scholarly journals Renoprotective Effects of the Dipeptidyl Peptidase-4 Inhibitor Sitagliptin: A Review in Type 2 Diabetes

2017 ◽  
Vol 2017 ◽  
pp. 1-14 ◽  
Author(s):  
Cristina Mega ◽  
Edite Teixeira-de-Lemos ◽  
Rosa Fernandes ◽  
Flávio Reis
Keyword(s):  
Type 2 Diabetes ◽  
Current Knowledge ◽  
Diabetic Patients ◽  
Dipeptidyl Peptidase 4 ◽  
Dipeptidyl Peptidase 4 Inhibitor ◽  
Increased Risk ◽  
Long Time ◽  
Stage Renal Disease ◽  
End Stage

Diabetic nephropathy (DN) is now the single commonest cause of end-stage renal disease (ESRD) worldwide and one of the main causes of death in diabetic patients. It is also acknowledged as an independent risk factor for cardiovascular disease (CVD). Since sitagliptin was approved, many studies have been carried out revealing its ability to not only improve metabolic control but also ameliorate dysfunction in various diabetes-targeted organs, especially the kidney, due to putative underlying cytoprotective properties, namely, its antiapoptotic, antioxidant, anti-inflammatory, and antifibrotic properties. Despite overall recommendations, many patients spend a long time well outside the recommended glycaemic range and, therefore, have an increased risk for developing micro- and macrovascular complications. Currently, it is becoming clearer that type 2 diabetes mellitus (T2DM) management must envision not only the improvement in glycaemic control but also, and particularly, the prevention of pancreatic deterioration and the evolution of complications, such as DN. This review aims to provide an overview of the current knowledge in the field of renoprotective actions of sitagliptin, namely, improvement in diabetic dysmetabolism, hemodynamic factors, renal function, diabetic kidney lesions, and cytoprotective properties.

scholarly journals Association of Short Stature with An Increased Risk of End-Stage Renal Disease in Type 2 Diabetic Patients: A Nationwide Population-Based Cohort Study

2019 ◽  
Author(s):  
Yu Ah Hong ◽  
Kyung-Do Han ◽  
Jae-Seung Yun ◽  
Eun Sil Koh ◽  
Seung-Hyun Ko ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Short Stature ◽  
End Stage Renal Disease ◽  
Adult Height ◽  
Diabetic Patients ◽  
Increased Risk ◽  
All Cause Mortality ◽  
Stage Renal Disease ◽  
End Stage

Short stature has been associated with increased various disease and all-cause death, but no reliable data exist the association between height and end-stage renal disease (ESRD) in diabetic patients. We investigated the relationship between short stature, development of ESRD, and mortality in type 2 diabetes. This study analyzed clinical data using the National Health Insurance Database in Korea. Height was stratified by five groups according to age and sex. Risk of ESRD and all-cause mortality was analyzed with Cox proportional hazards models. During a 6.9-year follow-up period, 220,457 subjects (8.4%) died and 28,704 subjects (1.1%) started dialysis. Short stature significantly increased the incidence of ESRD and all-cause mortality in the overall cohort analysis. In multivariable analysis, hazard ratios (HR) for development of ESRD comparing the highest versus lowest quartiles of adult height were 0.86 (95% confidence interval (CI), 0.83–0.89). All-cause mortality also decreased with highest height compared to patients with lowest height after fully adjusting for confounding variables (HR 0.79, 95% CI, 0.78–0.81). Adult height had an inverse relationship with newly diagnosed ESRD and all-cause in both males and females. Short stature is strongly associated with an increased risk of ESRD and all-cause mortality in type 2 diabetes.

scholarly journals Optimal Early Diagnosis and Monitoring of Diabetic Kidney Disease in Type 2 Diabetes Mellitus: Addressing the Barriers to Albuminuria Testing

2021 ◽  
Vol 12 ◽  
pp. 215013272110036
Author(s):  
Elena A. Christofides ◽  
Niraj Desai
Keyword(s):  
Type 2 Diabetes ◽  
Kidney Disease ◽  
Diabetic Kidney Disease ◽  
Urine Albumin ◽  
Increased Risk ◽  
Ckd Stage ◽  
Stage Renal Disease ◽  
End Stage ◽  
Kidney Health

Chronic kidney disease (CKD) in patients with type 2 diabetes (T2D) is associated with increased risk of end-stage renal disease (ESRD) and cardiovascular disease (CVD). Urine albumin-to-creatinine ratio (UACR) is a sensitive and early indicator of kidney damage, which should be used routinely to accurately assess CKD stage and monitor kidney health. However, this test currently is performed in only a minority of patients with T2D. Here, we review the importance of albuminuria testing and current barriers that hinder patient access to UACR testing and describe solutions to such testing in a community clinical setting.

scholarly journals Solidified glomerulosclerosis, identified using single glomerular proteomics, predicts end-stage renal disease in Chinese patients with type 2 diabetes

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Lijun Zhao ◽  
Fang Liu ◽  
Lin Li ◽  
Junlin Zhang ◽  
Tingli Wang ◽  
...  
Keyword(s):  
Risk Factors ◽  
Type 2 Diabetes ◽  
Renal Disease ◽  
End Stage Renal Disease ◽  
Chinese Patients ◽  
Prognostic Indicators ◽  
Diabetic Patients ◽  
Stage Renal Disease ◽  
End Stage

AbstractFew histological prognostic indicators for end-stage renal disease (ESRD) have been validated in diabetic patients. This biopsy-based study aimed to identify nephropathological risk factors for ESRD in Chinese patients with type 2 diabetes. Histological features of 322 Chinese type 2 diabetic patients with biopsy-confirmed diabetic nephropathy (DN) were retrospectively analysed. Cox proportional hazards analysis was used to estimate the hazard ratio (HR) for ESRD. Single glomerular proteomics and immunohistochemistry were used to identify differentially expressed proteins and enriched pathways in glomeruli. During the median follow-up period of 24 months, 144 (45%) patients progressed to ESRD. In multivariable models, the Renal Pathology Society classification failed to predict ESRD, although the solidified glomerulosclerosis (score 1: HR 1.65, 95% confidence interval [CI] 1.04–2.60; score 2: HR 2.48, 95% CI 1.40–4.37) and extracapillary hypercellularity (HR 2.68, 95% CI 1.55–4.62) were identified as independent risk factors. Additionally, single glomerular proteomics, combined with immunohistochemistry, revealed that complement C9 and apolipoprotein E were highly expressed in solidified glomerulosclerosis. Therefore, solidified glomerulosclerosis and extracapillary hypercellularity predict diabetic ESRD in Chinese patients. Single glomerular proteomics identified solidified glomerulosclerosis as a unique pathological change that may be associated with complement overactivation and abnormal lipid metabolism.

scholarly journals Effects of Incretin-Related Diabetes Drugs on Bone Formation and Bone Resorption

2021 ◽  
Vol 22 (12) ◽  
pp. 6578
Author(s):  
Hideki Kitaura ◽  
Saika Ogawa ◽  
Fumitoshi Ohori ◽  
Takahiro Noguchi ◽  
Aseel Marahleh ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Bone Resorption ◽  
Bone Formation ◽  
Current Knowledge ◽  
Osteoclast Differentiation ◽  
Glucose Absorption ◽  
Dipeptidyl Peptidase 4 ◽  
Increased Risk ◽  
Glucagon Like Peptide 1

Patients with type 2 diabetes have an increased risk of fracture compared to the general population. Glucose absorption is accelerated by incretin hormones, which induce insulin secretion from the pancreas. The level of the incretin hormone, glucagon-like peptide-1 (GLP-1), shows an immediate postprandial increase, and the circulating level of intact GLP-1 is reduced rapidly by dipeptidyl peptidase-4 (DPP-4)-mediated inactivation. Therefore, GLP-1 receptor agonists and DPP-4 inhibitors are effective in the treatment of type 2 diabetes. However, these incretin-related diabetic agents have been reported to affect bone metabolism, including bone formation and resorption. These agents enhance the expression of bone markers, and have been applied to improve bone quality and bone density. In addition, they have been reported to suppress chronic inflammation and reduce the levels of inflammatory cytokine expression. Previously, we reported that these incretin-related agents inhibited both the expression of inflammatory cytokines and inflammation-induced bone resorption. This review presents an overview of current knowledge regarding the effects of incretin-related diabetes drugs on osteoblast differentiation and bone formation as well as osteoclast differentiation and bone resorption. The mechanisms by which incretin-related diabetes drugs regulate bone formation and bone resorption are also discussed.

scholarly journals Short adult height increases the risk of end-stage renal disease in type 2 diabetes

2020 ◽  
Vol 9 (9) ◽  
pp. 912-921
Author(s):  
Yu Ah Hong ◽  
Kyung-Do Han ◽  
Jae-Seung Yun ◽  
Eun Sil Sil ◽  
Seung-Hyun Ko ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Renal Disease ◽  
End Stage Renal Disease ◽  
Adult Height ◽  
Diabetic Patients ◽  
Type 2 Dm ◽  
All Cause Mortality ◽  
Stage Renal Disease ◽  
End Stage

Objective: Although short adult height has been associated with an increasing variety of diseases and all-cause death, no reliable data exist on the association between adult height and end-stage renal disease (ESRD) in diabetic patients. We investigated the relationship between short adult height, development of ESRD, and mortality in type 2 diabetes mellitus (DM). Methods: This nationwide population-based cohort study analyzed clinical data from a total of 2,621,907 subjects aged ≥30 years with type 2 DM between January 1, 2009 and December 31, 2012, using the National Health Insurance Database in Korea. Results: During a 6.9-year follow-up period, 220,457 subjects (8.4%) died, and 28,704 subjects (1.1%) started dialysis. Short adult height significantly increased the incidence of ESRD and all-cause mortality in the overall cohort analysis. In multivariable Cox models, hazard ratios (HR) for the development of ESRD comparing the highest and lowest quartiles of adult height were 0.86 (95% CI 0.83–0.89). All-cause mortality also decreased with the highest height compared to patients with the lowest height, after fully adjusting for confounding variables (HR 0.79, 95% CI 0.78–0.81). Adult height had an inverse relationship to newly diagnosed ESRD (male: HR 0.86, 95% CI 0.83–0.90, female: HR 0.84, 95% CI 0.79–0.90) and all-cause mortality (male: HR 0.81, 95% CI 0.79–0.82, female: HR 0.80, 95% CI 0.78–0.82). Conclusions: Short adult height is strongly associated with the increased risk of ESRD development and all-cause mortality in type 2 DM.

scholarly journals Natural history and risk factors for diabetic nephropathy in Italy: insights from AMD Annals initiative

2019 ◽  
Vol 22 (4) ◽  
pp. 178
Author(s):  
Piscitelli, P.
Keyword(s):  
Blood Pressure ◽  
Type 2 Diabetes ◽  
Diabetic Nephropathy ◽  
Kidney Disease ◽  
Natural History ◽  
Disease Onset ◽  
Diabetic Patients ◽  
Increased Risk ◽  
End Stage

Diabetic patients have a high risk to develop diabetic nephropathy. Diabetic nephropathy represents non only a risk factor for progression toward end stage renal disease but it is also associates with an increased risk to have of major cardiovascular events. Over the last few years, analysis of the AMD annals dataset has contributed several important insights on the clinical features of type 2 diabetes kidney disease and their prognostic and therapeutic implications. First, non-albuminuric renal impairment is the predominant clinical phenotype. Even though associated with a lower risk of progression compared to overt albuminuria, it contributes significantly to the burden of end-stage renaldisease morbidity. Second, optimal blood pressure control provides significant but incomplete renal protection. It reduces albuminuria but there may be a J curve phenomenon with eGFR at very low blood pressure values. Third, hyperuricemia and diabetic hyperlipidemia, namely elevated triglycerides and low HDL cholesterol, are strong independent predictorsof chronic kidney disease onset in diabetes, although the pathogenetic mechanisms underlying these associationsremain uncertain. These data help clarify the natural history of CKD in patients with type 2 diabetes and provide important clues for designing futureinterventional studies. KEY WORDS albuminuria; glomerular filtration rate; hypertension; uric acid; type2 diabetes mellitus.

scholarly journals Severe hypoglycemia and the risk of end stage renal disease in type 2 diabetes

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Jae-Seung Yun ◽  
Yong-Moon Park ◽  
Kyungdo Han ◽  
Hyung-Wook Kim ◽  
Seon-Ah Cha ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Renal Disease ◽  
End Stage Renal Disease ◽  
Severe Hypoglycemia ◽  
National Health Insurance System ◽  
Increased Risk ◽  
Baseline Evaluation ◽  
Stage Renal Disease ◽  
End Stage

AbstractWe investigated the association between the incidence of severe hypoglycemia and the risk of end-stage renal disease (ESRD) in patients with type 2 diabetes. Baseline and follow-up data for 988,333 participants with type 2 diabetes were retrieved from the National Health Insurance System database. The number of severe hypoglycemia episodes experienced from 2007 to 2009 was determined. The primary outcome was the development of ESRD after the baseline evaluation. Participants were followed from the baseline until death or December 31, 2016, during this period 14,545 participants (1.5%) developed ESRD. In the crude model, compared with those who experienced no severe hypoglycemia, the hazard ratios (95% confidential intervals) for developing ESRD were 4.96 (4.57–5.39), 6.84 (5.62–8.32), and 9.51 (7.14–12.66) in participants who experienced one, two, and three or more episodes of severe hypoglycemia, respectively. Further adjustment for various confounding factors attenuated the association between severe hypoglycemia and ESRD; the significance of the association between severe hypoglycemia and ESRD was maintained. Having three or more severe hypoglycemia episodes was associated with a nearly two-fold increased risk of developing ESRD. Prior episodes of severe hypoglycemia were associated with an increased risk of ESRD among Korean adults with type 2 diabetes.

scholarly journals Renal safety profile of di-peptidyl-peptidase inhibitors: a review of available literature

2017 ◽  
Vol 6 (3) ◽  
pp. 487
Author(s):  
Arindam Dey ◽  
Unnikrishanan A.G. ◽  
Gaurav Saxena ◽  
Rishi Jain
Keyword(s):  
Diabetic Nephropathy ◽  
Glycemic Control ◽  
Diabetic Patients ◽  
Dipeptidyl Peptidase 4 ◽  
Antidiabetic Treatment ◽  
Strict Glycemic Control ◽  
Dipeptidyl Peptidase 4 Inhibitor ◽  
Stage Renal Disease ◽  
End Stage ◽  
Renal Safety

Diabetic Nephropathy has become the single most import cause of End Stage Renal Disease (ESRD). Various strategies to limit or slow the progress the Diabetic nephropathy are suggested by the guidelines and evidences. By maintaining strict glycemic control the progression of diabetic nephropathy can be altered. Glycemic control in diabetic patients with nephropathy is complex as falling eGFR renders many ant diabetic medications contraindicated while others are needed to be done in low dose. The intent of this review article is to collate the available evidences for renal safety with one such anti diabetic class of medication, dipeptidyl peptidase 4 inhibitor and evaluate the guideline based antidiabetic treatment in Type 2 Diabetes Mellitus patients with renal insufficiency. 

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