Type 1 diabetes mellitus(T1DM)is one of the important causes of chronic kidney disease(CKD)and end-stage renal failure(ESRF).Even with the best available treatment options,management of T1DM poses significant challeng...Type 1 diabetes mellitus(T1DM)is one of the important causes of chronic kidney disease(CKD)and end-stage renal failure(ESRF).Even with the best available treatment options,management of T1DM poses significant challenges for clinicians across the world,especially when associated with CKD and ESRF.Substantial increases in morbidity and mortality along with marked rise in treatment costs and marked reduction of quality of life are the usual consequences of onset of CKD and progression to ESRF in patients with T1DM.Simultaneous pancreas-kidney transplant(SPK)is an attractive and promising treatment option for patients with advanced CKD/ESRF and T1DM for potential cure of these diseases and possibly several complications.However,limited availability of the organs for transplantation,the need for long-term immunosuppression to prevent rejection,peri-and post-operative complications of SPK,lack of resources and the expertise for the procedure in many centers,and the cost implications related to the surgery and postoperative care of these patients are major issues faced by clinicians across the globe.This clinical update review compiles the latest evidence and current recommendations of SPK for patients with T1DM and advanced CKD/ESRF to enable clinicians to care for these diseases.展开更多
Diabetic muscle infarction(DMI) refers to spontaneous ischemic necrosis of skeletal muscle among people with diabetes mellitus, unrelated to arterial occlusion. People with DMI may have coexisting end-stage renal dise...Diabetic muscle infarction(DMI) refers to spontaneous ischemic necrosis of skeletal muscle among people with diabetes mellitus, unrelated to arterial occlusion. People with DMI may have coexisting end-stage renal disease(ESRD) but little is known about its epidemiology and clinical outcomes in this setting. This scoping review seeks to investigate the characteristics, clinical features, diagnostic evaluation, management and outcomes of DMI among people with ESRD. Electronic database (Pub Med/MEDLINE, CINAHL, SCOPUS and and EMBASE) searches were conducted for ("diabetic muscle infarction" or "diabetic myonecrosis") and("chronic kidney disease" or "renal impairment" or "dialysis" or "renal replacement therapy" or "kidney transplant ") from January 1980 to June 2017. Relevant cases from reviewed bibliographies in reports retrieved were also included. Data were extracted in a standardized form. A total of 24 publications with 41 patients who have ESRD were included. The mean age at the time of presentation with DMI was 44.2 years. Type 2 diabetes was present in 53.7% of patients while type 1 in 41.5%. In this cohort, 60.1% were receiving hemodialysis, 21% on peritoneal dialysis and 12.2% had kidney transplantation. The proximal lower limb musculature was the most commonly affected site. Muscle pain and swelling were the most frequent manifestation on presentation. Magnetic resonance imaging (MRI) provided the most specific findings for DMI. Laboratory investigation findings are usually non-specific. Non-surgical therapy is usually used in the management of DMI. Short-term prognosis of DMI is good but recurrence occurred in 43.9%. DMI is an uncommon complication in patients with diabetes mellitus, including those affected by ESRD. In comparison with unselected patients with DMI, the characteristics and outcomes of those with ESRD are generally similar. DMI may also occur inkidney transplant recipients, including pancreas-kidney transplantation. MRI is the most useful diagnostic investigation. Non-surgical treatment involving analgesia, optimization of glycemic control and initial bed rest can help to improve recovery rate. However, recurrence of DMI is relatively frequent.展开更多
Diabetic Kidney Disease (DKD) is a common chronic complication of diabetes. Despite advancements in accurately identifying biomarkers for detecting and diagnosing this harmful disease, there remains an urgent need for...Diabetic Kidney Disease (DKD) is a common chronic complication of diabetes. Despite advancements in accurately identifying biomarkers for detecting and diagnosing this harmful disease, there remains an urgent need for new biomarkers to enable early detection of DKD. In this study, we modeled publicly available transcriptome datasets as a graph problem and used GraphSAGE Neural Networks (GNNs) to identify potential biomarkers. The GraphSAGE model effectively learned representations that captured the intricate interactions, dependencies among genes, and disease-specific gene expression patterns necessary to classify samples as DKD and Control. We finally extracted the features of importance;the identified set of genes exhibited an impressive ability to distinguish between healthy and unhealthy samples, even though these genes differ from previous research findings. The unexpected biomarker variations in this study suggest more exploration and validation studies for discovering biomarkers in DKD. In conclusion, our study showcases the effectiveness of modeling transcriptome data as a graph problem, demonstrates the use of GraphSAGE models for biomarker discovery in DKD, and advocates for integrating advanced machine-learning techniques in DKD biomarker research, emphasizing the need for a holistic approach to unravel the intricacies of biological systems.展开更多
Objective Modified upper abdominal cluster transplantation ( MCT) ,which was inspired by classical cluster transplant technique,has been proven more effective and feasible in the treatment of patients with end stage l...Objective Modified upper abdominal cluster transplantation ( MCT) ,which was inspired by classical cluster transplant technique,has been proven more effective and feasible in the treatment of patients with end stage liver diseases associated with insulin - dependent展开更多
BACKGROUND The genetic backgrounds of diabetic kidney disease(DKD)and end-stage kidney disease(ESKD)have not been fully elucidated.AIM To examine the individual and cumulative effects of single-nucleotide polymorphism...BACKGROUND The genetic backgrounds of diabetic kidney disease(DKD)and end-stage kidney disease(ESKD)have not been fully elucidated.AIM To examine the individual and cumulative effects of single-nucleotide polymorphisms(SNPs)previously associated with DKD on the risk for ESKD of diabetic etiology and to determine if any associations observed were specific for DKD.METHODS Fourteen SNPs were genotyped in hemodialyzed 136 patients with diabetic ESKD(DKD group)and 121 patients with non-diabetic ESKD(NDKD group).Patients were also re-classified on the basis of the primary cause of chronic kidney disease(CKD).The distribution of alleles was compared between diabetic and nondiabetic groups as well as between different sub-phenotypes.The weighted multilocus genetic risk score(GRS)was calculated to estimate the cumulative risk conferred by all SNPs.The GRS distribution was then compared between the DKD and NDKD groups as well as in the groups according to the primary cause of CKD.RESULTS One SNP(rs841853;SLC2A1)showed a nominal association with DKD(P=0.048;P>0.05 after Bonferroni correction).The GRS was higher in the DKD group(0.615±0.260)than in the NDKD group(0.590±0.253),but the difference was not significant(P=0.46).The analysis of associations between GRS and individual factors did not show any significant correlation.However,the GRS was significantly higher in patients with glomerular disease than in those with tubulointerstitial disease(P=0.014)and in those with a combined group(tubulointerstitial,vascular,and cystic and congenital disease)(P=0.018).CONCLUSION Our results suggest that selected SNPs that were previously associated with DKD may not be specific for DKD and may confer risk for CKD of different etiology,particularly those affecting renal glomeruli.展开更多
Diabetic kidney disease is a leading cause of end-stage renal disease,making it a global public health concern.The molecular mechanisms underlying diabetic kidney disease have not been elucidated due to its complex pa...Diabetic kidney disease is a leading cause of end-stage renal disease,making it a global public health concern.The molecular mechanisms underlying diabetic kidney disease have not been elucidated due to its complex pathogenesis.Thus,exploring these mechanisms from new perspectives is the current focus of research concerning diabetic kidney disease.lon channels are important proteins that maintain the physiological functions of cells and organs.Among ion channels,potassium channels stand out,because they are the most common and important channels on eukaryotic cell surfaces and function as the basis for cell excitability.Certain potassium channel abnormalities have been found to be closely related to diabetic kid-ney disease progression and genetic susceptibility,such as K_(ATP),K_(ca),K_(ir),and K_(v).In this review,we summarized the roles of different types of potassium channels in the occurrence and devel-opment of diabetic kidney disease to discuss whether the development of DKD is due to potas-sium channel dysfunction and present new ideas for the treatment of DKD.展开更多
BACKGROUND The risk of early mortality of patients who start dialysis urgently is high;however,in patients with diabetes undergoing urgent-start peritoneal dialysis(USPD),the risk of,and risk factors for,early mortali...BACKGROUND The risk of early mortality of patients who start dialysis urgently is high;however,in patients with diabetes undergoing urgent-start peritoneal dialysis(USPD),the risk of,and risk factors for,early mortality are unknown.AIM To identify risk factors for mortality during high-risk periods in patients with diabetes undergoing USPD.METHODS This retrospective cohort study enrolled 568 patients with diabetes,aged≥18 years,who underwent USPD at one of five Chinese centers between 2013 and 2019.We divided the follow-up period into two survival phases:The first 6 mo of USPD therapy and the months thereafter.We compared demographic and baseline clinical data of living and deceased patients during each period.Kaplan-Meier survival curves were generated for all-cause mortality according to the New York Heart Association(NYHA)classification.A multivariate Cox proportional hazard regression model was used to identify risk factors for mortality within the first 6 mo and after 6 mo of USPD.RESULTS Forty-one patients died within the first 6 mo,accounting for the highest proportion of mortalities(26.62%)during the entire follow-up period.Cardiovascular disease was the leading cause of mortality within 6 mo(26.83%)and after 6 mo(31.86%).The risk of mortality not only within the first 6 mo but also after the first 6 mo was higher for patients with obvious baseline heart failure symptoms than for those with mild or no heart failure symptoms.Independent risk factors for mortality within the first 6 mo were advanced age hazard ratio(HR:1.908;95%CI:1.400-2.600;P<0.001),lower baseline serum creatinine level(HR:0.727;95%CI:0.614-0.860;P<0.001),higher baseline serum phosphorus level(HR:3.162;95%CI:1.848-5.409;P<0.001),and baseline NYHA class III-IV(HR:2.148;95%CI:1.063-4.340;P=0.033).Independent risk factors for mortality after 6 mo were advanced age(HR:1.246;95%CI:1.033-1.504;P=0.022)and baseline NYHA class III-IV(HR:2.015;95%CI:1.298-3.130;P=0.002).CONCLUSION To reduce the risk of mortality within the first 6 mo of USPD in patients with diabetes,controlling the serum phosphorus level and improving cardiac function are recommended。展开更多
Objectives To study the change in plasma hemoglobin concentration in elderly patients with primary hypertension and/or type 2 diabetes complicated with end-stage renal disease （ESRD） determined by estimated glomerul...Objectives To study the change in plasma hemoglobin concentration in elderly patients with primary hypertension and/or type 2 diabetes complicated with end-stage renal disease （ESRD） determined by estimated glomerular filtration rate. Methods Two hundred and thirty cases of Chinese patients aged 60 years or older with primary hypertension and/or type 2 diabetes complicated with chronic kidney disease were enrolled in the study. Patients with chronic kidney disease were divided into ESRD group with estimated glomemlar filtration rate less than 15 mL . min^-1.1.73 m^-2 （7.80 ± 3. 14 mL. min^-1 . 1.73 m^-2） and non-ESRD group with estimated glomerular filtration rate 15 mL.min^-1 . 1.73 m^-2（29. 76 ± 12. 90 mL.min^-1 . 1.73 m^-2） or higher. The plasma hemoglobin concentration was compared between the above two groups retrospectively. Results There was significant decrease in plasma hemoglobin concentration in ESRD group compared with non-ESRD group （74.4 ± 22. 5 g/L vs 100. 8 ± 23.0 g/L, P 〈 0. 05 ）. After stratification by sex, there was also significant decrease in plasma hemoglobin concentration both in male and female of ESRD groups compared with their respective non-ESRD groups（77. 2±22. 0 g/L vs 104. 9 ±20. 7 g/L; 69. 7 ±22. 8 g/L vs 96.4± 24.8 g/L, P 〈 0. 05, respectively）. Plasma hemoglobin concentration was positively related to estimated glomerular filtration rate significantly in patients with ESRD （ P 〈 0. 05 ）. Conclusions Plasma hemoglobin concentration is decreased significantly, and is positively related to estimated glomerular filtration rate significantly in elderly patients with primary hypertension and/or type 2 diabetes complicated with ESRD determined by estimated glomerular filtration rate.展开更多
文摘Type 1 diabetes mellitus(T1DM)is one of the important causes of chronic kidney disease(CKD)and end-stage renal failure(ESRF).Even with the best available treatment options,management of T1DM poses significant challenges for clinicians across the world,especially when associated with CKD and ESRF.Substantial increases in morbidity and mortality along with marked rise in treatment costs and marked reduction of quality of life are the usual consequences of onset of CKD and progression to ESRF in patients with T1DM.Simultaneous pancreas-kidney transplant(SPK)is an attractive and promising treatment option for patients with advanced CKD/ESRF and T1DM for potential cure of these diseases and possibly several complications.However,limited availability of the organs for transplantation,the need for long-term immunosuppression to prevent rejection,peri-and post-operative complications of SPK,lack of resources and the expertise for the procedure in many centers,and the cost implications related to the surgery and postoperative care of these patients are major issues faced by clinicians across the globe.This clinical update review compiles the latest evidence and current recommendations of SPK for patients with T1DM and advanced CKD/ESRF to enable clinicians to care for these diseases.
文摘Diabetic muscle infarction(DMI) refers to spontaneous ischemic necrosis of skeletal muscle among people with diabetes mellitus, unrelated to arterial occlusion. People with DMI may have coexisting end-stage renal disease(ESRD) but little is known about its epidemiology and clinical outcomes in this setting. This scoping review seeks to investigate the characteristics, clinical features, diagnostic evaluation, management and outcomes of DMI among people with ESRD. Electronic database (Pub Med/MEDLINE, CINAHL, SCOPUS and and EMBASE) searches were conducted for ("diabetic muscle infarction" or "diabetic myonecrosis") and("chronic kidney disease" or "renal impairment" or "dialysis" or "renal replacement therapy" or "kidney transplant ") from January 1980 to June 2017. Relevant cases from reviewed bibliographies in reports retrieved were also included. Data were extracted in a standardized form. A total of 24 publications with 41 patients who have ESRD were included. The mean age at the time of presentation with DMI was 44.2 years. Type 2 diabetes was present in 53.7% of patients while type 1 in 41.5%. In this cohort, 60.1% were receiving hemodialysis, 21% on peritoneal dialysis and 12.2% had kidney transplantation. The proximal lower limb musculature was the most commonly affected site. Muscle pain and swelling were the most frequent manifestation on presentation. Magnetic resonance imaging (MRI) provided the most specific findings for DMI. Laboratory investigation findings are usually non-specific. Non-surgical therapy is usually used in the management of DMI. Short-term prognosis of DMI is good but recurrence occurred in 43.9%. DMI is an uncommon complication in patients with diabetes mellitus, including those affected by ESRD. In comparison with unselected patients with DMI, the characteristics and outcomes of those with ESRD are generally similar. DMI may also occur inkidney transplant recipients, including pancreas-kidney transplantation. MRI is the most useful diagnostic investigation. Non-surgical treatment involving analgesia, optimization of glycemic control and initial bed rest can help to improve recovery rate. However, recurrence of DMI is relatively frequent.
文摘Diabetic Kidney Disease (DKD) is a common chronic complication of diabetes. Despite advancements in accurately identifying biomarkers for detecting and diagnosing this harmful disease, there remains an urgent need for new biomarkers to enable early detection of DKD. In this study, we modeled publicly available transcriptome datasets as a graph problem and used GraphSAGE Neural Networks (GNNs) to identify potential biomarkers. The GraphSAGE model effectively learned representations that captured the intricate interactions, dependencies among genes, and disease-specific gene expression patterns necessary to classify samples as DKD and Control. We finally extracted the features of importance;the identified set of genes exhibited an impressive ability to distinguish between healthy and unhealthy samples, even though these genes differ from previous research findings. The unexpected biomarker variations in this study suggest more exploration and validation studies for discovering biomarkers in DKD. In conclusion, our study showcases the effectiveness of modeling transcriptome data as a graph problem, demonstrates the use of GraphSAGE models for biomarker discovery in DKD, and advocates for integrating advanced machine-learning techniques in DKD biomarker research, emphasizing the need for a holistic approach to unravel the intricacies of biological systems.
文摘Objective Modified upper abdominal cluster transplantation ( MCT) ,which was inspired by classical cluster transplant technique,has been proven more effective and feasible in the treatment of patients with end stage liver diseases associated with insulin - dependent
基金Supported by Ministry of Science and Higher Education Grant,No.171/12.
文摘BACKGROUND The genetic backgrounds of diabetic kidney disease(DKD)and end-stage kidney disease(ESKD)have not been fully elucidated.AIM To examine the individual and cumulative effects of single-nucleotide polymorphisms(SNPs)previously associated with DKD on the risk for ESKD of diabetic etiology and to determine if any associations observed were specific for DKD.METHODS Fourteen SNPs were genotyped in hemodialyzed 136 patients with diabetic ESKD(DKD group)and 121 patients with non-diabetic ESKD(NDKD group).Patients were also re-classified on the basis of the primary cause of chronic kidney disease(CKD).The distribution of alleles was compared between diabetic and nondiabetic groups as well as between different sub-phenotypes.The weighted multilocus genetic risk score(GRS)was calculated to estimate the cumulative risk conferred by all SNPs.The GRS distribution was then compared between the DKD and NDKD groups as well as in the groups according to the primary cause of CKD.RESULTS One SNP(rs841853;SLC2A1)showed a nominal association with DKD(P=0.048;P>0.05 after Bonferroni correction).The GRS was higher in the DKD group(0.615±0.260)than in the NDKD group(0.590±0.253),but the difference was not significant(P=0.46).The analysis of associations between GRS and individual factors did not show any significant correlation.However,the GRS was significantly higher in patients with glomerular disease than in those with tubulointerstitial disease(P=0.014)and in those with a combined group(tubulointerstitial,vascular,and cystic and congenital disease)(P=0.018).CONCLUSION Our results suggest that selected SNPs that were previously associated with DKD may not be specific for DKD and may confer risk for CKD of different etiology,particularly those affecting renal glomeruli.
基金supported by the National Natural Science Foundation of China(No.82070745 to J.G.)the Science and Technology Research Project of Henan Province,China(No.202102310051,182102310571to J.G.)the Innovation Scientists and Technicians Troop Construction Projects of Henan Province,China(No.182101510002 to Z.L.).
文摘Diabetic kidney disease is a leading cause of end-stage renal disease,making it a global public health concern.The molecular mechanisms underlying diabetic kidney disease have not been elucidated due to its complex pathogenesis.Thus,exploring these mechanisms from new perspectives is the current focus of research concerning diabetic kidney disease.lon channels are important proteins that maintain the physiological functions of cells and organs.Among ion channels,potassium channels stand out,because they are the most common and important channels on eukaryotic cell surfaces and function as the basis for cell excitability.Certain potassium channel abnormalities have been found to be closely related to diabetic kid-ney disease progression and genetic susceptibility,such as K_(ATP),K_(ca),K_(ir),and K_(v).In this review,we summarized the roles of different types of potassium channels in the occurrence and devel-opment of diabetic kidney disease to discuss whether the development of DKD is due to potas-sium channel dysfunction and present new ideas for the treatment of DKD.
基金Supported by Jilin Province Health and Technology Innovation Development Program Funded Project,No. 2018FP031
文摘BACKGROUND The risk of early mortality of patients who start dialysis urgently is high;however,in patients with diabetes undergoing urgent-start peritoneal dialysis(USPD),the risk of,and risk factors for,early mortality are unknown.AIM To identify risk factors for mortality during high-risk periods in patients with diabetes undergoing USPD.METHODS This retrospective cohort study enrolled 568 patients with diabetes,aged≥18 years,who underwent USPD at one of five Chinese centers between 2013 and 2019.We divided the follow-up period into two survival phases:The first 6 mo of USPD therapy and the months thereafter.We compared demographic and baseline clinical data of living and deceased patients during each period.Kaplan-Meier survival curves were generated for all-cause mortality according to the New York Heart Association(NYHA)classification.A multivariate Cox proportional hazard regression model was used to identify risk factors for mortality within the first 6 mo and after 6 mo of USPD.RESULTS Forty-one patients died within the first 6 mo,accounting for the highest proportion of mortalities(26.62%)during the entire follow-up period.Cardiovascular disease was the leading cause of mortality within 6 mo(26.83%)and after 6 mo(31.86%).The risk of mortality not only within the first 6 mo but also after the first 6 mo was higher for patients with obvious baseline heart failure symptoms than for those with mild or no heart failure symptoms.Independent risk factors for mortality within the first 6 mo were advanced age hazard ratio(HR:1.908;95%CI:1.400-2.600;P<0.001),lower baseline serum creatinine level(HR:0.727;95%CI:0.614-0.860;P<0.001),higher baseline serum phosphorus level(HR:3.162;95%CI:1.848-5.409;P<0.001),and baseline NYHA class III-IV(HR:2.148;95%CI:1.063-4.340;P=0.033).Independent risk factors for mortality after 6 mo were advanced age(HR:1.246;95%CI:1.033-1.504;P=0.022)and baseline NYHA class III-IV(HR:2.015;95%CI:1.298-3.130;P=0.002).CONCLUSION To reduce the risk of mortality within the first 6 mo of USPD in patients with diabetes,controlling the serum phosphorus level and improving cardiac function are recommended。
基金supported by the medical science & technology research fund of Health Bureau of Chongqing City, China(No.2004(53)04-2-154)the natural science research fund of Chongqing Science & Technology Commission in Chongqing City, China(No.CSTC,2007BB5276)
文摘Objectives To study the change in plasma hemoglobin concentration in elderly patients with primary hypertension and/or type 2 diabetes complicated with end-stage renal disease （ESRD） determined by estimated glomerular filtration rate. Methods Two hundred and thirty cases of Chinese patients aged 60 years or older with primary hypertension and/or type 2 diabetes complicated with chronic kidney disease were enrolled in the study. Patients with chronic kidney disease were divided into ESRD group with estimated glomemlar filtration rate less than 15 mL . min^-1.1.73 m^-2 （7.80 ± 3. 14 mL. min^-1 . 1.73 m^-2） and non-ESRD group with estimated glomerular filtration rate 15 mL.min^-1 . 1.73 m^-2（29. 76 ± 12. 90 mL.min^-1 . 1.73 m^-2） or higher. The plasma hemoglobin concentration was compared between the above two groups retrospectively. Results There was significant decrease in plasma hemoglobin concentration in ESRD group compared with non-ESRD group （74.4 ± 22. 5 g/L vs 100. 8 ± 23.0 g/L, P 〈 0. 05 ）. After stratification by sex, there was also significant decrease in plasma hemoglobin concentration both in male and female of ESRD groups compared with their respective non-ESRD groups（77. 2±22. 0 g/L vs 104. 9 ±20. 7 g/L; 69. 7 ±22. 8 g/L vs 96.4± 24.8 g/L, P 〈 0. 05, respectively）. Plasma hemoglobin concentration was positively related to estimated glomerular filtration rate significantly in patients with ESRD （ P 〈 0. 05 ）. Conclusions Plasma hemoglobin concentration is decreased significantly, and is positively related to estimated glomerular filtration rate significantly in elderly patients with primary hypertension and/or type 2 diabetes complicated with ESRD determined by estimated glomerular filtration rate.
