Serum Lipoprotein(a) and High-Density Lipoprotein Cholesterol Associate with Diabetic Nephropathy: Evidence from Machine Learning Perspectives

Diabetes Metabolic Syndrome and Obesity, Journal Year: 2023, Volume and Issue: Volume 16, P. 1847 - 1858

Published: June 1, 2023

Diabetic nephropathy (DN) is a common complication of type 2 diabetes mellitus (T2DM) that significantly impacts the quality life for affected patients. Dyslipidemia known risk factor developing cardiovascular complications in T2DM However, association between serum lipoprotein(a) (Lp(a)) and high-density lipoprotein cholesterol (HDL-C) with DN requires further investigation.For this cross-sectional study, we randomly selected patients (DN, n = 211) without (T2DM, 217) from cohort 142,611 based on predefined inclusion exclusion criteria. We collected clinical data to identify potential factors using binary logistic regression machine learning. After obtaining feature importance score indicators by building random forest classifier, examined correlations Lp(a), HDL-C top 10 indicators. Finally, trained decision tree models features training evaluated their performance independent testing data.Compared group, group had higher levels Lp(a) (p < 0.001) lower 0.028). was identified as DN, while found be protective. were associated and/or HDL-C, including urinary albumin (uALB), uALB creatinine ratio (uACR), cystatin C, creatinine, ɑ1-microglobulin, estimated glomerular filtration rate (eGFR), β2-microglobulin, urea nitrogen, superoxide dismutase fibrinogen. The at cut-off value 31.1 mg/L showed an average area under receiver operating characteristic curve (AUC) 0.874, AUC range 0.870 0.890.Our findings indicate are have provided model predictor DN.

Language: Английский

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NEW DIRECTIONS IN PHARMACOLOGICAL TREATMENT WITH SGLT-2 INHIBITOR MOLECULES IN THE LIGHT OF CURRENT GUIDELINES FOR DIABETES MELLITUS, HEART FAILURE AND KIDNEY DISEASE

FARMACIA, Journal Year: 2023, Volume and Issue: 71(4), P. 686 - 696

Published: Aug. 31, 2023

Sodium-glucose cotransporter-2 (SGLT-2) inhibitors, a newer class of oral anti-hyperglycaemic agents, have been shown to improve cardiovascular and renal outcomes in patients with type 2 diabetes mellitus (T2DM), by reducing the risk heart failure, death, events.This review aimed describe mechanism action clinical benefits SGLT-2 highlighting their cardiorenal protection, glucose lowering effects, efficacy management T2DM multiple factors.SGLT-2 inhibitors reduce reabsorption sodium from proximal tubules, thereby increasing excretion.In addition glucose-lowering property, involve weight loss major cardio-and reno-protective effects such as decreased preload afterload, reversed cardiac remodelling, improved endothelial function, reduced albuminuria, glomerular hemodynamic preserved kidney function.Therefore, SGLT2 are crucial component guidelines for diabetes, failure chronic disease, even those without T2DM.

Language: Английский

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Population Health Management and Guideline-Concordant Care in CKD

Journal of the American Society of Nephrology, Journal Year: 2024, Volume and Issue: unknown

Published: Nov. 1, 2024

Key Points Implementation gaps in guideline-concordant care for CKD are associated with poor clinical outcomes. A population health management–based, multidisciplinary approach improved exposure days to sodium-glucose cotransporter-2 inhibitor and glucagon-like peptide-1 receptor agonists compared usual care. Angiotensin-converting enzyme inhibitor/angiotensin blocker albuminuric patients statin use was not improved, nor BP control, glycemic or albuminuria testing. Background Gaps lead The Kidney Coordinated HeAlth Management Partnership (K-CHAMP) cluster randomized trial tested the effect of a management intervention versus on progression evidence-based delivery primary setting. Methods K-CHAMP included adults aged 18–85 years eGFR<60 ml/min per 1.73 m 2 moderate-high risk who were seeing nephrologist. multifaceted nephrology e-consult, pharmacist-led medication management, patient education. In this post hoc analysis, we evaluate effectiveness processes (BP annual testing) (angiotensin-converting [ACEi]/angiotensin [ARB], intensity statin, [SGLT2i], [GLP-1RA]). Given multiplicity outcomes, Benjamini–Hochberg method used control false discovery rate. Results All 1596 (754 intervention, 842 care) enrolled (mean age 74±9 years, eGFR 37±8 , 928 [58%] female, 127 [8%] Black) analyzed. After median 17-month follow-up, arm had significantly higher year SGLT2i (56 32 days; relative benefit 1.72; 95% confidence interval [CI], 1.14 2.30) GLP-1RA (78 29 2.65; CI, 1.59 3.71) adjusted analysis. At study initiation 2019, similar proportion prescribed and/or (8% 6%, respectively; rate ratio 1.23; 0 2.99), but by 2022, prescription these medications (44% 27%, 1.63; 1.32 1.94). There no significant difference any process measures ACEi/ARB statin. Conclusions effective accelerating implementation did increase improve testing individuals Clinical Trial registry name registration number: K-CHAMP, NCT03832595.

Language: Английский

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Evidence for Cardiorenal Protection with SGLT-2 Inhibitors and GLP-1 Receptor Agonists in Patients with Diabetic Kidney Disease

Journal of Personalized Medicine, Journal Year: 2022, Volume and Issue: 12(2), P. 223 - 223

Published: Feb. 6, 2022

For almost two decades, the management of patients with type 2 diabetes mellitus (T2DM) and chronic kidney disease (CKD) was based on optimal glycemic blood pressure control as well adequate blockade renin-angiotensin-system. Over past few years, sodium-glucose co-transporter (SGLT-2) inhibitors glucagone-like peptide 1 receptor agonists (GLP1-RAs) were added to our therapeutic armarhatum, offering promise for more effective mitigation substantial residual cardiorenal risk these patients. Large randomized controlled trials (RCTs) designed demonstrate cardiovascular safety SGLT-2 GLP1-RAs showed that novel anti-diabetic medications improve outcomes in T2DM. RCTs conducted specifically CKD or without T2DM demonstrated also retarding progression injury end-stage disease. The protective effects GLP1-RA are not yet proven, but currently ongoing investigate this crucial research question. In article, we review available clinical-trial evidence supporting use protection CKD. We provide clinical practice recommendations a personalized approach therapies, according severity presence other cardiometabolic factors.

Language: Английский

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A systematic review of the value of clinical decision support systems in the prescription of antidiabetic drugs

International Journal of Medical Informatics, Journal Year: 2024, Volume and Issue: 191, P. 105581 - 105581

Published: July 30, 2024

Language: Английский

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