Recent advances in metabolomics have clarified the role of dysregulated energy metabolism and uremic toxins in DKD pathophysiology (Current Diabetes Reports)
Diabetes News
Category: Nephrology
Early detection of diabetic kidney disease by urinary proteomics and subsequent intervention with spironolactone to delay progression
In people with type 2 diabetes and normoalbuminuria, a high-risk score from the urinary proteomic classifier CKD273 was associated with an increased risk of progression to microalbuminuria over a median of 2·5 years, independent of clinical characteristics. However, spironolactone did not prevent progression to microalbuminuria in high-risk patients (The Lancet Diabetes & Endocrinology)
Effect of Insulin on Proximal Tubules Handling of Glucose: A Systematic Review
Available data points to an important insulin participation in renal glucose handling, including tubular glucose transport, but human studies with reproducible and comparable method are still needed (Journal of Diabetes Research)
Renal glucosuria is associated with lower body weight and lower rates of elevated systolic blood pressure: results of a nationwide cross-sectional study of 2.5 million adolescents
Renal glucosuria is associated with lower body weight and obesity as well as with lower rates of elevated systolic blood pressure (Cardiovascular Diabetology)
The Association Between Kidney Disease and Diabetes Remission in Bariatric Surgery Patients With Type 2 Diabetes
Remission of type 2 diabetes 5 years after bariatric surgery was associated with improvements in albuminuria and stabilized prognostic risk for CKD, but not with eGFR. Lower kidney function and greater prognostic risk at the time of bariatric surgery was linked to a lower likelihood of diabetes remission (American Journal of Kidney Diseases)
Lower Renal Threshold for Glucose Reabsorption in Type 1 Diabetes Mellitus (T1DM) May Explain the Smaller Contribution of SGLT2 Inhibitors to the Improvement of Plasma Glucose Control Compared with T2DM
These results indicate that it is advisable to estimate the renal threshold for glucose reabsorption prior to initiating SGLT2 inhibitor therapy in patients with T1DM (Diabetes Therapy)
Temporal variation of renal function in people with type 2 diabetes mellitus: a retrospective UK Clinical Practice Research Datalink cohort study
Overall, eGFR declined over time, although there was considerable variation between GFR categories and individuals. This highlights the difficulty in prescribing many glucose‐lowering therapies, which require dose adjustment for renal function. The study also emphasizes the importance of regular monitoring of renal impairment in people with T2DM (Diabetes, Obesity and Metabolism)
Effect of sodium-glucose cotransporter 2 inhibitor on proximal tubular function and injury in patients with type 2 diabetes: a randomized controlled trial
This study indicates that dapagliflozin in T2DM patients can decrease the levels of urinary proximal tubular injury biomarkers, thus highlighting its renoprotective effect. SGLT2 inhibitors could prove useful in treating T2DM by protecting against renal tubular injury and may lead to reduced long-term renal outcomes (Clinical Kidney Journal)
Comparative efficacy of individual renin–angiotensin system inhibitors on major renal outcomes in diabetic kidney disease: a network meta-analysis
Based on the available evidence, individual ACEIs and ARBs at goal doses appeared to have no or little differences in their effect on major renal outcomes (Nephrology Dialysis Transplantation)
Association of microalbuminuria with diabetes is stronger in people with prehypertension compared to those with ideal blood pressure
Findings revealed a statistically significant link between diabetes and microalbuminuria only in prehypertensive subjects. They also found that the interaction between perhypertension and diabetes conferred risk for MA (Nephrology)
Renal glucose metabolism in normal physiological conditions and in diabetes
The kidney plays a direct and significant role in glucose homeostasis via gluconeogenesis, glucose uptake and utilization, and glucose reabsorption from glomerular filtrate … (Diabetes Research and Clinical Practice)
Urinary albumin excretion with sitagliptin compared to sulfonylurea as add on to metformin in type 2 diabetes patients with albuminuria: a real-world evidence study
Our results suggest that both sitagliptin and SU reduce albuminuria as an add-on therapy to metformin, but that sitagliptin may provide greater reductions in albuminuria independent of glycemic control when compared to SU. Larger population studies are required to further explore this (Diabetes and Its Complications)
Sodium Glucose Cotransporter 2 Inhibition in the Diabetic Kidney
The findings expand and refine our understanding of SGLT2 and its inhibition, have relevance for clinical practice, and will help interpret ongoing clinical trials on the long-term safety and cardiovascular effects of SGLT2 inhibitors (Medscape) – Registration required
The renal threshold for glucose re-absorption predicts diabetes improvement by sodium glucose co-transporter 2 inhibitor therapy
These findings indicate that patients who have higher renal threshold for glucose re-absorption can be expected to more effectively respond to SGLT2 inhibitor therapy in terms of lowering HbA1c level (Journal of Diabetes Investigation)
Urinary Potassium Excretion and Renal and Cardiovascular Complications in Patients with Type 2 Diabetes and Normal Renal Function
Higher urinary potassium excretion was associated with the slower decline of renal function and the lower incidence of cardiovascular complications in type 2 diabetic patients with normal renal function. Interventional trials are necessary to determine whether increasing dietary potassium is beneficial (Clinical Journal of the American Society of Nephrology)
Diabetic Kidney Disease: Pathophysiology and Therapeutic Targets
The purpose of this review is to describe the current understanding of how the hemodynamic, metabolic, inflammatory, and alternative pathways are all entangled in pathogenesis of DKD and detail the various therapeutic targets that may one day play a role in quelling this epidemic (Journal of Diabetes Research)
Glucagon-Like Peptide 1 Receptor Agonist (GLP-1 RA): Long-Term Effect on Kidney Function in Patients with Type 2 Diabetes
Long-term treatment with liraglutide was associated with a reduction in measured GFR similar to the effect during short-term treatment, suggesting a metabolic or haemodynamic reversible effect and not structural changes. Moreover, UAER and 24-hour SBP were reduced (Journal of Diabetes and Its Complications)
Present and Future in the Treatment of Diabetic Kidney Disease
The aim of this review is to explain the advances in newer agents to treat diabetic kidney disease, along with the background of the renin-angiotensin system blockade (Journal of Diabetes Research)
Renal effects of atorvastatin and rosuvastatin in patients with diabetes who have progressive renal disease (PLANET I)
Despite high-dose rosuvastatin lowering plasma lipid concentrations to a greater extent than did high-dose atorvastatin, atorvastatin seems to have more renoprotective effects for the studied chronic kidney disease population (The Lancet Diabetes & Endocrinology)
Cardiac Autonomic Dysfunction Is Associated With High-Risk Albumin-to-Creatinine Ratio in Young Adolescents With Type 1 Diabetes in AdDIT (Adolescent Type 1 Diabetes Cardio-Renal Interventional Trial)
Adolescents at potentially higher risk for nephropathy show an adverse cardiac autonomic profile, indicating sympathetic overdrive, compared with the lower-risk group. Longitudinal follow-up of this cohort will further characterize the relationship between autonomic and renal dysfunction and the effect of interventions in this population (Diabetes Care)
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