, p = 0.04). Further, VSIG4 expression was almost twice as high in db/db mice at 20 weeks of age. Intrarenal VSIG immunoreactivity in db/db mice was also significantly higher than that in control mice. In cultured podocytes, both high glucose and angiotensin II significantly upregulated the expression of VSIG4 mRNA and protein. In conclusion, VSIG4 was upregulated in an animal model of type 2 diabetes and was related to albuminuria and pro-fibrotic markers. Considering these relationships, VSIG4 may be an important mediator of diabetic nephropathy progression.
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Affiliation(s)
- Sang Youb Han
- Department of Internal Medicine, Inje University, Ilsan-Paik Hospital, Goyang 10380, Korea
- Correspondence: (S.Y.H.); (D.R.C.); Tel.: +82-31-910-7201 (S.Y.H.); +82-31-412-5572 (D.R.C.); Fax: +82-31-910-7219 (S.Y.H.); +82-31-412-5574 (D.R.C.)
| | - Jung Yeon Ghee
- Department of Internal Medicine, Korea University, Ansan Hospital, Ansan 15355, Korea; (J.Y.G.); (J.J.C.); (Y.S.K.)
| | - Jin Joo Cha
- Department of Internal Medicine, Korea University, Ansan Hospital, Ansan 15355, Korea; (J.Y.G.); (J.J.C.); (Y.S.K.)
| | - Young Sun Kang
- Department of Internal Medicine, Korea University, Ansan Hospital, Ansan 15355, Korea; (J.Y.G.); (J.J.C.); (Y.S.K.)
| | - Dae Young Hur
- Department of Anatomy and Tumor Immunology, Inje University College of Medicine, Busan 47392, Korea;
| | - Han Seong Kim
- Department of Pathology, Inje University, Ilsan-Paik Hospital, Goyang 10380, Korea;
| | - Dae Ryong Cha
- Department of Internal Medicine, Korea University, Ansan Hospital, Ansan 15355, Korea; (J.Y.G.); (J.J.C.); (Y.S.K.)
- Correspondence: (S.Y.H.); (D.R.C.); Tel.: +82-31-910-7201 (S.Y.H.); +82-31-412-5572 (D.R.C.); Fax: +82-31-910-7219 (S.Y.H.); +82-31-412-5574 (D.R.C.)
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Kurata Y, Nangaku M. Dapagliflozin for the treatment of chronic kidney disease. Expert Rev Endocrinol Metab 2022; 17:275-291. [PMID: 35822873 DOI: 10.1080/17446651.2022.2099373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 07/05/2022] [Indexed: 10/17/2022]
Abstract
INTRODUCTION Sodium-dependent glucose cotransporter 2 (SGLT2) is a glucose transporter expressed on the proximal tubular cells, where it reabsorbs glucose from the glomerular filtrate. SGLT2 inhibitors (SGLT2is), initially developed as an antidiabetic drug, have recently attracted considerable attention because they have cardiorenal protective effects. Among SGLT2is, dapagliflozin was the first to demonstrate the renoprotective effect in patients with and without diabetes and has been approved for chronic kidney disease (CKD) treatment. AREAS COVERED This review covers the pharmacological characteristics and the clinical efficacy and safety profiles of dapagliflozin, including comparison with other SGLT2is and risk modification strategies. EXPERT OPINION In DAPA-CKD, dapagliflozin reduced the primary outcome (≥50% estimated glomerular filtration rate [eGFR] decline, end-stage kidney disease [ESKD], or renal or cardiovascular [CV] death) by 39% in CKD patients. This beneficial effect was consistent across prespecified subgroups, including those based on the presence of diabetes. Dapagliflozin also decreased the CV composite outcome and all-cause death by 29% and 31%, respectively. Although an increased risk of adverse events such as ketoacidosis and volume depletion has been reported, the robust renal and CV benefits of dapagliflozin are expected to outweigh potential risks. SGLT2is, including dapagliflozin, will constitute the mainstay of CKD treatment.
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Affiliation(s)
- Yu Kurata
- Division of Nephrology and Endocrinology, The University of Tokyo Graduate School of Medicine, Bunkyo-ku, Japan
| | - Masaomi Nangaku
- Division of Nephrology and Endocrinology, The University of Tokyo Graduate School of Medicine, Bunkyo-ku, Japan
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