The combined effects of ARBs on ESRD and CVD and mortality in patients with diabetic nephropathy varies considerably between patients. A substantial proportion of patients remain at high risk for both outcomes despite ARB treatment (Diabetes, Obesity and Metabolism)
Diabetes News
Category: Nephropathy
Urinary Biomarkers in the Assessment of Early Diabetic Nephropathy
The concomitant assessment of several urinary biomarkers in relationship with microalbuminuria could represent at present a method of diagnosing early DN. The great progress in discovering new biomarkers could lead to the development of an “ideal” urinary biomarker to detect early diabetic DN in the future (Journal of Diabetes Research)
Empagliflozin and Progression of Kidney Disease in Type 2 Diabetes
In patients with type 2 diabetes at high cardiovascular risk, empagliflozin was associated with slower progression of kidney disease and lower rates of clinically relevant renal events than was placebo when added to standard care (NEJM)
A comparison between angiotensin converting enzyme inhibitors and angiotensin receptor blockers on end stage renal disease and major adverse cardiovascular events in diabetic patients
ACEi compared with ARB was associated with a lower incidence of ESRD, especially in those with CKD. Though ACEi and ARB had a similar risk of composite MACE outcome, ACEi had a slightly higher incidence of stroke than ARB, among the Asian diabetic patients (Cardiovascular Diabetology)
Association Between Plasma Uric Acid Levels and Cardiorenal Function in Adolescents With Type 1 Diabetes
Even within the physiological range, PUA levels were significantly lower in T1D adolescent patients compared with HC subjects. There was an inverse relationship between PUA and eGFR in T1D, likely reflecting an increase in clearance (Diabetes Care)
Immune Cells and Inflammation in Diabetic Nephropathy
In this review, the authors consider the metabolic profile of several relevant immune types and discuss their respective roles (Journal of Diabetes Research)
Non-Alcoholic Fatty Liver Disease Is a Risk Factor for the Development of Diabetic Nephropathy in Patients with Type 2 Diabetes Mellitus
NAFLD might be a risk factor for DN. Elevated liver fat content could be associated with higher DN burden (PLoS ONE)
Elevated baseline glomerular filtration rate (GFR) is independently associated with a more rapid decline in renal function of patients with type 1 diabetes
In patients with T1DM, higher baseline mGFR is associated with more rapid mGFR decline. Patients with high baseline mGFR who developed rapid mGFR decline had higher HbA1c measurements throughout the study. These findings are consistent with the concept that poor glycaemic control over time may be a determining factor for the rapid renal function decline observed in some hyperfiltering patients (Journal of Diabetes and Its Complications)
Early renin-angiotensin-system intervention is more beneficial than late intervention in delaying end-stage renal disease in patients with type 2 diabetes
RAS intervention early in the course of proteinuric DKD is more beneficial than late intervention in delaying ESRD (Diabetes, Obesity and Metabolism)
Helicobacter pylori infection associated with type 2 diabetic nephropathy in patients with dyspeptic symptoms
Diabetic nephropathy patients are more susceptible to H. pylori infection. Our data support an association between H. pylori infection and diabetic nephropathy (Diabetes Research and Clinical Practice)
Estimating Glomerular Filtration Rate: Performance of the CKD-EPI Equation over time in Patients with Type 2 Diabetes
The CKD-EPI formula underestimates mGFR and the rate of decline of mGFR in patients with type 2 diabetes with a mGFR greater than 60ml/min/1.73m2. The association between LDL cholesterol, triglycerides, HbA1c, diastolic blood pressure and the difference between mGFR and eGFR warrants further study (Journal of Diabetes and Its Complications)
The Relationship Between Levels of Advanced Glycation End-Products and Their Soluble Receptor and Adverse Outcomes in Adults With Type 2 Diabetes
In adults with type 2 diabetes, increased levels of sRAGE are independently associated with new or worsening kidney disease and mortality over the next 5 years (Diabetes Care)
Effect of Patiromer on Serum Potassium Level in Patients With Hyperkalemia and Diabetic Kidney Disease
Among patients with hyperkalemia and diabetic kidney disease, patiromer starting doses of 4.2 to 16.8 g twice daily resulted in statistically significant decreases in serum potassium level after 4 weeks of treatment, lasting through 52 weeks (JAMA)
Potential glycemic overtreatment in patients ≥75 years with type 2 diabetes mellitus and renal disease
In clinical practice, a substantial proportion of elderly patients may be overtreated. RI is insufficiently taken into account when prescribing OAD (Diabetes, Metabolic Syndrome and Obesity)
Estimated glomerular filtration rate progression in UK primary care patients with type 2 diabetes and diabetic kidney disease: a retrospective cohort study
Only a minority of diabetic patients with DKD had quantitative albuminuria assessments. The relatively low proportion of DKD patients with ACEi or ARB prescriptions suggests a gap between healthcare practice and available scientific evidence during the study period. Increased albuminuria and older age were the most consistent predictors of subsequent eGFR decline (International Journal of Clinical Practice)
Comparative efficacy and safety of blood pressure-lowering agents in adults with diabetes and kidney disease: a network meta-analysis
No blood pressure-lowering strategy prolonged survival in adults with diabetes and kidney disease. ACE inhibitors and ARBs, alone or in combination, were the most effective strategies against end-stage kidney disease. Any benefits of combined ACE inhibitor and ARB treatment need to be balanced against potential harms of hyperkalaemia and acute kidney injury (Lancet)
Glomerular haemodynamic profile of patients with Type 1 diabetes compared with healthy control subjects
Hyperfiltration in Type 1 diabetes is primarily driven by alterations in afferent arteriolar resistance rather than efferent arteriolar resistance. Renal protective therapies should focus on afferent renal arteriolar mechanisms through the use of pharmacological agents that target tubuloglomerular feedback, including sodium-glucose cotransporter 2 inhibitors and incretins (Diabetic Medicine)
Soluble CD36 in plasma and urine: a plausible prognostic marker for diabetic nephropathy
Our study implies a plausible prognostic/adjuvant biomarker role of soluble CD36 for diabetic nephropathy (Journal of Diabetes and Its Complications)
Significance of renal biopsy in presumed diabetic nephropathy
These data suggest that, even for patients with long-term DM, renal biopsy should be carried out in patients with presumed DN. Because treatment options differ between DN and primary glomerulopathies, renal biopsy should especially be considered for presumed DN without DR (Journal of Diabetes Investigation)
Urinary Cystatin C & Tubular Proteinuria Predict Progression of DN
The results of this study suggest that urinary cystatin C and NAP may be predictors of the progression of type 2 diabetic nephropathy (Diabetes Care)
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