A special issue on from bench to bedside: An integrated and multidisciplinary approach to tackling diabetic kidney disease DOI Open Access
Janaka Karalliedde, Claire E. Hills

Diabetic Medicine, Journal Year: 2024, Volume and Issue: unknown

Published: Dec. 15, 2024

More than 800 million people have chronic kidney disease (CKD) globally and type 2 diabetes accounts for between 30% 50% of cases CKD.1 Diabetic Kidney (DKD) is associated with increased cardiovascular (CVD) morbidity mortality in many countries also the leading cause end stage needing replacement therapy (dialysis or transplantation).2 DKD impacts on length quality life significantly contributes to global healthcare expenditure these human economic costs are likely rise further future.2, 3 Prognosis progression can differ from one individual another, which often a consequence interactions traditional emerging risk factors as well social-demographic factors, such ethnicity socio-economic factors.4 The recent Research UK health inequalities report demonstrated that South Asian Black backgrounds three five times more require dialysis white background.5 This observation may be part linked increasing prevalence currently unknown determinants progression. management requires multifactorial multidisciplinary approach key focus early identification CKD screening then prompt intervention focussing important lifestyle modifications, using evidence-based medical treatments holistic care.3, 6 With advances pillars treatment includes renin angiotensin system inhibition, sodium glucose co-transporter inhibition (SGLT2-inh), non-steroidal mineralocorticoid receptor antagonists glucagon like peptide 1 agonists (GLP-1 RA) parallel CVD factor modification, there an opportunity intervene change risk.7, 8 For DKD, gaps care options limited contrast diabetes, indeed, high burden this cohort underappreciated.9 natural history has evolved over last 40 years, remains significant residual ESKD premature CVD.9, 10 Despite 30 not optimal present late when modifiability progression/risk less feasible. There thus urgent need better methods biomarkers aid stratification ensure those at highest recognized guideline directed therapies initiated promptly morbidity/mortality.8, 11 glycaemic control challenging setting individualized approach. pathophysiology multifaceted encompasses metabolic haemodynamic perturbations lead structural functional disturbances including glomerular hyper-filtration, mesangial expansion interstitial fibrosis, convergence fundamental mechanisms, 'sterile' inflammation age changes, example cell senescence.12, 13 Although precise role development unclear, studies suggest accelerated ageing phenotype, coupled maladaptive immune response, underlies Furthermore, coexistence disease, so called 'cardiorenal syndrome', occurs face multi-organ crosstalk, evidence suggesting systemic vascular robust predictor poor dyslipidaemia. As obesity, syndrome continue rise, major worldwide. A understanding interrelationships crosstalk different organs/systems contributing complications will enhance scientific could facilitate new interventions prevent treat diabetes-related co-morbidities. mechanisms underpin clinical benefits existing therapies, GLPRA SGLT2i, inform how why drug works both within inter-organ cardiovascular-kidney-metabolic other secondary diabetes. special issue diabetic medicine focussed basic translational research, potential therapeutic targets,12-15 changing diabetes,10 scenarios,11 guidelines their implementation day-to-day patient practice.16 We hope readers enjoy reading collection articles apply related learning drive future research help improve outcomes DKD. None. authors declare no conflicts interest.

Language: Английский

Pathophysiology of vascular ageing and the effect of novel cardio‐renal protective medications in preventing progression of chronic kidney disease in people living with diabetes DOI Creative Commons
Nikolaos Fountoulakis, Yoshihisa Miyamoto, Meda E. Pavkov

et al.

Diabetic Medicine, Journal Year: 2024, Volume and Issue: unknown

Published: Nov. 5, 2024

Abstract Aim Among people with diabetes those chronic kidney disease (CKD) have a reduced life expectancy increased risk of cardiovascular (CVD) major contributor to morbidity and mortality. CKD related is growing worldwide one the leading causes failure globally. Diabetes associated accelerated vascular ageing mechanisms mediators that drive progression CVD in may help provide insights into pathophysiology cardio‐renal complications guide treatment interventions diabetes. Methods We conducted narrative review literature using PubMed for English language articles contained keywords diabetes, or diabetic disease, ageing, cellular senescence, arterial stiffness, Klotho sirtuins, sodium‐glucose co‐transporter‐2 (SGLT‐2) inhibitors, renin angiotensin aldosterone system (RAAS) glucagon‐like peptide‐1 (GLP‐1) receptor agonists. Results Progressive driven part by multiple processes such as inflammation, oxidative stress circulating uremic toxins. This phenotype contributes endothelial dysfunction, cognitive decline muscle wasting, thereby elevating mortality individuals CKD. Deficiency kidney‐derived anti‐ageing hormone sirtuin levels play pivotal roles these pathways. Dietary, lifestyle pharmacological targeting reduce The current standard care pillars RAAS SGLT‐2 inhibitors GLP‐1 agonists all influence pathways involved ageing. Conclusions A multifactorial intervention prevent development traditional factors well novel agents beneficial effects can extend lifespan

Language: Английский

Citations

4
The Role of Statins in Managing Chronic Kidney Disease: A Comprehensive Review DOI
Saket Toshniwal,

P Avinash,

Anand C. Loya

et al.

International journal of Nutrition Pharmacology Neurological Diseases, Journal Year: 2025, Volume and Issue: 15(1), P. 10 - 17

Published: Jan. 1, 2025

This comprehensive review examines the multifaceted role of statins in managing chronic kidney disease (CKD), highlighting their impact beyond traditional lipid-lowering functions. CKD poses a significant global health challenge due to its association with elevated cardiovascular risks. Statins, known primarily for lowering cholesterol, have been explored potential benefits both and renal aspects CKD. discusses statins’ mechanisms action, including effects, anti-inflammatory properties, reno-protective mechanisms. By evaluating evidence from clinical studies, it addresses on outcomes, atherosclerosis reduction, function, specifically terms proteinuria glomerular filtration rate. Addressing safety concerns, also delves into common side monitoring strategies, considerations patients. Challenges controversies surrounding statin therapy, such as individual variability, applicability across stages, long-term are thoroughly examined. The implications practice underscore need personalized approach, while conclusion emphasizes evolving crucial components management CKD, challenges this complex landscape.

Language: Английский

Citations

0
The Non-High-Density Lipoprotein Cholesterol (Non-HDL-C) to HDL-C Ratio (NHHR) and Its Association with Chronic Kidney Disease in Chinese Adults with Type 2 Diabetes: A Preliminary Study DOI Open Access
Xiangyu Chen,

Mingbin Liang,

Jie Zhang

et al.

Nutrients, Journal Year: 2025, Volume and Issue: 17(7), P. 1125 - 1125

Published: March 24, 2025

Objectives: The objective of this study was to examine the association between non-high-density lipoprotein cholesterol (non-HDL-C) high-density (HDL-C) ratio (NHHR) and chronic kidney disease (CKD) in Chinese adults with type 2 diabetes mellitus (T2DM). Methods: This originated from a survey carried out Zhejiang Province, located eastern China, March November 2018. To explore relationship NHHR CKD, multivariable logistic regression model employed. dose-response assessed using restricted cubic spline (RCS) analysis, while generalized additive models (GAMs) were applied associations urinary albumin-to-creatinine (UACR) as well estimated glomerular filtration rate (eGFR). Subgroup analyses performed across various demographic clinical categories assess consistency NHHR-CKD association. optimal cutoff for CKD diagnosis, its predictive accuracy, comparison components HbA1c determined through receiver operating characteristic (ROC) curve analysis. Results: enrolled 1756 participants, including 485 individuals 1271 without CKD. Multivariable revealed significant positive each standard deviation (SD) increase linked 23% higher odds (OR = 1.23, 95% CI: 1.09-1.37) after adjusting potential confounders. When comparing quartiles, fully adjusted ORs Q2, Q3, Q4 1.29 (0.92-1.79), 1.31 (0.94-1.83), 1.87 (1.34-2.60), respectively, relative Q1 (p trend < 0.01). RCS analysis confirmed linear both sexes nonlinearity > 0.05). GAMs indicated correlation UACR (ρ 0.109, p 0.001) but no eGFR -0.016, 0.502). demonstrated consistent most subgroups, except 18-44 years age group, well-controlled glycemic non-alcohol drinking group ROC identified an 3.48 prediction, area under (AUC) 0.606 (95% 0.577-0.635). Notably, outperformed individual performance. Conclusions: link levels increased prevalence T2DM patients. may also serve complementary biomarker early detection, though further prospective studies are needed confirm value utility high-risk populations.

Language: Английский

Citations

0
Glucagon like peptide-1 modulates urinary sodium excretion in diabetic kidney disease via ENaC activation DOI Creative Commons

Goh Kodama,

Kensei Taguchi,

Sakuya Ito

et al.

Scientific Reports, Journal Year: 2025, Volume and Issue: 15(1)

Published: April 3, 2025

Diabetic kidney disease (DKD) is a leading cause of end stage disease. Elevated salt sensitivity by epithelial sodium channel (ENaC) overexpression may be residual risk factor for DKD. We found that combination therapy linagliptin (LINA) to empagliflozin (EMPA), but not EMPA alone decreased phosphorylated Nedd4-2 (p-Nedd4-2) and ENaC levels in DKD rats association with the increased urinary excretion (USE). More extensive renoprotective effects were observed LINA deoxycorticosterone high salt-treated mice. Acute injection experiments showed time-lagged administration USE, its effect sustained until 3 h. High glucose p-Nedd4-2 cultured distal tubules, which was inhibited or glucagon like peptide-1 (GLP-1), there no additive on GLP-1, latter blocked GLP-1 receptor agonist. USE higher expression lower patients received SGLT2is DPP4is than those without. Our present findings suggest addition decreases via activation GLP-1-receptor axis, could ameliorate help prevent injury

Language: Английский

Citations

0
Endothelin receptor antagonists for diabetic kidney disease: back to the future? DOI
Panagiota Anyfanti, Marieta Theodorakopoulou, Fotini Iatridi

et al.

Expert Opinion on Investigational Drugs, Journal Year: 2025, Volume and Issue: unknown, P. 1 - 11

Published: May 2, 2025

Diabetic kidney disease (DKD) is a leading cause of chronic worldwide. Endothelin-1 (ET-1) potent vasoconstrictor secreted by vascular endothelial cells, actively involved in the pathophysiology numerous cardiovascular diseases. Based on differential downstream effects ET-1 binding to its two distinct types receptors (ETA/ETB) within kidney, selective ETA receptor blockade has been long proposed as promising treatment modality for DKD. This review aims examine available evidence base use ERAs DKD, critically reappraising landmark trials and discussing their possible position context current this disease. Despite early enthusiasm widespread expectations, endothelin antagonists (ERAs) faded into obscurity following release first randomized controlled (RCTs). More recent RCTs using different compounds have re-introduced growing pharmaceutical armamentarium While future DKD management will be based more personalized approach, new, robust from appropriately designed eagerly anticipated clearly define role

Language: Английский

Citations

0
Current management of chronic kidney disease in type‐2 diabetes—A tiered approach: An overview of the joint Association of British Clinical Diabetologists and UK Kidney association (ABCD‐UKKA) guidelines DOI Creative Commons
Indranil Dasgupta,

Sagen Zac‐Varghese,

Khuram Chaudhry

et al.

Diabetic Medicine, Journal Year: 2024, Volume and Issue: unknown

Published: Oct. 17, 2024

Abstract A growing and significant number of people with diabetes develop chronic kidney disease (CKD). Diabetes‐related CKD is a leading cause end‐stage (ESKD) have high morbidity mortality, predominantly related to cardiovascular (CVD). Despite advances in care over the recent decades, most type 2 are likely die CVD before developing ESKD. Hyperglycaemia hypertension modifiable risk factors prevent onset progression CVD. People often dyslipidaemia per se an independent factor for CVD, therefore require intensive lipid lowering reduce burden Recent clinical trials demonstrated reduction composite end point events (significant decline function, need replacement therapy death) sodium‐glucose co‐transporter‐2 (SGLT‐2) inhibitors, non‐steroidal mineralocorticoid receptor antagonist finerenone glucagon‐like peptide 1 agonists. The Association British Clinical Diabetologists (ABCD) UK Kidney (UKKA) Diabetic Disease Speciality Group previously undertaken narrative review critical appraisal available evidence inform practice guidelines management hyperglycaemia, hyperlipidaemia adults CKD. This 2024 abbreviated updated guidance summarises recommendations implications healthcare professionals who treat primary, community secondary settings.

Language: Английский

Citations

2
Sodium‐glucose co‐transporter‐2 inhibitors: A paradigm shift in treatment for type 2 diabetes DOI Creative Commons
David R. Matthews

Diabetes Obesity and Metabolism, Journal Year: 2024, Volume and Issue: 26(S5), P. 3 - 4

Published: Sept. 28, 2024

Language: Английский

Citations

1
A special issue on from bench to bedside: An integrated and multidisciplinary approach to tackling diabetic kidney disease DOI Open Access
Janaka Karalliedde, Claire E. Hills

Diabetic Medicine, Journal Year: 2024, Volume and Issue: unknown

Published: Dec. 15, 2024

More than 800 million people have chronic kidney disease (CKD) globally and type 2 diabetes accounts for between 30% 50% of cases CKD.1 Diabetic Kidney (DKD) is associated with increased cardiovascular (CVD) morbidity mortality in many countries also the leading cause end stage needing replacement therapy (dialysis or transplantation).2 DKD impacts on length quality life significantly contributes to global healthcare expenditure these human economic costs are likely rise further future.2, 3 Prognosis progression can differ from one individual another, which often a consequence interactions traditional emerging risk factors as well social-demographic factors, such ethnicity socio-economic factors.4 The recent Research UK health inequalities report demonstrated that South Asian Black backgrounds three five times more require dialysis white background.5 This observation may be part linked increasing prevalence currently unknown determinants progression. management requires multifactorial multidisciplinary approach key focus early identification CKD screening then prompt intervention focussing important lifestyle modifications, using evidence-based medical treatments holistic care.3, 6 With advances pillars treatment includes renin angiotensin system inhibition, sodium glucose co-transporter inhibition (SGLT2-inh), non-steroidal mineralocorticoid receptor antagonists glucagon like peptide 1 agonists (GLP-1 RA) parallel CVD factor modification, there an opportunity intervene change risk.7, 8 For DKD, gaps care options limited contrast diabetes, indeed, high burden this cohort underappreciated.9 natural history has evolved over last 40 years, remains significant residual ESKD premature CVD.9, 10 Despite 30 not optimal present late when modifiability progression/risk less feasible. There thus urgent need better methods biomarkers aid stratification ensure those at highest recognized guideline directed therapies initiated promptly morbidity/mortality.8, 11 glycaemic control challenging setting individualized approach. pathophysiology multifaceted encompasses metabolic haemodynamic perturbations lead structural functional disturbances including glomerular hyper-filtration, mesangial expansion interstitial fibrosis, convergence fundamental mechanisms, 'sterile' inflammation age changes, example cell senescence.12, 13 Although precise role development unclear, studies suggest accelerated ageing phenotype, coupled maladaptive immune response, underlies Furthermore, coexistence disease, so called 'cardiorenal syndrome', occurs face multi-organ crosstalk, evidence suggesting systemic vascular robust predictor poor dyslipidaemia. As obesity, syndrome continue rise, major worldwide. A understanding interrelationships crosstalk different organs/systems contributing complications will enhance scientific could facilitate new interventions prevent treat diabetes-related co-morbidities. mechanisms underpin clinical benefits existing therapies, GLPRA SGLT2i, inform how why drug works both within inter-organ cardiovascular-kidney-metabolic other secondary diabetes. special issue diabetic medicine focussed basic translational research, potential therapeutic targets,12-15 changing diabetes,10 scenarios,11 guidelines their implementation day-to-day patient practice.16 We hope readers enjoy reading collection articles apply related learning drive future research help improve outcomes DKD. None. authors declare no conflicts interest.

Language: Английский

Citations

0