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Dean YE, Elawady SS, Shi W, Salem AA, Chotwatanapong A, Ashraf H, Reddi T, Dundi POR, Habash WY, Habash MY, Ahmed S, Samir HM, Elsayed A, Arora A, Arora A, Elsayed A, Mady T, Tanas Y, Hazimeh Y, Alazmy M, Aiash H. Progression of diabetic nephropathy and vitamin D serum levels: A pooled analysis of 7722 patients. Endocrinol Diabetes Metab 2023; 6:e453. [PMID: 37743677 PMCID: PMC10638614 DOI: 10.1002/edm2.453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 09/05/2023] [Accepted: 09/14/2023] [Indexed: 09/26/2023] Open
Abstract
BACKGROUND AND AIM Low serum Vitamin D levels have been associated with diabetic nephropathy (DN). Our study aimed to analyse the serum levels of vitamin D in patients suffering from DN and the subsequent changes in serum vitamin D levels as the disease progresses. METHODS PubMed, Embase, SCOPUS and Web of Science were searched using keywords such as '25 hydroxyvitamin D' and 'diabetic nephropathy'. We included observational studies that reported the association between the serum 25 hydroxy vitamin D levels and diabetic nephropathy without restriction to age, gender, and location. R Version 4.1.2 was used to perform the meta-analysis. The continuous outcomes were represented as mean difference (MD) and standard deviation (SD) and dichotomous outcomes as risk ratios (RR) with their 95% confidence interval (CI). RESULTS Twenty-three studies were included in our analysis with 7722 patients. Our analysis revealed that vitamin D was significantly lower in diabetic patients with nephropathy than those without nephropathy (MD: -4.32, 95% CI: 7.91-0.74, p-value = .0228). On comparing diabetic patients suffering from normoalbuminuria, microalbuminuria, or macroalbuminuria, we found a significant difference in serum vitamin D levels across different groups. Normoalbuminuria versus microalbuminuria showed a MD of -1.69 (95% CI: -2.28 to -1.10, p-value = .0002), while microalbuminuria versus macroalbuminuria showed a MD of (3.75, 95% CI: 1.43-6.06, p-value = .0058), proving that serum vitamin D levels keep declining as the disease progresses. Notwithstanding, we detected an insignificant association between Grade 4 and Grade 5 DN (MD: 2.29, 95% CI: -2.69-7.28, p-value = .1862). CONCLUSION Serum Vitamin D levels are lower among DN patients and keep declining as the disease progresses, suggesting its potential benefit as a prognostic marker. However, on reaching the macroalbuminuria stage (Grades 4 and 5), vitamin D is no longer a discriminating factor.
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Affiliation(s)
- Yomna E. Dean
- Faculty of MedicineAlexandria UniversityAlexandriaEgypt
| | - Sameh Samir Elawady
- Neuro‐endovascular Surgery DepartmentMedical University of South CarolinaCharlestonSouth CarolinaUSA
| | - Wangpan Shi
- Faculty of MedicineChulalongkorn UniversityBangkokThailand
| | | | | | - Haya Ashraf
- Faculty of MedicineSuez Canal UniversityIsmailiaEgypt
| | - Tharun Reddi
- Arkansas College of Osteopathic MedicineFort SmithArkansasUSA
| | | | | | | | - Safaa Ahmed
- Faculty of MedicineSuez Canal UniversityIsmailiaEgypt
| | - Hana M. Samir
- Faculty of MedicineSuez Canal UniversityIsmailiaEgypt
| | - Ahmed Elsayed
- Faculty of MedicineSuez Canal UniversityIsmailiaEgypt
| | | | | | | | - Tamer Mady
- International American University, College of MedicineVieux FortSaint Lucia
| | - Yousef Tanas
- Faculty of MedicineAlexandria UniversityAlexandriaEgypt
| | - Yusef Hazimeh
- Lebanese UniversityBeirutLebanon
- Zahraa Hospital, University Medical CenterBeirutLebanon
| | - Mohamed Alazmy
- Medical director, Dhaman Health Assurance CompanyKuwaitKuwait
| | - Hani Aiash
- Faculty of MedicineSuez Canal UniversityIsmailiaEgypt
- SUNY Upstate Medical UniversitySyracuseNew YorkUSA
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Hu Y, Wang X, Xiao S, Wu H, Huan C, Xu T, Guo M, Liu A, Jiang X, Wang J, Zhu H, Pan D. Development and validation of a risk nomogram model for predicting pulmonary hypertension in patients with stage 3-5 chronic kidney disease. Int Urol Nephrol 2022; 55:1353-1363. [PMID: 36562902 PMCID: PMC10105676 DOI: 10.1007/s11255-022-03431-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Accepted: 11/18/2022] [Indexed: 12/24/2022]
Abstract
OBJECTIVES The occurrence of pulmonary arterial hypertension (PAH) can greatly affect the prognosis of patients with chronic kidney disease (CKD). We aimed to construct a nomogram to predict the probability of PAH development in patients with stage 3-5 CKD to guide early intervention and to improve prognosis. METHODS From August 2018 to December 2021, we collected the data of 1258 patients with stage 3-5 CKD hospitalized at the Affiliated Hospital of Xuzhou Medical University as a training set and 389 patients hospitalized at Zhongda Hospital as a validation set. These patients were divided into PAH and N-PAH groups with pulmonary arterial systolic pressure ≥ 35 mmHg as the cutoff. The results of univariate and multivariate logistic regression analyses were used to establish the nomogram. Then, areas under the receiver operating characteristic curve (AUC-ROCs), a calibration plot, and decision curve analysis (DCA) were used to validate the nomogram. RESULTS The nomogram included nine variables: age, diabetes mellitus, hemoglobin, platelet count, serum creatinine, left ventricular end-diastolic diameter, left atrial diameter, main pulmonary artery diameter and left ventricular ejection fraction. The AUC-ROCs of the training set and validation set were 0.801 (95% confidence interval (CI) 0.771-0.830) and 0.760 (95% CI 0.699-0.818), respectively, which showed good discriminative ability of the nomogram. The calibration diagram showed good agreement between the predicted and observed results. DCA also demonstrated that the nomogram could be clinically useful. CONCLUSION The evaluation of the nomogram model for predicting PAH in patients with CKD based on risk factors showed its ideal efficacy. Thus, the nomogram can be used to screen for patients at high risk for PAH and has guiding value for the subsequent formulation of prevention strategies and clinical treatment.
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Affiliation(s)
- Yue Hu
- Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Intensive Care Unit Department, No. 23, Mei Shu Guan Hou Jie, Beijing, 100010, Dongcheng, China
| | - Xiaotong Wang
- Department of Cardiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, 221004, Jiangsu, China
| | - Shengjue Xiao
- Department of Cardiology, School of Medicine, Zhongda Hospital, Southeast University, 87 Dingjiaqiao, Nanjing, 210009, Jiangsu, China
| | - Huimin Wu
- Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Intensive Care Unit Department, No. 23, Mei Shu Guan Hou Jie, Beijing, 100010, Dongcheng, China
| | - Chunyan Huan
- Department of Cardiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, 221004, Jiangsu, China
| | - Tao Xu
- Department of Cardiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, 221004, Jiangsu, China
| | - Minjia Guo
- Department of Cardiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, 221004, Jiangsu, China
| | - Ailin Liu
- Department of Cardiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, 221004, Jiangsu, China
| | - Xiaoyao Jiang
- Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Intensive Care Unit Department, No. 23, Mei Shu Guan Hou Jie, Beijing, 100010, Dongcheng, China
| | - Jia Wang
- Department of Nephrology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, 221004, Jiangsu, China
| | - Hong Zhu
- Department of Cardiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, 221004, Jiangsu, China
| | - Defeng Pan
- Department of Cardiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, 221004, Jiangsu, China.
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Li M, Cheng J, Zhao J, Xue W, Bao H, Song Y, Qin L. Relationship between intact parathyroid hormone and all-cause death, cardiovascular events, and ectopic calcification in patients with diabetic kidney disease: A retrospective study. Diabetes Res Clin Pract 2021; 177:108926. [PMID: 34161808 DOI: 10.1016/j.diabres.2021.108926] [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: 03/16/2021] [Revised: 06/11/2021] [Accepted: 06/17/2021] [Indexed: 11/29/2022]
Abstract
AIM We aimed to investigate the relationship between intact parathyroid hormone (iPTH) levels and all-cause death, cardiovascular events, and ectopic calcification in patients with diabetic kidney disease (DKD). METHODS In this retrospective cohort study, we collected the clinical data of 508 patients with clinically diagnosed DKD. The primary and secondary outcomes were all-cause death or cardiovascular events and ectopic calcification, respectively. We used different regression methods to analyze the relationship between various clinical parameters and the two clinical outcomes. RESULTS We found that iPTH was a risk factor for all-cause death and cardiovascular events (hazards ration [HR]: 2.817, 95% confidence interval [CI]: 1.045-6.562, P = 0.016). Meanwhile, diabetes duration (HR: 1.090, 95% CI: 1.045-1.138, P < 0.0001), triglycerides (TG) (HR: 1.254, 95% CI: 1.049-1.499, P = 0.013), and iPTH (HR: 1.954, 95% CI: 1.001-3.813, P = 0.049) were independent risk factors for ectopic calcification. In contrast to patients with lower iPTH levels (iPTH < 31.7 pg/mL), patients with higher iPTH levels (iPTH ≥ 31.7 pg/mL) had increased ectopic calcification rate (P = 0.002) and decreased survival time (P < 0.001). CONCLUSION In patients with DKD, higher iPTH levels were significantly related to worsen clinical outcomes.
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Affiliation(s)
- Mengyuan Li
- Department of Nephrology & Rheumatology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, 301, Middle Yanchang Road, Shanghai 200072, China
| | - Jiafen Cheng
- Department of Nephrology & Rheumatology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, 301, Middle Yanchang Road, Shanghai 200072, China
| | - Jian Zhao
- Department of Nephrology & Rheumatology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, 301, Middle Yanchang Road, Shanghai 200072, China
| | - Wen Xue
- Department of Nephrology & Rheumatology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, 301, Middle Yanchang Road, Shanghai 200072, China
| | - Hui Bao
- Department of Nephrology & Rheumatology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, 301, Middle Yanchang Road, Shanghai 200072, China
| | - Yaxiang Song
- Department of Nephrology & Rheumatology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, 301, Middle Yanchang Road, Shanghai 200072, China.
| | - Ling Qin
- Department of Nephrology & Rheumatology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, 301, Middle Yanchang Road, Shanghai 200072, China.
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Li M, Xu J, Wan Q, He Q, Ma Y, Tang YQ, Peng HY. Relationship between serum vitamin D3 concentration and anaemia in patients with chronic kidney disease in China. J Int Med Res 2021; 49:3000605211012231. [PMID: 34018838 PMCID: PMC8150523 DOI: 10.1177/03000605211012231] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Objective In the present study, we aimed to investigate the relationship between serum vitamin D3 concentration and anaemia in patients with chronic kidney disease (CKD) in China, to assist understanding of the effects of vitamin D treatment in such patients. Methods A total of 225 patients with CKD were enrolled and a range of laboratory parameters were measured. The participants were allocated to three groups, according to their serum 25-hydroxyvitamin D3 concentration: a severe deficiency group, a deficiency group, and a sufficiency group. The prevalences of anaemia in the three groups were assessed, and the factors associated with anaemia in patients with CKD were analysed using logistic regression. Results The prevalences of anaemia were 79.5% in the severe deficiency group, 63.5% in the deficiency group, and 48.0% in the sufficiency group. The prevalence of anaemia gradually increased with the severity of vitamin D3 deficiency. The prevalences of anaemia in participants with stages 1 to 5 CKD were 21.1%, 30.4%, 39.5%, 78.7%, and 94.6%, respectively. Conclusion Vitamin D3 deficiency may increase the risk of anaemia in patients with CKD.
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Affiliation(s)
- Meng Li
- Department of Pneumology, Bijie Hospital of Traditional Chinese Medicine, Guizhou, China.,Guizhou Medical University, Guizhou, China
| | - Jun Xu
- Department of Nephrology, Affiliated Baiyun Hospital of Guizhou Medical University, Guizhou, China
| | - Qin Wan
- Department of Nephrology, Qianxi County People's Hospital, Guizhou, China
| | - Qiang He
- Department of Nephrology, Pingba County People's Hospital, Guizhou, China
| | - Yan Ma
- Department of Nephrology, Affiliated Baiyun Hospital of Guizhou Medical University, Guizhou, China
| | - Ying-Qian Tang
- Department of Nephrology, Affiliated Hospital of Guizhou Medical University, Guizhou, China
| | - Hong-Ying Peng
- Department of Nephrology, Affiliated Baiyun Hospital of Guizhou Medical University, Guizhou, China
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Yan LJ. NADH/NAD + Redox Imbalance and Diabetic Kidney Disease. Biomolecules 2021; 11:biom11050730. [PMID: 34068842 PMCID: PMC8153586 DOI: 10.3390/biom11050730] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 05/11/2021] [Accepted: 05/12/2021] [Indexed: 12/11/2022] Open
Abstract
Diabetic kidney disease (DKD) is a common and severe complication of diabetes mellitus. If left untreated, DKD can advance to end stage renal disease that requires either dialysis or kidney replacement. While numerous mechanisms underlie the pathogenesis of DKD, oxidative stress driven by NADH/NAD+ redox imbalance and mitochondrial dysfunction have been thought to be the major pathophysiological mechanism of DKD. In this review, the pathways that increase NADH generation and those that decrease NAD+ levels are overviewed. This is followed by discussion of the consequences of NADH/NAD+ redox imbalance including disruption of mitochondrial homeostasis and function. Approaches that can be applied to counteract DKD are then discussed, which include mitochondria-targeted antioxidants and mimetics of superoxide dismutase, caloric restriction, plant/herbal extracts or their isolated compounds. Finally, the review ends by pointing out that future studies are needed to dissect the role of each pathway involved in NADH-NAD+ metabolism so that novel strategies to restore NADH/NAD+ redox balance in the diabetic kidney could be designed to combat DKD.
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Affiliation(s)
- Liang-Jun Yan
- Department of Pharmaceutical Sciences, College of Pharmacy, University of North Texas Health Science Center, Fort Worth, TX 76107, USA
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Gorbacheva AM, Shklyayev SS, Eremkina AK, Bratchikova AA, Mokrysheva NG. Anemia in primary hyperparathyroidism. RUSSIAN JOURNAL OF HEMATOLOGY AND TRANSFUSIOLOGY 2020. [DOI: 10.35754/0234-5730-2020-65-4-514-526] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Introduction. Anaemia is a complication of primary hyperparathyroidism (PHPT). Pathogenesis of PHPT-induced anaemia involves inhibited erythroid cell proliferation associated with the underlying disease and non-specific factors (blood loss, chronic kidney disease). However, its specific mechanisms remain unclear.Aim. Clinical description of a PHPT case with multifactorial complicating anaemia.Main findings. With putative evidence existing on relationships between PHPT and anaemia, no large clinical trials substantiated suitable algorithms for such patients’ management. The genesis of anaemia reported in this case was multifactorial and not decisively excluding PHPT from putative causes.
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Affiliation(s)
| | - S. S. Shklyayev
- National Research Center for Endocrinology; A. Tsyb Medical Radiological Research Center — Branch of the National Medical Research Radiological Center
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