scholarly journals Association of HbA1C Variability and Renal Progression in Patients with Type 2 Diabetes with Chronic Kidney Disease Stages 3–4

2018 ◽  
Vol 19 (12) ◽  
pp. 4116 ◽  
Author(s):  
Mei-Yueh Lee ◽  
Jiun-Chi Huang ◽  
Szu-Chia Chen ◽  
Hsin-Ying Chiou ◽  
Pei-Yu Wu
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Lower Risk ◽  
Glycosylated Hemoglobin ◽  
Diabetic Patients ◽  
Patients With Diabetes ◽  
Cox Analysis ◽  
Stage Renal Disease ◽  
End Stage ◽  
Hba1c Variability

Little is known about the predictive value of glycosylated hemoglobin (HbA1C) variability in patients with advanced chronic kidney disease (CKD). The aim of this study was to investigate whether HbA1C variability is associated with progression to end-stage renal disease in diabetic patients with stages 3–5 CKD, and whether different stages of CKD affect these associations. Three hundred and eighty-eight patients with diabetes and stages 3–5 CKD were enrolled in this longitudinal study. Intra-individual HbA1C variability was defined as the standard deviation (SD) of HbA1C, and the renal endpoint was defined as commencing dialysis. The results indicated that, during a median follow-up period of 3.5 years, 108 patients started dialysis. Adjusted Cox analysis showed an association between the highest tertile of HbA1C SD (tertile 3 vs. tertile 1) and a lower risk of the renal endpoint (hazard ratio = 0.175; 95% confidence interval = 0.059–0.518; p = 0.002) in the patients with an HbA1C level ≥ 7% and stages 3–4 CKD, but not in stage 5 CKD. Further subgroup analysis showed that the highest two tertiles of HbA1C SD were associated with a lower risk of the renal endpoint in the group with a decreasing trend of HbA1C. Our results demonstrated that greater HbA1C variability and a decreasing trend of HbA1C, which may be related to intensive diabetes control, was associated with a lower risk of progression to dialysis in the patients with stages 3–4 CKD and poor glycemic control (HbA1c ≥ 7%).

scholarly journals An Update on the Controversies in Anemia Management in Chronic Kidney Disease: Lessons Learned and Lost

Anemia ◽  
2011 ◽  
Vol 2011 ◽  
pp. 1-5 ◽  
Author(s):  
Geoffrey Teehan ◽  
Robert L. Benz
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Randomized Trials ◽  
Lessons Learned ◽  
Patients With Diabetes ◽  
Anemia Management ◽  
Erythropoietin Deficiency ◽  
Stage Renal Disease ◽  
End Stage

Background. Erythropoietin deficiency and anemia occur in Chronic Kidney Disease (CKD) and may be treated with Erythropoietin Stimulating Agents (ESAs). The optimal hemoglobin, in non-End Stage Renal Disease CKD, is controversial.Methods. We review three recent randomized trials in anemia in CKD: CHOIR, CREATE, and TREAT.Results. CHOIR (N=1432) was terminated early with more frequent death and cardiovascular outcomes in the higher Hb group (HR 1.34: 95% C.I. 1.03–1.74,P=.03). CREATE (N=603) showed no difference in primary cardiovascular endpoints. Stroke was more common in the higher Hb group (HR 1.92; 95% C.I. 1.38–2.68;P<.001) in TREAT (N=4038).Conclusions. There is no benefit to an Hb outside the 10–12 g/dL range in this population. To avoid transfusions and improve Quality of Life, ESAs should be used cautiously, especially in patients with Diabetes, CKD, risk factors for stroke, and ESA resistance.

Abstract 134: Temporal Characterization of the Development Diabetic Induced Renal Disease in Strains of Goto-kakizaki Rats

Hypertension ◽  
2012 ◽  
Vol 60 (suppl_1) ◽  
Author(s):  
Tiffani Slaughter ◽  
Adrienne Paige ◽  
Carlos Rucker ◽  
Patrick Kyle ◽  
Naoki Kojima ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Renal Disease ◽  
Signaling Pathways ◽  
Molecular Transport ◽  
Diabetic Rats ◽  
Diabetic Patients ◽  
Glucose Levels ◽  
Patients With Diabetes ◽  
Stage Renal Disease

End stage renal disease is a major problem of patients suffering from diabetes and the development of novel therapeutic drugs are needed to help prevent the progression of diabetic nephropathy (DN). However, little is known about the pathogenesis of DN because the lack of an appropriate rodent model that develops progressive chronic kidney disease and renal histopathology seen in diabetic patients. The current study characterized the temporal changes in renal hemodynamics during the development of renal disease in Goto-Kakizaki (GK Control ) diabetic rats that are resistant to the development of renal disease and a genetically modified GK substrain (GK T2DN ) that is far more susceptible to the development of DN. Both strains have similar elevations in plasma glucose levels by 3 months of age. The GK T2DN strain exhibited hyperfiltration reflected by an increase in GFR (measured by the clearance of FITC-inulin) at 6 months of age compared to GK Control rats. GK T2DN rats develop progressive proteinuria that increases from 39±4 to 524±64 mg/day and a decline in GFR (from 934±68 to 370±50 μL/min/gkw) (n=21) as the rats age from 3 to 18 months of age. In contrast, proteinuria only increased to 194±33 mg/day in GK Control rats and GFR remained relatively unaltered over the same time period (n=19). The kidneys of GK T2DN rats exhibited mesangial expansion, glomerulosclerosis, and interstitial and renal fibrosis characteristic of patients with diabetes while the GK Control strain did not. We next utilized microarray analysis to identify differences in gene signaling pathways in the renal cortex between the two strains at the early onset of renal disease (6 months of age). We found 1266 genes that were differential expressed in signaling pathways associated with inflammation, cell proliferation, molecular transport and apoptosis between the susceptible strain (GK T2DN ) versus the resistant strain (GK Control ). In summary, these data indicate that the GK T2DN rat exhibits hyperfiltration and progressive proteinuria and chronic kidney disease and is a useful model to explore new therapies and genetic factors in the pathogenesis of DN.

STUDY OF ANAEMIA & IRON PROFILE IN CHRONIC KIDNEY DISEASE (CKD) PATIENTS ON MAINTENANCE DIALYSIS AND ITS CORRELATION WITH DIABETES MELLITUS

2021 ◽  
pp. 37-39
Author(s):  
Sandeep Chavda ◽  
Shaila Shah ◽  
Jay Shah
Keyword(s):  
Diabetes Mellitus ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Diabetic Group ◽  
Diabetic Patients ◽  
Blood Indices ◽  
Poor Patient ◽  
Stage Renal Disease ◽  
End Stage ◽  
Iron Profile

Most patients with chronic kidney disease (CKD) have anaemia, the cause of which is erythropoietin and iron deciency. Anaemia in patients on haemodialysis is associated with poor patient outcomes. Diabetes remains one of the predominant aetiologies of CKD all over the world. The study was undertaken to study the iron prole in haemodialyzed patients and its corelation with diabetes mellitus. Sixty-six patients were enrolled in the study with the aim to study the prevalence of anaemia and diabetes in haemodialyzed patients as well as the iron prole in these patients. Patients were studied as a single group as well as divided into two groups, a non-diabetic group comprising of 36 patients and a diabetic group comprising of 30 patients. Anaemia was found to be prevalent in 56(84.84%) patients out of which 28(50%) were diabetics. Also, diabetics comprised of 45.45% of the study group. Various parameters like haemoglobin with blood indices and iron prole was studied and compared in both groups. There was no signicant difference in the various parameters in both groups except a signicantly low MCH and MCHC and signicantly high ferritin levels in the diabetic group. We concluded that the low MCH and MCHC might be suggestive of an increased cardiovascular risk in diabetic patients while higher levels of serum ferritin may suggest sub-clinical inammation rather than iron overload. In conclusion diabetes remains to be the single most important aetiology for the causation of end stage renal disease and appropriate management of anaemia in terms of EPO and iron therapy remains the mainstay of therapy in haemodialyzed patients.

Ambulatory Blood Pressure Trajectories and Blood Pressure Variability in Diabetic and Non-Diabetic Chronic Kidney Disease

2020 ◽  
Vol 51 (5) ◽  
pp. 411-420
Author(s):  
Maria Schoina ◽  
Charalampos Loutradis ◽  
Ioanna Minopoulou ◽  
Marieta Theodorakopoulou ◽  
Nikolaos Pyrgidis ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Diabetic Kidney Disease ◽  
Repeated Measurements ◽  
Diabetic Patients ◽  
Ckd Stage ◽  
Average Real Variability ◽  
Stage Renal Disease ◽  
End Stage

Background: Diabetic kidney disease is the leading cause of end-stage renal disease worldwide. Whether diabetes mellitus (DM) is an additional factor leading to elevated blood pressure (BP) levels and BP variability (BPV) in patients with chronic kidney disease (CKD) is unknown. This study aimed to compare ambulatory BP levels, BP trends and BPV in diabetic and non-diabetic patients with CKD. Methods: This study included 48 diabetic and 48 non-diabetic adult patients (>18 years) with CKD (estimated glomerular filtration rate [eGFR] <90 and ≥15 mL/min/1.73 m2), matched in a 1:1 ratio for age, sex and eGFR within each CKD stage (2, 3a, 3b and 4). All patients underwent 24-h ambulatory BP measurement with the Mobil-O-graph device. To evaluate the effect of DM and time on the trajectories of 24-h BP levels, we performed two-way mixed ANOVA analysis for repeated measurements using hourly means. BPV was calculated with validated formulas. Results: In total, patients with DM had significantly higher 24-h systolic BP (SBP; 132.13 ± 10.71 vs. 124.16 ± 11.45; p = 0.001) and pulse pressure (PP; 57.1 ± 9.6 vs. 49.5 ± 10.9; p < 0.001), but similar 24-h diastolic BP (DBP; 75.00 ± 8.43 vs. 74.62 ± 6.86 mm Hg; p = 0.809) compared to patients without DM. A similar trend was evident across all CKD stages. The effect of DM on BP trajectories during the recording period was significant for SBP (F = 18.766, p < 0.001, partial η2 = 0.261) and marginally significant for DBP (F = 3.782, p = 0.057, partial η2 = 0.067). Twenty-four hour SBP SD, weighted SD (wSD) and average real variability (ARV; 10.94 ± 2.75 vs. 9.46 ± 2.10; p = 0.004), as well as 24 h DBP SD, wSD, coefficient of variation (CV) and ARV (8.23 ± 2.10 vs. 7.10 ± 1.33; p = 0.002) were significantly higher in diabetic compared to non-diabetic CKD patients. Conclusions: Ambulatory SBP and PP levels are higher and SBP-profile is different in patients with diabetic compared to those with non-diabetic CKD. Systolic and diastolic BPV are also higher in diabetics. These findings may signify a higher cardiovascular risk for patients with both DM and CKD compared to patients with CKD alone, through higher BP levels and BPV.

scholarly journals Investigation of the Impact of Endodontic Therapy on Survival among Dialysis Patients in Taiwan: A Nationwide Population-Based Cohort Study

2021 ◽  
Vol 18 (1) ◽  
pp. 326
Author(s):  
Chih-Chien Chiu ◽  
Ya-Chieh Chang ◽  
Ren-Yeong Huang ◽  
Jenq-Shyong Chan ◽  
Chi-Hsiang Chung ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Renal Disease ◽  
End Stage Renal Disease ◽  
Root Canal ◽  
Dialysis Patients ◽  
Root Canal Therapy ◽  
Risk Of Death ◽  
Stage Renal Disease ◽  
End Stage

Objectives Dental problems occur widely in patients with chronic kidney disease (CKD) and may increase comorbidities. Root canal therapy (RCT) is a common procedure for advanced decayed caries with pulp inflammation and root canals. However, end-stage renal disease (ESRD) patients are considered to have a higher risk of potentially life-threatening infections after treatment and might fail to receive satisfactory dental care such as RCT. We investigated whether appropriate intervention for dental problems had a potential impact among dialysis patients. Design Men and women who began maintenance dialysis (hemodialysis or peritoneal dialysis) between January 1, 2000, and December 31, 2015, in Taiwan (total 12,454 patients) were enrolled in this study. Participants were followed up from the first reported dialysis date to the date of death or end of dialysis by December 31, 2015. Setting Data collection was conducted in Taiwan. Results A total of 2633 and 9821 patients were classified into the RCT and non-RCT groups, respectively. From the data of Taiwan’s National Health Insurance, a total of 5,092,734 teeth received RCT from 2000 to 2015. Then, a total of 12,454 patients were followed within the 16 years, and 4030 patients passed away. The results showed that members of the non-RCT group (34.93%) had a higher mortality rate than those of the RCT group (22.79%; p = 0.001). The multivariate-adjusted hazard ratio for the risk of death was 0.69 (RCT vs. non-RCT; p = 0.001). Conclusions This study suggested that patients who had received RCT had a relatively lower risk of death among dialysis patients. Infectious diseases had a significant role in mortality among dialysis patients with non-RCT. Appropriate interventions for dental problems may increase survival among dialysis patients. Abbreviations: CKD = chronic kidney disease, ESRD = end-stage renal disease, RCT = root canal therapy.

Serum Sodium Levels and Patient Outcomes in an Ambulatory Clinic-Based Chronic Kidney Disease Cohort

2015 ◽  
Vol 41 (3) ◽  
pp. 200-209 ◽  
Author(s):  
Sang-Woong Han ◽  
Anca Tilea ◽  
Brenda W. Gillespie ◽  
Fredric O. Finkelstein ◽  
Margaret A. Kiser ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Patient Outcomes ◽  
Serum Sodium ◽  
Risk Of Mortality ◽  
Ambulatory Patients ◽  
Lower Egfr ◽  
Stage Renal Disease ◽  
End Stage ◽  
Improve Patient

Background: Chronic kidney disease (CKD) patients are prone to both hypo- and hypernatremia. Little has been published on the epidemiology of hypo- and hypernatremia in ambulatory patients with non-dialysis CKD. Methods: Data collected in two contemporaneous CKD cohort studies, the Renal Research Institute (RRI)-CKD study (n = 834) and the Study of Treatment of Renal Insufficiency: Data and Evaluation (STRIDE) (n = 1,348) were combined and analyzed to study the association between serum sodium (Na+) and clinical outcomes. Results: Baseline estimated glomerular filtration rate (eGFR) and Na+ were 26 ± 11 ml/min/1.73 m2 and 140.2 ± 3.4 mEq/l, respectively. The prevalence of Na+ ≤135 mEq/l and ≥144 mEq/l was 6 and 16%, respectively. Higher baseline Na+ was significantly associated with male sex, older age, systolic blood pressure, BMI, serum albumin, presence of heart failure, and lower eGFR. The risk of end-stage renal disease (ESRD) was marginally significantly higher among patients with Na+ ≤135 mEq/l, compared with 140< Na+ <144 mEq/l (referent), in time-dependent models (adjusted hazard ratio, HR = 1.52, p = 0.06). Mortality risk was significantly greater at 135< Na+ ≤140 mEq/l (adjusted HR = 1.68, p = 0.02) and Na+ ≥144 mEq/l (adjusted HR = 2.01, p = 0.01). Conclusion: CKD patients with Na+ ≤135 mEq/l were at a higher risk for progression to ESRD, whereas both lower and higher Na+ levels were associated with a higher risk of mortality. While caring for CKD patients, greater attention to serum sodium levels by clinicians is warranted and could potentially help improve patient outcomes.

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