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Park Y. Analysis of the relationship between components of metabolic syndrome and estimated glomerular filtration rate (eGFR). Heliyon 2025; 11:e42591. [PMID: 40034317 PMCID: PMC11874539 DOI: 10.1016/j.heliyon.2025.e42591] [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: 11/10/2024] [Revised: 02/08/2025] [Accepted: 02/08/2025] [Indexed: 03/05/2025] Open
Abstract
Early recognition and management of risk factors that reduce kidney function are essential. This study aims to analyze the relationship between the components of metabolic syndrome and estimated glomerular filtration rate (eGFR), and to provide basic data that can help develop educational materials for the prevention of kidney diseases. Data from the second round of the KNHNES(korea national health and nutrition examination survey, 8th) which was conducted by the Korea Disease Control and Prevention Agency (2020), were downloaded and analyzed for the current research. Binary logistic analysis was used to identify factors that were risk predictors for metabolic syndrome. Identified factors were categories of metabolic syndrome, including waist circumference, blood pressure, triglycerides, blood glucose, HDL-cholesterol, triglycerides, and eGFR. eGFR was 0.03 % lower in males with metabolic syndrome (OR:0.973) and 0.03 % lower in females (OR:0.974). The eGFR was significantly lower for those with metabolic syndrome. According to this study, there was a significant correlation between reduced GFR and metabolic syndrome. Therefore, the meaningful baseline data for decreasing the prevalence of kidney disease and preventing metabolic syndrome provided by this study's results are significant.
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Affiliation(s)
- Yoonjin Park
- Department of Nursing, Joongbu University, 201 Daehak-ro, Chubu-myeon, Geumsan-gun, Chungcheongnam-do, 32713, South Korea
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Yoshida D, Ikeda S, Shinohara K, Kazurayama M, Tanaka S, Yamaizumi M, Nagayoshi H, Toyama K, Kinugawa S. Triglyceride-Glucose Index Associated with Future Renal Function Decline in the General Population. J Gen Intern Med 2024; 39:3225-3233. [PMID: 38782808 PMCID: PMC11618565 DOI: 10.1007/s11606-024-08809-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2023] [Accepted: 05/09/2024] [Indexed: 05/25/2024]
Abstract
BACKGROUND The triglyceride-glucose index (TyG index), calculated as the logarithmic product of fasting triglyceride and glucose concentrations, is recognized as a simple marker of insulin resistance. However, the association between the TyG index and future decline of renal function remains unclear in the general population. OBJECTIVE To investigate whether the TyG index was associated with future decline of renal function in the general population who had not progressed to chronic kidney disease stage G2. DESIGN Retrospective longitudinal observational cohort study. PARTICIPANTS Individuals who received a population-based health checkup at JA Ehime Kouseiren Checkup Center from 2010 to 2019 (n = 134,007). Individuals without data of baseline fasting triglyceride or glucose levels, or baseline and follow-up data of estimated glomerular filtration rate (eGFR), or those with baseline eGFR < 60 mL/min/1.73 m2 were excluded. MAIN MEASURES Future renal function decline, defined as a ≥ 25% decrease in eGFR from baseline. KEY RESULTS Of 10,758 participants, 8,076 were classified into the low TyG index group (TyG index < 8.76, 1st to 3rd quartiles) and 2,682 into the high TyG index group (TyG index ≥ 8.76, 4th quartile). The mean follow-up period was 37.8 ± 23.6 months. The incidence rates of renal function decline were 0.31 and 0.69 per 100 person-years in the low and high TyG index groups, respectively. In multivariate Cox proportional hazard models, high TyG index was significantly associated with future renal function decline (hazard ratio 2.25, 95% CI 1.40-3.60). This association was consistent across subgroups stratified by age, sex, body mass index, baseline eGFR, and diagnosed hypertension, diabetes, or dyslipidemia. CONCLUSION In the general population, high TyG index was associated with future renal function decline. The TyG index may be useful in identifying individuals at high risk for future renal function decline in the setting of health checkups.
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Affiliation(s)
- Daisuke Yoshida
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Shota Ikeda
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, Kyushu University, Fukuoka, Japan
- Cardiovascular Center, Steel Memorial Yawata Hospital, Fukuoka, Japan
| | - Keisuke Shinohara
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, Kyushu University, Fukuoka, Japan.
| | | | | | | | | | - Kensuke Toyama
- JA Ehime Kouseiren Checkup Center, Ehime, Japan
- Department of Pharmacology, Ehime University Graduate School of Medicine, Ehime, Japan
| | - Shintaro Kinugawa
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, Kyushu University, Fukuoka, Japan
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Valizadeh A, Nikoohemmat M, Ebadinejad A, Soltani S, Tape PMK, Sohrabi A, Abiri B, Valizadeh M. Metabolic syndrome as a risk factor for the development of kidney dysfunction: a meta-analysis of observational cohort studies. J Diabetes Metab Disord 2024; 23:215-227. [PMID: 38932881 PMCID: PMC11196551 DOI: 10.1007/s40200-023-01348-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 11/08/2023] [Indexed: 06/28/2024]
Abstract
Background Chronic kidney disease (CKD) is a major global health concern with increasing prevalence and associated complications. Metabolic syndrome (MetS) has been linked to CKD, but the evidence remains inconsistent. We conducted a systematic review and meta-analysis to investigate the association between MetS and kidney dysfunction. Method We conducted a comprehensive search of databases until December 2022 for cohort studies assessing the association between MetS and incident kidney dysfunction. Meta-analysis was performed using fixed and random effects models. Subgroup analyses were conducted to explore heterogeneity. Publication bias was assessed using Egger's and Begg's tests. Result A total of 24 eligible studies, involving 6,573,911 participants, were included in this meta-analysis. MetS was significantly associated with an increased risk of developing CKD (OR, 1.42; 95% CI, 1.28, 1.57), albuminuria or proteinuria (OR, 1.43; 95% CI, 1.10, 1.86), and rapid decline in kidney function (OR, 1.25; 95% CI, 1.07, 1.47). Subgroup analyses showed a stronger association as the number of MetS components increased. However, gender-specific subgroups demonstrated varying associations. Conclusion Metabolic syndrome is a significant risk factor for kidney dysfunction, requiring close renal monitoring. Lifestyle changes and targeted interventions may help reduce CKD burden. Further research is needed to understand the connection fully and assess intervention efficacy. Supplementary Information The online version contains supplementary material available at 10.1007/s40200-023-01348-5.
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Affiliation(s)
- Ali Valizadeh
- Obesity Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Department of Industrial Engineering, Iran University of Science and Technology, Tehran, Iran
| | - Mohammad Nikoohemmat
- Obesity Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Amir Ebadinejad
- Obesity Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Sepideh Soltani
- Yazd Cardiovascular Research Center, Noncommunicable Diseases Research Institute, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Parya Mozafari Komesh Tape
- Obesity Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ali Sohrabi
- Student Research Committee, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Behnaz Abiri
- Obesity Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Majid Valizadeh
- Obesity Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Liu S, Sun H, Liu J, Wang G. Accessing the relationship between six surrogate insulin resistance indexes and the incidence of rapid kidney function decline and the progression to chronic kidney disease among middle-aged and older adults in China: Results from the China health and retirement longitudinal study. Diabetes Res Clin Pract 2024; 212:111705. [PMID: 38735539 DOI: 10.1016/j.diabres.2024.111705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Revised: 04/27/2024] [Accepted: 05/09/2024] [Indexed: 05/14/2024]
Abstract
AIMS Insulin resistance is closely related to kidney function decline, but which insulin resistance index could better predict rapid kidney function decline (RKFD) remains unclear. We aimed to evaluate the prospective association between six insulin resistance indexes: Chinese Visceral Adiposity Index (CVAI), Lipid Accumulation Product (LAP), Atherogenic Index of Plasma (AIP), triglyceride-glucose (TyG) index, triglyceride-glucose × Body Mass Index (TyGBMI) and triglyceride-glucose × waist circumference (TyGWC) with RKFD and further the progression to chronic kidney disease (CKD). METHODS AND MEASUREMENTS Data were obtained from the China Health and Retirement Longitudinal Study. Participants with normal kidney function (eGFRcr-cys ≥60 ml/min per 1.73 m2) and ≥45 years old were included at the baseline (year 2011). The eGFR was estimated by a combination of serum creatinine and cystatin C. The primary outcome was RKFD, defined as an annualized decline in eGFRcr-cys of 5 ml/min per 1.73 m2 or more. Secondary outcome was progression to CKD under the condition of RKFD, defined as an annualized decline in eGFRcr-cys of 5 ml/min per 1.73 m2 or more combined with eGFRcr-cys <60 ml/min per 1.73 m2 at the exit visit. Logistic analysis was applied for analysis of the association between six insulin resistance indexes and RKFD or progression to CKD. We use receiver operating characteristic curves to study the predictive performance of six insulin resistance indexes. Subgroup analysis were conducted by diabetes or hypertension status of the participants. RESULTS A total of 3899 participants with normal kidney function were included in this study. After a 3.99 years follow-up, 191 of them ended up with RKFD. Among them, 66 participants progressed to CKD. Logistic analysis showed that per SD increase of all the six insulin resistance indexes were significantly associated with the incidence of RKFD (all P < 0.01), among which, TyGWC had the best predictive value for RKFD. There were significant association between per SD increase of CVAI, LAP, TyGBMI and TyGWC with progression to CKD (all P < 0.01), and CVAI had better predictive role than other indexes. In subgroup analysis, we found that the association between insulin resistance indexes and progression to CKD was more significant in subjects with hypertension or without diabetes. However, no significant differences were observed in the RKFD group. CONCLUSIONS In this study we proved six insulin resistance indexes were predictively associated with RKFD in Chinese with normal renal function over age 45. TyGWC is the best insulin resistance index for predicting RKFD. CVAI is the best index for predicting further progression to CKD.
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Affiliation(s)
- Siti Liu
- Department of Endocrinology, Beijing Chao-yang Hospital, Capital Medical University, Beijing 100020, China
| | - Honglin Sun
- Department of Endocrinology, Beijing Chao-yang Hospital, Capital Medical University, Beijing 100020, China
| | - Jia Liu
- Department of Endocrinology, Beijing Chao-yang Hospital, Capital Medical University, Beijing 100020, China.
| | - Guang Wang
- Department of Endocrinology, Beijing Chao-yang Hospital, Capital Medical University, Beijing 100020, China.
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Hou Q, Zhang H, Zhang R, Li B, Li L, Li D, Wang X, Liu Y, Wan Z, Zhang J, Shuai P. Relationship between the longitudinal trajectory of the triglyceride-glucose index and the development of CKD: an 8-year retrospective longitudinal cohort study. Front Endocrinol (Lausanne) 2024; 15:1376166. [PMID: 38859908 PMCID: PMC11163917 DOI: 10.3389/fendo.2024.1376166] [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: 01/25/2024] [Accepted: 05/02/2024] [Indexed: 06/12/2024] Open
Abstract
Background The triglyceride-glucose (TyG) index, a simple surrogate marker of insulin resistance, is significantly associated with chronic kidney disease (CKD). However, there is limited research on the longitudinal trajectory of TyG index over time and its relationship with CKD. Objective To analyse the characteristics of the longitudinal trajectory of the TyG index over time and its association with the development of CKD in a health check-up population. Methods Participants who underwent at least three annual health check-ups at the Health Management Center of Sichuan Provincial People's Hospital from 2015 to 2022 were included in this retrospective cohort study. The TyG index was calculated as ln [fasting triglycerides (mg/dL) × fasting glucose (mg/dL)/2]. The latent class mixed model (LCMM) was used to identify the TyG index trajectory of the study population. A Cox proportional hazard model was used to estimate the CKD incidence risk in different quartile groups and the association of changes in the TyG index trajectory with the development of CKD. Results A total of 4,921 participants were included in this study, and they were divided into four groups according to the quartiles of the baseline TyG index: Q1 (5.43-6.66), Q2 (6.67-7.04), Q3 (7.05-7.43), and Q4 (7.43-9.97). There was no difference in the risk of CKD occurrence among the TyG groups. Three different TyG index trajectories were identified in this study: a high-level group, middle-level stable group and low-level stable group, respectively. The incidence rate of CKD in the high-level TyG index trajectory group was 2.399 times greater than that in the low-level stable trajectory group (HR=2.399, 95% CI 1.167-4.935). Conclusion Individuals with long-term exposure to high TyG index levels had a significantly greater risk of CKD. Routine monitoring of the TyG index and its longitudinal trend will aid in the risk stratification of CKD in the general population and will be helpful for CKD prevention and targeted management.
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Affiliation(s)
- Qinchuan Hou
- Health Management Center & Health Management Research Institute, Sichuan Provincial People’s Hospital, Chengdu, China
- School of Public Health, Southwest Medical University, Luzhou, China
| | - Huiwang Zhang
- Health Management Center & Health Management Research Institute, Sichuan Provincial People’s Hospital, Chengdu, China
- School of Public Health, Southwest Medical University, Luzhou, China
| | - Rui Zhang
- Health Management Center & Health Management Research Institute, Sichuan Provincial People’s Hospital, Chengdu, China
- School of Public Health, Southwest Medical University, Luzhou, China
| | - Binghong Li
- Health Management Center & Health Management Research Institute, Sichuan Provincial People’s Hospital, Chengdu, China
- School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Lei Li
- Health Management Center & Health Management Research Institute, Sichuan Provincial People’s Hospital, Chengdu, China
- School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Dongyu Li
- Health Management Center & Health Management Research Institute, Sichuan Provincial People’s Hospital, Chengdu, China
- School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Xian Wang
- Health Management Center & Health Management Research Institute, Sichuan Provincial People’s Hospital, Chengdu, China
| | - Yuping Liu
- Health Management Center & Health Management Research Institute, Sichuan Provincial People’s Hospital, Chengdu, China
| | - Zhengwei Wan
- Health Management Center & Health Management Research Institute, Sichuan Provincial People’s Hospital, Chengdu, China
| | - Junlin Zhang
- Health Management Center & Health Management Research Institute, Sichuan Provincial People’s Hospital, Chengdu, China
| | - Ping Shuai
- Health Management Center & Health Management Research Institute, Sichuan Provincial People’s Hospital, Chengdu, China
- School of Public Health, Southwest Medical University, Luzhou, China
- School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
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Bashyal S, Qu S, Karki M. Bariatric Surgery and Its Metabolic Echo Effect on Serum Uric Acid Levels. Cureus 2024; 16:e58103. [PMID: 38616980 PMCID: PMC11013573 DOI: 10.7759/cureus.58103] [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: 04/12/2024] [Indexed: 04/16/2024] Open
Abstract
Bariatric surgery (BS) has been a significant means of reducing weight in obese individuals. The metabolic changes after bariatric surgery are crucial as they extend its advantages beyond weight loss. As its name implies, "metabolic surgery" also addresses obesity-related metabolic concerns. Bariatric surgery has always been associated with lessened serum uric acid (SUA) levels. In this review, we examined current studies to understand how surgical therapies impact serum uric acid levels. Strongly minded on the extent and timing of changes in the level of serum uric acid after bariatric surgeries. We conducted a comprehensive search for relevant current studies in PubMed, Google Scholar, JAMA, and the Cochrane Library until February 1, 2024. We aimed to analyze the metabolic advantages of bariatric surgery, focusing on its function in treating hyperuricemia and lowering the risk of associated disorders. Our review elaborates on factors contributing to decreased serum uric acid levels after bariatric surgery, such as alterations in renal function, insulin sensitivity, and inflammatory markers.
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Affiliation(s)
- Subodh Bashyal
- Department of Endocrinology and Metabolism, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai, CHN
| | - Shen Qu
- Department of Endocrinology and Metabolism, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai, CHN
- Shanghai Center of Thyroid Diseases, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai, CHN
- SinoUnited Health, Endocrinology, Metabolism and Thyroid Center, Shanghai, CHN
| | - Manoj Karki
- Department of Internal Medicine, Endocrinology and Metabolism, Universal College of Medical Sciences, Tribhuvan University, Bhairahawa, NPL
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Yoon Y, Kim YM, Lee S, Shin BC, Kim HL, Chung JH, Son M. Association between Neck Circumference and Chronic Kidney Disease in Korean Adults in the 2019-2021 Korea National Health and Nutrition Examination Survey. Nutrients 2023; 15:5039. [PMID: 38140298 PMCID: PMC10745966 DOI: 10.3390/nu15245039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2023] [Revised: 12/01/2023] [Accepted: 12/06/2023] [Indexed: 12/24/2023] Open
Abstract
Chronic kidney disease (CKD) is a major public health problem and a leading cause of cardiovascular disease and death. Early recognition and management of CKD risk factors are necessary to prevent its onset and progression. Neck circumference (NC) is a non-invasive and easily accessible anthropometric measure associated with central obesity and subcutaneous fat accumulation in the upper body. Our study aimed to explore the relationship between NC and the prevalence of CKD using data from the nationally representative Korea National Health and Nutrition Examination Survey (2019-2021). We analyzed data from 10,219 subjects (age > 19 years, no missing values). CKD was defined as an estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m2. Logistic regression analysis was performed, which revealed a significant association between NC and CKD prevalence even after adjusting for confounding factors, both when NC was considered a continuous variable (OR [95% CI], 1.11 [1.03-1.19]) and in quartiles (Q1 as reference; Q2 OR [95% CI], 1.23 [0.91-1.67]; Q3 OR [95% CI], 1.59 [1.16-2.18]; Q4 OR [95% CI], 1.70 [1.16-2.50]). Our findings suggest that NC could be a simple and effective anthropometric measurement for identifying individuals at risk for CKD.
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Affiliation(s)
- Youngmin Yoon
- Division of Nephrology, Department of Medicine, Chosun University Hospital, Chosun University School of Medicine, Gwangju 61453, Republic of Korea; (Y.Y.); (S.L.); (B.-C.S.); (H.-L.K.); (J.-H.C.)
| | - Yoo-min Kim
- Department of Obstetrics and Gynecology, Chung-Ang University Gwang-myung Hospital, Chung-Ang University College of Medicine, Gwangmyeong-si 14353, Republic of Korea;
| | - Somin Lee
- Division of Nephrology, Department of Medicine, Chosun University Hospital, Chosun University School of Medicine, Gwangju 61453, Republic of Korea; (Y.Y.); (S.L.); (B.-C.S.); (H.-L.K.); (J.-H.C.)
| | - Byung-Chul Shin
- Division of Nephrology, Department of Medicine, Chosun University Hospital, Chosun University School of Medicine, Gwangju 61453, Republic of Korea; (Y.Y.); (S.L.); (B.-C.S.); (H.-L.K.); (J.-H.C.)
| | - Hyun-Lee Kim
- Division of Nephrology, Department of Medicine, Chosun University Hospital, Chosun University School of Medicine, Gwangju 61453, Republic of Korea; (Y.Y.); (S.L.); (B.-C.S.); (H.-L.K.); (J.-H.C.)
| | - Jong-Hoon Chung
- Division of Nephrology, Department of Medicine, Chosun University Hospital, Chosun University School of Medicine, Gwangju 61453, Republic of Korea; (Y.Y.); (S.L.); (B.-C.S.); (H.-L.K.); (J.-H.C.)
| | - Minkook Son
- Department of Physiology, Dong-A University College of Medicine, Busan 49201, Republic of Korea
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Zhou YY, Wang JF, Yao Q, Jian QF, Luo ZP. Prevalence of sarcopenic obesity in patients with diabetes and adverse outcomes: A systematic review and meta-analysis. Clin Nutr ESPEN 2023; 58:128-135. [PMID: 38056996 DOI: 10.1016/j.clnesp.2023.09.920] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2023] [Revised: 09/14/2023] [Accepted: 09/20/2023] [Indexed: 12/08/2023]
Abstract
BACKGROUND & AIMS Sarcopenic obesity (SO), which refers to the coexistence of sarcopenia and obesity. The aim of this systematic review and meta-analysis was first to assess the prevalence of SO in patients with diabetes, and second, to evaluate possible adverse outcomes. METHODS This study was conducted in adherence to the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) guidelines and the data were collated by means of meta-analysis and narrative synthesis. We comprehensively and systematically searched PubMed, Embase, Web of Science, CBM, CNKI, Wanfang Database from the establishment of the database to December 2022, and collected related studies on SO in patients with diabetes. Using Stata 16.0 software to pool the estimates for the prevalence of SO in patients with diabetes, and a descriptive systematic review of possible adverse outcomes was performed. RESULTS The prevalence of 20 included studies were pooled by a random-effects model, which showed that the prevalence of SO in patients with diabetes was 27%. Subgroup analyses showed that the prevalence of SO was higher among studies using BIA (24%) to assess muscle mass, and those focused on literature of moderate-quality (29%), being published from 2013 to 2016 (29%), female patients with diabetes (17%), North Americans (30%). SO in patients with diabetes can lead to adverse outcomes including decreased glomerular filtration rate, massive proteinuria, cognitive decline, and insulin resistance. CONCLUSION The systematic review and meta-analysis revealed a prevalence of 27% for SO in patients with diabetes, and it is associated with potential serious adverse outcomes. Therefore, we should attach importance to the screening of SO in patients with diabetes and early detection of susceptible groups, then selecting appropriate interventions to reduce the occurrence of it and various adverse outcomes in this demographic.
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Affiliation(s)
- Yuan-Yuan Zhou
- Chengdu University of Traditional Chinese Medicine, Sichuan, 610075, China
| | - Jin-Feng Wang
- Chengdu University of Traditional Chinese Medicine, Sichuan, 610075, China
| | - Qian Yao
- Chengdu Second People's Hospital, Sichuan, 610017, China.
| | - Qiu-Feng Jian
- Chengdu University of Traditional Chinese Medicine, Sichuan, 610075, China
| | - Zhi-Peng Luo
- The Tibet Autonomous Region People's Government Office in a Hospital in Chengdu, Chengdu, Sichuan, 610000, China
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Yan S, Chen S, Liu Y, Liang H, Zhang X, Zhang Q, Xiu J. Associations of serum carotenoids with visceral adiposity index and lipid accumulation product: a cross-sectional study based on NHANES 2001-2006. Lipids Health Dis 2023; 22:209. [PMID: 38037060 PMCID: PMC10691056 DOI: 10.1186/s12944-023-01945-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 10/15/2023] [Indexed: 12/02/2023] Open
Abstract
BACKGROUND Visceral adiposity index (VAI) and lipid accumulation product (LAP) are comprehensive indicators to evaluate visceral fat and determine the metabolic health of individuals. Carotenoids are a group of naturally occurring antioxidants associated with several diseases. The purpose of this investigation was to explore the association between serum carotenoid concentration and VAI or LAP. METHODS The data were obtained from the National Health and Nutrition Examination Survey between 2001 and 2006. The levels of serum carotenoids were evaluated using high-performance liquid chromatography. Multivariate linear regression models were employed to investigate the relationship between levels of serum carotenoids and VAI or LAP. The potential non-linear relationship was determined using threshold effect analysis and fitted smoothing curves. Stratification analysis was performed to investigate the potential modifying factors. RESULTS In total, 5,084 participants were included in this population-based investigation. In the multivariate linear regressions, compared to the lowest quartiles of serum carotenoids, the highest quartiles were significantly associated with VAI, and the effect size (β) and 95% CI was - 0.98 (- 1.34, - 0.62) for α-carotene, - 1.39 (- 1.77, - 1.00) for β-carotene, - 0.79 (- 1.18, - 0.41) for β-cryptoxanthin, - 0.68 (- 0.96, - 0.39) for lutein/zeaxanthin, and - 0.88 (- 1.50, - 0.27) for trans-lycopene. Using piece-wise linear regression models, non-linear relationships were found between β-carotene and trans-lycopene and VAI with an inflection point of 2.44 (log2-transformed, ug/dL) and 3.80 (log2-transformed, ug/dL), respectively. The results indicated that α-carotene, β-cryptoxanthin, and lutein/zeaxanthin were linearly associated with VAI. An inverse association was also found between serum carotenoids and LAP after complete adjustments. CONCLUSION This study revealed that several serum carotenoids were associated with VAI or LAP among the general American population. Further large prospective investigations are warranted to support this finding.
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Affiliation(s)
- Shaohua Yan
- Department of Cardiology, Nanfang Hospital, Southern Medical University, No. 1838, Guangzhou Avenue North, Guangzhou, 510515, China
| | - Siyu Chen
- Department of Cardiology, Nanfang Hospital, Southern Medical University, No. 1838, Guangzhou Avenue North, Guangzhou, 510515, China
| | - Yumiao Liu
- Department of Cardiology, Nanfang Hospital, Southern Medical University, No. 1838, Guangzhou Avenue North, Guangzhou, 510515, China
| | - Hongbin Liang
- Department of Cardiology, Nanfang Hospital, Southern Medical University, No. 1838, Guangzhou Avenue North, Guangzhou, 510515, China
| | - Xinlu Zhang
- Department of Cardiology, Nanfang Hospital, Southern Medical University, No. 1838, Guangzhou Avenue North, Guangzhou, 510515, China
| | - Qiuxia Zhang
- Department of Cardiology, Nanfang Hospital, Southern Medical University, No. 1838, Guangzhou Avenue North, Guangzhou, 510515, China.
| | - Jiancheng Xiu
- Department of Cardiology, Nanfang Hospital, Southern Medical University, No. 1838, Guangzhou Avenue North, Guangzhou, 510515, China.
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Smeijer JD, Kohan DE, Rossing P, Correa-Rotter R, Liew A, Tang SCW, de Zeeuw D, Gansevoort RT, Ju W, Lambers Heerspink HJ. Insulin resistance, kidney outcomes and effects of the endothelin receptor antagonist atrasentan in patients with type 2 diabetes and chronic kidney disease. Cardiovasc Diabetol 2023; 22:251. [PMID: 37716952 PMCID: PMC10505320 DOI: 10.1186/s12933-023-01964-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 08/14/2023] [Indexed: 09/18/2023] Open
Abstract
BACKGROUND Insulin resistance (IR) is a pathophysiologic hallmark of type 2 diabetes and associated with the presence of chronic kidney disease (CKD). Experimental studies suggest that endothelin-1 increases IR. We assessed the association between IR and cardio-renal outcomes and the effect of the selective endothelin receptor antagonist atrasentan on IR in patients with type 2 diabetes and CKD. METHODS We used data from the RADAR and SONAR trials that recruited participants with type 2 diabetes and CKD [eGFR 25-75 mL/min/1.73 m², urine albumin-to-creatinine ratio of 300-5000 mg/g]. IR was calculated using the homeostatic model assessment (HOMA-IR). The association between HOMA-IR and the pre-specified cardio-renal outcomes was assessed using multivariable Cox proportional hazards regression, and effects of atrasentan on HOMA-IR by a linear mixed effect model. RESULTS In the SONAR trial, each log-unit increase in HOMA-IR was associated with an increased risk of the composite cardio-renal outcome [hazard ratio 1.32 (95%CI 1.09,1.60; p = 0.004)], kidney outcome [hazard ratio 1.30 (95%CI 1.00,1.68; p-value = 0.048)], and the kidney or all-cause mortality outcome [hazard ratio 1.25 (95%CI 1.01,1.55; p-value = 0.037)]. After 12 weeks treatment in the RADAR trial (N = 123), atrasentan 0.75 mg/day and 1.25 mg/day compared to placebo reduced HOMA-IR by 19.1 (95%CI -17.4, 44.3) and 26.7% (95%CI -6.4, 49.5), respectively. In the SONAR trial (N = 1914), atrasentan 0.75 mg/day compared to placebo reduced HOMA-IR by 9.6% (95%CI 0.6, 17.9). CONCLUSIONS More severe IR is associated with increased risk of cardio-renal outcomes. The endothelin receptor antagonist atrasentan reduced IR. TRIAL REGISTRATION RADAR trial (Reducing Residual Albuminuria in Subjects With Diabetes and Nephropathy With AtRasentan): NCT01356849. SONAR trial (The Study Of Diabetic Nephropathy With AtRasentan) NCT01858532.
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Affiliation(s)
- J David Smeijer
- Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Donald E Kohan
- Division of Nephrology, University of Utah Health, Salt Lake City, UT, USA
| | - Peter Rossing
- Steno Diabetes Center Copenhagen, Herlev, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Ricardo Correa-Rotter
- National Medical Science and Nutrition Institute Salvador Zubirán, Mexico City, Mexico
| | - Adrian Liew
- Mount Elizabeth Novena Hospital, Singapore, Singapore
- George Institute for Global Health, Newtown, Australia
| | - Sydney C W Tang
- Division of Nephrology, Department of Medicine, The University of Hong Kong, Hong Kong, Hong Kong
| | - Dick de Zeeuw
- Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Ron T Gansevoort
- Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Wenjun Ju
- Department of Computational Medicine and Bioinformatics, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Hiddo J Lambers Heerspink
- Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
- George Institute for Global Health, Newtown, Australia.
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11
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Chen CM, Weng SC, Tsai JR, Shen PS. The mean residual life model for the right-censored data in the presence of covariate measurement errors. Stat Med 2023. [PMID: 37019842 DOI: 10.1002/sim.9736] [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: 09/10/2022] [Revised: 02/21/2023] [Accepted: 03/25/2023] [Indexed: 04/07/2023]
Abstract
In this article, we consider the mean residual life regression model in the presence of covariate measurement errors. In the whole cohort, the surrogate variable of the error-prone covariate is available for each subject, while the instrumental variable (IV), which is related to the underlying true covariates, is measured only for some subjects, the calibration sample. Without specifying distributions of measurement errors but assuming that the IV is missing at random, we develop two estimation methods, the IV calibration and cohort estimators, for the regression parameters by solving estimation equations (EEs) based on the calibration sample and cohort sample, respectively. To improve estimation efficiency, a synthetic estimator is derived by applying the generalized method of moment for all EEs. The large sample properties of the proposed estimators are established and their finite sample performance are evaluated via simulation studies. Simulation results show that the cohort and synthetic estimators outperform the IV calibration estimator and the relative efficiency of the cohort and synthetic estimators mainly depends on the missing rate of IV. In the case of low missing rate, the synthetic estimator is more efficient than the cohort estimator, while the result can be reversed when the missing rate is high. We illustrate the proposed method by application to data from the patients with stage 5 chronic kidney disease in Taiwan.
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Affiliation(s)
- Chyong-Mei Chen
- Institute of Public Health, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Shuo-Chun Weng
- Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, Taiwan
- Department of Internal Medicine, Division of Nephrology, Center for Geriatrics and Gerontology, Taichung Veterans General Hospital, Taichung, Taiwan
- Institute of Clinical Medicine, School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Research Center for Geriatrics and Gerontology, College of Medicine, National Chung Hsing University, Taichung, Taiwan
| | - Jia-Ren Tsai
- Department of Statistics and Information Science, Fu Jen Catholic University, New Taipei City, Taiwan
| | - Pao-Sheng Shen
- Department of Statistics, Tunghai University, Taichung, Taiwan
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12
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Li X, Liang Q, Zhong J, Gan L, Zuo L. The Effect of Metabolic Syndrome and Its Individual Components on Renal Function: A Meta-Analysis. J Clin Med 2023; 12:jcm12041614. [PMID: 36836149 PMCID: PMC9962508 DOI: 10.3390/jcm12041614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 02/01/2023] [Accepted: 02/15/2023] [Indexed: 02/22/2023] Open
Abstract
BACKGROUND Observational studies have reported inconsistent findings in the relationship between metabolic syndrome (MetS), its components, and loss of renal function, mainly including eGFR decline, new-onset CKD, and ESRD. This meta-analysis was performed to investigate their potential associations. METHODS PubMed and EMBASE were systematically searched from their inception to 21 July 2022. Observational cohort studies in English assessing the risk of renal dysfunction in individuals with MetS were identified. Risk estimates and their 95% confidence intervals (CIs) were extracted and pooled using the random-effects approach. RESULTS A total of 32 studies with 413,621 participants were included in the meta-analysis. MetS contributed to higher risks of renal dysfunction (RR = 1.50, 95% CI = 1.39-1.61) and, specifically, rapid decline in eGFR (RR 1.31, 95% CI 1.13-1.51), new-onset CKD (RR 1.47, 95% CI 1.37-1.58), as well as ESRD (RR 1.55, 95% CI 1.08-2.22). Moreover, all individual components of MetS were significantly associated with renal dysfunction, while elevated BP conveyed the highest risk (RR = 1.37, 95% CI = 1.29-1.46), impaired fasting glucose with the lowest and diabetic-dependent risk (RR = 1.20, 95% CI = 1.09-1.33). CONCLUSIONS Individuals with MetS and its components are at higher risk of renal dysfunction.
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Selle J, Bohl K, Höpker K, Wilke R, Dinger K, Kasper P, Abend B, Schermer B, Müller RU, Kurschat C, Nüsken KD, Nüsken E, Meyer D, Savai Pullamsetti S, Schumacher B, Dötsch J, Alcazar MAA. Perinatal Obesity Sensitizes for Premature Kidney Aging Signaling. Int J Mol Sci 2023; 24:ijms24032508. [PMID: 36768831 PMCID: PMC9916864 DOI: 10.3390/ijms24032508] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Revised: 12/08/2022] [Accepted: 12/18/2022] [Indexed: 01/31/2023] Open
Abstract
Chronic Kidney Disease (CKD), a global health burden, is strongly associated with age-related renal function decline, hypertension, and diabetes, which are all frequent consequences of obesity. Despite extensive studies, the mechanisms determining susceptibility to CKD remain insufficiently understood. Clinical evidence together with prior studies from our group showed that perinatal metabolic disorders after intrauterine growth restriction or maternal obesity adversely affect kidney structure and function throughout life. Since obesity and aging processes converge in similar pathways we tested if perinatal obesity caused by high-fat diet (HFD)-fed dams sensitizes aging-associated mechanisms in kidneys of newborn mice. The results showed a marked increase of γH2AX-positive cells with elevated 8-Oxo-dG (RNA/DNA damage), both indicative of DNA damage response and oxidative stress. Using unbiased comprehensive transcriptomics we identified compartment-specific differentially-regulated signaling pathways in kidneys after perinatal obesity. Comparison of these data to transcriptomic data of naturally aged kidneys and prematurely aged kidneys of genetic modified mice with a hypomorphic allele of Ercc1, revealed similar signatures, e.g., inflammatory signaling. In a biochemical approach we validated pathways of inflammaging in the kidneys after perinatal obesity. Collectively, our initial findings demonstrate premature aging-associated processes as a consequence of perinatal obesity that could determine the susceptibility for CKD early in life.
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Affiliation(s)
- Jaco Selle
- Translational Experimental Pediatrics—Experimental Pulmonology, Department of Pediatric and Adolescent Medicine, University Hospital Cologne, 50931 Cologne, Germany
| | - Katrin Bohl
- Department of Medicine II, Nephrology Research Laboratory, University Hospital of Cologne, Faculty of Medicine, University of Cologne, 50931 Cologne, Germany
- Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), Faculty of Medicine, University of Cologne, 50931 Cologne, Germany
| | - Katja Höpker
- Department of Medicine II, Nephrology Research Laboratory, University Hospital of Cologne, Faculty of Medicine, University of Cologne, 50931 Cologne, Germany
- Department of Pediatric and Adolescent Medicine, University Hospital Cologne, 50931 Cologne, Germany
| | - Rebecca Wilke
- Translational Experimental Pediatrics—Experimental Pulmonology, Department of Pediatric and Adolescent Medicine, University Hospital Cologne, 50931 Cologne, Germany
| | - Katharina Dinger
- Translational Experimental Pediatrics—Experimental Pulmonology, Department of Pediatric and Adolescent Medicine, University Hospital Cologne, 50931 Cologne, Germany
| | - Philipp Kasper
- Department of Gastroenterology and Hepatology, University Hospital Cologne, Faculty of Medicine, University of Cologne, 50931 Cologne, Germany
| | - Bastian Abend
- Translational Experimental Pediatrics—Experimental Pulmonology, Department of Pediatric and Adolescent Medicine, University Hospital Cologne, 50931 Cologne, Germany
| | - Bernhard Schermer
- Department of Medicine II, Nephrology Research Laboratory, University Hospital of Cologne, Faculty of Medicine, University of Cologne, 50931 Cologne, Germany
- Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), Faculty of Medicine, University of Cologne, 50931 Cologne, Germany
- Center for Molecular Medicine Cologne (CMMC), University Hospital Cologne, Faculty of Medicine, University of Cologne, 50931 Cologne, Germany
| | - Roman-Ulrich Müller
- Department of Medicine II, Nephrology Research Laboratory, University Hospital of Cologne, Faculty of Medicine, University of Cologne, 50931 Cologne, Germany
- Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), Faculty of Medicine, University of Cologne, 50931 Cologne, Germany
- Center for Molecular Medicine Cologne (CMMC), University Hospital Cologne, Faculty of Medicine, University of Cologne, 50931 Cologne, Germany
| | - Christine Kurschat
- Department of Medicine II, Nephrology Research Laboratory, University Hospital of Cologne, Faculty of Medicine, University of Cologne, 50931 Cologne, Germany
- Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), Faculty of Medicine, University of Cologne, 50931 Cologne, Germany
- Center for Molecular Medicine Cologne (CMMC), University Hospital Cologne, Faculty of Medicine, University of Cologne, 50931 Cologne, Germany
| | - Kai-Dietrich Nüsken
- Department of Pediatric and Adolescent Medicine, University Hospital Cologne, 50931 Cologne, Germany
| | - Eva Nüsken
- Department of Pediatric and Adolescent Medicine, University Hospital Cologne, 50931 Cologne, Germany
| | - David Meyer
- Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), Faculty of Medicine, University of Cologne, 50931 Cologne, Germany
- Institute for Genome Stability in Aging and Disease, Medical Faculty, University Hospital Cologne, Faculty of Medicine, University of Cologne, 50931 Cologne, Germany
| | - Soni Savai Pullamsetti
- Department of Lung Development and Remodeling, Max-Planck-Institute for Heart and Lung Research, Member of the German Center for Lung Research (DZL), 61231 Bad Nauheim, Germany
- Institute for Lung Health (ILH), Universities of Gießen and Marburg Lung Centre (UGMLC), Cardiopulmonary Institute (CPI), Member of the German Center of Lung Research (DZL), 35392 Gießen, Germany
| | - Björn Schumacher
- Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), Faculty of Medicine, University of Cologne, 50931 Cologne, Germany
- Institute for Genome Stability in Aging and Disease, Medical Faculty, University Hospital Cologne, Faculty of Medicine, University of Cologne, 50931 Cologne, Germany
| | - Jörg Dötsch
- Department of Pediatric and Adolescent Medicine, University Hospital Cologne, 50931 Cologne, Germany
| | - Miguel A. Alejandre Alcazar
- Translational Experimental Pediatrics—Experimental Pulmonology, Department of Pediatric and Adolescent Medicine, University Hospital Cologne, 50931 Cologne, Germany
- Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), Faculty of Medicine, University of Cologne, 50931 Cologne, Germany
- Center for Molecular Medicine Cologne (CMMC), University Hospital Cologne, Faculty of Medicine, University of Cologne, 50931 Cologne, Germany
- Institute for Lung Health (ILH), Universities of Gießen and Marburg Lung Centre (UGMLC), Cardiopulmonary Institute (CPI), Member of the German Center of Lung Research (DZL), 35392 Gießen, Germany
- Correspondence: ; Tel.: +49-221-478-96876; Fax: +49-221-478-46868
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Farhadnejad H, Teymoori F, Jahromi MK, Asghari G, Mokhtari E, Mirmiran P, Azizi F. High insulinemic potential of diet and lifestyle is associated with increased risk of chronic kidney disease incident in adults. BMC Nephrol 2023; 24:6. [PMID: 36624389 PMCID: PMC9830921 DOI: 10.1186/s12882-023-03059-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Accepted: 01/05/2023] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND The role of higher insulinemic effects of dietary pattern and lifestyle factors on the risk of chronic kidney disease (CKD) is not well-studied. In the current study, we aimed to investigate the relationship between the insulinemic potential of diet and lifestyle with the risk of CKD in adults. METHODS A total of 6044 individuals without CKD, aged>18 years, were recruited from among participants of the Tehran Lipid and Glucose Study (third and fourth surveys) and followed a mean of 6.03 years(follow-up rate:94.95%). The dietary intake data were collected using a food frequency questionnaire. The insulinemic potential of diet and lifestyle was determined based on four empirical indices, including the empirical dietary index for hyperinsulinemia (EDIH), the empirical dietary index for insulin resistance (EDIR), the empirical lifestyle index for hyperinsulinemia (ELIH), and the empirical lifestyle index for insulin resistance (ELIR). RESULTS Mean ± SD age of all study participants (54.3% women) was 37.8 ± 12.8 years. During the 6.03 years of follow-up (46,889.8 person-years), 1216(20.1%) new cases of CKD were identified. According to the multivariable-adjusted model, the risk of CKD incident is increased across quintiles of EDIR (OR = 1.29;95% CI: 1.06-1.57), ELIH (OR = 1.35; 95%CI: 1.10-1.67), and ELIR (OR = 1.24; 95%CI:1.02-1.51). However, no significant relationship was found between the EDIH score and the risk of CKD. CONCLUSION Results of the current study showed that dietary pattern with a high EDIR score and a lifestyle with higher ELIH and ELIR scores may be related to increasing the risk of CKD incident. However, no significant association was observed between EDIH score and CKD incident.
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Affiliation(s)
- Hossein Farhadnejad
- grid.411600.2Nutrition and Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Farshad Teymoori
- grid.411600.2Nutrition and Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran ,grid.411746.10000 0004 4911 7066Department of Nutrition, School of Public Health, Iran University of Medical Sciences, Tehran, Iran
| | - Mitra Kazemi Jahromi
- grid.412237.10000 0004 0385 452XEndocrinology and Metabolism Research Center, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - Golaleh Asghari
- grid.411600.2Nutrition and Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran ,grid.411600.2Department of Clinical Nutrition and Dietetics, Faculty of Nutrition Sciences and Food Technology, National Nutrition and Food Technology Research Institute, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ebrahim Mokhtari
- grid.411600.2Nutrition and Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Parvin Mirmiran
- grid.411600.2Nutrition and Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran ,grid.411600.2Department of Clinical Nutrition and Dietetics, Faculty of Nutrition Sciences and Food Technology, National Nutrition and Food Technology Research Institute, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Fereidoun Azizi
- grid.411600.2Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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15
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Structural and Functional Changes in Aging Kidneys. Int J Mol Sci 2022; 23:ijms232315435. [PMID: 36499760 PMCID: PMC9737118 DOI: 10.3390/ijms232315435] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 11/30/2022] [Accepted: 12/04/2022] [Indexed: 12/12/2022] Open
Abstract
The renal condition is one of the crucial predictors of longevity; therefore, early diagnosis of any dysfunction plays an important role. Kidneys are highly susceptible to the aging process. Unfavorable conditions may lead to a significant disturbance of the body's homeostasis. Apart from physiological changes, there are some conditions such as hypertension, diabetes or obesity which contribute to the acceleration of the aging process. A determination of macroscopic and microscopic changes is essential for assessing the progression of aging. With age, we observe a decrease in the volume of renal parenchyma and an increase in adipose tissue in the renal sinuses. Senescence may also be manifested by the roughness of the kidney surface or simple renal cysts. The main microscopic changes are a thickening of the glomerular basement membrane, nephrosclerosis, an accumulation of extracellular matrix, and mesangial widening. The principal aspect of stopping unfavorable changes is to maintain health. Studies have shown many useful ways to mitigate renal aging. This review is focused especially on medications such as renin-angiotensin-aldosterone system blockers or resveratrol, but even eating habits and lifestyle.
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Lin CA, Li WC, Lin SY, Chen YC, Yu W, Huang HY, Xiong XJ, Chen JY. Gender differences in the association between insulin resistance and chronic kidney disease in a Chinese population with metabolic syndrome. Diabetol Metab Syndr 2022; 14:184. [PMID: 36461016 PMCID: PMC9716739 DOI: 10.1186/s13098-022-00956-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Accepted: 11/14/2022] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Insulin resistance (IR) was reported to be associated with renal function impairment, but little is known about the gender difference. Hence, our study aimed to investigate the relationship between IR (estimated by the homeostasis model assessment of IR (HOMA-IR) index) and chronic kidney disease (CKD) in a Chinese population with metabolic syndrome (MetS) and discern whether there was any gender disparity or not. METHODS This retrospective cross-sectional study enrolled 13,638 men and 10,450 women who received health examinations from 2013 to 2016 at Xiamen Chang Gung Hospital. Among the participants, 3,253 men (64.3%) and 1,808 women (35.7%) who had MetS and met the inclusion criteria were included for analysis. Spearman's correlation was conducted to analyze the relationship between HOMA-IR and cardio-metabolic risk factors. Multivariable linear regression was analyzed to explore the relationship between HOMA-IR and cardio-metabolic variables. Logistic regression analysis was performed to assess the association between HOMA-IR and CKD. RESULTS The median HOMA-IR and prevalence of CKD was 2.2 and 11.31%, respectively, for men and 2.09 and 15.93%, respectively, for women. In multivariable linear regression analysis, HOMA-IR was significant associated with estimated GFR, albumin/creatinine ratio in men. Multivariable logistic regression revealed a significant difference between HOMA-IR value and the prevalence of CKD in men but not in women (odds ratio in male = 1.21; 95% CI 1.14-1.28, p ≤ 0.001; odds ratio in female = 1.01; 95% CI 0.99-1.02, p = 0.38). CONCLUSIONS HOMA-IR was independently associated with CKD among men with MetS but not in women.
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Affiliation(s)
- Chieh-An Lin
- Department of Family Medicine, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan, Taiwan
| | - Wen-Cheng Li
- Department of Family Medicine, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Department of Health Management, Xiamen Chang Gung Hospital, Xiamen, China
| | - Szu-Yu Lin
- Department of Family Medicine, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan, Taiwan
| | - Yi-Chuan Chen
- Department of Family Medicine, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Wei Yu
- Department of Health Management, Xiamen Chang Gung Hospital, Xiamen, China
| | - Hsiung-Ying Huang
- Department of Pulmonary and Critical Care Medicine, Xiamen Chang Gung Hospital, Xiamen, China
| | - Xue-Jie Xiong
- Department of Oncology, Xiamen Chang Gung Hospital, Xiamen, China
| | - Jau-Yuan Chen
- Department of Family Medicine, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan, Taiwan.
- College of Medicine, Chang Gung University, Taoyuan, Taiwan.
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Hu Y, Wang X, Xiao S, Sun N, Huan C, Wu H, Guo M, Xu T, Pan D. A Clinical Nomogram Based on the Triglyceride-Glucose Index to Predict Contrast-Induced Acute Kidney Injury after Percutaneous Intervention in Patients with Acute Coronary Syndrome with Diabetes Mellitus. Cardiovasc Ther 2022; 2022:5443880. [PMID: 36349299 PMCID: PMC9633196 DOI: 10.1155/2022/5443880] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 10/14/2022] [Indexed: 08/02/2023] Open
Abstract
The aim of the study was to investigate the factors influencing contrast-induced acute kidney injury (CI-AKI) after percutaneous intervention (PCI) in patients with acute coronary syndrome (ACS) with diabetes mellitus (DM). A total of 1073 patients with ACS combined with DM who underwent PCI at the Affiliated Hospital of Xuzhou Medical University were included in this study. We divided the patients into the CI-AKI and non-CI-AKI groups according to whether CI-AKI occurred or not. The patients were then randomly assigned to the training and validation sets at a proportion of 7 : 3. Based on the results of the LASSO regression and multivariate analyses, we determined that the subtypes of ACS, age, multivessel coronary artery disease, hyperuricemia, low-density lipoprotein cholesterol, triglyceride-glucose index, and estimated glomerular filtration rate were independent predictors on CI-AKI after PCI in patients with ACS combined with DM. Using the above indicators to develop the nomogram, the AUC-ROC of the training and validation sets were calculated to be 0.811 (95% confidence interval (CI): 0.766-0.844) and 0.773 (95% CI: 0.712-0.829), respectively, indicating high prediction efficiency. After verification by the Bootstrap internal verification, we found that the calibration curves showed good agreement between the nomogram predicted and observed values. And the DCA results showed that the nomogram had a high clinical application. In conclusion, we constructed and validated the nomogram to predict CI-AKI risk after PCI in patients with ACS and DM. The model can provide a scientific reference for predicting the occurrence of CI-AKI and improving the prognosis of patients.
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Affiliation(s)
- Yue Hu
- Department of General Practice, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China 221004
| | - Xiaotong Wang
- Department of Cardiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China 221004
| | - Shengjue Xiao
- Department of Cardiology, Zhongda Hospital, School of Medicine, Southeast University 87 Dingjiaqiao, Nanjing, Jiangsu, China 210009
| | - Na Sun
- Department of Cardiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China 221004
| | - Chunyan Huan
- Department of Cardiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China 221004
| | - Huimin Wu
- Department of General Practice, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China 221004
| | - Minjia Guo
- Department of Cardiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China 221004
| | - Tao Xu
- Department of Cardiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China 221004
| | - Defeng Pan
- Department of Cardiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China 221004
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Liu P, Tang L, Fang J, Chen C, Liu X. Association between recovery/occurrence of metabolic syndrome and rapid estimated glomerular filtration rate decline in middle-aged and older populations: evidence from the China Health and Retirement Longitudinal Study. BMJ Open 2022; 12:e059504. [PMID: 36261237 PMCID: PMC9582318 DOI: 10.1136/bmjopen-2021-059504] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES Few studies have explored correlations between metabolic syndrome (MetS) alterations and renal deterioration in longitudinal cohorts. We aim to investigate associations between MetS recovery/development and rapid estimated glomerular filtration rate (eGFR) decline in the China Health and Retirement Longitudinal Study (CHARLS). DESIGN Longitudinal cohort study. SETTING This study is a secondary analysis of CHARLS. PARTICIPANTS After excluding individuals with age <45 years old, eGFR <60 mL/min/1.73 m2 and clinician-reported malignant tumour, heart disease, stroke or kidney disease at baseline, 4142 participants with complete data were selected from the CHARLS during the 4-year follow-up period (2011-2015). OUTCOME MEASURES MetS were measured at 2011 and 2015 in CHARLS. A rapid eGFR decline was defined as an average annual eGFR decline of >3 mL/min/1.73 m2. The associations between rapid eGFR decline and MetS recovery/development were analysed using multivariable adjusted logistic models. RESULTS According to MetS baseline status and follow-up, participants were divided into four groups: (1) 2460 (59.4%) in the MetS-free group, (2) 361 (8.7%) in the MetS-developed group, (3) 499 (12.0%) in the MetS recovery group and (4) 822 (19.8%) in the MetS chronic group. When compared with the MetS chronic group, the multivariable adjusted OR of rapid eGFR decline in the MetS recovery group was 0.64 (OR: 0.64; 95% CI 0.45 to 0.90, p=0.01). In contrast, when compared with the MetS-free group, the multivariable adjusted OR of rapid eGFR decline in the MetS-developed group was 1.00 (OR: 1.00; 95% CI 0.73 to 1.38, p=0.98). CONCLUSIONS Over the 4-year follow-up period, we found that MetS recovery was associated with a reduced risk of rapid eGFR decline in middle-aged and older adults, while MetS occurrence was not related to rapid eGFR decline. Recovery from MetS appeared to protect against a rapid decline in eGFR.
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Affiliation(s)
- Peijia Liu
- Department of Nephrology, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, China
- Department of Nephrology, Guangzhou Eighth People's Hospital，Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Leile Tang
- Department of Cardiology, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Jia Fang
- Department of Nephrology, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Chaojin Chen
- Department of Anesthesiology, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Xun Liu
- Department of Nephrology, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, China
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Choi Y, Cho J, Kim J, Bae JH, Cho EJ, Chang E, Joa KL, Kim J, Park DH, Kang JH, Kwak HB. Dynapenic-abdominal obesity as an independent risk factor for chronic kidney disease in postmenopausal women: a population-based cohort study. Menopause 2022; 29:1040-1046. [PMID: 36040432 PMCID: PMC9422766 DOI: 10.1097/gme.0000000000002032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 04/22/2022] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Low muscle strength and obesity lead to a higher risk of chronic kidney disease (CKD). Perimenopause is associated with a natural decline in muscle strength and an increase in visceral adiposity. Dynapenic obesity, which is the coexistence of low muscle strength and obesity, is expected to synergistically increase the prevalence of CKD in postmenopausal women. The aim of this study was to determine combined associations of dynapenia and obesity with CKD in postmenopausal women. METHODS This study used data from the Korean National Health and Nutrition Examination Survey, 2016 to 2019. The study included 4,525 postmenopausal women aged 42 to 80 years that were classified into four groups based on waist circumference (≥85 cm) and hand grip strength (<18 kg): normal, dynapenic, obese, or dynapenic-obese. According to the Kidney Disease: Improving Global Outcomes, we defined CKD as an estimated glomerular filtration rate <60 mL/min per 1.73 m2. Complex sample logistic regression models were conducted to determine the relationships among coexistence of dynapenia, abdominal obesity, and the risk of CKD. RESULTS Dynapenic-abdominal obese group displayed lower estimated glomerular filtration rate levels than other groups (P < 0.05 for all data). The prevalence rates of CKD were 15.5%, 7.8%, 6.2%, and 2.4% in the dynapenic-abdominal obese, dynapenic, abdominal obese, and normal groups, respectively (P < 0.001). Complex sample logistic regression analyses, after adjusting for age, height, health behaviors, and comorbidities, showed that the odds ratio for CKD with respect to dynapenic-abdominal obesity was 1.82 (95% confidence interval, 1.19-2.79) and to abdominal obesity was 1.54 (95% confidence interval, 1.07-2.22) than in the normal group. CONCLUSIONS This study demonstrated that dynapenic-abdominal obesity, as determined by low handgrip strength and high waist circumference values, was associated with increased risk of CKD in postmenopausal women.
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Affiliation(s)
- Youngju Choi
- From the Institute of Sports and Arts Convergence (ISAC), Inha University, Incheon
| | - Jinkyung Cho
- From the Institute of Sports and Arts Convergence (ISAC), Inha University, Incheon
- Korea Institute of Sports Science, Seoul
| | - Jiyeon Kim
- From the Institute of Sports and Arts Convergence (ISAC), Inha University, Incheon
| | - Jun Hyun Bae
- From the Institute of Sports and Arts Convergence (ISAC), Inha University, Incheon
| | - Eun-Jeong Cho
- From the Institute of Sports and Arts Convergence (ISAC), Inha University, Incheon
- Department of Biomedical Science, Program in Biomedical Science and Engineering, Inha University
| | - Eunwook Chang
- From the Institute of Sports and Arts Convergence (ISAC), Inha University, Incheon
- Department of Kinesiology, College of Arts & Sports, Inha University
| | - Kyung-Lim Joa
- From the Institute of Sports and Arts Convergence (ISAC), Inha University, Incheon
- Department of Physical & Rehabilitation Medicine, College of Medicine, Inha University
| | - Junghoon Kim
- Sports and Exercise Medicine Laboratory, Korea Maritime and Ocean University, Busan
| | - Dong-Ho Park
- From the Institute of Sports and Arts Convergence (ISAC), Inha University, Incheon
- Department of Biomedical Science, Program in Biomedical Science and Engineering, Inha University
- Department of Kinesiology, College of Arts & Sports, Inha University
| | - Ju-Hee Kang
- From the Institute of Sports and Arts Convergence (ISAC), Inha University, Incheon
- Department of Biomedical Science, Program in Biomedical Science and Engineering, Inha University
- Department of Pharmacology, College of Medicine, Inha University, Incheon, Republic of Korea
| | - Hyo-Bum Kwak
- From the Institute of Sports and Arts Convergence (ISAC), Inha University, Incheon
- Department of Biomedical Science, Program in Biomedical Science and Engineering, Inha University
- Department of Kinesiology, College of Arts & Sports, Inha University
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Metabolic Syndrome and Obesity-Related Indices Are Associated with Rapid Renal Function Decline in a Large Taiwanese Population Follow-Up Study. Biomedicines 2022; 10:biomedicines10071744. [PMID: 35885048 PMCID: PMC9312807 DOI: 10.3390/biomedicines10071744] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 07/16/2022] [Accepted: 07/18/2022] [Indexed: 12/18/2022] Open
Abstract
A rapid decline in renal function can cause many complications, and therefore it is important to detect associated risk factors. Few studies have evaluated the associations among obesity-related indices and metabolic syndrome (MetS) with renal function decline. This longitudinal study aimed to explore these relationships in a large cohort of Taiwanese participants. The studied obesity-related indices were waist-to-height ratio (WHtR), A body shape index (ABSI), visceral adiposity index (VAI), lipid accumulation product (LAP), waist-to-hip ratio (WHR), body roundness index (BRI), conicity index (CI), body mass index (BMI), body adiposity index (BAI) and abdominal volume index (AVI). We included 122,068 participants in the baseline study, of whom 27,033 were followed for a median of four years. The baseline prevalence of MetS was 17.7%. Multivariable analysis showed that the participants with MetS and high VAI, WHtR, WHR, LAP, CI, BRI, BMI, BAI, AVI, and ABSI values were significantly associated with a high baseline estimated glomerular filtration rate (eGFR) (all p < 0.001). In addition, the participants with MetS (p < 0.001), high WHtR (p = 0.007), low LAP (p < 0.001), high BRI (p = 0.002), high CI (p = 0.002), high AVI (p = 0.001), high VAI (p = 0.017), and high ABSI (p = 0.013) were significantly associated with a low △eGFR, indicating a rapid decline in renal function. These results showed associations between MetS and high values of obesity-related indices except LAP with high baseline eGFR and rapid decline in kidney function. These findings suggest that screening for MetS and obesity may help to slow the decline in renal function in high-risk populations.
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21
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TG/HDL-C Ratio Is a Risk Factor Associated with CKD: Use in Assessing the Risk of Progression of CKD. PATHOPHYSIOLOGY 2022; 29:374-382. [PMID: 35893599 PMCID: PMC9326757 DOI: 10.3390/pathophysiology29030029] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Revised: 07/14/2022] [Accepted: 07/14/2022] [Indexed: 11/20/2022] Open
Abstract
Background: Dyslipidemia is highly prevalent in patients with chronic kidney disease (CKD), and the relationship between dyslipidemia and renal function in these patients remains controversial. Our objectives were to determine the triglycerides/HDL-cholesterol ratio (TG/HDL-C), evaluate the correlation between TG/HDL-C and the urine albumin/creatinine ratio (ACR), and estimate the glomerular filtration rate (eGFR) according to MDRD in CKD patients. Methods: A descriptive cross-sectional study was conducted on 152 patients with CKD at the Endocrine Clinic, the University of Medicine and Pharmacy Hospital, Ho Chi Minh City, Vietnam. Study subjects were medically examined and recorded information on the data collection form. Subjects were tested for total cholesterol, triglycerides, HDL-C, LDL-C, urea, creatinine and albumin, urine creatinine, and eGFR according to the MDRD formula. Data were analyzed using SPSS Statistics version 20.0. Results: The average age was 58.08 ± 15.69 years, and the overweight and obesity rate was 54%. Most patients had comorbidities, among which the most common diseases were hypertension and diabetes mellitus. Among the subjects, 57.3% were CKD stage 3 patients, and ACR was in the range of 30−300 mg/g. According to the classification of CKD using GFR and ACR categories, 40.8% of patients were at very high risk. The average TG/HDL-C ratio was 5.09 ± 4.26. There was a medium negative correlation between TG/HDL-C and eGFR (R = 0.44, p < 0.01) and a weak positive correlation between TG/HDL-C and ACR (R = 0.34, p < 0.01). Conclusions: The TG/HDL-C ratio was a risk factor associated with CKD and was noticeable in monitoring and assessing the risk of progression of CKD.
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22
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Patel N, Yaqoob MM, Aksentijevic D. Cardiac metabolic remodelling in chronic kidney disease. Nat Rev Nephrol 2022; 18:524-537. [DOI: 10.1038/s41581-022-00576-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/14/2022] [Indexed: 11/09/2022]
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Cao X, Lin Y, Yang B, Li Y, Zhou J. Comparison Between Statistical Model and Machine Learning Methods for Predicting the Risk of Renal Function Decline Using Routine Clinical Data in Health Screening. Risk Manag Healthc Policy 2022; 15:817-826. [PMID: 35502445 PMCID: PMC9056070 DOI: 10.2147/rmhp.s346856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Accepted: 04/16/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose Using machine learning method to predict and judge unknown data offers opportunity to improve accuracy by exploring complex interactions between risk factors. Therefore, we evaluate the performance of machine learning (ML) algorithms and to compare them with logistic regression for predicting the risk of renal function decline (RFD) using routine clinical data. Patients and Methods This retrospective cohort study includes datasets from 2166 subjects, aged 35–74 years old, provided by an adult health screening follow-up program between 2010 and 2020. Seven different ML models were considered – random forest, gradient boosting, multilayer perceptron, support vector machine, K-nearest neighbors, adaptive boosting, and decision tree - and were compared with standard logistic regression. There were 24 independent variables, and the baseline estimate glomerular filtration rate (eGFR) was used as the predictive variable. Results A total of 2166 participants (mean age 49.2±11.2 years old, 63.3% males) were enrolled and randomly divided into a training set (n=1732) and a test set (n=434). The area under receiver operating characteristic curve (AUROC) for detecting RFD corresponding to the different models were above 0.85 during the training phase. The gradient boosting algorithms exhibited the best average prediction accuracy (AUROC: 0.914) among all algorithms validated in this study. Based on AUROC, the ML algorithms improved the RFD prediction performance, compared to logistic regression model (AUROC:0.882), except the K-nearest neighbors and decision tree algorithms (AUROC:0.854 and 0.824, respectively). However, the improvement differences with logistic regression were small (less than 4%) and nonsignificant. Conclusion Our results indicate that the proposed health screening dataset-based RFD prediction model using ML algorithms is readily applicable, produces validated results. But logistic regression yields as good performance as ML models to predict the risk of RFD with simple clinical predictors.
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Affiliation(s)
- Xia Cao
- Health Management Center, The Third Xiangya Hospital, Central South University, Changsha, Hunan, People’s Republic of China
- Health Management Research Center, Central South University, Changsha, Hunan, People’s Republic of China
- Hunan Chronic Disease Health Management Medical Research Center, Central South University, Changsha, Hunan, People’s Republic of China
| | - Yanhui Lin
- Health Management Center, The Third Xiangya Hospital, Central South University, Changsha, Hunan, People’s Republic of China
- Health Management Research Center, Central South University, Changsha, Hunan, People’s Republic of China
- Hunan Chronic Disease Health Management Medical Research Center, Central South University, Changsha, Hunan, People’s Republic of China
| | - Binfang Yang
- Health Management Center, The Third Xiangya Hospital, Central South University, Changsha, Hunan, People’s Republic of China
- Health Management Research Center, Central South University, Changsha, Hunan, People’s Republic of China
- Hunan Chronic Disease Health Management Medical Research Center, Central South University, Changsha, Hunan, People’s Republic of China
| | - Ying Li
- Health Management Center, The Third Xiangya Hospital, Central South University, Changsha, Hunan, People’s Republic of China
- Health Management Research Center, Central South University, Changsha, Hunan, People’s Republic of China
- Hunan Chronic Disease Health Management Medical Research Center, Central South University, Changsha, Hunan, People’s Republic of China
| | - Jiansong Zhou
- National Clinical Research Center for Mental Disorders, and Department of Psychiatry, The Second Xiangya Hospital, Central South University, Changsha, Hunan, People’s Republic of China
- Correspondence: Jiansong Zhou, National Clinical Research Center for Mental Disorders, and Department of Psychiatry, The Second Xiangya Hospital, Central South University, Changsha, 410011, People’s Republic of China, Tel/Fax +86 073188618573, Email
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Han X, Wang F, Wang J, He M. Cardiometabolic traits mediate the association of past shift work and chronic kidney disease: the Dongfeng-Tongji cohort study. Int Arch Occup Environ Health 2022; 95:1501-1510. [PMID: 35357576 DOI: 10.1007/s00420-022-01854-8] [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: 11/18/2021] [Accepted: 03/02/2022] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Present shift work has been associated with chronic disease. But influence of past shift work has not been established. This study is designed to investigate whether shift work in the past is associated with chronic kidney disease (CKD) in retired workers, and whether cardiometabolic traits affect the relationship. METHODS Overall, 15,775 retired workers (aged 62.3 ± 7.2 years) without CKD at baseline in the Dongfeng-Tongji cohort were included. Duration of past shift work was obtained through questionnaires, and divided into < 10.0, 10.0-20.0, and ≥ 20.0 years. CKD was diagnosed if individual's estimated glomerular filtration rate (eGFR) < 60 mL/min/1.73 m2. Logistic regression model was used to estimate the association between past shift work and CKD. Mediation analysis was conducted to analyze the mediating effects of cardiometabolic traits. RESULTS During the median follow-up of 4.7 years, 1072 (6.8%) incident CKD cases were recorded. Retired workers with past shift work had elevated CKD risk [ORs and 95% CIs for those with < 10.0, 10.0-20.0, and ≥ 20.0 years of past shift work were 1.61 (1.30, 2.00), 0.90 (0.72, 1.12), and 1.33 (1.11, 1.61)]. The associations were more evident among participants with poor or terrible sleep quality (P for interaction, 0.022). Mediation analysis showed that cardiometabolic traits including diastolic blood pressure and high density lipoprotein cholesterol mediated 7.02% and 10.05% of the relationship from past shift work to higher CKD risk. CONCLUSIONS Past shift work was related with increased risk of incident CKD among retired workers, and this relationship was partly mediated by cardiometabolic traits.
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Affiliation(s)
- Xu Han
- Department of Biostatistics and Epidemiology, School of Public Health, Shenzhen University Health Science Center, No. 1066 Xueyuan Avenue, Nanshan District, Shenzhen, 518060, Guangdong, People's Republic of China
- Department of Occupational and Environmental Health and Key Laboratory of Environmental and Health, Ministry of Education and Ministry of Environmental Protection, and State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, People's Republic of China
| | - Fei Wang
- Department of Occupational and Environmental Health and Key Laboratory of Environmental and Health, Ministry of Education and Ministry of Environmental Protection, and State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, People's Republic of China
| | - Jing Wang
- Department of Occupational and Environmental Health and Key Laboratory of Environmental and Health, Ministry of Education and Ministry of Environmental Protection, and State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, People's Republic of China
| | - Meian He
- Department of Occupational and Environmental Health and Key Laboratory of Environmental and Health, Ministry of Education and Ministry of Environmental Protection, and State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, People's Republic of China.
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Lei L, Dai L, Zhang Q, Lu J, Tang Y, Xiao M, Li G, Yan S, Li X, Chen Y, Chen Y, Li Y, An S, Xiu J. The Association Between Visceral Adiposity Index and Worsening Renal Function in the Elderly. Front Nutr 2022; 9:861801. [PMID: 35399655 PMCID: PMC8987107 DOI: 10.3389/fnut.2022.861801] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 02/10/2022] [Indexed: 11/13/2022] Open
Abstract
Background Visceral adiposity index (VAI) is an indicator of visceral fat accumulation and dysfunction. However, little is known about whether VAI is associated with worsening renal function (WRF) in the elderly. Therefore, our study aimed to explore the association between VAI and WRF among the elderly population. Methods In total, 5,583 elderly participants (aged ≥ 65 years) who participated in the annual health checkups at least twice between January 2017 and July 2021 were enrolled and divided into four groups according to the VAI quartiles. The primary endpoint was incident chronic kidney disease (CKD), defined as incident estimated glomerular filtration rate (eGFR) < 60 ml/min/1.73 m2. The secondary endpoint was rapid kidney function decline (RKFD), defined as decline in eGFR of 40%. To evaluate the association between VAI and WRF, three Cox regression models were conducted, where VAI was treated as a continuous variable and a categorical variable (Q1 as reference), respectively. Subgroup analysis in participants with different baseline characteristics was also performed. Results During a median of 2.46 year follow-up, 931 (16.68%) participants developed CKD. After fully adjusting for confounding factors, VAI was significantly associated with incident CKD (HR, 1.052; 95% CI: 1.029–1.076, p < 0.001), and RKFD (HR, 1.077; 95% CI: 1.041–1.114, p < 0.001). Moreover, compared to those with the lowest VAI quartiles, subjects with the highest quartiles had a higher risk of incident CKD (HR, 1.286; 95% CI: 1.033–1.601, p = 0.024), and RKFD (HR, 1.895; 95% CI: 1.086–3.307, p = 0.025). The risk of incident CKD also tended to increase with elevated VAI quartiles (all p-values for trend <0.05). This positive association remained consistent among participants with different genders, baseline weights, or kidney functions. Conclusion In our study, elevated VAI was associated with increased risk of incident CKD and RKFD in the elderly population.
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Affiliation(s)
- Li Lei
- Department of Cardiology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Lei Dai
- Department of Cardiology, Zengcheng Branch of Nanfang Hospital, Guangzhou, China
| | - Qiuxia Zhang
- Department of Cardiology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Junyan Lu
- Department of Cardiology, Zengcheng Branch of Nanfang Hospital, Guangzhou, China
| | - Yongzhen Tang
- Department of Cardiology, Zengcheng Branch of Nanfang Hospital, Guangzhou, China
| | - Min Xiao
- Department of Cardiology, Zengcheng Branch of Nanfang Hospital, Guangzhou, China
| | - Guodong Li
- Department of Cardiology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Shaohua Yan
- Department of Cardiology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Xiaobo Li
- Department of Cardiology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Yejia Chen
- Department of Cardiology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Yaode Chen
- Department of Cardiology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Yun Li
- Department of Public Health Management, Zengcheng Xintang Hospital, Guangzhou, China
| | - Shengli An
- Department of Biostatistics, School of Public Health, Southern Medical University, Guangzhou, China
| | - Jiancheng Xiu
- Department of Cardiology, Nanfang Hospital, Southern Medical University, Guangzhou, China
- Department of Cardiology, Zengcheng Branch of Nanfang Hospital, Guangzhou, China
- *Correspondence: Jiancheng Xiu,
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Renal mitochondrial injury in the pathogenesis of CKD: mtDNA and mitomiRs. Clin Sci (Lond) 2022; 136:345-360. [PMID: 35260892 PMCID: PMC10018514 DOI: 10.1042/cs20210512] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Revised: 02/14/2022] [Accepted: 02/24/2022] [Indexed: 12/31/2022]
Abstract
Chronic kidney disease (CKD) is a public health concern that affects over 200 million people worldwide and is associated with a tremendous economic burden. Therefore, deciphering the mechanisms underpinning CKD is crucial to decelerate its progression towards end-stage renal disease (ESRD). Renal tubular cells are populated with a high number of mitochondria, which produce cellular energy and modulate several important cellular processes, including generation of reactive oxygen species (ROS), calcium homeostasis, proliferation, and apoptosis. Over the past few years, increasing evidence has implicated renal mitochondrial damage in the pathogenesis of common etiologies of CKD, such as diabetes, hypertension, metabolic syndrome (MetS), chronic renal ischemia, and polycystic kidney disease (PKD). However, most compelling evidence is based on preclinical studies because renal biopsies are not routinely performed in many patients with CKD. Previous studies have shown that urinary mitochondrial DNA (mtDNA) copy numbers may serve as non-invasive biomarkers of renal mitochondrial dysfunction. Emerging data also suggest that CKD is associated with altered expression of mitochondria-related microRNAs (mitomiRs), which localize in mitochondria and regulate the expression of mtDNA and nucleus-encoded mitochondrial genes. This review summarizes relevant evidence regarding the involvement of renal mitochondrial injury and dysfunction in frequent forms of CKD. We further provide an overview of non-invasive biomarkers and potential mechanisms of renal mitochondrial damage, especially focusing on mtDNA and mitomiRs.
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Dong J, Yang H, Zhang Y, Chen L, Hu Q. A high triglyceride glucose index is associated with early renal impairment in the hypertensive patients. Front Endocrinol (Lausanne) 2022; 13:1038758. [PMID: 36589813 PMCID: PMC9794992 DOI: 10.3389/fendo.2022.1038758] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 12/02/2022] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE Serum β2-microglobulin (β2-MG) and serum cystatin C (CysC) are sensitive and reliable indicators of early renal impairment. Triglyceride glucose index (TyG) is an emerging vital indicator of insulin resistance and is associated with increased risk of hypertension. We aimed to analyze the relationship between TyG and early renal impairment in hypertensive patients. METHODS A retrospective analysis was performed on 881 hypertensive patients treated in Qinghai Provincial People, s Hospital from March 2018 to March 2021, their clinical data and corresponding laboratory index values were recorded, and the TyG index was calculated. According to the TyG index, the patients were divided into a low TyG (L-TyG) group (TyG ≤ 8.50, n=306), medium TyG (M-TyG) group (8.51≤TyG ≤ 8.94, n=281), and high TyG (H-TyG) group (TyG>8.95, n=294) in sequence by using tertiles. Then, according to serum β2-MG and CysC levels, they were divided into a normal renal function group (β2-MG ≤ 2.4 mg/L, n=700 and CysC ≤ 1.25mg/L, n=721) and a renal function injury group (β2-MG>2.4 mg/L, n=181, and CysC>1.25 mg/L, n=160). Multivariate linear regression analysis was used to analyze the influencing factors of serum β2-microglobulin and cystatin C. Multivariate Logistic regression was used to analyze the relationship between the TyG index and early renal impairment in hypertensive patients. The receiver operating characteristic curve (ROC) was used to determine the value of the TyG index in predicting early renal impairment in patients with hypertension. RESULT As the TyG index level increased, serum β2-MG and CysC levels also gradually increased. Multivariate linear regression analysis showed that TyG index was the influencing factor of serum β2-MG (B=0.060, P=0.007) and serum CysC (B=0.096, P<0.001). For every 1 standard deviation increase in the TyG index, the serum β2-MG and CysC increased by 0.06mg/L and 0.096mg/L, respectively. When compared to the normal group, the TyG level (8.91 ± 0.65 vs 8.64 ± 0.60, P<0.001) was higher in the renal impairment group with β2-MG>2.4 mg/L. The results of multivariate logistic regression analysis revealed that for every 1 standard deviation increase in the TyG index, the risk of early renal impairment in hypertensive patients increased 1.53 times (OR=1.53, 95%CI 1.006-2.303).The ROC curves showed that the TyG index was not superior to TG in predicting early renal impairment in hypertensive patients. the AUC values were 0.623 and 0.617, respectively. Then, when CysC>1.25 mg/L was used as the renal damage group, the level of TyG was still higher than that in the normal group (8.94 ± 0.67 and 8.64 ± 0.60, P<0.001). Multivariate Logistic regression analysis showed that for every 1 standard deviation increase in the TyG index, the risk of early renal impairment in hypertensive patients increased 2.82 times (OR=2.82, 95%CI 1.863-4.262). The ROC curves showed that the TyG index was not superior to TG in predicting early renal impairment in hypertensive patients. the AUC values were 0.629 and 0.626, respectively. CONCLUSION TyG index is an influential factor in serum β2-MG and CysC levels. The elevated TyG index levels are closely associated with the occurrence and development of early renal impairment in hypertensive patients, but it should be used cautiously in the prediction of early renal impairment.
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Affiliation(s)
- Jiankai Dong
- Department of Cardiology, Fujian Medical University Union Hospital, Fujian Cardiovascular Medical Center, Fujian Institute of Coronary Heart Disease, Fuzhou, China
| | - Huijie Yang
- Department of Cardiology, Qinghai Provincial People’s Hospital, Xining, China
| | - Yaping Zhang
- Department of Cardiology, Qinghai Provincial People’s Hospital, Xining, China
| | - Lianglong Chen
- Department of Cardiology, Fujian Medical University Union Hospital, Fujian Cardiovascular Medical Center, Fujian Institute of Coronary Heart Disease, Fuzhou, China
- *Correspondence: Lianglong Chen, ; Quanzhong Hu,
| | - Quanzhong Hu
- Department of Cardiology, Qinghai Provincial People’s Hospital, Xining, China
- *Correspondence: Lianglong Chen, ; Quanzhong Hu,
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Weng SC, Chen CM, Chen YC, Wu MJ, Tarng DC. Trajectory of Estimated Glomerular Filtration Rate and Malnourishment Predict Mortality and Kidney Failure in Older Adults With Chronic Kidney Disease. Front Med (Lausanne) 2021; 8:760391. [PMID: 34912823 PMCID: PMC8666586 DOI: 10.3389/fmed.2021.760391] [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: 08/18/2021] [Accepted: 11/08/2021] [Indexed: 11/29/2022] Open
Abstract
Objective: The trajectory patterns of estimated glomerular filtration rates (eGFR) in chronic kidney disease (CKD) older adults with malnourishment and their association with subsequent patient outcomes have not been elucidated. We aimed to assess the eGFR trajectory patterns for predicting patient survival and kidney failure in the elderly without or with malnourishment. Materials and Methods: Based on a prospective longitudinal cohort, CKD patients aged 65 years or older were enrolled from 2001 to 2013. Among the 3,948 patients whose eGFR trajectory patterns were analyzed, 1,872 patients were stratified by the absence or presence of malnourishment, and 765 patients were identified and categorized as having malnourishment. Four eGFR trajectory patterns [gradual decline (T0), early non-decline and then persistent decline (T1), persistent increase (T2), and low baseline and then progressive increase (T3)] were classified by utilizing a linear mixed-effect model with a quadratic term in time. The malnourishment was defined as body mass index < 22 kg/m2, serum albumin < 3.0 mg/dL, or Geriatric Nutritional Risk Index (GNRI) < 98. This study assessed the effectiveness of eGFR trajectory patterns in a median follow-up of 2.27 years for predicting all-cause mortality and kidney failure. Results: The mean age was 76.9 ± 6.7 years, and a total of 82 (10.7%) patients with malnourishment and 57 (5.1%) patients without malnourishment died at the end of the study. Compared with the reference trajectory T0, the overall mortality of T1 was markedly reduced [adjusted hazard ratio (aHR) = 0.52, 95% confidence interval (CI) 0.32–0.83]. In patients with trajectory, T3 was associated with a high risk for kidney failure (aHR = 5.68, 95% CI 3.12–10.4) compared with the reference, especially higher risk in the presence of malnourishment. Patients with high GNRI values were significantly associated with a lower risk of death and kidney failure, but patients with malnourishment and concomitant alcohol consumption had a higher risk of kidney failure. Conclusions: Low baseline eGFR and progressively increasing eGFR trajectory were high risks for kidney failure in CKD patients. These findings may be attributed to multimorbidity, malnourishment, and decompensation of renal function.
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Affiliation(s)
- Shuo-Chun Weng
- College of Medicine, National Chung Hsing University, Taichung, Taiwan.,Center for Geriatrics and Gerontology, Division of Nephrology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan.,Institute of Clinical Medicine, School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Chyong-Mei Chen
- Institute of Public Health, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Yu-Chi Chen
- Institute of Clinical Nursing, College of Nursing, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Ming-Ju Wu
- College of Medicine, National Chung Hsing University, Taichung, Taiwan.,Center for Geriatrics and Gerontology, Division of Nephrology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan.,School of Medicine, Chung Shan Medical University, Taichung, Taiwan.,Rong Hsing Research Center for Translational Medicine, Institute of Biomedical Science, College of Life Science, National Chung Hsing University, Taichung, Taiwan.,Graduate Institute of Clinical Medical Science, School of Medicine, China Medical University, Taichung, Taiwan
| | - Der-Cherng Tarng
- Institute of Clinical Medicine, School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Department and Institute of Physiology, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Division of Nephrology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Center for Intelligent Drug Systems and Smart Bio-devices (IDS2B), National Yang Ming Chiao Tung University, Hsinchu, Taiwan
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Tawfik M, Fathy N, Mousa AA, Ghonem M, Abdelsalam M. Thyroid dysfunction and insulin resistance in end-stage renal disease patients before and 1 year after starting maintenance hemodialysis: A prospective multicenter study. Semin Dial 2021; 35:138-145. [PMID: 34881448 DOI: 10.1111/sdi.13044] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Accepted: 11/18/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Thyroid dysfunction and insulin resistance (IR) are common findings in patients with ESRD. We aimed to evaluate thyroid dysfunction and IR in ESRD before and after 1 year of starting hemodialysis (HD). METHODS This was a prospective study that recruited newly starting HD patients who fulfilled the inclusion criteria. Patients were evaluated for TSH, free T4, free T3, fasting insulin, fasting glucose, HOMA-IR, serum ferritin, and hs-CRP levels before starting their first dialysis session and after 1 year of regular HD. RESULTS Eighty-one patients have completed the 1-year follow-up period. After 1 year of regular HD, there were statistically significant increments of hs-CRP, serum ferritin, and TSH levels. On the other hand, fasting insulin level and HOMA-IR showed statistically significant increments after 1 year of starting HD. After 1 year of regular HD, TSH level showed a positive correlation with hs-CRP and serum ferritin level, while free T3 was negatively correlated with HOMA-IR. On the other hand, there was a significant positive correlation between HOMA-IR, hs-CRP, and serum ferritin levels, while HOMA-IR was negatively correlated with Kt/V. CONCLUSIONS This study suggests overlapping complex pathogenesis of thyroid dysfunction, chronic inflammation, and IR in chronic HD patients.
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Affiliation(s)
- Mona Tawfik
- Mansoura Nephrology and Dialysis Unit, Internal Medicine Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Noha Fathy
- Internal Medicine Department, Talkha Central Hospital, Talkha, Egypt
| | - Amany A Mousa
- Endocrinology Unit, Internal Medicine Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Mohamed Ghonem
- Endocrinology Unit, Internal Medicine Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Mostafa Abdelsalam
- Mansoura Nephrology and Dialysis Unit, Internal Medicine Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt
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许 晓, 汤 旭, 车 红, 关 聪, 赵 楠, 傅 松, 刘 丽, 叶 月, 郭 梦, 闵 行, 甄 东. [Triglyceride-glucose product is an independent risk factor for predicting chronic kidney disease in middle-aged and elderly population: a prospective cohort study]. NAN FANG YI KE DA XUE XUE BAO = JOURNAL OF SOUTHERN MEDICAL UNIVERSITY 2021; 41:1600-1608. [PMID: 34916184 PMCID: PMC8685706 DOI: 10.12122/j.issn.1673-4254.2021.11.02] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To explore the correlation of triglyceride-glucose product (TyG) index with chronic kidney disease (CKD) in elderly population in Lanzhou (Gansu Province, China). METHODS From May to September, 2011, a total of 3868 middleaged and elderly individuals without CKD from 3 communities in Lanzhou were selected as the cohort study population and were followed for an average of 3.1 years (from June, 2014 to August, 2015). After excluding those with missing follow-up data, a total of 3439 individuals were included for analysis, who were divided according to the quartile of TyG index into Q1 group (TyG≤8.47), Q2 group (TyG 8.48-8.84), Q3 group (TyG 8.85-9.20) and Q4 group (TyG>9.20). The estimated glomerular filtration rate (eGFR) and urinary albumin/creatinine ratio (UACR) were used to evaluate the renal function of the participants. RESULTS In this cohort, a high TyG index was found to correlate with a high risk of CKD (P < 0.05). Analysis of the follow-up data showed that the TyG index was significantly higher in patients who developed CKD during the follow-up than in those without CKD (P < 0.05). Logistic regression analysis showed that TyG index was an independent risk factor for abnormal eGFR and CKD (P < 0.05). CONCLUSION A high TyG index is an independent risk factor for CKD in middle-aged and elderly population.
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Affiliation(s)
- 晓双 许
- 兰州大学第一临床医学院，甘肃 兰州 730099First Clinical Medical College, Lanzhou University, Lanzhou 730099, China
- 兰州大学第一医院内分泌科，甘肃 兰州 730099Department of Endocrinology, First Hospital of Lanzhou University, Lanzhou 730099, China
| | - 旭磊 汤
- 兰州大学第一医院内分泌科，甘肃 兰州 730099Department of Endocrinology, First Hospital of Lanzhou University, Lanzhou 730099, China
| | - 红霞 车
- 甘肃省第三人民医院内分泌科，甘肃 兰州 730000Department of Endocrinology, Third People's Hospital of Gansu Province, Lanzhou 730000, China
| | - 聪会 关
- 兰州大学第一医院内分泌科，甘肃 兰州 730099Department of Endocrinology, First Hospital of Lanzhou University, Lanzhou 730099, China
| | - 楠 赵
- 兰州大学第一医院内分泌科，甘肃 兰州 730099Department of Endocrinology, First Hospital of Lanzhou University, Lanzhou 730099, China
| | - 松波 傅
- 兰州大学第一医院内分泌科，甘肃 兰州 730099Department of Endocrinology, First Hospital of Lanzhou University, Lanzhou 730099, China
| | - 丽娟 刘
- 兰州大学第一医院内分泌科，甘肃 兰州 730099Department of Endocrinology, First Hospital of Lanzhou University, Lanzhou 730099, China
| | - 月 叶
- 兰州大学第一临床医学院，甘肃 兰州 730099First Clinical Medical College, Lanzhou University, Lanzhou 730099, China
- 兰州大学第一医院内分泌科，甘肃 兰州 730099Department of Endocrinology, First Hospital of Lanzhou University, Lanzhou 730099, China
| | - 梦然 郭
- 兰州大学第一临床医学院，甘肃 兰州 730099First Clinical Medical College, Lanzhou University, Lanzhou 730099, China
- 兰州大学第一医院内分泌科，甘肃 兰州 730099Department of Endocrinology, First Hospital of Lanzhou University, Lanzhou 730099, China
| | - 行 闵
- 兰州大学第一临床医学院，甘肃 兰州 730099First Clinical Medical College, Lanzhou University, Lanzhou 730099, China
- 兰州大学第一医院内分泌科，甘肃 兰州 730099Department of Endocrinology, First Hospital of Lanzhou University, Lanzhou 730099, China
| | - 东户 甄
- 兰州大学第一医院内分泌科，甘肃 兰州 730099Department of Endocrinology, First Hospital of Lanzhou University, Lanzhou 730099, China
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Park S, Cho NJ, Heo NH, Rhee EJ, Gil H, Lee EY. Vascular Calcification as a Novel Risk Factor for Kidney Function Deterioration in the Nonelderly. J Am Heart Assoc 2021; 10:e019300. [PMID: 34151587 PMCID: PMC8403323 DOI: 10.1161/jaha.120.019300] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Background The relationship between vascular calcification and chronic kidney disease is well known. However, whether vascular calcification affects renal function deterioration remains unclear. We investigated whether kidney function deteriorated more rapidly in individuals with higher vascular calcification indicated by the coronary artery calcium score (CACS). Methods and Results Individuals with a normal estimated glomerular filtration rate (>60 mL/min per 1.73 m2) who underwent cardiac computed tomography in our institution (a tertiary teaching hospital in Cheonan, Korea) from January 2010 to July 2012 were retrospectively reviewed. All participants were aged 20 to 65 years. Among 739 patients, 447, 175, and 117 had CACSs of 0, 1 to 99, and ≥100 units, respectively. The participants were followed for 7.8 (interquartile range, 5.5–8.8) years. The adjusted annual estimated glomerular filtration rates declined more rapidly in patients in the CACS ≥100 group compared with those in the CACS 0 group (adjusted‐β, −0.40; 95% CI, −0.80 to −0.03) when estimated using a linear mixed model. The adjusted hazard ratio in the CACS ≥100 group for Kidney Disease: Improving Global Outcomes criteria (a drop in estimated glomerular filtration rate category accompanied by a 25% or greater drop in estimated glomerular filtration rate) was 2.52 (1.13–5.61). After propensity score matching, more prevalent renal outcomes (13.2%) were observed in patients with a CACS of ≥100 compared with those with a CACS of 0 (1.9%), with statistical significance (P=0.004). Conclusions Our results showed that renal function declined more rapidly in patients with higher CACSs, suggesting that vascular calcification might be associated with chronic kidney disease progression.
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Affiliation(s)
- Samel Park
- Department of Internal Medicine Soonchunhyang University Cheonan Hospital Cheonan Korea
| | - Nam-Jun Cho
- Department of Internal Medicine Soonchunhyang University Cheonan Hospital Cheonan Korea
| | - Nam Hun Heo
- Department of Biostatistics Soonchunhyang University Cheonan Hospital Cheonan Korea
| | - Eun-Jung Rhee
- Department of Internal Medicine Kangbuk Samsung Hospital Seoul Korea
| | - Hyowook Gil
- Department of Internal Medicine Soonchunhyang University Cheonan Hospital Cheonan Korea
| | - Eun Young Lee
- Department of Internal Medicine Soonchunhyang University Cheonan Hospital Cheonan Korea.,Institute of Tissue Regeneration College of Medicine Soonchunhyang University Cheonan Korea
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Peng J, Qin C, Tian SY, Peng JQ. MiR-93 inhibits the vascular calcification of chronic renal failure by suppression of Wnt/β-catenin pathway. Int Urol Nephrol 2021; 54:225-235. [PMID: 34138419 DOI: 10.1007/s11255-021-02907-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 05/30/2021] [Indexed: 12/19/2022]
Abstract
OBJECTIVE To explore the effect of miR-93-mediated Wnt/β-catenin pathway on the vascular calcification (VC) of chronic renal failure (CRF). METHODS SD rats were utilized to construct CRF models and divided into Control, CRF, CRF + LV (lentiviral vector)-miR-93 and CRF + LV-Con groups. Renal tissues collected from rats were performed hematoxylin and eosin (HE) staining and Masson staining, while the abdominal aorta was dissected for alizarin red staining and Von Kossa staining. VC-related genes were determined by qRT-PCR while Wnt/β-catenin pathway-related proteins were examined by Western blotting. RESULTS As compared to Control group, the serum levels of blood urea nitrogen (BUN), serum creatinine (Scr), phosphorus (P), cystatin C (Cys-C) and 24-h urea protein (24 h Upro), and the scores of renal interstitial lesion and fibrotic area in rats from CRF group were elevated, with the increased calcified area of aorta as well as the enhanced calcium content and ALP. Meanwhile, rats in the CRF group had up-regulated expression of OPN, OCN, RUNX2 and BMP-2 and down-regulated expression of miR-93. As for the expression of Wnt/β-catenin pathway, rats in the CRF group had sharp increases in the protein expression of TCF4 and β-catenin, while α-SMA was down-regulated. However, changes of the above were reversed in rats from CRF + LV-miR-93 group, and TCF4 was confirmed to be a target gene of miR-93. CONCLUSION MiR-93, via inhibiting the activity of Wnt/β-catenin pathway by targeting TCF4, can improve the renal function of CRF rats, thereby mitigating the vascular calcification of CRF.
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Affiliation(s)
- Jun Peng
- Department of Nephrology, Jingzhou Central Hospital, Jingzhou, 434020, Hubei, China
| | - Chao Qin
- Department of Orthopaedics, Jingzhou Central Hospital, Jingzhou, Hubei, China
| | - Shu-Yan Tian
- Department of Nephrology, Jingzhou Central Hospital, Jingzhou, 434020, Hubei, China
| | - Jia-Qing Peng
- Department of Nephrology, Jingzhou Central Hospital, Jingzhou, 434020, Hubei, China.
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Ren M, You L, Lin D, Feng Q, Huang C, Li F, Qi Y, Feng W, Yang C, Yan L, Sun K. Association of metabolic syndrome with the incidence of low-grade albuminuria: a cohort study in middle-aged and elderly Chinese adults. Aging (Albany NY) 2021; 13:7350-7360. [PMID: 33686966 PMCID: PMC7993658 DOI: 10.18632/aging.202592] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Accepted: 01/14/2021] [Indexed: 11/30/2022]
Abstract
Background: Individuals with metabolic syndrome have elevated risks of micro- and macro-albuminuria as well as chronic kidney disease (CKD). Objective: To assess the influence of metabolic abnormalities on the presence of low-grade albuminuria (below the threshold for microalbuminuria). Design, participants, and main outcome measures: This community-based cohort study included 3,935 eligible individuals aged 40 years or older. The presence of low-grade albuminuria was detected in those without micro- or macro-albuminuria and analyzed according to the highest quartile of the baseline urinary albumin-to-creatinine ratio (ACR ≥11.13 mg/g). CKD was defined by an estimated glomerular filtration rate <60 mL/min/1.73 m2 or the new presence of albuminuria (ACR ≥30 mg/g). Results: Overall, 577 (14.7%) participants developed low-grade albuminuria and 164 (4.2%) participants developed CKD during a mean follow-up period of 3.6 years. Compared with participants without metabolic syndrome, those with metabolic syndrome had greater risks of low-grade albuminuria [adjusted odd ratio (OR) and 95% confidence interval (95% CI): 1.30 (1.05–1.61)] and CKD [1.71 (1.20–2.44)]. Moreover, the incidence rates of low-grade albuminuria and CKD increased as the number of metabolic syndrome components increased (P for trend <0.0001). Conclusions: The presence of metabolic syndrome is associated with increased incidence rates of low-grade albuminuria and CKD the middle-aged and elderly Chinese populations.
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Affiliation(s)
- Meng Ren
- Department of Endocrinology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, People' s Republic of China
| | - Lili You
- Department of Endocrinology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, People' s Republic of China
| | - Diaozhu Lin
- Department of Endocrinology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, People' s Republic of China
| | - Qiling Feng
- Department of Endocrinology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, People' s Republic of China
| | - Chulin Huang
- Department of Endocrinology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, People' s Republic of China
| | - Feng Li
- Department of Endocrinology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, People' s Republic of China
| | - Yiqin Qi
- Department of Endocrinology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, People' s Republic of China
| | - Wanting Feng
- Department of Endocrinology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, People' s Republic of China
| | - Chuan Yang
- Department of Endocrinology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, People' s Republic of China
| | - Li Yan
- Department of Endocrinology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, People' s Republic of China
| | - Kan Sun
- Department of Endocrinology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, People' s Republic of China
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Zhang Y, Wu T, Xie J, Yan L, Guo X, Xu W, Wang L. Effects of metabolic syndrome on renal function after radical nephrectomy in patients with renal cell carcinoma. Int Urol Nephrol 2021; 53:2127-2135. [PMID: 33459957 DOI: 10.1007/s11255-020-02759-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Accepted: 12/15/2020] [Indexed: 11/30/2022]
Abstract
PURPOSE Nephrectomy, partial or radical, remains the standard treatment for renal cell carcinoma (RCC). However, increased risk of chronic kidney disease (CKD) must still be considered. This study aimed to evaluate the effects of concomitant metabolic syndrome (MetS) on renal function in patients with RCC after radical nephrectomy. METHODS Medical records of 310 patients who underwent radical nephrectomy for clear-cell RCC at 900th Hospital of the Joint Logistics Support Force, PLA from December 2012 to January 2017 were reviewed retrospectively. Estimated glomerular filtration rate (eGFR) and CKD stages were calculated at one week preoperative as baseline and then at postoperative 1 week, 3 months, 12 months and 24 months. MetS patients were identified and enrolled in the MetS group (n = 31), and a non-MetS group was selected by propensity score matching (n = 31). Non-neoplastic renal parenchyma specimens taken at least 2 cm from edge of tumor were evaluated. RESULTS Baseline characteristics between the two groups were comparable. At 24 months postoperative, mean eGFR levels of the MetS group were significantly lower than those in the non-MetS group (62.7 vs. 73.3 ml/min/1.73 m2; p = 0.004). CKD stages were still more severe in the MetS group than those in the non-MetS group (p = 0.006). The proportions of global sclerosis, tubular atrophy and interstitial fibrosis were all significantly more prevalent in MetS patients, compared to non-MetS patients (all p < 0.05). CONCLUSION In RCC patients with MetS, the possibility of declining eGFR and CKD progression must be considered after radical nephrectomy. Routine monitoring of renal function must be emphasized.
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Affiliation(s)
- Yong Zhang
- Fuzong Clinical Medical College of Fujian Medical University, Fuzhou, People's Republic of China.,Division of Nephrology, The 900th Hospital of Joint Logistic Support Force, PLA, 156 West Second Ring Road, Fuzhou, 350025, People's Republic of China
| | - Tingkun Wu
- Fuzong Clinical Medical College of Fujian Medical University, Fuzhou, People's Republic of China
| | - Jingjing Xie
- Fuzong Clinical Medical College of Fujian Medical University, Fuzhou, People's Republic of China
| | - Liqun Yan
- Fuzong Clinical Medical College of Fujian Medical University, Fuzhou, People's Republic of China
| | - Xiuli Guo
- Fuzong Clinical Medical College of Fujian Medical University, Fuzhou, People's Republic of China
| | - Weijia Xu
- Fuzong Clinical Medical College of Fujian Medical University, Fuzhou, People's Republic of China
| | - Liping Wang
- Fuzong Clinical Medical College of Fujian Medical University, Fuzhou, People's Republic of China. .,Division of Nephrology, The 900th Hospital of Joint Logistic Support Force, PLA, 156 West Second Ring Road, Fuzhou, 350025, People's Republic of China.
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Pina AF, Borges DO, Meneses MJ, Branco P, Birne R, Vilasi A, Macedo MP. Insulin: Trigger and Target of Renal Functions. Front Cell Dev Biol 2020; 8:519. [PMID: 32850773 PMCID: PMC7403206 DOI: 10.3389/fcell.2020.00519] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Accepted: 06/02/2020] [Indexed: 12/16/2022] Open
Abstract
Kidney function in metabolism is often underestimated. Although the word “clearance” is associated to “degradation”, at nephron level, proper balance between what is truly degraded and what is redirected to de novo utilization is crucial for the maintenance of electrolytic and acid–basic balance and energy conservation. Insulin is probably one of the best examples of how diverse and heterogeneous kidney response can be. Kidney has a primary role in the degradation of insulin released in the bloodstream, but it is also incredibly susceptible to insulin action throughout the nephron. Fluctuations in insulin levels during fast and fed state add another layer of complexity in the understanding of kidney fine-tuning. This review aims at revisiting renal insulin actions and clearance and to address the association of kidney dysmetabolism with hyperinsulinemia and insulin resistance, both highly prevalent phenomena in modern society.
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Affiliation(s)
- Ana F Pina
- Centro de Estudos de Doenças Crónicas, NOVA Medical School/Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal.,ProRegeM Ph.D. Programme, NOVA Medical School/Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal.,Department of Medical Sciences, University of Aveiro, Aveiro, Portugal
| | - Diego O Borges
- Centro de Estudos de Doenças Crónicas, NOVA Medical School/Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal.,Molecular Biosciences Ph.D. Programme, Instituto de Tecnologia Química e Biológica António Xavier, Universidade Nova de Lisboa, Oeiras, Portugal
| | - Maria João Meneses
- Centro de Estudos de Doenças Crónicas, NOVA Medical School/Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal.,ProRegeM Ph.D. Programme, NOVA Medical School/Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Patrícia Branco
- Department of Nephrology, Centro Hospitalar Lisboa Ocidental, Lisbon, Portugal.,Portuguese Diabetes Association - Education and Research Center (APDP-ERC), Lisbon, Portugal
| | - Rita Birne
- Department of Nephrology, Centro Hospitalar Lisboa Ocidental, Lisbon, Portugal.,Portuguese Diabetes Association - Education and Research Center (APDP-ERC), Lisbon, Portugal
| | - Antonio Vilasi
- Institute of Clinical Physiology - National Research Council, Reggio Calabria Unit1, Reggio Calabria, Italy
| | - Maria Paula Macedo
- Centro de Estudos de Doenças Crónicas, NOVA Medical School/Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal.,Department of Medical Sciences, University of Aveiro, Aveiro, Portugal.,Portuguese Diabetes Association - Education and Research Center (APDP-ERC), Lisbon, Portugal
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Bogataj Š, Pajek J, Buturović Ponikvar J, Pajek M. Functional training added to intradialytic cycling lowers low-density lipoprotein cholesterol and improves dialysis adequacy: a randomized controlled trial. BMC Nephrol 2020; 21:352. [PMID: 32811448 PMCID: PMC7436960 DOI: 10.1186/s12882-020-02021-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 08/13/2020] [Indexed: 12/02/2022] Open
Abstract
Background Exercise has various positive effects on hemodialysis patients. However, there is no clear evidence which type of exercise yields better results. This study aimed to determine the effects of guided functional training added to the intradialytic cycling on dialysis adequacy and biochemical parameters in hemodialysis patients. Additionally, we aimed to investigate if patients could transfer functional exercise to an unsupervised home environment and retain gained improvements. Methods Randomization was done to a functional training intervention group (INT) (n = 20) or intradialytic cycling control group (CON) (n = 20). The INT attended a pre-dialysis functional training in the first 8 weeks. In the second 8 weeks, they performed functional exercises at unsupervised home environment on non-dialysis days. During the whole study, both groups participated in the intradialytic cycling program. Results Both groups demonstrated a significant increase in dialysis adequacy (Kt/V) in the eight (0.15, 95% CI 0.06 to 0.24; p = 0.003 for INT and 0.21, 95% CI 0.11 to 0.3; p < 0.001 for CON) and the 16th study week (0.13, 95% CI 0.03 to 0.24; p = 0.017 for INT and 0.13, 95% CI 0.03 to 0.22; p = 0.013 for CON) compared to their baseline values with no significant between-group differences. At week eight, the total cholesterol was significantly lowered in the INT (− 0.34 mmol/L, 95% CI − 0.6 to − 0.07; p = 0.016) and remained lower at week 16 (− 0.32 mmol/L, 95% CI − 0.64 to − 0.01; p = 0.049) with no significant changes in the CON. Low-density lipoprotein levels in the INT were significantly reduced after 8 weeks (− 0.35 mmol/L, 95% CI − 0.64 to − 0.06; p = 0.022) and remained reduced after 16 weeks (− 0.28 mmol/L, 95% CI − 0.52 to − 0.03; p = 0.030). There were no significant differences found for albumin, high-density lipoprotein cholesterol, triglycerides, C-reactive protein, and hemoglobin in both groups. Conclusions We demonstrated that functional training added to intradialytic cycling improved lipid profile and dialysis adequacy. Additionally, the effects of the unsupervised, home-based program were preserved during the second study phase. This study supports the assumption that combined training is more effective compared to solely intradialytic exercise. Trial registration ClinicalTrials.Gov, NCT03334123. Registered 07 November 2017.
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Affiliation(s)
- Špela Bogataj
- Department of Nephrology, University Medical Centre, 1000, Ljubljana, Slovenia.,University of Ljubljana, Faculty of Sport, 1000, Ljubljana, Slovenia
| | - Jernej Pajek
- Department of Nephrology, University Medical Centre, 1000, Ljubljana, Slovenia.,University of Ljubljana, Faculty of Medicine, 1000, Ljubljana, Slovenia
| | - Jadranka Buturović Ponikvar
- Department of Nephrology, University Medical Centre, 1000, Ljubljana, Slovenia.,University of Ljubljana, Faculty of Medicine, 1000, Ljubljana, Slovenia
| | - Maja Pajek
- University of Ljubljana, Faculty of Sport, 1000, Ljubljana, Slovenia.
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Xie Z, Li Z, Dong W, Chen Y, Li R, Wu Y, Lin T, Tao Y, Liang H, Wang W, Liu S, Ye Z, Shi W, Liang X. Metabolic syndrome and concomitant diabetes mellitus are associated with higher risk of cardiovascular comorbidity in patients with primary glomerular diseases: A retrospective observational study. Clin Cardiol 2020; 43:949-956. [PMID: 32469090 PMCID: PMC8101350 DOI: 10.1002/clc.23388] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Revised: 04/18/2020] [Accepted: 05/01/2020] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Metabolic syndrome (MS) and diabetes mellitus (DM) are risk factors for cardiovascular diseases in general population. However, there was a paucity of studies investigating their impact in primary glomerular diseases (PGD). HYPOTHESIS MS and concomitant DM are associated with higher risk of cardiovascular comorbidity in PGD. METHODS In a retrospective observational design, we analyzed 3622 hospitalized adult PGD patients and compared the prevalence of cardiovascular comorbidity in non-MS, MS with and without DM. Risk factors for cardiovascular comorbidity were identified using univariate and multivariate logistic regression. RESULTS Among 3622 PGD patients, 308 (8.5%) cases accompanied with MS, including 180 (5.0%) patients with DM and 128 (3.5%) without DM. One hundred and sixty four (4.5%) cases coexisted with cardiovascular comorbidity. Patients with MS and concomitant DM exhibited a higher prevalence of cardiovascular comorbidity than those without MS stratified by estimated glomerular filtration rate and pathological types. Logistic regression showed that MS and concomitant DM (OR: 2.496, 95% CI: 1.600-3.894, P < .001), older age (OR: 1.060, 95% CI: 1.047-1.074, P < .001), male (OR: 1.536, 95% CI: 1.072-2.200, P = .019), higher level of serum ti (OR: 1.002, 95% CI: 1.001-1.003, P < .001), hyperuricemia (OR: 1.901, 95% CI: 1.327-2.725, P < .001), idiopathic membranous nephropathy (OR: 2.874, 95% CI: 1.244-6.640, P < .001) and focal segmental glomerulosclerosis (OR: 2.906, 95% CI: 1.147-7.358, P < .001) were independently associated with a higher risk for cardiovascular comorbidity. CONCLUSIONS In PGD patients, MS and concomitant DM are associated with an increased risk for cardiovascular comorbidity. More evidence for the causal link between MS/DM and cardiovascular outcomes is needed to be clarified.
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Affiliation(s)
- Zhiyong Xie
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China.,Division of Nephrology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Zhilian Li
- Division of Nephrology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Wei Dong
- Division of Nephrology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Yuanhan Chen
- Division of Nephrology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Ruizhao Li
- Division of Nephrology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Yanhua Wu
- Division of Nephrology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Ting Lin
- Division of Nephrology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Yiming Tao
- Division of Nephrology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Huaban Liang
- Division of Nephrology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Wenjian Wang
- Division of Nephrology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Shuangxin Liu
- Division of Nephrology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Zhiming Ye
- Division of Nephrology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Wei Shi
- Division of Nephrology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Xinling Liang
- Division of Nephrology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.,The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
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Addition of Metabolic Syndrome to Albuminuria Provides a New Risk Stratification Model for Diabetic Kidney Disease Progression in Elderly Patients. Sci Rep 2020; 10:6788. [PMID: 32321994 PMCID: PMC7176677 DOI: 10.1038/s41598-020-63967-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2019] [Accepted: 04/08/2020] [Indexed: 12/28/2022] Open
Abstract
Elderly patients with type 2 diabetes (T2DM) are more prone to developing diabetic kidney disease (DKD). Patients with DKD can develop albuminuria, and some studies have suggested an association between metabolic syndrome and albuminuria. The prevalence of both metabolic syndrome and albuminuria increases with age. We evaluated the association of these risk factors with worsening renal function and albuminuria progression in 460 T2DM patients with a mean age of 72 years. During the 5-year follow-up period, progression of albuminuria and worsening of renal function were observed in 97 (21.2%) and 23 (5.1%) patients, respectively. After adjusting for confounding factors, the group with metabolic syndrome had a higher multivariable-adjusted hazard ratio (HR) for worsening renal function (P = 0.038) and albuminuria progression (P = 0.039) than the group without metabolic syndrome. When patients were divided into four groups according to the presence of metabolic syndrome and/or albuminuria, the HR gradually increased. The group with both albuminuria and metabolic syndrome exhibited the highest cumulative incidence of worsening renal function (P = 0.003). When we redefined metabolic syndrome to exclude the blood pressure (BP) component, similar results were obtained. We concluded that the presence of metabolic syndrome independently predicts the progression of renal disease in elderly patients with T2DM. The use of both metabolic syndrome and albuminuria provides a better risk stratification model for DKD progression than albuminuria alone.
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Mediterranean Diet Nutrients to Turn the Tide against Insulin Resistance and Related Diseases. Nutrients 2020; 12:nu12041066. [PMID: 32290535 PMCID: PMC7230471 DOI: 10.3390/nu12041066] [Citation(s) in RCA: 160] [Impact Index Per Article: 32.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 04/06/2020] [Accepted: 04/10/2020] [Indexed: 12/11/2022] Open
Abstract
Insulin resistance (IR), defined as an attenuated biological response to circulating insulin, is a fundamental defect in obesity and type 2 diabetes (T2D), and is also linked to a wide spectrum of pathological conditions, such as non-alcoholic fatty liver disease (NAFLD), cognitive impairment, endothelial dysfunction, chronic kidney disease (CKD), polycystic ovary syndrome (PCOS), and some endocrine tumors, including breast cancer. In obesity, the unbalanced production of pro- and anti-inflammatory adipocytokines can lead to the development of IR and its related metabolic complications, which are potentially reversible through weight-loss programs. The Mediterranean diet (MedDiet), characterized by high consumption of extra-virgin olive oil (EVOO), nuts, red wine, vegetables and other polyphenol-rich elements, has proved to be associated with greater improvement of IR in obese individuals, when compared to other nutritional interventions. Also, recent studies in either experimental animal models or in humans, have shown encouraging results for insulin-sensitizing nutritional supplements derived from MedDiet food sources in the modulation of pathognomonic traits of certain IR-related conditions, including polyunsaturated fatty acids from olive oil and seeds, anthocyanins from purple vegetables and fruits, resveratrol from grapes, and the EVOO-derived, oleacein. Although the pharmacological properties and clinical uses of these functional nutrients are still under investigation, the molecular mechanism(s) underlying the metabolic benefits appear to be compound-specific and, in some cases, point to a role in gene expression through an involvement of the nuclear high-mobility group A1 (HMGA1) protein.
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Fukuda T, Bouchi R, Asakawa M, Takeuchi T, Shiba K, Tsujimoto K, Komiya C, Yoshimoto T, Ogawa Y, Yamada T. Sarcopenic obesity is associated with a faster decline in renal function in people with type 2 diabetes. Diabet Med 2020; 37:105-113. [PMID: 31621107 DOI: 10.1111/dme.14153] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/14/2019] [Indexed: 01/18/2023]
Abstract
AIM To evaluate the association between sarcopenic obesity and the decline in estimated GFR in people with type 2 diabetes. METHODS We enrolled 745 people with type 2 diabetes (mean age 64.6 years, 53.6% men). Body composition was evaluated using dual-energy X-ray absorptiometry. Skeletal muscle index, calculated as appendicular non-fat mass (kg) divided by height squared (m2 ), was used to determine sarcopenia. Sarcopenic obesity was defined as the coexistence of sarcopenia and a ratio of android to gynoid fat mass greater than the median values in each gender. The association of sarcopenic obesity both with the annual rate of decline in estimated GFR and a >30% decline in estimated GFR was evaluated using multivariate linear regression models and Cox proportional hazard models, respectively. RESULTS Participants with sarcopenic obesity were at an increased risk of a high annual rate of decline in estimated GFR, even after adjustment for the confounding variables (standardized β = -0.228, P <0.001). Sarcopenic obesity was also significantly associated with risk of a >30% decline in estimated GFR (hazard ratio 4.52, 95% CI 2.16-9.47; P < 0.01) in multivariate model. CONCLUSIONS Sarcopenic obesity evaluated by dual energy X-ray absorptiometry is associated with a faster decline in renal function in people with type 2 diabetes.
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Affiliation(s)
- T Fukuda
- Department of Molecular Endocrinology and Metabolism, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo
| | - R Bouchi
- Department of Molecular Endocrinology and Metabolism, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo
- Department of Diabetes, Endocrinology and Metabolism, National Centre for Global Health and Medicine, Tokyo
- Diabetes and Metabolism Information Centre, National Centre for Global Health and Medicine, Tokyo
| | - M Asakawa
- Department of Molecular Endocrinology and Metabolism, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo
| | - T Takeuchi
- Department of Molecular Endocrinology and Metabolism, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo
| | - K Shiba
- Department of Molecular Endocrinology and Metabolism, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo
| | - K Tsujimoto
- Department of Molecular Endocrinology and Metabolism, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo
| | - C Komiya
- Department of Molecular Endocrinology and Metabolism, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo
| | - T Yoshimoto
- Department of Molecular Endocrinology and Metabolism, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo
| | - Y Ogawa
- Department of Molecular Endocrinology and Metabolism, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo
- Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka
- Department of Molecular and Cellular Metabolism, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - T Yamada
- Department of Molecular Endocrinology and Metabolism, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo
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A Systematic Review of NAFLD-Associated Extrahepatic Disorders in Youths. J Clin Med 2019; 8:jcm8060868. [PMID: 31213030 PMCID: PMC6617181 DOI: 10.3390/jcm8060868] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Revised: 06/04/2019] [Accepted: 06/13/2019] [Indexed: 02/07/2023] Open
Abstract
Background: There is growing evidence that non-alcoholic fatty liver disease (NAFLD) is a disease affecting not only the liver but also extrahepatic organs. Aim: To investigate whether in youths NAFLD is associated with extrahepatic complications such as subclinical atherosclerosis, cardiac abnormalities, hypertension, type 2 diabetes, decreased bone mineral density, renal dysfunction, obstructive sleep apnea, and polycystic ovary syndrome. Methods: We systematically reviewed PubMed; Scopus; Embase; and the Cochrane Library databases up to 28 February 2019 and assessed the quality of studies using the Newcastle-Ottawa Scale. Results: Thirty-five articles were selected for this systematic review: fifteen (4627 participants) evaluated the association of NAFLD with subclinical atherosclerosis; four (969 participants) with cardiac abnormalities; two (550 participants) with hypertension; four (1328 participants) with diabetes; six (523 participants) with low bone mineral density; two (865 participants) with renal dysfunction; one with obstructive sleep apnea; and one with polycystic ovary syndrome. Most studies found that youths with NAFLD have increased features of subclinical atherosclerosis; as well as of cardiac alterations. Limited data were available to endorse a solid estimate of the prevalence of diabetes; low mineral density and renal dysfunction in the pediatric NAFLD population. Conclusion: NAFLD-related intermediate CVD outcomes can occur and be detected early in young populations.
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Wang IK, Tsai TH, Hung YC, Wang TY, Yen TH, Lin CL, Sung FC. Increased risk of new-onset type 2 diabetes in people with chronic kidney disease. Int Urol Nephrol 2019; 51:707-712. [PMID: 30689178 DOI: 10.1007/s11255-019-02075-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2018] [Accepted: 01/03/2019] [Indexed: 11/30/2022]
Abstract
PURPOSE This study investigated whether people with chronic kidney disease (CKD) are at the risk of new-onset type 2 diabetes. METHODS A cohort comprising 16,624 people with CKD, and an age- and sex-matched control cohort of 66,496 persons without any clinical kidney disease were identified from the Taiwan National Health Insurance Database during the period of 2000-2010. Both cohorts were followed up to 2011 to evaluate the incidence and hazard ratio (HR) of developing new-onset type 2 diabetes. Diseases were identified based on diagnosis coding. RESULTS The incidence of type 2 diabetes was 1.51-fold higher in the CKD cohort than in the control cohort (16.9 versus 11.2 per 1,000 person-years) with an adjusted hazard ratio of 1.17 (95% confidence interval, (CI)1.10-1.24). In the multivariate Cox regression model considering the competing-risk death, the adjusted subhazard ratio of type 2 diabetes was 1.30 (95% CI1.22-1.38) for the CKD cohort compared to the control cohort. CONCLUSIONS People with CKD patients are at an increased risk of developing new-onset type 2 diabetes. Close surveillance for diabetes should be considered for these people.
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Affiliation(s)
- I-Kuan Wang
- Department of Internal Medicine, College of Medicine, China Medical University, Taichung, Taiwan
- Division of Nephrology, China Medical University Hospital, Taichung, Taiwan
| | - Tsung-Hsun Tsai
- Graduate Institute of Clinical Medical Science, China Medical University College of Medicine, Taichung, Taiwan
- Division of Urology, Department of Surgery, Taichung Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taichung, Taiwan
| | - Yi-Chih Hung
- Division of Endocrinology, China Medical University Hospital, Taichung, Taiwan
| | - Tzu-Yuan Wang
- Division of Endocrinology, China Medical University Hospital, Taichung, Taiwan
| | - Tzung-Hai Yen
- Division of Nephrology, Chang Gung Memorial Hospital, Taipei, Taiwan
- Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Cheng-Li Lin
- Division of Nephrology, Chang Gung Memorial Hospital, Taipei, Taiwan
| | - Fung-Chang Sung
- Graduate Institute of Clinical Medical Science, China Medical University College of Medicine, Taichung, Taiwan.
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan.
- Department of Health Services Administration, China Medical University, 91 Hsueh Shih Road, Taichung, 404, Taiwan.
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Schrauben SJ, Jepson C, Hsu JY, Wilson FP, Zhang X, Lash JP, Robinson BM, Townsend RR, Chen J, Fogelfeld L, Kao P, Landis JR, Rader DJ, Hamm LL, Anderson AH, Feldman HI. Insulin resistance and chronic kidney disease progression, cardiovascular events, and death: findings from the chronic renal insufficiency cohort study. BMC Nephrol 2019; 20:60. [PMID: 30786864 PMCID: PMC6383235 DOI: 10.1186/s12882-019-1220-6] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Accepted: 01/17/2019] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Insulin resistance contributes to the metabolic syndrome, which is associated with the development of kidney disease. However, it is unclear if insulin resistance independently contributes to an increased risk of chronic kidney disease (CKD) progression or CKD complications. Additionally, predisposing factors responsible for insulin resistance in the absence of diabetes in CKD are not well described. This study aimed to describe factors associated with insulin resistance and characterize the relationship of insulin resistance to CKD progression, cardiovascular events and death among a cohort of non-diabetics with CKD. METHODS Data was utilized from Chronic Renal Insufficiency Cohort Study participants without diabetes (N = 1883). Linear regression was used to assess associations with insulin resistance, defined using the Homeostasis Model Assessment of Insulin Resistance (HOMA-IR). The relationship of HOMA-IR, fasting glucose, hemoglobin A1c (HbA1c), and C-peptide with CKD progression, cardiovascular events, and all-cause mortality was examined with Cox proportional hazards models. RESULTS Novel positive associations with HOMA-IR included serum albumin, uric acid, and hemoglobin A1c. After adjustment, HOMA-IR was not associated with CKD progression, cardiovascular events, or all-cause mortality. There was a notable positive association of one standard deviation increase in HbA1c with the cardiovascular endpoint (HR 1.16, 95% CI: 1.00-1.34). CONCLUSION We describe potential determinants of HOMA-IR among a cohort of non-diabetics with mild-moderate CKD. HOMA-IR was not associated with renal or cardiovascular events, or all-cause mortality, which adds to the growing literature describing an inconsistent relationship of insulin resistance with CKD-related outcomes.
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Affiliation(s)
- Sarah J Schrauben
- Division of Renal-Electrolyte and Hypertension, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, 19103, PA, USA. .,Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, 19103, USA.
| | - Christopher Jepson
- Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, 19103, USA.,Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Jesse Y Hsu
- Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, 19103, USA.,Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - F Perry Wilson
- Department of Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Xiaoming Zhang
- Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, 19103, USA.,Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - James P Lash
- Department of Medicine, University of Illinois at Chicago College of Medicine, Chicago, IL, USA
| | - Bruce M Robinson
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI; Arbor Research Collaborative for Health, Ann Arbor, MI, USA
| | - Raymond R Townsend
- Division of Renal-Electrolyte and Hypertension, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, 19103, PA, USA
| | - Jing Chen
- Department of Medicine, Tulane University School of Medicine, New Orleans, Lousiana, USA
| | - Leon Fogelfeld
- Department of Medicine, Rush University Medical Center, Chicago, IL, USA
| | - Patricia Kao
- Deparment of Medicine, Washington University School of Medicine in Saint Louis, St. Louis, MO, USA
| | - J Richard Landis
- Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, 19103, USA.,Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Daniel J Rader
- Division of Renal-Electrolyte and Hypertension, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, 19103, PA, USA
| | - L Lee Hamm
- Department of Medicine, Tulane University School of Medicine, New Orleans, Lousiana, USA
| | - Amanda H Anderson
- Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.,Tulane University, School of Public Health and Tropical Medicine, New Orleans, LA, USA
| | - Harold I Feldman
- Division of Renal-Electrolyte and Hypertension, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, 19103, PA, USA.,Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, 19103, USA.,Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
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Wu Z, Jiang Y, Jia J, He D, Sun P, Li J, Huo Y, Fan F, Zhang Y. Metabolic Syndrome Is Associated With Rapid Estimated Glomerular Filtration Rate Decline In A Chinese Community-Based Population. Diabetes Metab Syndr Obes 2019; 12:2085-2093. [PMID: 31632118 PMCID: PMC6792942 DOI: 10.2147/dmso.s217326] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Accepted: 09/24/2019] [Indexed: 12/15/2022] Open
Abstract
PURPOSE This study aimed to determine the relationship between the metabolic syndrome (MetS) and rapid estimated glomerular filtration rate (eGFR) decline in a Chinese community-based population. PATIENTS AND METHODS A total of 3108 participants were recruited between December 2011 and July 2014 from an observational study cohort designed for the study of atherosclerotic diseases in Beijing, China. The outcome was a rapid eGFR decline. Subgroup and interaction analyses were performed with respect to a number of covariates. RESULTS Over a median follow-up period of 2.34 (IQR: 2.29-2.41) years, the overall incidence of rapid eGFR decline was 7.24%. We found that the MetS was significantly associated with the risk of rapid eGFR decline (odds ratio [OR]=1.69, 95% confidence interval [CI]: 1.28-2.23, p<0.001) in a model adjusted for age, sex, and eGFR, and this relationship remained significant after adjustment for smoking, drinking, and low-density lipoprotein-cholesterol (OR=1.78, 95% CI: 1.34-2.35, p<0.001). Waist circumference (OR=1.38, 95% CI: 1.04-1.83, p=0.027), triglycerides (OR=1.40, 95% CI: 1.05-1.86, p=0.022), blood pressure (OR=2.05, 95% CI: 1.49-2.82, p<0.001), and fasting plasma glucose (OR=2.12, 95% CI: 1.57-2.85, p<0.001), but not high-density lipoprotein-cholesterol (OR=1.26, 95% CI: 0.94-1.69, p=0.117), were positively associated with the risk of rapid eGFR decline. Similarly, an increase in the number of MetS components present was associated with an increase in the risk of rapid eGFR decline. Furthermore, this association was modified by smoking status (OR=3.78, 95% CI: 1.68-8.49, p-interaction=0.030). CONCLUSION The MetS independently predicted rapid eGFR decline in a Chinese community-based cohort recruited for the study of atherosclerosis. The relationship between the MetS and the risk of rapid eGFR decline was modified by smoking status.
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Affiliation(s)
- Zhongli Wu
- Department of Cardiology, Peking University First Hospital, Beijing, People’s Republic of China
| | - Yimeng Jiang
- Department of Cardiology, Peking University First Hospital, Beijing, People’s Republic of China
| | - Jia Jia
- Department of Cardiology, Peking University First Hospital, Beijing, People’s Republic of China
| | - Danmei He
- Department of Cardiology, Peking University First Hospital, Beijing, People’s Republic of China
| | - Pengfei Sun
- Department of Cardiology, Peking University First Hospital, Beijing, People’s Republic of China
| | - Jianping Li
- Department of Cardiology, Peking University First Hospital, Beijing, People’s Republic of China
| | - Yong Huo
- Department of Cardiology, Peking University First Hospital, Beijing, People’s Republic of China
| | - Fangfang Fan
- Department of Cardiology, Peking University First Hospital, Beijing, People’s Republic of China
- Correspondence: Fangfang Fan; Yan Zhang Department of Cardiology, Peking University First Hospital, Beijing100034, People’s Republic of ChinaTel +86 10 8357 5262; +86 10 8357 5728Fax +86 10 6655 1383 Email
| | - Yan Zhang
- Department of Cardiology, Peking University First Hospital, Beijing, People’s Republic of China
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BMI is associated with the development of chronic kidney diseases in hypertensive patients with normal renal function. J Hypertens 2018; 36:2085-2091. [DOI: 10.1097/hjh.0000000000001817] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Satapathy SK, Joglekar K, Molnar MZ, Ali B, Gonzalez HC, Vanatta JM, Eason JD, Nair SP. Achieving Sustained Virological Response in Liver Transplant Recipients With Hepatitis C Decreases Risk of Decline in Renal Function. Liver Transpl 2018; 24:1040-1049. [PMID: 29573131 DOI: 10.1002/lt.25059] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2017] [Revised: 02/28/2018] [Accepted: 03/10/2018] [Indexed: 12/15/2022]
Abstract
The effect of antiviral therapy (AVT) on kidney function in liver transplantation (LT) recipients has not been well described despite known association of hepatitis C virus (HCV) infection with chronic kidney disease (CKD). We compared the incidence of CKD and end-stage renal disease (ESRD) in 204 LT recipients with HCV based on treatment response to AVT. The mean estimated glomerular filtration rate (eGFR) at baseline (3 months after LT) was similar in the sustained virological response (SVR; n = 145) and non-SVR group (n = 59; 69 ± 21 versus 65 ± 33 mL/minute/1.73 m2 ; P = 0.27). In the unadjusted Cox proportional regression analysis, the presence of SVR was associated with an 88% lower risk of CKD (hazard ratio, 0.12; 95% confidence interval [CI], 0.05-0.31) and 86% lower risk of ESRD (odds ratio, 0.14; 95% CI, 0.05-0.35). Similar results were found after adjusting for propensity score and time-dependent Cox regression analyses. The estimated slopes of eGFR based on a 2-stage mixed model of eGFR were calculated. Patients with SVR had a less steep slope in eGFR (-0.60 mL/minute/1.73 m2 /year; 95% CI, -1.50 to 0.30; P = 0.190) than recipients without SVR (-2.53 mL/minute/1.73 m2 /year; 95% CI, -3.99 to -1.07; P = 0.001), and the differences in the slopes were statistically significant (P = 0.026). In conclusion, in LT recipients with chronic HCV infection, achieving SVR significantly lowers the risk of decline in renal function and progression to ESRD independent of the AVT therapy used.
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Affiliation(s)
- Sanjaya K Satapathy
- Division of Transplant Surgery, Methodist University Hospital Transplant Institute, Memphis, TN
- Departments of Surgery, University of Tennessee Health Science Center, Memphis, TN
| | - Kiran Joglekar
- Departments of Medicine, University of Tennessee Health Science Center, Memphis, TN
| | - Miklos Z Molnar
- Division of Transplant Surgery, Methodist University Hospital Transplant Institute, Memphis, TN
- Departments of Surgery, University of Tennessee Health Science Center, Memphis, TN
- Departments of Medicine, University of Tennessee Health Science Center, Memphis, TN
- Department of Transplantation and Surgery, Semmelweis University, Budapest, Hungary
| | - Bilal Ali
- Division of Transplant Surgery, Methodist University Hospital Transplant Institute, Memphis, TN
- Departments of Gastroenterology, University of Tennessee Health Science Center, Memphis, TN
| | - Humberto C Gonzalez
- Division of Transplant Surgery, Methodist University Hospital Transplant Institute, Memphis, TN
- Departments of Surgery, University of Tennessee Health Science Center, Memphis, TN
| | - Jason M Vanatta
- Division of Transplant Surgery, Methodist University Hospital Transplant Institute, Memphis, TN
- Departments of Surgery, University of Tennessee Health Science Center, Memphis, TN
| | - James D Eason
- Division of Transplant Surgery, Methodist University Hospital Transplant Institute, Memphis, TN
- Departments of Surgery, University of Tennessee Health Science Center, Memphis, TN
| | - Satheesh P Nair
- Division of Transplant Surgery, Methodist University Hospital Transplant Institute, Memphis, TN
- Departments of Surgery, University of Tennessee Health Science Center, Memphis, TN
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Fu S, Yao Y, Luan F, Zhao Y. Prevalence of metabolic syndrome risk factors and their relationships with renal function in Chinese centenarians. Sci Rep 2018; 8:9863. [PMID: 29959374 PMCID: PMC6026211 DOI: 10.1038/s41598-018-28316-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Accepted: 06/19/2018] [Indexed: 01/16/2023] Open
Abstract
As the first time, this study was to investigate the prevalence of metabolic syndrome (MetS) risk factors and explore their relationships with renal function in Chinese centenarians. China Hainan Centenarian Cohort Study was performed in 18 cities and counties of Hainan Province. Home interview, physical examination and blood analysis were performed in 874 centenarians following standard procedures. Prevalence of MetS was 15.6% (136 centenarians). There were 229 centenarians with abdominal obesity (26.2%), 645 centenarians (73.8%) with hypertension, 349 centenarians with dyslipidemia (39.9%) and 92 centenarians with diabetes mellitus (10.5%). In multivariate linear regression, age, smoking, waist circumstance (WC), systolic blood pressure (SBP) and triglyceride levels were inversely and diastolic blood pressure (DBP) levels were positively associated with glomerular filtration rate levels (P < 0.05 for all). This study reported low prevalence of MetS risk factors and demonstrated that age, smoking, abdominal obesity (WC), hypertension (SBP and DBP) and triglyceride levels were independently associated with renal function in Chinese centenarians. This study provided reliable data about Chinese centenarians, analyzed significant relationships between Mets risk factors and renal function, and explained possible reason (low prevalence of MetS and its risk factors) and mechanism (interrelationship of age, Mets risk factors with renal function) of longevity.
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Affiliation(s)
- Shihui Fu
- Department of Geriatric Cardiology, Chinese People's Liberation Army General Hospital, Beijing, China.,Department of Cardiology and Hainan Branch, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Yao Yao
- Institute of Geriatrics, Chinese People's Liberation Army General Hospital, Beijing, China.,Beijing Key Laboratory of Aging and Geriatrics, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Fuxin Luan
- Central Laboratory, Hainan Branch of Chinese People's Liberation Army General Hospital, Sanya, China.
| | - Yali Zhao
- Central Laboratory, Hainan Branch of Chinese People's Liberation Army General Hospital, Sanya, China.
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Siméon S, Massy Z, Højlund K, Lalic K, Porcellati F, Dekker J, Petrie J, Currie G, Balkau B. Renal function markers and insulin sensitivity after 3 years in a healthy cohort, the EGIR-RISC study. BMC Nephrol 2018; 19:124. [PMID: 29855339 PMCID: PMC5984396 DOI: 10.1186/s12882-018-0918-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Accepted: 05/14/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND People with chronic renal disease are insulin resistant. We hypothesized that in a healthy population, baseline renal function is associated with insulin sensitivity three years later. METHODS We studied 405 men and 528 women from the European Group for the study of Insulin Resistance - Relationship between Insulin Sensitivity and Cardiovascular disease cohort. Renal function was characterized by the estimated glomerular filtration rate (eGFR) and by the urinary albumin-creatinine ratio (UACR). At baseline only, insulin sensitivity was quantified using a hyperinsulinaemic-euglycaemic clamp; at baseline and three years, we used surrogate measures: the Matsuda insulin sensitivity index (ISI), the HOmeostasis Model Assessment of Insulin Sensitivity (HOMA-IS). Associations between renal function and insulin sensitivity were studied cross-sectionally and longitudinally. RESULTS In men at baseline, no associations were seen with eGFR, but there was some evidence of a positive association with UACR. In women, all insulin sensitivity indices showed the same negative trend across eGFR classes, albeit not always statistically significant; for UACR, women with values above the limit of detection, had higher clamp measured insulin sensitivity than other women. After three years, in men only, ISI and HOMA-IS showed a U-shaped relation with baseline eGFR; women with eGFR> 105 ml/min/1.73m2 had a significantly higher insulin sensitivity than the reference group (eGFR: 90-105 ml/min/1.73m2). For both men and women, year-3 insulin sensitivity was higher in those with higher baseline UACR. All associations were attenuated after adjusting on significant covariates. CONCLUSIONS There was no evidence to support our hypothesis that markers of poorer renal function are associated with declining insulin sensitivity in our healthy population.
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Affiliation(s)
- Soline Siméon
- CESP team5, Faculty of Medicine - University Paris-South, Faculty of Medicine - University Versailles-St Quentin, INSERM U1018, University Paris-Saclay, Villejuif, France
| | - Ziad Massy
- CESP team5, Faculty of Medicine - University Paris-South, Faculty of Medicine - University Versailles-St Quentin, INSERM U1018, University Paris-Saclay, Villejuif, France.,Division of Nephrology, Ambroise Paré Hospital APHP (Z.M.), Boulogne-Billancourt, Paris, France
| | - Kurt Højlund
- Department of Endocrinology (K.H.) Odense University Hospital, DK-5000, Odense, Denmark.,The Section of Molecular Diabetes & Metabolism, Department of Clinical Research and Institute of Molecular Medicine, University of Southern Denmark, DK-5000, Odense, Denmark
| | - Katarina Lalic
- Faculty of Medicine, University of Belgrade, Clinic for Endocrinology, Diabetes and Metabolic Diseases, Belgrade, Serbia
| | - Francesca Porcellati
- Section of Internal Medicine, Endocrinology and Metabolism, Department of Medicine, Perugia University School of Medicine, Perugia, Italy
| | - Jacqueline Dekker
- Department of Epidemiology and Biostatistics, Amsterdam Public Health research institute, VU University Medical Center, Amsterdam, the Netherlands
| | - John Petrie
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, Scotland, UK
| | - Gemma Currie
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, Scotland, UK
| | - Beverley Balkau
- CESP team5, Faculty of Medicine - University Paris-South, Faculty of Medicine - University Versailles-St Quentin, INSERM U1018, University Paris-Saclay, Villejuif, France. .,CESP, INSERM U1018 Equipe 5, 16 Avenue Paul Vaillant Couturier, 94807, Villejuif cedex, France.
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Alizadeh S, Ahmadi M, Ghorbani Nejad B, Djazayeri A, Shab-Bidar S. Metabolic syndrome and its components are associated with increased chronic kidney disease risk: Evidence from a meta-analysis on 11 109 003 participants from 66 studies. Int J Clin Pract 2018; 72:e13201. [PMID: 29790628 DOI: 10.1111/ijcp.13201] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2017] [Accepted: 04/06/2018] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND & AIMS Observational studies examining the relationship between metabolic syndrome and the risk of chronic kidney disease (CKD) have reported inconclusive results. This meta-analysis was performed to resolve these controversies. METHODS The MEDLINE, EMBASE, and PubMed databases were systematically searched from their inception until March 2016 to identify all relevant studies. Risk estimates and their corresponding 95% confidence intervals (CIs) for the associations of MetS and its components with CKD risk were extracted and pooled using a random-effects model. RESULTS A total of 66 studies, including 18 prospective cohorts and 48 cross-sectional studies, with 699 065 CKD patients and 11 109 003 participants were included in the meta-analysis. When all definitions were pooled, the presence of MetS was associated with a significant 50% increase of CKD risk (OR = 1.50, 95% CI = 1.43-1.56), with evidence of moderate heterogeneity (I2 = 72.3%, P < .001). The risk of CKD associated with MetS was higher in studies using the American Heart Association/National Heart, Lung, and Blood Institute criteria (OR = 1.68, 95% CI = 1.25-2.10) compared with those using the Adult Treatment Panel III (OR = 1.49, 95% CI = 1.42-1.56) and the International Diabetes Federation (OR = 1.32, 95% CI = 1.22-1.41) definitions. This relationship was independent of diabetes status. Moreover, all individual components of the MetS were significantly associated with CKD, and their coexistence resulted in an escalating dose-response relationship. The sensitivity and subgroup analyses established the stability of the findings. CONCLUSIONS This meta-analysis strongly suggests that the metabolic syndrome and its components are independently associated with the increased risk of CKD.
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Affiliation(s)
- Shahab Alizadeh
- Department of Cellular and Molecular Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - Mahsa Ahmadi
- Department of Microbiology, Faculty of Basic Sciences, Karaj Branch, Islamic Azad University, Alborz, Iran
| | - Behnam Ghorbani Nejad
- Department of pharmacology, School of Medicine, Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - Abolghassem Djazayeri
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - Sakineh Shab-Bidar
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences (TUMS), Tehran, Iran
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Pathophysiological Links Between Diabetes and Blood Pressure. Can J Cardiol 2018; 34:585-594. [DOI: 10.1016/j.cjca.2018.01.010] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2017] [Revised: 01/08/2018] [Accepted: 01/08/2018] [Indexed: 02/06/2023] Open
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