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Trial, esrd, gfr and diabetes

Gemma Currie, M Angelyn Bethel, Björn Holzhauer, Steven M Haffner, Rury R Holman, John J V McMurray
AIMS: Renin-angiotensin system blockers reduce the incidence and progression of microalbuminuria and the subsequent development of end-stage renal disease (ESRD) in patients with type 2 diabetes. We aimed to examine the effect of valsartan on kidney outcomes in patients with impaired glucose tolerance (IGT). METHODS: In a double-blind randomized trial, 9306 patients with IGT were assigned to valsartan (160 mg daily) or placebo. The co-primary endpoints were the development of diabetes and two composite cardiovascular outcomes...
January 17, 2017: Diabetes, Obesity & Metabolism
Tazeen Jafar
Chronic kidney disease (CKD) defined as reduced estimated glomerular filtration rate (eGFR) or presence of albuminuria, progresses to end stage renal disease (ESRD), needing dialysis or kidney transplant to sustain life, and is associated with increased risks of premature cardiovascular disease (CVD) and mortality. CKD ranked 18 leading (and most rapidly rising cause of mortality by the Global Burden of Disease Study 2010. The social and economic consequences of CKD are far worse in low and middle income countries (LMICs) including India, Pakistan, Bangladesh, and Sri Lanka...
September 2016: Journal of Hypertension
Tazeen Jafar
Chronic kidney disease (CKD) defined as reduced estimated glomerular filtration rate (eGFR) or presence of albuminuria, progresses to end stage renal disease (ESRD), needing dialysis or kidney transplant to sustain life, and is associated with increased risks of premature cardiovascular disease (CVD) and mortality. CKD ranked 18 leading (and most rapidly rising cause of mortality by the Global Burden of Disease Study 2010. The social and economic consequences of CKD are far worse in low and middle income countries (LMICs) including India, Pakistan, Bangladesh, and Sri Lanka...
September 2016: Journal of Hypertension
Nancy Helou, Andrew Dwyer, Maya Shaha, Anne Zanchi
BACKGROUND: The increasing prevalence of diabetes poses significant challenges to healthcare systems around the world. Diabetes is the leading cause of end-stage renal disease. Diabetic kidney disease (DKD) is becoming a global health concern because it is a progressive disease associated with major health complications and increased health costs. The treatment goals for DKD are to slow the progression of the renal disease and prevent cardiovascular events. Accordingly, patients are expected to adhere to prescribed treatments and manage a wide range of daily self-care activities...
July 2016: JBI Database of Systematic Reviews and Implementation Reports
Patricia M Howse, Lyudmila N Chibrikova, Laurie K Twells, Brendan J Barrett, John-Michael Gamble
BACKGROUND: The pharmacokinetics and pharmacodynamics of antidiabetic therapies for patients with type 2 diabetes are often altered in the context of chronic kidney disease (CKD). STUDY DESIGN: Systematic review and meta-analysis. SETTING & POPULATION: Patients with type 2 diabetes and CKD. SELECTION CRITERIA FOR STUDIES: 2 reviewers independently screened studies identified through bibliographic databases (Cochrane Library, PubMed, Embase, International Pharmaceutical Abstracts), clinical trial registries, and references from pertinent articles and clinical practice guidelines...
August 12, 2016: American Journal of Kidney Diseases: the Official Journal of the National Kidney Foundation
Kenneth A Earle, Karima Zitouni, John Pepe, Maria Karaflou, James Godbold
BACKGROUND: Diabetes is the western world's leading cause of end-stage renal disease. Glucose-dependent, oxidative stress is linked to the development of renal inflammation and sclerosis, which, in animal models of diabetes, can be prevented by anti-oxidative treatment. Patients of non-Caucasian heritage have low activity of the selenoprotein, antioxidant enzyme, glutathione peroxidase (GPx) and its co-factor vitamin E, which may be linked to their increased propensity to developing end-stage renal disease...
2016: Journal of Translational Medicine
Paola Fioretto, Alberto Zambon, Marco Rossato, Luca Busetto, Roberto Vettor
Diabetic nephropathy (DN) is the most common cause of end-stage renal disease worldwide. Blood glucose and blood pressure control reduce the risk of developing this complication; however, once DN is established, it is only possible to slow progression. Sodium-glucose cotransporter 2 (SGLT2) inhibitors, the most recent glucose-lowering oral agents, may have the potential to exert nephroprotection not only through improving glycemic control but also through glucose-independent effects, such as blood pressure-lowering and direct renal effects...
August 2016: Diabetes Care
Justin Parekh, Garrett R Roll, Steven Wisel, Robert J Rushakoff, Ryutaro Hirose
Recipient diabetes accounts for ~34% of end stage renal disease in patients awaiting renal transplantation and has been linked to poor graft function. We conducted a single center, open label, randomized controlled trial to determine if moderately intense glucose control during allograft reperfusion would reduce the incidence of poor graft function. Adult diabetics undergoing deceased donor renal transplant were randomized to moderately intense glucose control (n=30) or standard control (n=30). The primary outcome was poor graft function (dialysis within seven days of transplant or failure of serum creatinine to fall by 10% for three consecutive days)...
July 16, 2016: Clinical Transplantation
Xu Zhou, Ling Li, Joey S W Kwong, Jiajie Yu, Youping Li, Xin Sun
BACKGROUND: The impact of bariatric surgery on renal functions in patients with type 2 diabetes (T2D) remains uncertain. OBJECTIVES: To assess the impact of bariatric surgery on renal functions in patients with T2D. SETTING: Systemic review and meta-analysis of randomized trials and observational studies. METHODS: We searched PubMed, Embase, and Cochrane Central Register of Controlled Trials (CENTRAL) from inception to April 3, 2016...
December 2016: Surgery for Obesity and related Diseases: Official Journal of the American Society for Bariatric Surgery
N G C van der Sande, J A N Dorresteijn, F L J Visseren, J P Dwyer, P J Blankestijn, Y van der Graaf, H L J Heerspink
AIMS: To predict individualized treatment effects of angiotensin receptor blockers (ARBs) on cardiovascular and renal complications in order to help clinicians and patients assess the benefit of treatment (or adherence) and estimate remaining disease risk. MATERIALS AND METHODS: In patients with diabetic nephropathy, the 3-year treatment effect of ARBs was predicted in terms of absolute risk reduction (ARR) for end-stage renal disease (ESRD) and cardiovascular disease (CVD; i...
June 23, 2016: Diabetes, Obesity & Metabolism
Meihua Yan, Yumin Wen, Liping Yang, Xi'ai Wu, Xiaoguang Lu, Bingxuan Zhang, Weiping Huang, Ping Li
BACKGROUND: Diabetic kidney disease (DKD) is one of the most common microvascular complications of diabetes mellitus and the main cause of end-stage renal disease. Present medications for DKD are not entirely satisfactory. Preliminary studies indicate that the Chinese herbal formula Tangshen Formula (TSF) appears to decrease the proteinuria and improve the estimated glomerular filtration rate (eGFR) in DKD patients. METHODS/DESIGN: This trial is a five-center, randomized, double-blind, placebo-controlled study...
2016: Trials
Marwa A Sabe, Brian Claggett, Emmanuel A Burdmann, Akshay S Desai, Peter Ivanovich, Reshma Kewalramani, Eldrin F Lewis, John J V McMurray, Kurt A Olson, Patrick Parfrey, Scott D Solomon, Marc A Pfeffer
BACKGROUND: Although clear evidence shows that chronic kidney disease is a predictor of cardiovascular events, death, and accelerated coronary artery disease (CAD) progression, it remains unknown whether CAD is a predictor of progression of chronic kidney disease to end-stage renal disease. We sought to assess whether CAD adds prognostic information to established predictors of progression to dialysis in patients with chronic kidney disease, diabetes, and anemia. METHODS AND RESULTS: Using the previously described Trial to Reduce Cardiovascular Events With Aranesp Therapy (TREAT) population, we compared baseline characteristics of patients with and without CAD...
April 23, 2016: Journal of the American Heart Association
Joost C van den Born, Anne-Roos S Frenay, Stephan J L Bakker, Andreas Pasch, Jan-Luuk Hillebrands, Hiddo J Lambers Heerspink, Harry van Goor
Diabetes is associated with a high incidence of microvascular disease, including nephropathy. Diabetic nephropathy is the most common cause of chronic kidney disease in the Western world. Sulfate in the urine is the metabolic end product of hydrogen sulfide (H2S), a recent discovered gaseous signaling molecule. Urinary sulfate has earlier shown beneficial predictive properties in renal transplant recipients. Based on the protective role of exogenous H2S in experimental models of diabetic nephropathy, we aimed to cross-sectionally investigate the association of sulfate with renal risk markers, and to prospectively investigate its predictive value for renal events in patients with diabetic nephropathy...
May 1, 2016: Nitric Oxide: Biology and Chemistry
Hiddo J L Heerspink, Frederik Persson, Barry M Brenner, Nish Chaturvedi, Patrick Brunel, John J McMurray, Akshay S Desai, Scott D Solomon, Marc A Pfeffer, Hans-Henrik Parving, Dick de Zeeuw
BACKGROUND: The primary results of the ALTITUDE trial showed no benefit of aliskiren on renal outcomes (doubling of serum creatinine and end-stage renal disease) when used as an adjunct to angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs) in patients with type 2 diabetes and chronic kidney disease or cardiovascular disease. We did a prespecified analysis of the ALTITUDE trial to analyse the effects of aliskiren on surrogate renal outcomes in all patients and on primary renal outcomes in subgroups of patients...
April 2016: Lancet Diabetes & Endocrinology
Vasilios Devetzis, Arezoo Daryadel, Stefanos Roumeliotis, Marios Theodoridis, Carsten A Wagner, Stefan Hettwer, Uyen Huynh-Do, Passadakis Ploumis, Spyridon Arampatzis
BACKGROUND: Diabetes is the leading cause of CKD in the developed world. C-terminal fragment of agrin (CAF) is a novel kidney function and injury biomarker. We investigated whether serum CAF predicts progression of kidney disease in type 2 diabetics. METHODS: Serum CAF levels were measured in 71 elderly patients with diabetic nephropathy using a newly developed commercial ELISA kit (Neurotune®). Estimated glomerular filtration rate (eGFR) and proteinuria in spot urine were assessed at baseline and after 12 months follow up...
2015: PloS One
Morgan E Grams, Yingying Sang, Josef Coresh, Shoshana Ballew, Kunihiro Matsushita, Miklos Z Molnar, Zoltan Szabo, Kamyar Kalantar-Zadeh, Csaba P Kovesdy
BACKGROUND: Few trials of acute kidney injury (AKI) prevention after surgery have been conducted, and most observational studies focus on AKI following cardiac surgery. The frequency of, risk factors for, and outcomes after AKI following other types of major surgery have not been well characterized and may present additional opportunities for trials in AKI. STUDY DESIGN: Observational cohort study. SETTING & PARTICIPANTS: 3.6 million US veterans followed up from 2004 to 2011 for the receipt of major surgery (cardiac; general; ear, nose, and throat; thoracic; vascular; urologic; and orthopedic) and postoperative outcomes...
June 2016: American Journal of Kidney Diseases: the Official Journal of the National Kidney Foundation
Maria Vanessa Perez-Gomez, Maria Dolores Sanchez-Niño, Ana Belen Sanz, Catalina Martín-Cleary, Marta Ruiz-Ortega, Jesus Egido, Juan F Navarro-González, Alberto Ortiz, Beatriz Fernandez-Fernandez
Diabetic kidney disease is the most frequent cause of end-stage renal disease. This implies failure of current therapeutic approaches based on renin-angiotensin system (RAS) blockade. Recent phase 3 clinical trials of paricalcitol in early diabetic kidney disease and bardoxolone methyl in advanced diabetic kidney disease failed to meet the primary endpoint or terminated on safety concerns, respectively. However, various novel strategies are undergoing phase 2 and 3 randomized controlled trials targeting inflammation, fibrosis and signaling pathways...
June 18, 2015: Journal of Clinical Medicine
Daniela Dunkler, Maria Kohl, Koon K Teo, Georg Heinze, Mahshid Dehghan, Catherine M Clase, Peggy Gao, Salim Yusuf, Johannes F E Mann, Rainer Oberbauer
BACKGROUND: Although the prevalence of chronic kidney disease (CKD) is ∼ 30% in the group of people with diabetes, data on interventions in the very early stage of the disease are still missing. Furthermore, the effects of modifiable lifestyle factors such as nutrition on incidence and progression of CKD in patients with diabetes in Europe remain elusive. METHODS: We analyzed whether diet quality and adherence to dietary guidelines using the modified Alternate Healthy Eating Index (mAHEI) score was associated with CKD incidence or progression after 5...
August 2015: Nephrology, Dialysis, Transplantation
Enyu Imai, Sadayoshi Ito, Masakazu Haneda, Atsushi Harada, Fumiaki Kobayashi, Tetsu Yamasaki, Hirofumi Makino, Juliana C N Chan
BACKGROUND: Blood pressure (BP) control may have different effects on cardiovascular (CV) and renal outcomes in diabetes. We examined the impact of systolic BP (SBP) on renal and CV outcomes in a post hoc analysis in the Olmesartan Reducing Incidence of Endstage Renal Disease in Diabetic Nephropathy Trial. METHODS: We stratified mean follow-up SBP into three categories (≤130, 131-140 and >140 mmHg) and used a Cox regression model to estimate the hazard ratio (HR, 95% confidence interval) for the outcomes...
March 2016: Nephrology, Dialysis, Transplantation
Yehuda Handelsman, Zachary T Bloomgarden, George Grunberger, Guillermo Umpierrez, Robert S Zimmerman, Timothy S Bailey, Lawrence Blonde, George A Bray, A Jay Cohen, Samuel Dagogo-Jack, Jaime A Davidson, Daniel Einhorn, Om P Ganda, Alan J Garber, W Timothy Garvey, Robert R Henry, Irl B Hirsch, Edward S Horton, Daniel L Hurley, Paul S Jellinger, Lois Jovanovič, Harold E Lebovitz, Derek LeRoith, Philip Levy, Janet B McGill, Jeffrey I Mechanick, Jorge H Mestman, Etie S Moghissi, Eric A Orzeck, Rachel Pessah-Pollack, Paul D Rosenblit, Aaron I Vinik, Kathleen Wyne, Farhad Zangeneh
UNLABELLED: The American Association of Clinical Endocrinologists/American College of Endocrinology Medical Guidelines for Clinical Practice are systematically developed statements to assist healthcare professionals in medical decision making for specific clinical conditions. Most of the content herein is based on literature reviews. In areas of uncertainty, professional judgment was applied. These guidelines are a working document that reflects the state of the field at the time of publication...
April 2015: Endocrine Practice
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