BACKGROUND A number of recent studies indicate a transformation in the natural course of chronic kidney disease(CKD)in type 2 diabetes(T2D)patients:an increasing prevalence of declined renal function without proceedin...BACKGROUND A number of recent studies indicate a transformation in the natural course of chronic kidney disease(CKD)in type 2 diabetes(T2D)patients:an increasing prevalence of declined renal function without proceeding to the accompanying elevation of albuminuria.It has been suggested that albuminuric and nonalbuminuric CKD patterns could be different in their phenotypes and pathogenic mechanisms.AIM To identify the risk factors and biomarkers of albuminuric and non-albuminuric patterns of CKD in patients with T2D.METHODS Three hundred sixty patients with T2D duration≥10 years were included in this observational cross-sectional study.The associations of a panel of demographic and clinical characteristics,complications,comorbidities,and metabolic and hematology parameters with albuminuric and non-albuminuric CKD patterns were analyzed.The urinary excretion of nephrin and podocin,two podocytespecific markers,and WAP-four-disulfide core domain protein 2(WFDC-2),a marker of tubulointerstitial fibrosis,was determined by ELISA in comparison with healthy controls.RESULTS Non-albuminuric CKD was associated with age≥65 years(P=0.0001),female sex(P=0.04),diabetes duration≥15 years(P=0.0009),and the use of diuretics(P=0.0005).Male sex(P=0.01),smoking(P=0.01),waist-to-hip ratio>1.0(P=0.01)and hemoglobin A1c(HbA1c)>8.0%(P=0.005)were risk factors for elevated albuminuria not accompanied by a decrease in estimated glomerular filtration rate(eGFR).Duration of diabetes≥15 years and the use of calcium channel blockers were risk factors for albuminuria with decreased eGFR(both P=0.01).In multivariate logistic regression analysis,age,HbA1c,female sex and diuretics were significant predictors for reduced eGFR,while waist-to-hip ratio,HbA1c and male sex were associated with elevated urinary albumin-to-creatinine ratio(UACR).Excretion of nephrin and podocin was increased in patients with albuminuria,regardless of decline in renal function(P<0.001),correlating positively with UACR.The urinary excretion of WFDC-2 was markedly higher in men than in women(P<0.000001).Men with T2D demonstrated increased WFDC-2 levels independently of the CKD pattern(all P<0.05).In T2D women,WFDC-2 excretion was increased in those with reduced renal function(P≤0.01),correlating negatively with eGFR.CONCLUSION The data provide further evidence that albuminuric and non-albuminuric CKD phenotypes correspond to different pathways of diabetic kidney disease progression.展开更多
Facing the needs of an increasingly ageing population is rapidly becoming a major public health issue in western countries, Chronic kidney disease （CKD）, whose current prevalence is estimated around 10%-15% in the g...Facing the needs of an increasingly ageing population is rapidly becoming a major public health issue in western countries, Chronic kidney disease （CKD）, whose current prevalence is estimated around 10%-15% in the general population, with considerably higher figures in at-risk groups, is widely known to increase with age. In the elderly, renal impairment is often concomitant or secondary to several other systemic disorders such as hypertension, atherosclerosis,展开更多
In patients with primary hypertension,therapeutic strategies should be based on global cardiovascular risk profile rather than on the severity of blood pressure alone.Accurate assessment of concomitant risk factors an...In patients with primary hypertension,therapeutic strategies should be based on global cardiovascular risk profile rather than on the severity of blood pressure alone.Accurate assessment of concomitant risk factors and especially of the presence and extent of subclinical organ damage is of paramount importance in definingindividual risk.Given the high prevalence of hypertension in the population at large,however,extensive diagnostic evaluation is often impractical or unfeasible in clinical practice.Low cost,easy to use markers of risk are needed to improve the clinical management of patients with hypertension.Early renal abnormalities such as a slight reduction in glomerular filtration rate and/or the presence of microalbuminuria are well known and powerful predictors of cardio-renal morbidity and mortality and provide a useful,low cost tools to optimize cardiovascular risk assessment.A greater use of these tests should therefore be implemented in clinical practice in order to optimize the management of hypertensive patients.展开更多
文摘BACKGROUND A number of recent studies indicate a transformation in the natural course of chronic kidney disease(CKD)in type 2 diabetes(T2D)patients:an increasing prevalence of declined renal function without proceeding to the accompanying elevation of albuminuria.It has been suggested that albuminuric and nonalbuminuric CKD patterns could be different in their phenotypes and pathogenic mechanisms.AIM To identify the risk factors and biomarkers of albuminuric and non-albuminuric patterns of CKD in patients with T2D.METHODS Three hundred sixty patients with T2D duration≥10 years were included in this observational cross-sectional study.The associations of a panel of demographic and clinical characteristics,complications,comorbidities,and metabolic and hematology parameters with albuminuric and non-albuminuric CKD patterns were analyzed.The urinary excretion of nephrin and podocin,two podocytespecific markers,and WAP-four-disulfide core domain protein 2(WFDC-2),a marker of tubulointerstitial fibrosis,was determined by ELISA in comparison with healthy controls.RESULTS Non-albuminuric CKD was associated with age≥65 years(P=0.0001),female sex(P=0.04),diabetes duration≥15 years(P=0.0009),and the use of diuretics(P=0.0005).Male sex(P=0.01),smoking(P=0.01),waist-to-hip ratio>1.0(P=0.01)and hemoglobin A1c(HbA1c)>8.0%(P=0.005)were risk factors for elevated albuminuria not accompanied by a decrease in estimated glomerular filtration rate(eGFR).Duration of diabetes≥15 years and the use of calcium channel blockers were risk factors for albuminuria with decreased eGFR(both P=0.01).In multivariate logistic regression analysis,age,HbA1c,female sex and diuretics were significant predictors for reduced eGFR,while waist-to-hip ratio,HbA1c and male sex were associated with elevated urinary albumin-to-creatinine ratio(UACR).Excretion of nephrin and podocin was increased in patients with albuminuria,regardless of decline in renal function(P<0.001),correlating positively with UACR.The urinary excretion of WFDC-2 was markedly higher in men than in women(P<0.000001).Men with T2D demonstrated increased WFDC-2 levels independently of the CKD pattern(all P<0.05).In T2D women,WFDC-2 excretion was increased in those with reduced renal function(P≤0.01),correlating negatively with eGFR.CONCLUSION The data provide further evidence that albuminuric and non-albuminuric CKD phenotypes correspond to different pathways of diabetic kidney disease progression.
文摘Facing the needs of an increasingly ageing population is rapidly becoming a major public health issue in western countries, Chronic kidney disease （CKD）, whose current prevalence is estimated around 10%-15% in the general population, with considerably higher figures in at-risk groups, is widely known to increase with age. In the elderly, renal impairment is often concomitant or secondary to several other systemic disorders such as hypertension, atherosclerosis,
文摘In patients with primary hypertension,therapeutic strategies should be based on global cardiovascular risk profile rather than on the severity of blood pressure alone.Accurate assessment of concomitant risk factors and especially of the presence and extent of subclinical organ damage is of paramount importance in definingindividual risk.Given the high prevalence of hypertension in the population at large,however,extensive diagnostic evaluation is often impractical or unfeasible in clinical practice.Low cost,easy to use markers of risk are needed to improve the clinical management of patients with hypertension.Early renal abnormalities such as a slight reduction in glomerular filtration rate and/or the presence of microalbuminuria are well known and powerful predictors of cardio-renal morbidity and mortality and provide a useful,low cost tools to optimize cardiovascular risk assessment.A greater use of these tests should therefore be implemented in clinical practice in order to optimize the management of hypertensive patients.
