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Almalki AH, Sadagah LF, Makeen A, Balla ME, Alzahrani M, Kouther F, Aljuffri A, Marwan A, Kotbi E, Dahlan S, Banamah T, Awais M, Alharthi M. The Pattern of Practice in the Management of Early Diabetic Kidney Disease. Cureus 2024; 16:e68584. [PMID: 39371715 PMCID: PMC11450082 DOI: 10.7759/cureus.68584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/03/2024] [Indexed: 10/08/2024] Open
Abstract
Background and objectives Diabetes is a leading cause of kidney failure in various regions worldwide. To detect renal disease in individuals with diabetes, screening typically involves evaluating the glomerular filtration rate and measuring albuminuria. Although there are established guidelines for these screenings, adherence to them varies. This study aims to examine the prevalence of albuminuria screening among adults with diabetes mellitus (DM) and to assess the different practices in managing these patients across primary and tertiary care settings. Methods This cross-sectional observational study involved adult patients with DM attending outpatient clinics in both primary and tertiary care settings. Patient data were gathered using a standardized form, excluding those with established chronic kidney disease (CKD) who were under nephrology care. Results The study included 1,010 patients, with 303 (30%) from primary care clinics and 707 (70%) from tertiary care clinics. The cohort comprised 582 (58%) females, with a median age of 62 years (IQR: 55-70), and approximately 990 (98%) had type 2 DM (T2DM). Annual albumin-to-creatinine ratio (ACR) screening was conducted for 498 out of 1,010 patients (49%) (95% confidence interval {CI}: 46%-52%). Screening compliance was notably higher in primary care settings compared to tertiary care clinics. Older patients (over 60 years) and those with hypertension or cardiac conditions were less likely to undergo screening. Among those screened, 185 of 498 patients (37%) (95% CI: 33%-41%) had abnormal albuminuria (ACR > 3). Conclusion Albuminuria is a significant indicator of progressing renal disease and cardiovascular risk. The annual screening rate for albuminuria in diabetic patients is inadequate. Primary care physicians show better adherence to screening guidelines compared to their tertiary care counterparts. Increasing physician awareness about the importance of screening could improve guideline compliance and mitigate the adverse effects of albuminuria.
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Affiliation(s)
- Abdullah H Almalki
- Department of Medicine, Nephrology Section, King Abdulaziz Medical City, Ministry of National Guard, Jeddah, SAU
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, SAU
- Department of Medicine, King Abdullah International Medical Research Center, Jeddah, SAU
| | - Laila F Sadagah
- Department of Medicine, Nephrology Section, King Abdulaziz Medical City, Ministry of National Guard, Jeddah, SAU
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, SAU
- Department of Medicine, King Abdullah International Medical Research Center, Jeddah, SAU
| | - Ahmad Makeen
- Department of Medicine, Nephrology Section, King Abdulaziz Medical City, Ministry of National Guard, Jeddah, SAU
- Department of Medicine, King Abdullah International Medical Research Center, Jeddah, SAU
| | - Mohamed E Balla
- Department of Medicine, Nephrology Section, King Abdulaziz Medical City, Ministry of National Guard, Jeddah, SAU
- Department of Medicine, King Abdullah International Medical Research Center, Jeddah, SAU
| | - Meshari Alzahrani
- Department of Family Medicine, Al Salama Hospital, Jeddah, SAU
- Department of Medicine, King Abdullah International Medical Research Center, Jeddah, SAU
| | - Faisal Kouther
- Department of Obstetrics and Gynecology, King Abdulaziz Medical City, Ministry of National Guard, Jeddah, SAU
- Department of Medicine, King Abdullah International Medical Research Center, Jeddah, SAU
| | - Ahmed Aljuffri
- Department of Surgery, Pediatric Surgery Section, King Abdulaziz Medical City, Ministry of National Guard, Jeddah, SAU
- Department of Medicine, King Abdullah International Medical Research Center, Jeddah, SAU
| | - Ashraf Marwan
- Department of Medicine, Nephrology Section, King Abdulaziz Medical City, Ministry of National Guard, Jeddah, SAU
- Department of Medicine, King Abdullah International Medical Research Center, Jeddah, SAU
| | - Eman Kotbi
- Department of Medicine, Nephrology Section, King Abdulaziz Medical City, Ministry of National Guard, Jeddah, SAU
- Department of Medicine, King Abdullah International Medical Research Center, Jeddah, SAU
| | - Sarah Dahlan
- Department of Medicine, Nephrology Section, King Abdulaziz Medical City, Ministry of National Guard, Jeddah, SAU
- Department of Medicine, King Abdullah International Medical Research Center, Jeddah, SAU
| | - Turki Banamah
- Department of Medicine, Nephrology Section, King Abdulaziz Medical City, Ministry of National Guard, Jeddah, SAU
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, SAU
- Department of Medicine, King Abdullah International Medical Research Center, Jeddah, SAU
| | - Muhammed Awais
- Department of Medicine, Nephrology Section, King Abdulaziz Medical City, Ministry of National Guard, Jeddah, SAU
- Department of Medicine, King Abdullah International Medical Research Center, Jeddah, SAU
| | - Majed Alharthi
- Department of Medicine, Nephrology Section, King Abdulaziz Medical City, Ministry of National Guard, Jeddah, SAU
- Department of Medicine, King Abdullah International Medical Research Center, Jeddah, SAU
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Wei H, Liao B, Zhou Q, Zhou X, Zhong Y, Hao Y, Xie F, Wang R. The ratio of high aspartate aminotransferase to alanine aminotransferase: an independent risk factor associated with poor prognosis in IgA nephropathy. Clin Exp Nephrol 2024:10.1007/s10157-024-02513-7. [PMID: 38767689 DOI: 10.1007/s10157-024-02513-7] [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: 01/10/2024] [Accepted: 05/08/2024] [Indexed: 05/22/2024]
Abstract
OBJECTIVE To investigate the relationship between the aspartate aminotransferase to alanine aminotransferase ratio (AAR) and the prognosis of IgA nephropathy (IgAN). METHODS Clinical, pathological and follow-up data of 271 patients with IgAN from January 1, 2013, to July 31, 2023, were collected. A 50% decrease in estimated glomerular filtration rate (eGFR) or end-stage renal disease (ESRD) was used as renal composite end point events. A receiver operating characteristic (ROC) curve was plotted to predict the composite end point events by AAR. The optimal cutoff value of 1.24 was determined, and patients were allocated to high AAR and low AAR groups. Kaplan‒Meier (K‒M) curves and Cox proportional hazard models were used to evaluate the predictive effect of AAR on renal composite end point events. RESULTS After a mean follow-up of 29 months, 39 patients achieved renal composite end point events. Among them, 9 and 30 patients in the low and high AAR groups achieved renal composite end point events, respectively, with a significant difference (P < 0.001). After adjustment for confounding factors, AAR was found to be an independent prognostic factor for renal composite end point events (HR = 3.283, 95% CI: 1.489-7.238, P = 0.003). Kaplan‒Meier analysis showed that high AAR was associated with achieving renal composite end point events in patients with IgAN. Moreover, the clinical features in the high AAR group were more severe. Further subgroup analysis showed that high AAR had a better predictive effect in patients with more severe clinicopathological manifestations. CONCLUSION AAR is an independent prognostic factor in patients with IgAN.
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Affiliation(s)
- Hailang Wei
- Department of Nephrology, The First Affiliated Hospital, Gannan Medical University, Ganzhou, 341000, Jiangxi, China
| | - Bingqing Liao
- Department of Nephrology, The First Affiliated Hospital, Gannan Medical University, Ganzhou, 341000, Jiangxi, China
| | - Qi Zhou
- Department of Nephrology, The First Affiliated Hospital, Gannan Medical University, Ganzhou, 341000, Jiangxi, China
| | - Xuhua Zhou
- Department of Nephrology, The First Affiliated Hospital, Gannan Medical University, Ganzhou, 341000, Jiangxi, China
| | - Yue Zhong
- School of Basic Medicine, Gannan Medical University, Ganzhou, 341000, Jiangxi, China
| | - Yanbin Hao
- School of Public Health and Health Management, Gannan Medical University, Ganzhou, 341000, Jiangxi, China
| | - Fuhua Xie
- School of Basic Medicine, Gannan Medical University, Ganzhou, 341000, Jiangxi, China.
| | - Runxiu Wang
- Department of Nephrology, The First Affiliated Hospital, Gannan Medical University, Ganzhou, 341000, Jiangxi, China.
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Xing Y, Chai X, Liu K, Cao G, Wei G. Establishment and validation of a diagnostic model for diabetic nephropathy in type 2 diabetes mellitus. Int Urol Nephrol 2024; 56:1439-1448. [PMID: 37812376 DOI: 10.1007/s11255-023-03815-7] [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: 04/24/2023] [Accepted: 09/13/2023] [Indexed: 10/10/2023]
Abstract
PURPOSE There are few studies on the establishment of diagnostic models for diabetic nephropathy (DN) in in type 2 diabetes mellitus (T2DM) patients based on biomarkers. This study was to establish a model for diagnosing DN in T2DM. METHODS In this cross-sectional study, data were collected from the Second Hospital of Shijiazhuang between August 2018 to March 2021. Totally, 359 eligible participants were included. Clinical characteristics and laboratory data were collected. LASSO regression analysis was used to screen out diagnostic factors, and the selected factors were input into the decision tree for fivefold cross validation; then a diagnostic model was established. The performances of the diagnosis model were evaluated by the area under the receiver operator characteristic curve (AUC), sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy. The diagnostic performance of the model was also validated through risk stratifications. RESULTS Totally, 199 patients (55.43%) were diagnosed with DN. Age, diastolic blood pressure (DBP), fasting blood glucose, insulin treatment, mean corpuscular hemoglobin concentration (MCHC), platelet distribution width (PDW), uric acid (UA), serum creatinine (SCR), fibrinogen (FIB), international normalized ratio (INR), and low-density lipoprotein cholesterol (LDL-C) were the diagnostic factors for DN in T2DM. The diagnostic model presented good performances, with the sensitivity, specificity, PPV, NPV, AUC, and accuracy being 0.849, 0.969, 0.971, 0.838, 0.965, and 0.903, respectively. The diagnostic model based on the stratifications also showed excellent diagnostic performance for diagnosing DN in T2DM patients. CONCLUSION Our diagnostic model with simple and accessible factors provides a noninvasive method for the diagnosis of DN.
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Affiliation(s)
- Yuwei Xing
- Department of Endocrinology, The Second Hospital of Shijiazhuang, No. 53, Huaxi Road, Shijiazhuang, 050000, People's Republic of China.
| | - Xuejiao Chai
- Department of Endocrinology, The Second Hospital of Shijiazhuang, No. 53, Huaxi Road, Shijiazhuang, 050000, People's Republic of China
| | - Kuanzhi Liu
- Department of Endocrinology, The Third Hospital of Hebei Medical University, Shijiazhuang, 050000, People's Republic of China
| | - Guang Cao
- Department of Endocrinology, The Second Hospital of Shijiazhuang, No. 53, Huaxi Road, Shijiazhuang, 050000, People's Republic of China
| | - Geng Wei
- Department of Endocrinology, The Second Hospital of Shijiazhuang, No. 53, Huaxi Road, Shijiazhuang, 050000, People's Republic of China
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Tang L, Yang Q, Ma R, Zhou P, Peng C, Xie C, Liang Q, Wu T, Gao W, Yu H, Deng G, Dai Z, Mao N, Xiao X. Association between lactate dehydrogenase and the risk of diabetic kidney disease in patients with type 2 diabetes. Front Endocrinol (Lausanne) 2024; 15:1369968. [PMID: 38567310 PMCID: PMC10985160 DOI: 10.3389/fendo.2024.1369968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2024] [Accepted: 02/28/2024] [Indexed: 04/04/2024] Open
Abstract
Objective This study aims to investigate the association between lactate dehydrogenase (LDH) and the risk of diabetic kidney disease (DKD) in patients with type 2 diabetes (T2D). Methods The study enrolled patients with diagnosis of T2D between 2009 and 2018 from the National Nutrition and Health Examination Survey (NHANES) database. Demographic information, laboratory test, and diagnostic data were collected. Restricted cubic spline (RCS) plots were used to assess the dose-effect relationship between LDH levels and the risk of DKD in patients with T2D. Based on LDH levels, individuals were divided into higher and lower groups using dichotomy, and multivariate logistic regression analysis was conducted to explore the relationship between different LDH levels and the risk of DKD in T2D patients. Stratified analysis was performed to assess the consistency of the result. Results A total of 4888 patients were included in the study, with 2976 (60.9%) patients without DKD and 1912 (39.1%) patients with DKD. RCS plots showed that the risk of DKD increased with increasing LDH levels. Multifactorial logistic regression analysis revealed that T2D patients with higher LDH levels had a 45% increased risk of DKD compared to those with lower LDH levels (OR=1.45; 95% CI: 1.11-1.89). Furthermore, each standard deviation increase in LDH level was associated with a 24% increase in DKD incidence among T2D patients (OR=1.24; 95% CI: 1.07-1.44). Stratified analysis consistently supported these findings. Conclusions LDH can serve as a valuable biomarker for screening DKD in patients with T2D.
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Affiliation(s)
- Linqiao Tang
- Research Core Facility of West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Qianyu Yang
- Department of Nephrology, The First Affiliated Hospital of Chengdu Medical College, Chengdu, China
- Department of Clinical Medicine, Chengdu Medical College, Chengdu, China
| | - Rong Ma
- Department of Nephrology, People’s Hospital of Xindu District, Chengdu, China
| | - Ping Zhou
- Department of Nephrology, The First Affiliated Hospital of Chengdu Medical College, Chengdu, China
- Department of Clinical Medicine, Chengdu Medical College, Chengdu, China
| | - Cong Peng
- Department of Nephrology, The First Affiliated Hospital of Chengdu Medical College, Chengdu, China
- Department of Clinical Medicine, Chengdu Medical College, Chengdu, China
| | - Chunpeng Xie
- Department of Nephrology, The First Affiliated Hospital of Chengdu Medical College, Chengdu, China
- Department of Clinical Medicine, Chengdu Medical College, Chengdu, China
| | - Qiyuan Liang
- Department of Nephrology, The First Affiliated Hospital of Chengdu Medical College, Chengdu, China
- Department of Clinical Medicine, Chengdu Medical College, Chengdu, China
| | - Tingyu Wu
- Department of Nephrology, The First Affiliated Hospital of Chengdu Medical College, Chengdu, China
- Department of Clinical Medicine, Chengdu Medical College, Chengdu, China
| | - Wuyu Gao
- Department of Nephrology, The First Affiliated Hospital of Chengdu Medical College, Chengdu, China
- Department of Clinical Medicine, Chengdu Medical College, Chengdu, China
| | - Haiyan Yu
- Department of Nephrology, The First Affiliated Hospital of Chengdu Medical College, Chengdu, China
- Department of Clinical Medicine, Chengdu Medical College, Chengdu, China
| | - Guifei Deng
- Department of Nephrology, The First Affiliated Hospital of Chengdu Medical College, Chengdu, China
- Department of Clinical Medicine, Chengdu Medical College, Chengdu, China
| | - Zhen Dai
- Department of Nephrology, The First Affiliated Hospital of Chengdu Medical College, Chengdu, China
- Department of Clinical Medicine, Chengdu Medical College, Chengdu, China
| | - Nan Mao
- Department of Nephrology, The First Affiliated Hospital of Chengdu Medical College, Chengdu, China
- Department of Clinical Medicine, Chengdu Medical College, Chengdu, China
| | - Xiang Xiao
- Research Core Facility of West China Hospital, Sichuan University, Chengdu, Sichuan, China
- Department of Nephrology, The First Affiliated Hospital of Chengdu Medical College, Chengdu, China
- Department of Clinical Medicine, Chengdu Medical College, Chengdu, China
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Al-Qahtani M, Tawhari I, Alhmare AM, Badawi AS, Alsalem A, Gazzan MA, Hamdi AM, Rashid A, Alqahtani AM. The Awareness, Prevalence, and Risk Factors of Chronic Kidney Disease Among Diabetes Mellitus and Hypertensive Patients in the Aseer Region, Saudi Arabia. Cureus 2024; 16:e53366. [PMID: 38435149 PMCID: PMC10907928 DOI: 10.7759/cureus.53366] [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] [Accepted: 02/01/2024] [Indexed: 03/05/2024] Open
Abstract
Background and objective Given its ever-increasing burden, chronic kidney disease (CKD) represents a significant public health threat. CKD is characterized by a gradual alteration in the kidney's normal glomerular filtration rate, which results in the progressive loss of kidney function over a period of time ranging from a few months to years. Diabetes mellitus (DM) and hypertension (HTN) are well-known risk factors for developing CKD and end-stage renal failure. In light of this, this study aimed to assess the awareness, prevalence, and risk factors of CKD in patients with diabetes and those with HTN in the Aseer region, the Kingdom of Saudi Arabia. Methods A correlational cross-sectional study was conducted among a sample of people across Saudi Arabia. The data collection was conducted via an online questionnaire circulated on social media platforms. The study questionnaire included socioeconomic and demographic information and medical history of DM, HTN, and CKD. Also, patients' awareness of and attitude towards CKD were assessed. Results A total of 301 diabetic or hypertensive patients fulfilling the inclusion criteria completed the study questionnaire. Of them, 174 (57.8%) were aged less than 55 years, while 127 (42.2%) were aged more than 55 years; 200 (66.4%) patients were males. A total of 94 (31.2%) study patients were diabetic, 64 (21.3%) were hypertensive, and 143 (47.5%) were both diabetic and hypertensive; 226 (75.1%) study patients had an overall good awareness of CKD while only 75 (24.9%) showed a poor awareness level. Higher awareness was associated with patients' age, education, and having CKD, DM, or HTN (p<0.05). Conclusion Our findings revealed that CKD was not common among study patients, and its prevalence was found to be less than estimated based on many studies in the literature. Also, diabetic and hypertensive patients showed a higher than satisfactory level of awareness of CKD, especially young patients with high levels of education.
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Affiliation(s)
| | - Ibrahim Tawhari
- Internal Medicine, College of Medicine, King Khalid University, Abha, SAU
| | | | | | - Abdullah Alsalem
- Medicine, College of Medicine, King Khalid University, Abha, SAU
| | - Mohammed A Gazzan
- Medicine, College of Medicine, King Khalid University, Khamis Mushait, SAU
| | - Adel M Hamdi
- Medicine, College of Medicine, King Khalid University, Khamis Mushait, SAU
| | - Abdullah Rashid
- Medicine, College of Medicine, King Khalid University, Abha, SAU
| | - Ali M Alqahtani
- Medicine, College of Medicine, King Khalid University, Abha, SAU
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Sándor Z, Katics D, Varga Á, Kalmár Nagy K, Szakály P. Interpretation of LDH Values after Kidney Transplantation. J Clin Med 2024; 13:485. [PMID: 38256619 PMCID: PMC10816750 DOI: 10.3390/jcm13020485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2023] [Revised: 01/05/2024] [Accepted: 01/11/2024] [Indexed: 01/24/2024] Open
Abstract
Kidney transplantation is the gold-standard therapy for end-stage renal disease. However, in the early postoperative period following allograft kidney transplantation, insufficient graft function presents a diagnostic challenge to clinicians. Ischemic damage to the graft and/or an early autoimmune rejection may cause a decrease in function. Ischemic damage is a benign and transient condition, while acute immune rejection requires immediate therapy. A kidney graft ultrasound may produce a false negative result, and graft biopsy is invasive and slow to return results. Serum lactate dehydrogenase (LDH) is under examination as a possible tool for differential diagnosis between ischemic damage and immune rejection. Herein, we analyze the continuous lab results of four patients in the early post-transplantation period, showing patterns correlating with different clinical outcomes and prognoses. In our experience, a persistent elevated LDH accompanies ischemic damage. Immune rejection was, however, associated with a decrease in LDH. Hemodialysis was not a confounding factor, while packed red blood cell transfusion caused severe diagnostic problems.
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Affiliation(s)
- Zoltán Sándor
- Department of Surgery, Clinical Center, University of Pécs, 7624 Pécs, Hungary; (D.K.); (Á.V.)
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Al-Zahrani N, AlSwat HK, AlQarni AM, Alzahrani SS, Boubshait LA, Alassaf LA, Alsalman Z. Prevalence and Risk Factors of Diabetic Nephropathy Among Saudi Type-1 Diabetic Patients in Taif City, Saudi Arabia. Diabetes Metab Syndr Obes 2023; 16:3609-3616. [PMID: 37964940 PMCID: PMC10642383 DOI: 10.2147/dmso.s432700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 10/26/2023] [Indexed: 11/16/2023] Open
Abstract
Purpose We investigated the prevalence and associated risk factors of DNP in T1DM patients in Taif city, Saudi Arabia, where the renal diseases are prevalent. The incidence of diabetic nephropathy (DNP) is increasing in Saudi Arabia, and the country is also ranked 4th in terms of the number of diagnosed type-1 diabetes (T1DM) patients. Patients and Methods The retrospective cohort study was conducted with type-1 diabetes patients registered at King Abdulaziz Specialist Hospital in Taif, Saudi Arabia. A total of 198 patients (aged > 18 years), had T1DM for more than 5 years with documented albuminuria; albumin-creatinine ratio (ACR) ≥30 mg/g creatinine in two of three urine samples or estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m2, were included in the study. Patients' demographic and laboratory data were collected from medical records. A regression analysis model was used to identify risk factors for DNP. Statistical significance was set at P < 0.05. Results The overall prevalence of DNP was 23.7% in our study group, with 8% having low eGFR alone, 20.71% having positive ACR and 6.22% having both positive ACR and low eGFR. A statistically significant correlation between DNP and risk factors was found for uncontrolled and longer duration of T1DM, elevated ACR, and hypertension (P < 0.05). No statistical significance was found for age, sex, or body mass index (BMI). Conclusion The prevalence of DNP in T1DM patients in Taif city was higher (23.7%) than the pooled average prevalence in Saudi Arabia (20.59%). Patients' education regarding glycemic and blood pressure control could reduce the burden.
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Affiliation(s)
- Noura Al-Zahrani
- Department of Medicine, Hera General Hospital, Ministry of Health, Makkah, Saudi Arabia
| | - Hameed Khoshaiban AlSwat
- Pediatric Endocrinologist, Endocrine Diabetic Center, King Abdulaziz Specialist Hospital, Taif, Saudi Arabia
| | - Amani M AlQarni
- Family and Community medicine department, King Fahd Hospital of the University, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | | | - Leila A Boubshait
- Department of Family and Community Medicine, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Lujain A Alassaf
- Clinical Insights, Clinical Excellence, Saudi Center for National Health Insurance, Riyadh, Saudi Arabia
| | - Zaenb Alsalman
- Department of Family and Community Medicine, College of Medicine, King Faisal University, Al-Ahsa, Saudi Arabia
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Sultan S, Alharbi M, Alrayes N, Makki N, Faruqui H, Basuni L, Alhozali A, Abdulnoor R, Borai A, Almalki A, Alzahrani A, Alamoudi R, Almaghrabi M. Association of a single nucleotide polymorphism in SOD2 with susceptibility for the development of diabetic nephropathy in patients with type 2 diabetes: A Saudi population study. Endocrinol Diabetes Metab 2023; 6:e449. [PMID: 37698290 PMCID: PMC10638619 DOI: 10.1002/edm2.449] [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: 06/13/2023] [Revised: 09/01/2023] [Accepted: 09/04/2023] [Indexed: 09/13/2023] Open
Abstract
INTRODUCTION One of the complications of diabetes mellitus (DM) is diabetic nephropathy (DN), which plays a significant role in the progression of end-stage renal disease. Oxidative stress is implicated in DN pathogenesis, and genetic variations in antioxidant enzymes such as superoxide dismutase 2 (SOD2) and catalase (CAT) may contribute to the susceptibility. This study aimed to investigate the potential association between single nucleotide polymorphisms (SNPs) in antioxidant enzymes, specifically SOD2 rs4880 and CAT rs769217, and the risk of T2D and susceptibility to DN within the Saudi population. METHODS This case-control study included 150 participants, comprising 50 patients with T2D without DN (group 1), 50 patients with T2D with DN (group 2), and 50 healthy participants (group 3). The samples were genotyped using real-time PCR for SOD2 rs4880 and CAT rs769217 SNPs. Sanger sequencing was used for validation. Statistical analyses were performed to explore associations between these SNPs and T2D with or without DN. RESULTS No significant difference was observed in CAT rs769217 expression between the groups. However, a significant difference was observed in SOD2 rs4880 expression between the healthy controls and patients with T2D with DN (p = .028). Furthermore, SOD2 rs4880 was associated with approximately threefold increased risk of DN in patients with T2D compared to that in healthy participants (odds ratio [OR] = 2.99 [1.31-6.83]). Validation through Sanger sequencing further confirmed these findings. CONCLUSIONS The findings of this study provide evidence that SOD2 rs4880 SNP may contribute to inadequate defence by the antioxidant enzyme, SOD2, against DM-induced oxidative stress and thus cause DN in Saudi patients with T2D. Therefore, SOD2 rs4880 may serve as a predictive marker to prevent the development and progression of DN in patients with T2D.
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Affiliation(s)
- Samar Sultan
- Medical Laboratory Sciences, Faculty of Applied Medical SciencesKing Abdulaziz UniversityJeddahSaudi Arabia
| | - Meshari Alharbi
- Medical Laboratory Sciences, Faculty of Applied Medical SciencesKing Abdulaziz UniversityJeddahSaudi Arabia
- King Abdulaziz Medical CityNational Guard HospitalJeddahSaudi Arabia
| | - Nuha Alrayes
- Medical Laboratory Sciences, Faculty of Applied Medical SciencesKing Abdulaziz UniversityJeddahSaudi Arabia
- Princes Al‐Jawhara center of excellence in research of hereditary disorders, King Abdulaziz UniversityJeddahSaudi Arabia
| | - Nehad Makki
- Department of Medicine, Faculty of MedicineKing Abdulaziz UniversityJeddahSaudi Arabia
| | - Hanan Faruqui
- Department of Medicine, Faculty of MedicineKing Abdulaziz UniversityJeddahSaudi Arabia
| | - Lama Basuni
- Department of Medicine, Faculty of MedicineKing Abdulaziz UniversityJeddahSaudi Arabia
| | - Amani Alhozali
- Department of Medicine, Faculty of MedicineKing Abdulaziz UniversityJeddahSaudi Arabia
| | - Reham Abdulnoor
- Department of Medicine, Faculty of MedicineKing Abdulaziz UniversityJeddahSaudi Arabia
| | - Anwar Borai
- King Abdullah International Medical Research Center (KAIMRC)King Saud bin Abdulaziz University for Health Sciences (KSAU‐HS), King Abdulaziz Medical City, Ministry of National GuardJeddahSaudi Arabia
| | - Abdullah Almalki
- King saud bin Abdulaziz university for health sciences, king abdulaziz medical cityking Abdullah international research center (KAIMRC)JeddahSaudi Arabia
| | - Abdullah Alzahrani
- King Abdulaziz Medical city, College of MedicineKing Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research centerJeddahSaudi Arabia
| | - Reem Alamoudi
- King Abdulaziz Medical city, College of MedicineKing Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research centerJeddahSaudi Arabia
| | - Mazin Almaghrabi
- King Abdulaziz Medical CityNational Guard HospitalJeddahSaudi Arabia
- Department of Internal Medicine/EndocrinologyKing Abdulaziz Medical CityJeddahSaudi Arabia
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Deng Y, Li X, Lai Q, Wang F, Zhang C, Yang Y, Jiang D, Kang H, Wang H, Liao D. Prognostic implication of lactic dehydrogenase-to-albumin ratio in critically ill patients with acute kidney injury. Clin Exp Nephrol 2023; 27:349-357. [PMID: 36719499 PMCID: PMC9887249 DOI: 10.1007/s10157-023-02321-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Accepted: 01/17/2023] [Indexed: 02/01/2023]
Abstract
BACKGROUND No studies have been published on the correlation between lactic dehydrogenase-to-albumin ratio (LAR) and poor prognosis of acute kidney injury (AKI) patients, warranting further research. This analysis sought to investigate the prognostic implication of LAR in critically ill patients with AKI. METHODS The present study enrolled 11,046 and 5180 adults with AKI from the Medical Information Mart for Intensive Care III (MIMIC III) and MIMIC IV, respectively. Data from MIMIC IV were identified as the training cohort, and those from MIMIC III were identified as the validation cohort. We applied multivariate regression analysis to identify the link between LAR and all-cause mortality. Restricted cubic spline (RCS) was conducted to figure out the correlation between LAR and in-hospital mortality. Furthermore, we carried out stratification analyses to examine if the effects of LAR on in-hospital mortality were consistent across various subclasses. RESULTS The level of LAR was remarkably higher in the in-hospital non-survivor group (p < 0.001). Furthermore, the increased LAR group presented a remarkably higher rate of in-hospital mortality at AKI stages 1, 2, and 3 compared with the decreased LAR group (all p < 0.001). Multivariate regression analyses exhibited the independent prognostic significance of LAR for all-cause mortality (all p < 0.001). MIMIC III observed concordant results. RCS indicated a non-linear correlation between LAR and in-hospital death (P for non-linearity < 0.001). The relationship between LAR and in-hospital mortality was still significant in patients with various subclasses. CONCLUSIONS Elevated LAR at admission is a prognostic risk factor for critically ill patients with AKI.
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Affiliation(s)
- Yonghua Deng
- Department of Nephrology, Chengdu Second People's Hospital, Chengdu, China
| | - Xinchun Li
- North Sichuan Medical College, Nanchong, China
- Department of Nephrology, Mianyang Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Mianyang, China
| | - Qiancheng Lai
- Geriatric Diseases Institute of Chengdu, Department of Cardiothoracic Surgery, Chengdu Fifth People's Hospital, Chengdu, China
| | - Fengping Wang
- Department of Nephrology, Chengdu Second People's Hospital, Chengdu, China
| | - Chenglong Zhang
- Department of Nephrology, Chengdu Second People's Hospital, Chengdu, China
| | - Yingjia Yang
- Department of Nephrology, Chengdu Second People's Hospital, Chengdu, China
| | - Dan Jiang
- Department of Nephrology, Chengdu Second People's Hospital, Chengdu, China
| | - Han Kang
- Department of Nephrology, Chengdu Second People's Hospital, Chengdu, China
| | - Huan Wang
- Department of Nephrology, Chengdu Second People's Hospital, Chengdu, China
| | - Dan Liao
- Department of Nephrology, Mianyang Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Mianyang, China.
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10
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Siddiqui K, Nawaz SS, Alfadda AA, Mujammami M. Low Circulating Free Triiodothyronine Levels are Associated with the Progression of Diabetic Nephropathy in Patients with Type 2 Diabetes. Int J Gen Med 2022; 15:8659-8668. [PMID: 36568840 PMCID: PMC9785124 DOI: 10.2147/ijgm.s389071] [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: 09/20/2022] [Accepted: 11/14/2022] [Indexed: 12/23/2022] Open
Abstract
Background Diabetic Nephropathy (DN) is one of the most typical causes of end-stage renal disease and thyroid hormone exerts effects on the kidney. There are few reports on the role of thyroid hormone in the progression of DN. We aimed to assess the relationship between thyroid hormone and DN. Methods In this cross-sectional study, 400 patients with type 2 diabetes (T2D) (aged between 35 and 70 years) were divided into two groups T2D control and DN group according to albumin creatinine ratio (ACR). Clinical biochemistry parameters were measured using the Rx Daytona chemistry analyzer and thyroid hormone levels (TT4, TT3, TSH, FT4, and FT3) using the Evidence Biochip analyzer. To assess the relationship between thyroid hormone and DN, multiple logistic regression models were developed. Results Serum FT4 and FT3 levels were significantly lower in DN compared to T2D controls (p<0.05). Thyroid hormone levels tend to decrease with the progression of DN. In unadjusted and adjusted logistic regression models, FT3 levels were negatively associated with odds of having DN (OR=0.28, CI=0.128-0.616, p=0.002). Conclusion The free triiodothyronine level was negatively associated with the progression of DN. Further longitudinal studies are required to assess the cause of thyroid hormone differences.
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Affiliation(s)
- Khalid Siddiqui
- Strategic Center for Diabetes Research, College of Medicine, King Saud University, Riyadh, Saudi Arabia,Correspondence: Khalid Siddiqui, Strategic Center for Diabetes Research, College of Medicine, King Saud University, P.O. Box 245, Riyadh, 11411, Saudi Arabia, Tel +966 114724179 Ext.3106, Fax +966 114725682, Email
| | - Shaik Sarfaraz Nawaz
- Strategic Center for Diabetes Research, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Assim A Alfadda
- Strategic Center for Diabetes Research, College of Medicine, King Saud University, Riyadh, Saudi Arabia,Department of Medicine, College of Medicine, and King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia,Obesity Research Center, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Muhammad Mujammami
- Strategic Center for Diabetes Research, College of Medicine, King Saud University, Riyadh, Saudi Arabia,Department of Medicine, College of Medicine, and King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia,University Diabetes Center, King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia
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11
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Siddiqui K, George TP, Joy SS, Alfadda AA. Risk factors of chronic kidney disease among type 2 diabetic patients with longer duration of diabetes. Front Endocrinol (Lausanne) 2022; 13:1079725. [PMID: 36568108 PMCID: PMC9780388 DOI: 10.3389/fendo.2022.1079725] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 11/14/2022] [Indexed: 12/14/2022] Open
Abstract
Background Chronic kidney disease (CKD) in patients with type 2 diabetes mellitus (T2DM) is the major cause of end stage renal disease, characterized by proteinuria with a subsequent decline in glomerular filtration rate. Although hyperglycemia is the major risk factor for the development and progression of kidney disease among diabetic patients, many other risk factors also contribute to structural and functional changes in the kidneys. As recommended by Kidney Disease Improving Global Outcomes (KDIGO), CKD classification based on cause and severity, links to risk of adverse outcomes including mortality and kidney outcomes. Objective The aim of this study is to investigate the involvement of risk factors associated with the severity of CKD among participants with longer duration of diabetes. This study also aims to find whether number of risk factors vary among risk of CKD progression categories based on KDIGO classification. Material and methods This cross-sectional study retrospectively selected 424 participants from type 2 diabetic cohort and categorized them based on the classifications for the diagnosis of kidney diseases in patients with diabetes, according to the KDIGO guidelines. Odds ratios and 95% CI of each risk factors according to severity of renal disease were determined. Results Based on KDIGO classification, participants with type 2 diabetes (T2D) were categorized in to low risk (n=174); moderately increased risk (n=98); and high/very high risk (n=152). Type 2 diabetic participants with risk factors such as, hyperlipidemia, hypertension, DM duration ≥15 years and diabetic retinopathy showed a high/very high risk of CKD progression when compared with low-risk category. While T2D participants with risk factors such as, lack of exercise, hypertension, and diabetic retinopathy showed a moderately increased risk of CKD progression. In addition, participants with highest number of risk factors were significantly distributed among high/very high risk of CKD progression category. Conclusion This study findings conclude that patients with T2DM and duration of ≥15 years, hyperlipidemia, hypertension and diabetic retinopathy have an increased prevalence of advanced CKD. In addition to this, increased number of risk factors could be an indicator of the severity of CKD in T2D.
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Affiliation(s)
- Khalid Siddiqui
- Strategic Center for Diabetes Research, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Teena P. George
- Strategic Center for Diabetes Research, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Salini S. Joy
- Strategic Center for Diabetes Research, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Assim A. Alfadda
- Strategic Center for Diabetes Research, College of Medicine, King Saud University, Riyadh, Saudi Arabia
- Department of Medicine, College of Medicine, and King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia
- Obesity Research Center, College of Medicine, King Saud University, Riyadh, Saudi Arabia
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12
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Nawaz SS, Siddiqui K, Mujammami M, Alotaibi O, Alanazi SS, Rafiullah M. Determinant of Osteopontin Levels in Microvascular Complications in Patients with Diabetes. Int J Gen Med 2022; 15:4433-4440. [PMID: 35509601 PMCID: PMC9058230 DOI: 10.2147/ijgm.s354220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 04/07/2022] [Indexed: 11/28/2022] Open
Abstract
Background Osteopontin (OPN) is a 44-kDa multifunctional protein and has a diverse role in biomineralization, tissue remodeling, and chronic inflammation. However, its role in type 2 diabetes (T2D) patients with microvascular complications is not clear. Therefore, the present study aimed to investigate the role of OPN in T2D patients with microvascular complications. Methods A total of 324 type 2 diabetes patients in the age group of 38-66 years were included in this study; 249 T2D patients were diagnosed with microvascular complications. OPN was measured using an enzyme-linked immunosorbent assay kit. Clinical data, such as age, gender, diabetes duration, systolic blood pressure, diastolic blood pressure, were measured. Correlation between OPN levels with different clinical parameters was evaluated. Results In patients with microvascular complications, OPN levels were significantly higher than those without microvascular complications (p < 0.05). Moreover, OPN levels were positively associated with systolic blood pressure (SBP), C-reactive protein, and albumin creatinine ratio (ACR). Multiple linear regression analysis showed that OPN levels were independently associated with C-reactive protein (p < 0.045). Conclusion The findings in the present study showed that OPN level was more positively associated with C-reactive protein than that with glucose metabolism in patients with microvascular complications. Thus, OPN might serve as a marker in predicting vascular disease.
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Affiliation(s)
- Shaik Sarfaraz Nawaz
- Strategic Center for Diabetes Research, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Khalid Siddiqui
- Strategic Center for Diabetes Research, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Muhammad Mujammami
- Strategic Center for Diabetes Research, College of Medicine, King Saud University, Riyadh, Saudi Arabia
- University Diabetes Center, King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia
- Division of Endocrinology, Department of Medicine, College of Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - Obeed Alotaibi
- University Diabetes Center, King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia
| | - Saud Sulaiman Alanazi
- Strategic Center for Diabetes Research, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Mohamed Rafiullah
- Strategic Center for Diabetes Research, College of Medicine, King Saud University, Riyadh, Saudi Arabia
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13
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Comparison of Different Machine Learning Techniques to Predict Diabetic Kidney Disease. JOURNAL OF HEALTHCARE ENGINEERING 2022; 2022:7378307. [PMID: 35399848 PMCID: PMC8993553 DOI: 10.1155/2022/7378307] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 03/10/2022] [Accepted: 03/21/2022] [Indexed: 12/17/2022]
Abstract
Background Diabetic kidney disease (DKD), one of the complications of diabetes in patients, leads to progressive loss of kidney function. Timely intervention is known to improve outcomes. Therefore, screening patients to identify high-risk populations is important. Machine learning classification techniques can be applied to patient datasets to identify high-risk patients by building a predictive model. Objective This study aims to identify a suitable classification technique for predicting DKD by applying different classification techniques to a DKD dataset and comparing their performance using WEKA machine learning software. Methods The performance of nine different classification techniques was analyzed on a DKD dataset with 410 instances and 18 attributes. Data preprocessing was carried out using the PartitionMembershipFilter. A 10-fold cross validation was performed on the dataset. The performance was assessed on the basis of the execution time, accuracy, correctly and incorrectly classified instances, kappa statistics (K), mean absolute error, root mean squared error, and true values of the confusion matrix. Results With an accuracy of 93.6585% and a higher K value (0.8731), IBK and random tree classification techniques were found to be the best performing techniques. Moreover, they also exhibited the lowest root mean squared error rate (0.2496). There were 15 false-positive instances and 11 false-negative instances with these prediction models. Conclusions This study identified IBK and random tree classification techniques as the best performing classifiers and accurate prediction methods for DKD.
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14
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Huang L, Shao M, Zhu Y. Gastrodin inhibits high glucose‑induced inflammation, oxidative stress and apoptosis in podocytes by activating the AMPK/Nrf2 signaling pathway. Exp Ther Med 2021; 23:168. [PMID: 35069849 PMCID: PMC8753962 DOI: 10.3892/etm.2021.11091] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 06/14/2021] [Indexed: 11/25/2022] Open
Abstract
Diabetic nephropathy (DN) is a serious and common complication of type 1 and 2 diabetes. Gastrodin has been reported to suppress high glucose (HG)-induced inflammation and oxidative stress in vivo and in vitro. However, the effect of gastrodin on DN has not been fully elucidated. The present study aimed to investigate the underlying mechanism involved in the effect of gastrodin on podocyte injury caused by DN. Cell viability was evaluated using Cell Counting Kit-8 assay and secretion levels of TNF-α, IL-1β and IL-6 were measured using ELISA. The levels of malondialdehyde, activities of lactate dehydrogenase and superoxide dismutase were quantified using corresponding assay kits. Additionally, cell apoptosis was analyzed by TUNEL assay, whilst protein expressions related to inflammation, apoptosis and the 5'-AMP-activated protein kinase (AMPK)/nuclear factor erythroid 2-related factor 2 (Nrf2) signaling pathway were measured by western blot analysis. The results showed that gastrodin increased the viability of MPC5 cells following HG stimulation. Gastrodin also alleviated HG-induced inflammation, oxidative stress and apoptosis in MPC5 cells. Furthermore, gastrodin promoted activation of the AMPK/Nrf2 pathway in MPC5 cells. Treatment with the AMPK inhibitor, compound C, reversed the inhibitory effects of gastrodin on inflammation, oxidative stress and cell apoptosis. To conclude, treatment of MPC5 cells with gastrodin can attenuate HG-induced inflammation, oxidative stress and cell apoptosis by activating the AMPK/Nrf2 signaling pathway. Results from the current study suggest that gastrodin can be used as an effective therapeutic agent against HG-induced podocyte injury in DN.
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Affiliation(s)
- Luyan Huang
- Department of Traditional Chinese Medicine, Zhongshan Hospital (Minhang Branch), Fudan University, Shanghai 201199, P.R. China
| | - Minghai Shao
- Department of Nephrology, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai 200021, P.R. China
| | - Yan Zhu
- Department of Traditional Chinese Medicine, Shanghai Fourth People's Hospital Affiliated to Tongji University School of Medicine, Shanghai 200434, P.R. China
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15
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El-Kebbi IM, Bidikian NH, Hneiny L, Nasrallah MP. Epidemiology of type 2 diabetes in the Middle East and North Africa: Challenges and call for action. World J Diabetes 2021; 12:1401-1425. [PMID: 34630897 PMCID: PMC8472500 DOI: 10.4239/wjd.v12.i9.1401] [Citation(s) in RCA: 43] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 06/21/2021] [Accepted: 08/02/2021] [Indexed: 02/06/2023] Open
Abstract
Type 2 diabetes continues to be a serious and highly prevalent public health problem worldwide. In 2019, the highest prevalence of diabetes in the world at 12.2%, with its associated morbidity and mortality, was found in the Middle East and North Africa region. In addition to a genetic predisposition in its population, evidence suggests that obesity, physical inactivity, urbanization, and poor nutritional habits have contributed to the high prevalence of diabetes and prediabetes in the region. These risk factors have also led to an earlier onset of type 2 diabetes among children and adolescents, negatively affecting the productive years of the youth and their quality of life. Furthermore, efforts to control the rising prevalence of diabetes and its complications have been challenged and complicated by the political instability and armed conflict in some countries of the region and the recent coronavirus disease 2019. Broad strategies, coupled with targeted interventions at the regional, national, and community levels are needed to address and curb the spread of this public health crisis.
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Affiliation(s)
- Imad M El-Kebbi
- Department of Internal Medicine, Division of Endocrinology, American University of Beirut Medical Center, Faculty of Medicine, Beirut 11072020, Lebanon
- Department of Internal Medicine, Sheikh Shakhbout Medical City, Abou Dhabi 11001, United Arab Emirates
| | - Nayda H Bidikian
- School of Medicine, American University of Beirut, Faculty of Medicine, Beirut 11072020, Lebanon
| | - Layal Hneiny
- University Libraries, Saab Medical Library, American University of Beirut, Beirut 11072020, Lebanon
| | - Mona Philippe Nasrallah
- Department of Internal Medicine, Division of Endocrinology, American University of Beirut Medical Center, Faculty of Medicine, Beirut 11072020, Lebanon
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16
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Sharma G, Dubey A, Nolkha N, Singh JA. Hyperuricemia, urate-lowering therapy, and kidney outcomes: a systematic review and meta-analysis. Ther Adv Musculoskelet Dis 2021; 13:1759720X211016661. [PMID: 34104231 PMCID: PMC8161880 DOI: 10.1177/1759720x211016661] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Accepted: 01/03/2021] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Contradictory evidence exists for association of hyperuricemia and kidney function. To investigate the association of hyperuricemia and kidney function decline (hyperuricemia question) and effect of urate-lowering therapies (ULTs) on kidney function (ULT question), we performed a systematic review and meta-analysis. METHODS MEDLINE, Embase, Cochrane Central Register of Controlled Trials, and CINAHL were searched from inception to July 2020. We selected observational studies for the hyperuricemia question and controlled trials for the ULT question. Two investigators independently assessed study eligibility and abstracted the data. Risk of bias was assessed using the Newcastle-Ottawa Scale and Cochrane risk of bias tool. Meta-analysis was done using the inverse variance method and random effect model. We estimated odds ratio (OR), hazard ratio (HR), risk ratio (RR), and the mean difference (MD). Evidence certainty was evaluated using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system. RESULTS Of 12,037 studies screened, 131 studies with 3,414,226 patients were included. Hyperuricemia was associated with a significant risk of rapid estimated glomerula filtration rate (eGFR) decline ⩾3 ml/min per 1.73 m2 per year (OR 1.38, 95% CI 1.20-1.59; low certainty), albuminuria (OR/HR 1.94, 95% CI 1.34-2.79; very low certainty), chronic kidney disease (OR/HR 2.13, 95% CI 1.74-2.61; very low certainty), and kidney failure (HR 1.53, 95% CI 1.18-1.99; very low certainty). Compared with control, ULT use for ⩾1 year was associated with significantly more improved eGFR (MD 1.81 ml/min per 1.73 m2, 95% CI 0.26-3.35; very low certainty), serum creatinine (MD -0.33 mg/dl, 95% CI -0.47 to -0.19; low certainty), and proteinuria (MD -5.44 mg/day, 95% CI -8.49 to -2.39; low certainty), but no difference in kidney failure. CONCLUSION Hyperuricemia is associated with worsening eGFR, albuminuria, chronic kidney disease, and kidney failure. ULT use for ⩾1 year may improve kidney function. REGISTRATION The protocol was registered at PROSPERO database, CRD42015013859.
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Affiliation(s)
- Gaurav Sharma
- Department of Internal Medicine, University of South Alabama, Mobile, AL, USA
- Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham, AL, USA
- Department of Internal Medicine, Seth GS Medical College and KEM Hospital, Mumbai, MH, India
| | - Abhishek Dubey
- Department of Internal Medicine, Seth GS Medical College and KEM Hospital, Mumbai, MH, India
| | - Nilesh Nolkha
- Department of Rheumatology, Cannock Chase Hospital, Cannock, UK
| | - Jasvinder A. Singh
- Division of Clinical Immunology and Rheumatology, Department of Medicine at the School of Medicine and the Department of Epidemiology at the School of Public Health, University of Alabama at Birmingham, Faculty Office Tower 805B, 510 20th Street S., Birmingham, AL 35294-0022, USA
- Medicine Service, VA Medical Center, Birmingham, AL 35233, USA
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Ryu SY, Kleine CE, Hsiung JT, Park C, Rhee CM, Moradi H, Hanna R, Kalantar-Zadeh K, Streja E. Association of lactate dehydrogenase with mortality in incident hemodialysis patients. Nephrol Dial Transplant 2021; 36:704-712. [PMID: 33367881 DOI: 10.1093/ndt/gfaa277] [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] [Received: 05/05/2020] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Lactate dehydrogenase (LDH) plays a role in the glucose metabolism of the human body. Higher LDH levels have been linked to mortality in various cancer types; however, the relationship between LDH and survival in incident hemodialysis (HD) patients has not yet been examined. We hypothesized that higher LDH level is associated with higher death risk in these patients. METHODS We examined the association of baseline and time-varying serum LDH with all-cause, cardiovascular and infection-related mortality among 109 632 adult incident HD patients receiving care from a large dialysis organization in the USA during January 2007 to December 2011. Baseline and time-varying survival models were adjusted for demographic variables and available clinical and laboratory surrogates of malnutrition-inflammation complex syndrome. RESULTS There was a linear association between baseline serum LDH levels and all-cause, cardiovascular and infection-related mortality in both baseline and time-varying models, except for time-varying infection-related mortality. Adjustment for markers of inflammation and malnutrition attenuated the association in all models. In fully adjusted models, baseline LDH levels ≥360 U/L were associated with the highest risk of all-cause mortality (hazard ratios = 1.19, 95% confidence interval 1.14-1.25). In time-varying models, LDH >280 U/L was associated with higher death risk in all three hierarchical models for all-cause and cardiovascular mortality. CONCLUSIONS Higher LDH level >280 U/L was incrementally associated with higher all-cause and cardiovascular mortality in incident dialysis patients, whereas LDH <240 U/L was associated with better survival. These findings suggest that the assessment of metabolic functions and monitoring for comorbidities may confer survival benefit to dialysis patients.
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Affiliation(s)
- Soh Young Ryu
- Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology and Hypertension, University of California Irvine Medical Center, Orange, CA, USA
| | - Carola-Ellen Kleine
- Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology and Hypertension, University of California Irvine Medical Center, Orange, CA, USA
| | - Jui-Ting Hsiung
- Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology and Hypertension, University of California Irvine Medical Center, Orange, CA, USA.,Nephrology Section, Tibor Rubin VA Medical Center, Long Beach, CA, USA
| | - Christina Park
- Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology and Hypertension, University of California Irvine Medical Center, Orange, CA, USA
| | - Connie M Rhee
- Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology and Hypertension, University of California Irvine Medical Center, Orange, CA, USA.,Nephrology Section, Tibor Rubin VA Medical Center, Long Beach, CA, USA
| | - Hamid Moradi
- Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology and Hypertension, University of California Irvine Medical Center, Orange, CA, USA.,Nephrology Section, Tibor Rubin VA Medical Center, Long Beach, CA, USA
| | - Ramy Hanna
- Harold Simmons Center for Kidney 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 Kidney Disease Research and Epidemiology, Division of Nephrology and Hypertension, University of California Irvine Medical Center, Orange, CA, USA.,Nephrology Section, Tibor Rubin VA Medical Center, Long Beach, CA, USA
| | - Elani Streja
- Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology and Hypertension, University of California Irvine Medical Center, Orange, CA, USA.,Nephrology Section, Tibor Rubin VA Medical Center, Long Beach, CA, USA
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Sukkarieh HH, Bustami RT, Abdu MN, Khokhar AA, Salih AA, Abdalla HK. The current practice of using angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers in diabetic hypertensive and non-hypertensive patients. Is there a room for vitamin D? Saudi Med J 2020; 41:1083-1089. [PMID: 33026049 PMCID: PMC7841522 DOI: 10.15537/smj.2020.10.25428] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Accepted: 09/16/2020] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVES To determine the current pattern of using angiotensin-converting enzyme (ACE) inhibitors and angiotensin II receptor blockers (ARBs) in diabetic nephropathy (DN), and assess physician awareness of using vitamin D in the prevention and treatment of DN. METHODS A cross-sectional study implementing a validated questionnaire, which was distributed to physicians in the aforementioned specialties in 3 hospitals in Saudi Arabia (Almanee Hospital, King Saud Medical City [KSMC], and Riyadh Care Hospital [RCH]) between April 2019 and November 2019. We used IBM SPSS 26.0 to perform descriptive statistical analyses and comparisons were based on the Chi-square test. RESULTS Forty-one physicians (30%) reported the use of combination therapy of ACEi and ARBs. Fifty-six (41%) physicians reported that they never used vitamin D in the treatment of DN, and 48% agreed that vitamin D can benefit patients with DN. 52% of the respondents reported the existence of guidelines. The vast majority (94%) recommended clearer guidelines on monitoring renal function in patients treated with ACEi or ARBs. CONCLUSION There is a universal agreement among physicians regarding the use of ACEi and ARBs for the treatment of DN with limited awareness of the bene ts of using vitamin D. Hence, the development of specific guidelines for its use are recommended.
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Affiliation(s)
- Hatouf H Sukkarieh
- Department of Pharmacology, College of Medicine, Alfaisal University, Riyadh, Kingdom of Saudi Arabia. E-mail.
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Siddiqui K, Joy SS, Nawaz SS, Alnaqeb D, Mujammami M, Al-Rubeaan K. Association of urinary non-albumin protein with the different urinary marker for glomerular and tubular damage in patients with type 2 diabetes. BMC Nephrol 2020; 21:255. [PMID: 32631266 PMCID: PMC7336477 DOI: 10.1186/s12882-020-01906-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Accepted: 06/24/2020] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND/AIM In recent years, the diagnostic utility of urinary protein levels has been demonstrated for the early detection and progression of kidney disease. This study aimed to evaluate the associations of the non-albumin protein (NAP) with different urinary marker for tubular and glomerular damage in patients with type 2 diabetes (T2D). METHODS In this observational cross-sectional study, 424 patients with T2D duration > 10 years were classified into two groups according to estimated glomerular filtration rate (eGFR). The ratios of different urinary markers (albumin, NAP, total protein, transferrin, retinol-binding protein (RBP), and neutrophil gelatinase-associated lipocalin (NGAL) to creatinine were analyzed. RESULTS The levels of urinary biomarkers increased significantly with decrease in eGFR levels. In the group with moderately decreased eGFR, the albumin to-creatinine ratio (ACR), non-albumin protein-to-creatinine ratio (NAPCR), and total protein-to-creatinine ratio (PCR) were independently associated with all urinary markers after being adjusted for risk factors. The area under the receiver operating characteristics (ROC) curve for ACR and PCR had a better diagnostic value than other urinary biomarkers. Comparing ROC curve of NAPCR with other urinary biomarkers, it was significantly better than NGAL/Cr (p = 0.033). CONCLUSIONS The findings of the present study confirm that ACR and PCR are diagnostic biomarkers in T2D patients with decreased eGFR. NAPCR in these patients diagnostically only outperformed NGAL/Cr.
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Affiliation(s)
- Khalid Siddiqui
- Strategic Center for Diabetes Research, College of Medicine, King Saud University, Riyadh, Saudi Arabia.
- University Diabetes Center, King Abdulaziz University Hospital, King Saud University, Riyadh, Saudi Arabia.
| | - Salini Scaria Joy
- Strategic Center for Diabetes Research, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Shaik Sarfaraz Nawaz
- Strategic Center for Diabetes Research, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Dhekra Alnaqeb
- University Diabetes Center, King Abdulaziz University Hospital, King Saud University, Riyadh, Saudi Arabia
| | - Muhammad Mujammami
- Strategic Center for Diabetes Research, College of Medicine, King Saud University, Riyadh, Saudi Arabia
- University Diabetes Center, King Abdulaziz University Hospital, King Saud University, Riyadh, Saudi Arabia
- Endocrinology and Diabetes, Department of Medicine, King Khalid University Hospital & College of Medicine, King Saudi University, Riyadh, Saudi Arabia
| | - Khalid Al-Rubeaan
- Strategic Center for Diabetes Research, College of Medicine, King Saud University, Riyadh, Saudi Arabia
- University Diabetes Center, King Abdulaziz University Hospital, King Saud University, Riyadh, Saudi Arabia
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LncRNA ANRIL Silencing Alleviates High Glucose-Induced Inflammation, Oxidative Stress, and Apoptosis via Upregulation of MME in Podocytes. Inflammation 2020; 43:2147-2155. [DOI: 10.1007/s10753-020-01282-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Zhang P, Fang J, Zhang J, Ding S, Gan D. Curcumin Inhibited Podocyte Cell Apoptosis and Accelerated Cell Autophagy in Diabetic Nephropathy via Regulating Beclin1/UVRAG/Bcl2. Diabetes Metab Syndr Obes 2020; 13:641-652. [PMID: 32184643 PMCID: PMC7060797 DOI: 10.2147/dmso.s237451] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Accepted: 02/17/2020] [Indexed: 12/16/2022] Open
Abstract
INTRODUCTION Curcumin has various biological properties including being anti-inflammatory and antidiabetic. Podocyte apoptosis and autophagy dysfunction have been found to be responsible for the development of diabetic nephropathy (DN). Thus, the aim of the study was to investigate the effects of curcumin on the podocyte apoptosis and autophagy in DN and clarify its potential mechanisms. METHODS The mice with DN induced by injection of streptozotocin were treated with curcumin by gavage at a dose of 200 mg/kg/day for 8 weeks. The serum lipid levels were detected by total cholesterol (TC) and triglyceride (TG) kits at different time points. Renal damage was assessed by detecting urine albumin, serum creatinine (Scr), HE staining and PAS staining. The renal impairment was detected by immunohistochemical staining and TUNEL staining. Western blot assay tested the expression of autophagy-related and apoptotic-related proteins in vivo and vitro. The viabilities and apoptosis of MPC5 cells exposed to high glucose (HG) or curcumin were respectively detected by CCK-8 assay and flow cytometry. RESULTS The results showed that curcumin significantly decreased the progress of DN possibly via increasing autophagy and inhibiting apoptosis of renal cell in DN mice. Besides, podocyte marker proteins (podocalyxin and nephrin) were markedly increased in DN mice by curcumin treatment. The autophagy-related proteins LC3, p62, Beclin1, UVRAG and ATG5 were significantly affected in DN mice by curcumin, along with reducing expression of pro-apoptotic protein Bax and caspase-3 and increasing anti-apoptotic protein Bcl-2. In vitro, curcumin increased the viabilities and inhibited apoptosis of MPC5 cells exposed to high glucose (HG). In addition, the podocyte autophagy was enhanced partly via regulating beclin1/UVRAG. DISCUSSION Together, the results showed that curcumin inhibited podocyte apoptosis and accelerated cell autophagy via regulating Beclin1/UVRAG/Bcl2. Thus, the study showed that curcumin exerted significantly protective effects in DN.
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Affiliation(s)
- Pingping Zhang
- Department of Endocrinology, Ningbo Women and Children’s Hospital, Ningbo City, Zhejiang Province, People’s Republic of China
| | - Jie Fang
- Department of Endocrinology, Ningbo Women and Children’s Hospital, Ningbo City, Zhejiang Province, People’s Republic of China
| | - Jianping Zhang
- Department of Endocrinology, Ningbo Women and Children’s Hospital, Ningbo City, Zhejiang Province, People’s Republic of China
| | - Shuxia Ding
- Department of Endocrinology, Ningbo Women and Children’s Hospital, Ningbo City, Zhejiang Province, People’s Republic of China
| | - Dongmei Gan
- Department of Endocrinology, Ningbo Women and Children’s Hospital, Ningbo City, Zhejiang Province, People’s Republic of China
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Siddiqui K, Joy SS, George TP, Mujammami M, Alfadda AA. Potential Role and Excretion Level of Urinary Transferrin, KIM-1, RBP, MCP-1 and NGAL Markers in Diabetic Nephropathy. Diabetes Metab Syndr Obes 2020; 13:5103-5111. [PMID: 33408494 PMCID: PMC7780984 DOI: 10.2147/dmso.s282166] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 11/13/2020] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Analyzing urinary biomarkers may provide better insight into pathophysiological mechanisms of diabetic kidney diseases. The study aimed to analyze the pattern of selected excreted urinary biomarkers and its correlation with albuminuria and estimated glomerular filtration rate (eGFR) in patients with type 2 diabetes. METHODS A total of 185 patients with type 2 diabetes were categorized according to KDIGO guideline based on albuminuria and eGFR. The urinary markers (transferrin, KIM-1, RBP, MCP-1 and NGAL) were measured by ELISA. RESULTS The urinary markers were associated with eGFR (total protein/Cr, p=0.001; RBP/Cr, p=0.007; MCP-1/Cr, p=0.023; NGAL/Cr, p=0.011) and albuminuria (total protein/Cr, p<0.001; transferrin, p<0.001; RBP/Cr, p<0.001; MCP-1/Cr, p<0.001; NGAL/Cr, p=0.002). CONCLUSION The urinary marker levels (total protein, RBP, MCP-1, and NGAL) are elevated with severity of kidney damage and expressed more in progressive renal impairment.
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Affiliation(s)
- Khalid Siddiqui
- Strategic Center for Diabetes Research, College of Medicine, King Saud University, Riyadh, Saudi Arabia
- Correspondence: Khalid Siddiqui Strategic Center for Diabetes Research, College of Medicine, King Saud University, P.O. Box 245, Riyadh11411, Kingdom of Saudi ArabiaTel +966 114724179 ext.1340 Email
| | - Salini Scaria Joy
- Strategic Center for Diabetes Research, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | | | - Muhammad Mujammami
- Strategic Center for Diabetes Research, College of Medicine, King Saud University, Riyadh, Saudi Arabia
- University Diabetes Center, King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia
- Department of Medicine, College of Medicine, and King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia
| | - Assim A Alfadda
- Strategic Center for Diabetes Research, College of Medicine, King Saud University, Riyadh, Saudi Arabia
- Department of Medicine, College of Medicine, and King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia
- Obesity Research Center, College of Medicine, King Saud University, Riyadh, Saudi Arabia
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Siddiqui K, Joy SS, Al-Rubeaan K. Association of urinary monocyte chemoattractant protein-1 (MCP-1) and kidney injury molecule-1 (KIM-1) with risk factors of diabetic kidney disease in type 2 diabetes patients. Int Urol Nephrol 2019; 51:1379-1386. [PMID: 31250339 DOI: 10.1007/s11255-019-02201-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2019] [Accepted: 06/10/2019] [Indexed: 01/10/2023]
Abstract
PURPOSE Urinary kidney injury molecule-1 and monocyte chemoattractant protein-1 are significance factors in the diagnosis and intervention of diabetic kidney diseases. This study determined levels of these proteins in diabetic patients with varying degrees of kidney disease and assessed their relationship with risk factors associated with diabetic kidney diseases. METHODS A total of 185 patients with type 2 diabetes were divided into three groups [low risk (n = 47), moderate risk (n = 63), and high risk (n = 75)] based on the severity of diabetic kidney disease according to kidney disease: improving global outcomes guidelines. Both urinary kidney injury molecule-1 and monocyte chemoattractant protein-1 levels were measured by enzyme-linked immunosorbent assay. Student`s t test, analysis of variance, and Spearman's correlation were used for statistical analysis. RESULTS The kidney injury molecule-1-to-creatinine ratio (P = 0.035) and monocyte chemoattractant protein-1-to-creatinine ratio (P < 0.001) increased significantly with the increase in kidney disease severity and varied according to different albuminuria statuses and estimated glomerular-filtration rates. The monocyte chemoattractant protein-1-to-creatinine ratio showed a significant correlation with hemoglobin A1c (P = 0.002) and inflammatory marker levels (interleukin-6, P = 0.005; tumor necrosis factor-α, P < 0.001). CONCLUSION Urinary levels of both kidney injury molecule-1 and monocyte chemoattractant protein-1 represent distinguishing markers for the evaluation of diabetic kidney disease progression according to the associated degrees of albuminuria or/and the estimated glomerular-filtration rate. In addition, correlations between urinary monocyte chemoattractant protein-1 and glycemic and inflammatory marker levels revealed the role of hyperglycemia and chronic inflammation in the pathogenesis of diabetic kidney disease.
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Affiliation(s)
- Khalid Siddiqui
- Strategic Center for Diabetes Research, College of Medicine, King Saud University, Riyadh, Saudi Arabia.
| | - Salini Scaria Joy
- Strategic Center for Diabetes Research, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Khalid Al-Rubeaan
- University Diabetes Center, King Abdulaziz University Hospital, King Saud University, Riyadh, Saudi Arabia
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Alwin Robert A, Al Dawish MA. Microvascular complications among patients with diabetes: An emerging health problem in Saudi Arabia. Diab Vasc Dis Res 2019; 16:227-235. [PMID: 30599757 DOI: 10.1177/1479164118820714] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Diabetes mellitus, besides disrupting the carbohydrate metabolism process, also induces vascular disease and impacts nearly all the types and sizes of blood vessels. In fact, vascular complications cause majority of the morbidity, hospitalizations and mortality of patients with diabetes mellitus. Retinopathy, nephropathy and neuropathy (microvascular complications) impact hundreds of millions of diabetics and normally target those having long-term or uncontrolled forms of the disease; however, these disorders can also exist at the time of diagnosis or in those yet to be diagnosed. The Kingdom of Saudi Arabia is the biggest country in the Middle East that occupies around four-fifths of the Arabian Peninsula supporting a population of more than 33.3 million people. The prevalence of diabetes mellitus is increasing at an alarming rate in Saudi Arabia. Over 25% of the adult population is suffering and that figure is projected to more than double by 2030. In fact, diabetes mellitus has approximately registered a 10-fold upsurge in the past three decades in Saudi Arabia. However, the prevalence and risk factors of microvascular complications in diabetes mellitus patients have not yet been clearly documented in Saudi Arabia. Hence, in this review, we aim to provide an overview of the microvascular complications among patients with diabetes in Saudi Arabia, utilizing data from the currently available published literature. This is an attempt to facilitate the government and healthcare systems aware of the enormous worth of prevention, early detection and appropriate management of such microvascular complications.
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Affiliation(s)
- Asirvatham Alwin Robert
- Department of Endocrinology and Diabetes, Diabetes Treatment Center, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Mohamed Abdulaziz Al Dawish
- Department of Endocrinology and Diabetes, Diabetes Treatment Center, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
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Siddiqui K, Al-Malki B, George TP, Nawaz SS, Rubeaan KA. Urinary N-acetyl-beta-d-glucosaminidase (NAG) with neutrophil gelatinase-associated lipocalin (NGAL) improves the diagnostic value for proximal tubule damage in diabetic kidney disease. 3 Biotech 2019; 9:66. [PMID: 30729090 PMCID: PMC6364253 DOI: 10.1007/s13205-019-1593-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Accepted: 01/23/2019] [Indexed: 12/14/2022] Open
Abstract
Screening for diabetic kidney disease (DKD) remains a challenge; however, there has been an ongoing research to investigate the diagnostic value of different biomarkers to identify DKD. The aim of this study was to assess the diagnostic value of both N-acetyl-beta-d-glucosaminidase (NAG) and neutrophil gelatinase-associated lipocalin (NGAL) in the progression of DKD. This cross-sectional case-control study included 92 type 2 diabetic patients with or without DKD. Urinary NAG and NGAL were measured to evaluate their diagnostic values as biochemical markers related to DKD. Both urinary NAG and NGAL levels were significantly higher among patients with DKD. In multiple linear regression analysis, NAG showed a positive significant association with NGAL in the three different adjusted models, while no significant correlation with fasting blood glucose, glycated hemoglobin, serum creatinine, estimated glomerular filtration rate, and albumin creatinine ratio were observed. The area under the curve for NGAL was 0.659 (p = 0.01) and 0.564 (p = 0.297) for NAG in DKD patients. This study demonstrates the association between urinary NAG and NGAL as a tubular damage marker for DKD although longitudinal studies are needed to evaluate its diagnostic value.
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Affiliation(s)
- Khalid Siddiqui
- Strategic Center for Diabetes Research, King Saud University, Riyadh, Saudi Arabia
| | - Basim Al-Malki
- College of Medicine, University Diabetes Center, King Saud University, PO Box 18397, 11415 Riyadh, Saudi Arabia
| | | | - Shaik Sarfaraz Nawaz
- Strategic Center for Diabetes Research, King Saud University, Riyadh, Saudi Arabia
| | - Khalid Al Rubeaan
- College of Medicine, University Diabetes Center, King Saud University, PO Box 18397, 11415 Riyadh, Saudi Arabia
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Nawaz SS, Joy SS, Al Farsi Y, George TP, Siddiqui K. Potential role of serum fetuin-A in relation with pro-inflammatory, chemokine and adhesion molecules in diabetic kidney disease: a case-control study. Mol Biol Rep 2019; 46:1239-1246. [PMID: 30632070 DOI: 10.1007/s11033-019-04592-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Accepted: 01/03/2019] [Indexed: 12/11/2022]
Abstract
Inflammatory cytokine, adipokine and adhesion molecules are known to play a key role in pathogenesis of diabetic kidney disease (DKD). In this study, our aim was to investigate the role of fetuin-A in relation with pro-inflammatory cytokines (IL-6, IL-18), adipokines (adiponectin, leptin), chemokine (MCP-1), and adhesion molecules (ICAM-1, VCAM-1) in control and DKD subjects. We recruited a total of 224 type 2 diabetic (T2D) subjects. The control subjects were T2D with a normal albumin excrete (albumin-to-creatinine ratio-ACR ≤ 30 mg/g creatinine) and estimated glomerular filtration rate (eGFR) ≥ 60 (ml/min/1.73 m2), while cases were T2D subjects with albumin excrete (ACR ≥ 30 mg/g creatinine) and eGFR ≤ 60 (ml/min/1.73 m2). FBS, HbA1c, lipid profile (TC, LDL, HDL, triglyceride), ALT, AST, GGT, serum creatinine, BMI, blood pressure was evaluated in all the study subjects. Randox evidence biochip analyzer was used for measuring inflammatory cytokines, adipokines, and adhesion molecules by chemiluminescent assay. Serum fetuin-A and IL-18 were measured by ELISA kits. Serum fetuin-A levels were significantly decreased in DKD cases compare to control group [456.8 (299.2-649.0) µg/ml versus 670.6 (573.0-726.1) µg/ml; p < 0.001)]. Serum fetuin-A levels correlates significantly with IL-6, IL-18, TNF-α, PAI-1, leptin, resistin and ACR (p < 0.001). This study concludes that serum fetuin-A and pro-inflammatory markers (IL-18, IL-6, IL-1α and TNF-α) might play an important role in the pathophysiology and inflammatory process of DKD.
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Affiliation(s)
- Shaik Sarfaraz Nawaz
- Strategic Center for Diabetes Research, College of Medicine, King Saud University, P.O. Box 245, Riyadh, 11411, Kingdom of Saudi Arabia
| | - Salini Scaria Joy
- Strategic Center for Diabetes Research, College of Medicine, King Saud University, P.O. Box 245, Riyadh, 11411, Kingdom of Saudi Arabia
| | - Yousuf Al Farsi
- University Diabetes Center, College of Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - Teena P George
- Strategic Center for Diabetes Research, College of Medicine, King Saud University, P.O. Box 245, Riyadh, 11411, Kingdom of Saudi Arabia
| | - Khalid Siddiqui
- Strategic Center for Diabetes Research, College of Medicine, King Saud University, P.O. Box 245, Riyadh, 11411, Kingdom of Saudi Arabia.
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Hamzah S. Association between Lipid Profiles and Renal Functions among Adults with Type 2 Diabetes. DUBAI DIABETES AND ENDOCRINOLOGY JOURNAL 2019. [DOI: 10.1159/000502005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
<b><i>Introduction:</i></b> Type 2 diabetes mellitus (T2DM) affects renal functions and lipid profiles of patients. <b><i>Objectives:</i></b> In this study, 100 patients (65 females, 35 males) with T2DM were evaluated to determine whether renal function characteristics and lipid profiles are associated with T2DM. <b><i>Methods:</i></b> Blood samples were collected from all patients with T2DM, and the levels of hemoglobin A<sub>1c</sub> (HbA<sub>1c</sub>), blood urea, serum creatinine, cholesterol, triglyceride (TGR), low-density lipoprotein (LDL), high-density lipoprotein (HDL), and very low-density lipoprotein (VLDL) were analyzed. <b><i>Results:</i></b> A direct correlation of blood sugar and HbA<sub>1c</sub> was observed with blood urea, serum creatinine, serum cholesterol, serum TGR, HDL, LDL, and VLDL. The results revealed elevated TGR levels in patients administered medications for hyperglycemia. Furthermore, serum TGR levels were significantly correlated with blood sugar levels (<i>p</i> = 0.035). Blood urea levels were significantly correlated with glycated hemoglobin (<i>p</i> = 0.008). Blood urea, serum creatinine, and serum cholesterol levels were highly significantly correlated with HbA<sub>1c</sub> (<i>p</i> = 0.008, 0.017, and 0.005, respectively), while HDL, LDL, and VLDL were not significantly correlated with HbA<sub>1c</sub>. <b><i>Conclusion:</i></b> This study highlights the importance of serum TGR and serum creatinine measurement for guiding the treatment of T2DM.
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