Associations between cardiometabolic indices and the risk of diabetic kidney disease in patients with type 2 diabetes

Cardiovascular Diabetology, Journal Year: 2024, Volume and Issue: 23(1)

Published: April 25, 2024

Abstract Background This study was designed to assess the associations between emerging cardiometabolic indices—the atherogenic index of plasma (AIP), stress hyperglycemia ratio (SHR), triglyceride-glucose (TyG) index, and homeostasis model assessment insulin resistance (HOMA-IR)—and incidence diabetic kidney disease (DKD) in type 2 diabetes (T2D) patients. Methods We consecutively enrolled 4351 T2D The AIP, SHR, TyG HOMA-IR were calculated from baseline parameters. DKD defined as a urine albumin/creatinine > 30 mg/g or an eGFR < 60 mL/min per 1.73 m. All participants categorized into tertiles based on indices. Multivariate logistic regression models, restricted cubic splines, receiver operating characteristic (ROC) curves used for analysis. Results A total 1371 (31.5%) patients diagnosed with DKD. spline showed J-shaped association AIP DKD, log-shaped U-shaped SHR incidence. revealed that individuals highest tertile four indices had significantly greater risk than did those lowest (AIP: OR = 1.08, 95% CI 1.02–1.14, P 0.005; SHR: 1.42, 1.12–1.81, 0.004; index: 1.86, 1.42–2.45, 0.001; HOMA-IR: 2.24, 1.52–3.30, 0.001). score better other at predicting optimal cutoff 3.532. Conclusions Elevated are associated T2D. Among these indices, demonstrated strongest predictive value

Language: Английский

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Efficacy and safety of drugs for people with type 2 diabetes mellitus and chronic kidney disease on kidney and cardiovascular outcomes: A systematic review and network meta-analysis of randomized controlled trials

Diabetes Research and Clinical Practice, Journal Year: 2023, Volume and Issue: 198, P. 110592 - 110592

Published: Feb. 24, 2023

Language: Английский

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Cardiovascular Outcomes in Patients With Diabetes and Kidney Disease

Journal of the American College of Cardiology, Journal Year: 2023, Volume and Issue: 82(2), P. 161 - 170

Published: July 1, 2023

Chronic kidney disease (CKD) and cardiovascular (CVD) have a significant inter-relationship in patients with diabetes. Controlling blood pressure, dyslipidemia, glucose levels is common treatment approach to managing CVD risk CKD diabetes; despite strict control, however, high residual remains. This review focuses on who require pharmacotherapy, whom new existing cardiorenal therapies (renin-angiotensin-aldosterone system inhibitors, sodium-glucose cotransporter-2 glucagon-like peptide-1 receptor agonists, nonsteroidal mineralocorticoid antagonists) differing mechanisms of action safety profiles can reduce beyond the outcomes achieved or glycemic control alone. Several guidelines been updated recently reflect evidence. Studies these agents used combination are ongoing, results awaited interest, hope that potential synergistic effects may lead further improvements outcomes.

Language: Английский

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Cardiac and kidney benefits of empagliflozin in heart failure across the spectrum of kidney function: Insights from the EMPEROR‐Preserved trial

European Journal of Heart Failure, Journal Year: 2023, Volume and Issue: 25(8), P. 1337 - 1348

Published: April 17, 2023

In the EMPEROR-Preserved trial, empagliflozin improved clinical outcomes of patients with heart failure (HF) preserved ejection fraction. this pre-specified analysis, we aim to study effect on cardiovascular and kidney across spectrum function.Patients were categorized by presence or absence chronic disease (CKD) at baseline (CKD defined an estimated glomerular filtration rate [eGFR] <60 ml/min/1.73 m2 urine albumin creatinine ratio >300 mg/g). The primary key secondary (i) a composite death first HF hospitalization (primary outcome); (ii) total number hospitalization, (iii) eGFR slope; exploratory outcome including sustained ≥40% decline in eGFR, dialysis renal transplant. median follow-up was 26.2 months. A 5988 randomized placebo, whom 3198 (53.5%) had CKD. Irrespective CKD status, reduced (with CKD: hazard [HR] 0.80, 95% confidence interval [CI] 0.69-0.94; without HR 0.75, CI 0.60-0.95; interaction p = 0.67) (first recurrent) hospitalizations for 0.68, 0.54-0.86; 0.89, 0.66-1.21; 0.17). Empagliflozin slowed slope 1.43 (1.01-1.85) /year 1.31 (0.88-1.74) (interaction 0.70). did not reduce 0.97, 0.71-1.34; 0.92, 0.58-1.48; 0.86) but progression macroalbuminuria risk acute injury. consistent five categories (all >0.05). well tolerated independent status.In EMPEROR-Preserved, beneficial efficacy Overall, benefit safety wide range function spectrum, down 20 .

Language: Английский

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Lifestyle Modifications and Nutritional and Therapeutic Interventions in Delaying the Progression of Chronic Kidney Disease: A Review

Cureus, Journal Year: 2023, Volume and Issue: unknown

Published: Feb. 2, 2023

Chronic kidney disease (CKD) is a debilitating progressive illness that affects more than 10% of the world's population. In this literature review, we discussed roles nutritional interventions, lifestyle modifications, hypertension (HTN) and diabetes mellitus (DM) control, medications in delaying progression CKD. Walking, weight loss, low-protein diet (LPD), adherence to alternate Mediterranean (aMed) diet, Alternative Healthy Eating Index (AHEI)-2010 slow However, smoking binge alcohol drinking increase risk CKD progression. addition, hyperglycemia, altered lipid metabolism, low-grade inflammation, over-activation renin-angiotensin-aldosterone system (RAAS), overhydration (OH) diabetic The Kidney Disease: Improving Global Outcomes (KDIGO) guidelines recommend blood pressure (BP) control <140/90 mmHg patients without albuminuria <130/80 with prevent Medical therapies aim target epigenetic alterations, fibrosis, inflammation. Currently, RAAS blockade, sodium-glucose cotransporter-2 (SGLT2) inhibitors, pentoxifylline, finerenone are approved for managing according completed Study Diabetic Nephropathy Atrasentan (SONAR), atrasentan, an endothelin receptor antagonist (ERA), decreased renal events patients. ongoing trials studying role other agents slowing

Language: Английский

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SGLT-2 inhibitors, GLP-1 receptor agonists, and DPP-4 inhibitors and risk of hyperkalemia among people with type 2 diabetes in clinical practice: population based cohort study

BMJ, Journal Year: 2024, Volume and Issue: unknown, P. e078483 - e078483

Published: June 26, 2024

Abstract Objectives To evaluate the comparative effectiveness of sodium-glucose cotransporter-2 (SGLT-2) inhibitors, glucagon-like peptide-1 (GLP-1) receptor agonists, and dipeptidyl peptidase-4 (DPP-4) inhibitors in preventing hyperkalemia people with type 2 diabetes routine clinical practice. Design Population based cohort study active-comparator, new user design. Setting Claims data from Medicare two large commercial insurance databases United States April 2013 to 2022. Participants 1:1 propensity score matched adults newly starting SGLT-2 versus DPP-4 (n=778 908), GLP-1 agonists (n=729 820), (n=873 460). Main outcome measures Hyperkalemia diagnosis inpatient or outpatient setting. Secondary outcomes were defined as serum potassium levels ≥5.5 mmol/L emergency department Results Starting inhibitor treatment was associated a lower rate than (hazard ratio 0.75, 95% confidence interval (CI) 0.73 0.78) slight reduction compared (0.92, 0.89 0.95). Use (0.79, 0.77 0.82). The three year absolute risk 2.4% (95% CI 2.1% 2.7%) for (4.6% v 7.0%), 1.8% (1.4% 2.1%) (5.7% 7.5%), 1.2% (0.9% 1.5%) (4.7% 6.0%). Findings consistent secondary among subgroups by age, sex, race, medical conditions, other drug use, hemoglobin A1c on relative scale. Benefits scale largest those heart failure, chronic kidney disease, using mineralocorticoid antagonists. Compared consistently observed across individual agents (canagliflozin, dapagliflozin, empagliflozin) agonist (dulaglutide, exenatide, liraglutide, semaglutide) classes. Conclusions In diabetes, overall population relevant subgroups. consistency associations classes suggests class effect. These ancillary benefits further support their use especially at hyperkalemia.

Language: Английский

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Sodium-glucose co-transporter protein 2 (SGLT2) inhibitors for people with chronic kidney disease and diabetes

Cochrane library, Journal Year: 2024, Volume and Issue: 2024(5)

Published: May 21, 2024

Language: Английский

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New insights in the treatment of DKD: recent advances and future prospects

BMC Nephrology, Journal Year: 2025, Volume and Issue: 26(1)

Published: Feb. 11, 2025

Diabetic kidney disease (DKD) represents the predominant and severe microvascular complication associated with diabetes, frequently culminating in End-Stage Kidney Disease (ESKD). The escalating prevalence of diabetes has correspondingly led to a rise DKD incidence, imposing significant challenges on both individuals society. etiology is multifaceted remains devoid definitive therapeutic interventions. This article examines pharmacological actions mechanisms different drugs used for prevention treatment that are currently clinical use or undergoing development. goal offer insights early intervention based combinations potentially slow progression.

Language: Английский

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Practical considerations for the use of SGLT‐2 inhibitors in the Asia–Pacific countries—An expert consensus statement

Nephrology, Journal Year: 2023, Volume and Issue: 28(8), P. 415 - 424

Published: May 8, 2023

Abstract Recent clinical studies have demonstrated the effectiveness of SGLT‐2 inhibitors in reducing risks cardiovascular and renal events both patients with without type 2 diabetes mellitus. Consequently, many international guidelines begun advocating for use purpose organ protection rather than as simply a glucose‐lowering agent. However, despite consistent benefits available strong guideline recommendations, utilization been unexpectedly low countries, trend which is much more noticeable resource settings. Unfamiliarity recent focus their protective role indications; concerns potential adverse effects inhibitors, including acute kidney injury, genitourinary infections, euglycemic ketoacidosis; safety profile elderly populations identified deterring factors to widespread use. This review serves practical guide clinicians managing who could benefit from treatment instill greater confidence initiation these drugs, aim optimizing rates high‐risk populations.

Language: Английский

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Diabetes mellitus treatment

Elsevier eBooks, Journal Year: 2023, Volume and Issue: unknown, P. 417 - 427

Published: Aug. 31, 2023

Language: Английский

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