1
|
Abbad L, Détrait M, Kavvadas P, Bergonnier D, Melis L, Laudette M, Migeon T, Verpont MC, Lucas A, Chatziantoniou C, Lezoualc'h F. Signaling through cAMP-Epac1 induces metabolic reprogramming to protect podocytes in glomerulonephritis. Kidney Int 2024; 106:450-469. [PMID: 38821447 DOI: 10.1016/j.kint.2024.05.010] [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: 09/22/2023] [Revised: 03/27/2024] [Accepted: 05/17/2024] [Indexed: 06/02/2024]
Abstract
Unlike classical protein kinase A, with separate catalytic and regulatory subunits, EPACs are single chain multi-domain proteins containing both catalytic and regulatory elements. The importance of cAMP-Epac-signaling as an energy provider has emerged over the last years. However, little is known about Epac1 signaling in chronic kidney disease. Here, we examined the role of Epac1 during the progression of glomerulonephritis (GN). We first observed that total genetic deletion of Epac1 in mice accelerated the progression of nephrotoxic serum (NTS)-induced GN. Next, mice with podocyte-specific conditional deletion of Epac1 were generated and showed that NTS-induced GN was exacerbated in these mice. Gene expression analysis in glomeruli at the early and late phases of GN showed that deletion of Epac1 in podocytes was associated with major alterations in mitochondrial and metabolic processes and significant dysregulation of the glycolysis pathway. In vitro, Epac1 activation in a human podocyte cell line increased mitochondrial function to cope with the extra energy demand under conditions of stress. Furthermore, Epac1-induced glycolysis and lactate production improved podocyte viability. To verify the in vivo therapeutic potential of Epac1 activation, the Epac1 selective cAMP mimetic 8-pCPT was administered in wild type mice after induction of GN. 8-pCPT alleviated the progression of GN by improving kidney function with decreased structural injury with decreased crescent formation and kidney inflammation. Importantly, 8-pCPT had no beneficial effect in mice with Epac1 deletion in podocytes. Thus, our data suggest that Epac1 activation is an essential protective mechanism in GN by reprogramming podocyte metabolism. Hence, targeting Epac1 activation could represent a potential therapeutic approach.
Collapse
Affiliation(s)
- Lilia Abbad
- INSERM UMR S 1155, Common and Rare Kidney Diseases, Tenon Hospital, Faculty of Health, Sorbonne University, Paris, France
| | - Maximin Détrait
- Institut des Maladies Métaboliques et Cardiovasculaires, INSERM, University Toulouse III-Paul Sabatier, UMR 1297-I2MC, Toulouse, France
| | - Panagiotis Kavvadas
- INSERM UMR S 1155, Common and Rare Kidney Diseases, Tenon Hospital, Faculty of Health, Sorbonne University, Paris, France
| | - Dorian Bergonnier
- Institut des Maladies Métaboliques et Cardiovasculaires, INSERM, University Toulouse III-Paul Sabatier, UMR 1297-I2MC, Toulouse, France
| | - Lisa Melis
- INSERM UMR S 1155, Common and Rare Kidney Diseases, Tenon Hospital, Faculty of Health, Sorbonne University, Paris, France
| | - Marion Laudette
- Institut des Maladies Métaboliques et Cardiovasculaires, INSERM, University Toulouse III-Paul Sabatier, UMR 1297-I2MC, Toulouse, France
| | - Tiffany Migeon
- INSERM UMR S 1155, Common and Rare Kidney Diseases, Tenon Hospital, Faculty of Health, Sorbonne University, Paris, France
| | - Marie-Christine Verpont
- INSERM UMR S 1155, Common and Rare Kidney Diseases, Tenon Hospital, Faculty of Health, Sorbonne University, Paris, France
| | - Alexandre Lucas
- Institut des Maladies Métaboliques et Cardiovasculaires, INSERM, University Toulouse III-Paul Sabatier, UMR 1297-I2MC, Toulouse, France
| | - Christos Chatziantoniou
- INSERM UMR S 1155, Common and Rare Kidney Diseases, Tenon Hospital, Faculty of Health, Sorbonne University, Paris, France.
| | - Frank Lezoualc'h
- Institut des Maladies Métaboliques et Cardiovasculaires, INSERM, University Toulouse III-Paul Sabatier, UMR 1297-I2MC, Toulouse, France.
| |
Collapse
|
2
|
Hasan I, Rashid T, Jaikaransingh V, Heilig C, Abdel-Rahman EM, Awad AS. SGLT2 inhibitors: Beyond glycemic control. J Clin Transl Endocrinol 2024; 35:100335. [PMID: 38525377 PMCID: PMC10957445 DOI: 10.1016/j.jcte.2024.100335] [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: 02/08/2024] [Revised: 03/08/2024] [Accepted: 03/11/2024] [Indexed: 03/26/2024] Open
Abstract
Multiple randomized controlled trials have extensively examined the therapeutic effectiveness of sodium-glucose cotransporter 2 (SGLT2) inhibitors, ushering in a transformative approach to treating individuals with type 2 diabetes mellitus (DM). Notably, emerging reports have drawn attention to the potential positive impacts of SGLT2 inhibitors in nondiabetic patients. In an effort to delve into this phenomenon, a comprehensive systematic literature review spanning PubMed (NLM), Medline (Ovid), and Cochrane Library, covering publications from 2000 to 2024 was undertaken. This systematic review encompassed twenty-six randomized control trials (RCTs) involving 35,317 participants. The findings unveiled a multifaceted role for SGLT2 inhibitors, showcasing their ability to enhance metabolic control and yield cardioprotective effects through a reduction in cardiovascular death (CVD) and hospitalization related to heart failure (HF). Additionally, a renalprotective effect was observed, evidenced by a slowdown in chronic kidney disease (CKD) progression and a decrease in albuminuria. Importantly, these benefits were coupled with an acceptable safety profile. The literature also points to various biological plausibility and underlying mechanistic pathways, offering insights into the association between SGLT2 inhibitors and these positive outcomes in nondiabetic individuals. Current research trends indicate a continual exploration of additional role for SGLT2 inhibitors in. Nevertheless, further research is imperative to fully elucidate the mechanisms and long-term outcomes associated with the nondiabetic use of SGLT2 inhibitors.
Collapse
Affiliation(s)
- Irtiza Hasan
- University of Florida College of Medicine-Jacksonville, FL, USA
| | - Tasnuva Rashid
- University of Florida College of Medicine-Jacksonville, FL, USA
| | | | - Charles Heilig
- University of Florida College of Medicine-Jacksonville, FL, USA
| | | | - Alaa S. Awad
- University of Florida College of Medicine-Jacksonville, FL, USA
| |
Collapse
|
3
|
Huang PS, Cheng JF, Chen JJ, Wu CK, Wang YC, Hwang JJ, Tsai CT. CHA2DS2VASc score predicts risk of end stage renal disease in patients with atrial fibrillation: Long-term follow-up study. Heliyon 2023; 9:e13978. [PMID: 36879966 PMCID: PMC9984850 DOI: 10.1016/j.heliyon.2023.e13978] [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: 04/13/2022] [Revised: 02/02/2023] [Accepted: 02/16/2023] [Indexed: 02/24/2023] Open
Abstract
Background End stage renal disease (ESRD) is an increasing worldwide epidemic disease. CHA2DS2-VASc score is a well-established predictor of cardiovascular outcome among atrial fibrillation (AF) patients. Objective The aim of this study was to test whether CHA2DS2-VASc score is a good predictor for incident ESRD events. Methods This is a retrospective cohort study (from January 2010 to December 2020) with median follow-up of 61.7 months. Clinical parameters and baseline characteristics were recorded. The endpoint was defined as ESRD with dialysis dependent. Results The study cohort comprised 29,341 participants. Their median age was 71.0 years, 43.2% were male, 21.5% had diabetes mellitus, 46.1% had hypertension, and mean CHA2DS2-VASc score was 2.89. CHA2DS2-VASc score was incrementally associated with the risk of ESRD status during follow-up. Using the univariate Cox model, we found a 26% increase in ESRD risk with an increase of one point in the CHA2DS2-VASc score (HR 1.26 [1.23-1.29], P < 0.001). And using the multi-variate Cox model adjusted by initial CKD stage, we still observed a 5.9% increase in risk of ESRD with a one-point increase in the CHA2DS2-VASc score (HR 1.059 [1.037-1.082], P < 0.001). The CHA2DS2-VASC score and the initial stage of CKD were associated with the risk of ESRD development in patients with AF. Conclusions Our results first confirmed the utility of CHA2DS2-VASC score in predicting progression to ESRD in AF patients. The efficiency is best in CKD stage 1.
Collapse
Affiliation(s)
- Pang-Shuo Huang
- Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital Yun-Lin Branch, Yun-Lin, Taiwan.,Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taiwan.,Cardiovascular Center, National Taiwan University Hospital, Taipei, Taiwan
| | - Jen-Fang Cheng
- Division of Multidiciplinary Medicine, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.,Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.,Cardiovascular Center, National Taiwan University Hospital, Taipei, Taiwan
| | - Jien-Jiun Chen
- Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital Yun-Lin Branch, Yun-Lin, Taiwan
| | - Cho-Kai Wu
- Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.,Cardiovascular Center, National Taiwan University Hospital, Taipei, Taiwan
| | - Yi-Chih Wang
- Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.,Cardiovascular Center, National Taiwan University Hospital, Taipei, Taiwan
| | - Juey-Jen Hwang
- Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.,Cardiovascular Center, National Taiwan University Hospital, Taipei, Taiwan
| | - Chia-Ti Tsai
- Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.,Cardiovascular Center, National Taiwan University Hospital, Taipei, Taiwan
| |
Collapse
|
4
|
McEwan P, Boyce R, Sanchez JJG, Sjöström CD, Stefansson B, Nolan S, Correa-Rotter R, Rossing P, Chertow GM, McMurray JJV, Wheeler DC, Heerspink HJL. Extrapolated longer-term effects of the DAPA-CKD trial: a modelling analysis. Nephrol Dial Transplant 2022; 38:1260-1270. [PMID: 36301617 PMCID: PMC10157747 DOI: 10.1093/ndt/gfac280] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Indexed: 11/06/2022] Open
Abstract
ABSTRACT
Background
The Dapagliflozin and Prevention of Adverse Outcomes in Chronic Kidney Disease (DAPA-CKD) trial assessed dapagliflozin versus placebo, in addition to standard therapy, in patients with chronic kidney disease (CKD) and albuminuria, and was terminated prematurely due to overwhelming efficacy. The study objective was to model the long-term clinical outcomes of DAPA-CKD beyond the trial follow-up.
Methods
A Markov model extrapolated event incidence per 1000 patients and CKD progression rates for patients receiving dapagliflozin or placebo over a 10-year time horizon. We derived treatment-specific CKD stage transition matrices using DAPA-CKD trial data. We extrapolated relevant efficacy endpoints using parametric survival equations for all-cause mortality and generalized estimating equations for recurrent events.
Results
When extrapolated over a 10-year period, patients randomized to dapagliflozin spent more time in CKD stages 1–3 and less in stages 4–5 than placebo [0.65 (95% CrI 0.41, 0.90) and –0.23 (95% CrI -0.45, 0.00) years per patient, respectively]. Dapagliflozin prevented an estimated 83 deaths and 51 patients initiating kidney replacement therapy per 1000 patients over 10 years. Predicted rates of hospitalized heart failure and abrupt declines in kidney function were reduced (19 and 39 estimated events per 1000 patients, respectively).
Conclusions
Adding dapagliflozin to standard therapeutic management of CKD is expected to have long-term cardiorenal benefit beyond what has been demonstrated in the DAPA-CKD trial, with patients predicted to live longer with fewer complications.
Collapse
Affiliation(s)
- Phil McEwan
- Health Economics and Outcomes Research Ltd , Cardiff , UK
| | - Rebecca Boyce
- Health Economics and Outcomes Research Ltd , Cardiff , UK
| | | | - C David Sjöström
- Late-Stage Development, Cardiovascular, Renal, and Metabolism, BioPharmaceuticals R&D , AstraZeneca, Gothenburg , Sweden
| | - Bergur Stefansson
- Late-Stage Development, Cardiovascular, Renal, and Metabolism, BioPharmaceuticals R&D , AstraZeneca, Gothenburg , Sweden
| | - Stephen Nolan
- Global Medical Affairs, BioPharmaceuticals Medical , AstraZeneca, Cambridge , UK
| | - Ricardo Correa-Rotter
- Department of Nephrology and Mineral Metabolism, National Medical Science and Nutrition Institute Salvador Zubiran , Mexico City, Mexico
| | - Peter Rossing
- Steno Diabetes Center Copenhagen , Herlev Denmark
- Department of Clinical Medicine, University of Copenhagen , Copenhagen, Denmark
| | - Glenn M Chertow
- Departments of Medicine and Epidemiology and Population Health, Stanford University School of Medicine , Stanford, CA , USA
| | - John J V McMurray
- British Heart Foundation Cardiovascular Research Centre, University of Glasgow , Glasgow , UK
| | - David C Wheeler
- Department of Renal Medicine, University College London , London , UK
| | - Hiddo J L Heerspink
- Department of Clinical Pharmacy and Pharmacology, University of Groningen, University Medical Center Groningen , Groningen , The Netherlands
- The George Institute for Global Health , Sydney , Australia
| |
Collapse
|
5
|
Gautam G, Parveen B, Umar Khan M, Sharma I, Kumar Sharma A, Parveen R, Ahmad S. A systematic review on nephron protective AYUSH drugs as constituents of NEERI-KFT (A traditional Indian polyherbal formulation) for the management of chronic kidney disease. Saudi J Biol Sci 2021; 28:6441-6453. [PMID: 34764761 PMCID: PMC8568826 DOI: 10.1016/j.sjbs.2021.07.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 06/30/2021] [Accepted: 07/04/2021] [Indexed: 12/24/2022] Open
Abstract
Chronic Kidney Disease (CKD) is a major health problem characterized by kidney dysfunction with progressive segmental glomerulosclerosis to end-stage renal disease (ESRD). Due to lack of scientific data and comprehensive reports, the current systematic review provides an inclusive understanding and prospective associated with phytopharmacology of NEERI-KFT in CKD. The data was collected from more than five databases such as Science Direct, Google Scholar, Elsevier, PubMed, Springer, ACS publication etc using keywords like CKD/Kidney disease, epidemiology/prevalence, modern therapies for CKD management, NEERI-KFT and its role in kidney disease. The study was performed based on scientific reports screened by experts according to inclusion and exclusion criteria. The pre-clinical and clinical findings suggested that NEERI-KFT has promising effects as nephroprotective and considered safe and well effective in primary care of kidney against disease. Phytopharmacological evaluation of NEERI-KFT suggest that it exhibit substantial potential against oxidative and inflammatory stress induced apoptosis by exerting antioxidants, nephroprotective and immunomodulatory effects. Hence, it can be enlighten that NEERI-KFT have potential herbs which exerts significant antioxidants, nephroprotective and immunomodulatory effects in the patients associated with renal dysfunction or CKD thus improving altered renal architecture and renal physiology. Clinically, it is concluded that NEERI-KFT works kidney malfunction and cease ESRD progression or even reduce the number of dialysis.
Collapse
Affiliation(s)
- Gaurav Gautam
- Bioactive Natural Product Laboratory, School of Pharmaceutical Education and Research, Jamia Hamdard, New Delhi 110062, India
| | - Bushra Parveen
- Bioactive Natural Product Laboratory, School of Pharmaceutical Education and Research, Jamia Hamdard, New Delhi 110062, India
| | - Mohammad Umar Khan
- Bioactive Natural Product Laboratory, School of Pharmaceutical Education and Research, Jamia Hamdard, New Delhi 110062, India
| | - Ikshit Sharma
- AIMIL Pharmaceuticals (India) Ltd, Saini Majra, Ropar Nalagarh Rd, Tehsil Nalagarh, Solan District, H.P 174101, India
| | - Anil Kumar Sharma
- AIMIL Pharmaceuticals (India) Ltd, Saini Majra, Ropar Nalagarh Rd, Tehsil Nalagarh, Solan District, H.P 174101, India
| | - Rabea Parveen
- Human Genetics Laboratory, Department of Biosciences, Jamia Millia Islamia, New Delhi 110025, India
| | - Sayeed Ahmad
- Bioactive Natural Product Laboratory, School of Pharmaceutical Education and Research, Jamia Hamdard, New Delhi 110062, India
| |
Collapse
|
6
|
Alobaidi S. Knowledge of Chronic Kidney Disease Among the Population of Saudi Arabia Evaluated Using a Validated Questionnaire: A Cross-Sectional Study. Patient Prefer Adherence 2021; 15:1281-1288. [PMID: 34163145 PMCID: PMC8214335 DOI: 10.2147/ppa.s315369] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 06/02/2021] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Public knowledge and awareness regarding chronic kidney disease (CKD) is an important factor influencing the successful implementation of CKD prevention and screening programs. To the best of our knowledge, there are no studies conducted among the Saudi population to explore the public knowledge of CKD using a validated questionnaire. Hence, we explored the knowledge of CKD among the population of the Kingdom of Saudi using a validated questionnaire to determine the level of knowledge regarding CKD as well as the predictors of CKD knowledge. MATERIALS AND METHODS This was a cross-sectional online survey study conducted between 12 January 2020 and 11 February 2021. A structured study questionnaire in the GoogleTM platform, with socio-demographic variables and questions assessing CKD knowledge, was used to collect data. A snowball sampling technique was used to recruit participants. RESULTS A total of 983 people accessed the survey and 951 provided a complete response. Respondents belonging to the age group 41-55 years, having masters or PhD level education, having monthly income >15,000 SR, married, doing >150 minutes/week physical activity had significantly higher kidney disease knowledge. There were significant differences in the mean kidney disease knowledge total score between participants with and without: a history of kidney disease (5.63, df = 895, p<0.001), diabetes mellitus (2.34, df = 949, p = 0.019), hypertension (3.25, df = 949, p = 0.001), and family history of kidney failure (4.60, df = 949, p<0.001). CONCLUSION The study revealed a lack of awareness among the Saudi population regarding knowledge about CKD. However, a significantly higher level of knowledge prevailed among respondents from higher educational and higher economic backgrounds. Those with risk factors for CKD also held a greater knowledge about the disease.
Collapse
Affiliation(s)
- Sami Alobaidi
- Department of Internal Medicine, University of Jeddah, Jeddah, Saudi Arabia
- Correspondence: Sami Alobaidi Department of Internal Medicine, University of Jeddah, Jeddah, Saudi ArabiaTel +966566482649 Email
| |
Collapse
|
7
|
Almajed MR, Ali Jan SJ. Initiation of Hemodialysis After Eight Years Following the Diagnosis of Stage 5 Chronic Kidney Disease: A Case Report. Cureus 2020; 12:e11357. [PMID: 33178542 PMCID: PMC7651776 DOI: 10.7759/cureus.11357] [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] [Accepted: 11/06/2020] [Indexed: 11/05/2022] Open
Abstract
With the growing global rates of diabetes and hypertension, chronic kidney disease (CKD) appears to be a major contributor to morbidity and all-cause mortality. In recent years, there has been growing controversy regarding the optimal timing for the initiation of hemodialysis in this patient cohort. In this report, we present the case of a 52-year-old female with a 15-year history of CKD who was admitted to the hospital with clinical manifestations of uremia, volume overload, and symptomatic anemia. The patient presented with fatigue, nausea, progressive shortness of breath, and lightheadedness for two weeks, which had limited the activities of daily living. For the past eight years, her estimated glomerular filtration rate (GFR) had ranged from 5 to 15 mL/min/1.73 m2, consistent with kidney failure seen in stage 5 CKD. Prior to her recent admission, the patient had been grossly asymptomatic and had been responsive to medical therapy. After appropriate management with hemodialysis, a transfusion of packed red blood cells, and medication adjustment, the patient was scheduled for maintenance dialysis through an arteriovenous fistula. She had no further complaints and her laboratory abnormalities were found normalized at the six-month follow-up. This case report presents the survival and outcome of a patient with stage 5 CKD, who was only initiated on hemodialysis eight years after her diagnosis.
Collapse
Affiliation(s)
- Mohamed R Almajed
- Medicine, Salmaniya Medical Complex, Manama, BHR
- Medicine, Royal College of Surgeons in Ireland - Medical University of Bahrain, Busaiteen, BHR
| | - Salman J Ali Jan
- Medicine, King Hamad University Hospital, Muharraq, BHR
- Medicine, Royal College of Surgeons in Ireland, Dublin, IRL
| |
Collapse
|
8
|
Shchelochkov OA, Manoli I, Sloan JL, Ferry S, Pass A, Van Ryzin C, Myles J, Schoenfeld M, McGuire P, Rosing DR, Levin MD, Kopp JB, Venditti CP. Chronic kidney disease in propionic acidemia. Genet Med 2019; 21:2830-2835. [PMID: 31249402 PMCID: PMC7045176 DOI: 10.1038/s41436-019-0593-z] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Accepted: 06/13/2019] [Indexed: 12/12/2022] Open
Abstract
Purpose Propionic acidemia (PA) is a severe metabolic disorder characterized
by multiorgan pathology, including renal disease. The prevalence of chronic
kidney disease (CKD) in PA patients and factors associated with CKD in PA
are not known. Methods Thirty-one subjects diagnosed with PA underwent laboratory and
clinical evaluations through a dedicated natural history study at the NIH
(ClinicalTrials.gov identifier: NCT02890342). Results Cross-sectional analysis of the creatinine-based estimated glomerular
filtration rate (eGFR) in subjects with native kidneys revealed an
age-dependent decline in renal function (P <0.002). Among adults with
PA, 4/8 (50%) had eGFR <60 mL/min/1.73 m2. There was a
significant discrepancy between eGFRs calculated using estimating equations
based on serum creatinine compared to serum cystatin C (P <0.0001).
The tubular injury marker, plasma lipocalin-2, and plasma uric acid were
strongly associated with CKD (P <0.0001). The measured 24-hour
creatinine excretion was below normal, even after adjusting for age, height,
and sex. Conclusions CKD is common in adults with PA and is associated with age. The poor
predictive performance of standard eGFR estimating equations, likely due to
reduced creatine synthesis in kidney and liver, could delay the recognition
of CKD and management of ensuing complications in this population.
Collapse
Affiliation(s)
- Oleg A Shchelochkov
- National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, USA
| | - Irini Manoli
- National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, USA
| | - Jennifer L Sloan
- National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, USA
| | - Susan Ferry
- National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, USA
| | - Alexandra Pass
- National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, USA
| | - Carol Van Ryzin
- National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, USA
| | - Jennifer Myles
- Nutrition Department, Clinical Research Center, National Institutes of Health, Bethesda, MD, USA
| | - Megan Schoenfeld
- Nutrition Department, Clinical Research Center, National Institutes of Health, Bethesda, MD, USA
| | - Peter McGuire
- National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, USA
| | - Douglas R Rosing
- National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Mark D Levin
- National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Jeffrey B Kopp
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Charles P Venditti
- National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, USA.
| |
Collapse
|
9
|
Tesfaye WH, Peterson GM, Castelino RL, McKercher C, Jose M, Zaidi STR, Wimmer BC. Medication-Related Factors and Hospital Readmission in Older Adults with Chronic Kidney Disease. J Clin Med 2019; 8:jcm8030395. [PMID: 30901955 PMCID: PMC6462973 DOI: 10.3390/jcm8030395] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Revised: 03/15/2019] [Accepted: 03/19/2019] [Indexed: 12/20/2022] Open
Abstract
This study aimed to examine the association between medication-related factors and risk of hospital readmission in older patients with chronic kidney disease (CKD). A retrospective analysis was conducted targeting older CKD (n = 204) patients admitted to an Australian hospital. Medication appropriateness (Medication Appropriateness Index; MAI), medication regimen complexity (number of medications and Medication Regimen Complexity Index; MRCI) and use of selected medication classes were exposure variables. Outcomes were occurrence of readmission within 30 and 90 days, and time to readmission within 90 days. Logistic and Cox hazards regression were used to identify factors associated with readmission. Overall, 50 patients (24%) were readmitted within 30 days, while 81 (40%) were readmitted within 90 days. Mean time to readmission within 90 days was 66 (SD 34) days. Medication appropriateness and regimen complexity were not independently associated with 30- or 90-day hospital readmissions in older adults with CKD, whereas use of renin‒angiotensin blockers was associated with reduced occurrence of 30-day (adjusted OR 0.39; 95% CI 0.19⁻0.79) and 90-day readmissions (adjusted OR 0.45; 95% CI 0.24⁻0.84) and longer time to readmission within 90 days (adjusted HR 0.52; 95% CI 0.33⁻0.83). This finding highlights the importance of considering the potential benefits of individual medications during medication review in older CKD patients.
Collapse
Affiliation(s)
- Wubshet H Tesfaye
- Pharmacy, School of Medicine, College of Health and Medicine, University of Tasmania, Sandy Bay, TAS 7005, Australia.
| | - Gregory M Peterson
- Pharmacy, School of Medicine, College of Health and Medicine, University of Tasmania, Sandy Bay, TAS 7005, Australia.
| | - Ronald L Castelino
- Sydney Nursing School, The University of Sydney, Sydney, NSW 2006, Australia.
| | - Charlotte McKercher
- Menzies Institute for Medical Research, University of Tasmania, Hobart 7005, Australia.
| | - Matthew Jose
- Menzies Institute for Medical Research, University of Tasmania, Hobart 7005, Australia.
- Royal Hobart Hospital, University of Tasmania, GPO Box-1061, Hobart 7000, Australia.
| | | | - Barbara C Wimmer
- Pharmacy, School of Medicine, College of Health and Medicine, University of Tasmania, Sandy Bay, TAS 7005, Australia.
| |
Collapse
|
10
|
Liu H, Xiong J, He T, Xiao T, Li Y, Yu Y, Huang Y, Xu X, Huang Y, Zhang J, Zhang B, Zhao J. High Uric Acid-Induced Epithelial-Mesenchymal Transition of Renal Tubular Epithelial Cells via the TLR4/NF-kB Signaling Pathway. Am J Nephrol 2017; 46:333-342. [PMID: 29017152 DOI: 10.1159/000481668] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Accepted: 09/20/2017] [Indexed: 01/11/2023]
Abstract
BACKGROUND Hyperuricemia is an independent risk factor for causing chronic kidney disease and contributes to kidney fibrosis. After urate crystals get deposited in the kidney, they can cause hyperuricemia nephropathy, leading to glomerular hypertrophy and renal tubular interstitial fibrosis. Recent data showed that uric acid (UA) could induce epithelial mesenchymal transition (EMT) of renal tubular cells, in which NRLP3 inflammatory pathway was involved. However, whether TLR4/NF-κB signaling pathway is also involved in EMT of renal tubular cells induced by UA is not clear. METHODS Human renal tubular epithelial cells (HK-2) were directly treated with UA and the phenotypic transition was detected by morphological changes and the molecular markers of EMT. The activation of the TLR4/NF-κB signaling pathway induced by UA was measured by Western blot and its involvement was further confirmed by the inhibition of NF-κB activation or knockdown of toll like receptor 4 (TLR4) expression. RESULTS UA induced obvious morphological changes of HK-2 cell, accompanied with altered molecular markers of EMT including fibronectin, α-SMA and E-cadherin. In addition, UA significantly upregulated the gene expression of interleukin-1β and tumor necrosis factor-α in a time- and dose-dependent manner. Furthermore, UA significantly activated the TLR4/NF-κB signaling pathway in HK-2 cells, while the inhibition of the TLR4 expression by siRNA and NF-κB activation by PDTC significantly attenuated EMT induced by UA in HK-2 cells. CONCLUSIONS UA can induce EMT in renal tubular epithelial cells by the activation of the TLR4/NF-κB signaling pathway, and the targeted intervention of the TLR4/NF-κB signaling pathway might effectively inhibit UA-induced renal interstitial fibrosis mediated by EMT.
Collapse
Affiliation(s)
- Huifang Liu
- Department of Nephrology, Institute of Nephrology of Chongqing and Kidney Center of PLA, Xinqiao Hospital, Third Military Medical University, Chongqing, China
| | - Jiachuan Xiong
- Department of Nephrology, Institute of Nephrology of Chongqing and Kidney Center of PLA, Xinqiao Hospital, Third Military Medical University, Chongqing, China
| | - Ting He
- Department of Nephrology, Institute of Nephrology of Chongqing and Kidney Center of PLA, Xinqiao Hospital, Third Military Medical University, Chongqing, China
| | - Tangli Xiao
- Department of Nephrology, Institute of Nephrology of Chongqing and Kidney Center of PLA, Xinqiao Hospital, Third Military Medical University, Chongqing, China
| | - Yan Li
- Department of Nephrology, Institute of Nephrology of Chongqing and Kidney Center of PLA, Xinqiao Hospital, Third Military Medical University, Chongqing, China
| | - Yanlin Yu
- Department of Nephrology, Institute of Nephrology of Chongqing and Kidney Center of PLA, Xinqiao Hospital, Third Military Medical University, Chongqing, China
| | - Yinghui Huang
- Department of Nephrology, Institute of Nephrology of Chongqing and Kidney Center of PLA, Xinqiao Hospital, Third Military Medical University, Chongqing, China
| | - Xinli Xu
- Department of Nephrology, Institute of Nephrology of Chongqing and Kidney Center of PLA, Xinqiao Hospital, Third Military Medical University, Chongqing, China
| | - Yunjian Huang
- Department of Nephrology, Institute of Nephrology of Chongqing and Kidney Center of PLA, Xinqiao Hospital, Third Military Medical University, Chongqing, China
| | - Jingbo Zhang
- Department of Nephrology, Institute of Nephrology of Chongqing and Kidney Center of PLA, Xinqiao Hospital, Third Military Medical University, Chongqing, China
| | - Bo Zhang
- Department of Nephrology, Institute of Nephrology of Chongqing and Kidney Center of PLA, Xinqiao Hospital, Third Military Medical University, Chongqing, China
| | - Jinghong Zhao
- Department of Nephrology, Institute of Nephrology of Chongqing and Kidney Center of PLA, Xinqiao Hospital, Third Military Medical University, Chongqing, China,
| |
Collapse
|