Albuminuria, serum creatinine, and estimated glomerular filtration rate as predictors of cardio-renal outcomes in patients with type 2 diabetes mellitus and kidney disease: a systematic literature review

Norris, Keith C.; Smoyer, Karen E.; Rolland, Catherine; Vaart, J Van der; Grubb, Eliza Beth

doi:10.1186/s12882-018-0821-9

Cited by 67 publications

(50 citation statements)

References 75 publications

(186 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Albuminuria is commonly used to assess kidney disease progression among patients with DKD, but some studies have shown that this marker may have insufficient ability to predict kidney disease end points on its own [ 19 ]. On this basis, exploring novel biomarkers that can more reliably identify individuals at risk of experiencing adverse renal outcomes is warranted.…”

Section: Discussionmentioning

confidence: 99%

Urinary epidermal growth factor, monocyte chemoattractant protein-1 or their ratio as predictors for rapid loss of renal function in type 2 diabetic patients with diabetic kidney disease

et al. 2018

View full text Add to dashboard Cite

BackgroundIncreased monocyte chemoattractant protein-1 (MCP-1) and decreased epidermal growth factor (EGF) are promising biomarkers to predict progressive decline in kidney function in non-diabetic kidney diseases. We aimed to evaluate the performance of urinary EGF, MCP-1 or their ratio in predicting rapid decline of GFR in a cohort of Type 2 diabetic patients (T2DM) with diabetic kidney disease (DKD).MethodsT2DM patients (n = 83) with DKD at high risk for renal progression were followed up prospectively. The baseline urine values of MCP-1 to creatinine ratio (UMCP-1), EGF to creatinine ratio (UEGF), EGF to MCP-1 ratio (UEGF/MCP-1) and albumin to creatinine ratio (UACR) were measured. The primary outcome was a decline in estimated glomerular filtration rate (GFR) of ≥25% yearly from baseline.ResultsDuring follow-up time of 23 months, patients with rapid decline in estimated GFR of ≥25% yearly from baseline had significantly higher baseline levels of UMCP-1, and UACR and lower UEGF and UEGF/MCP-1 ratio. All renal biomarkers predicted primary outcomes with ROC (95%CI) for UMCP-1=0.73 (0.62-0.84), UEGF=0.68 (0.57-0.80), UEGF/MCP-1=0.74 (0.63-0.85), and UACR =0.84 (0.75-0.93). By univariate analysis, blood pressure, GFR, UACR, UMCP-1, UEGF, and UEGF/MCP-1 were associated with rapid decline GFR. By multivariate analysis, UACR, systolic blood pressure, and UMCP-1 or UEGF/MCP-1 were independently associated with rapid GFR decline.ConclusionsUMCP-1 or UEGF/MCP-1 ratio were associated with rapid renal progression independent from conventional risk factors in DKD.Electronic supplementary materialThe online version of this article (10.1186/s12882-018-1043-x) contains supplementary material, which is available to authorized users.

show abstract

Section: Discussionmentioning

confidence: 99%

Urinary epidermal growth factor, monocyte chemoattractant protein-1 or their ratio as predictors for rapid loss of renal function in type 2 diabetic patients with diabetic kidney disease

et al. 2018

View full text Add to dashboard Cite

show abstract

“…Concurrent with HTN, which occurs in approximately 65% of patients with DM, hyperglycemia, and genetic predisposition are key factors in the development and progression of kidney disease [8,13]. DN is characterized by the development of proteinuria with a subsequent decline in eGFR [6,8,11].…”

Section: Cardiovascular and Cerebrovascular Prognosismentioning

confidence: 99%

“…Albuminuria, albeit a strong predictor of DN progression, lacks speci city and sensitivity for the diagnosis of ESRD and the progressive decline in eGFR [8][9][10]. Kidney biopsy, which is the gold standard for de nitive diagnosis of DN, is not indicated in patients with DM [7].…”

Section: Introductionmentioning

confidence: 99%

“…Worsening DN over time is associated with increased risk of cardiovascular and cerebrovascular events as well as renal morbidity and mortality [8,14,15]. We evaluated the decline in renal function according to albuminuria levels in patients with DN and analyzed the prognosis of renal function and the incidence of cardiovascular disease (CVD), cerebrovascular disease, and peripheral artery disease (PAD).…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Progression to Chronic Kidney Disease According to Albuminuria in Diabetic Nephropathy Patients With Preserved Renal Function

Hr¹,

Kr²,

Lee³

et al. 2020

Preprint

View full text Add to dashboard Cite

Background: Albuminuria predicts progression of diabetic nephropathy (DN) but lacks specificity and sensitivity for the diagnosis of chronic kidney disease (CKD) and progressive decline in estimated glomerular filtration rate (eGFR). We evaluated the decline in renal function in patients with DN and analyzed the prognosis of renal function according to the level of albuminuria and the incidence of cardiovascular disease (CVD), cerebrovascular diseases, and peripheral artery disease (PAD) according to the level of albuminuria. Methods: This retrospective study included 331 patients with eGFR > 60 mL/min/1.73 m2 and urinary albumin/creatinine (Cr) ratio (ACR) > 30 mg/g Cr who were treated at the Chungnam National University Hospital between January 2012 and December 2018. Patients were divided into mildly increased albuminuria, moderately increased albuminuria, and severely increased albuminuria groups according to their urine ACRs of 30–300, 300–900, and >900 mg/g Cr, respectively. Renal outcomes and incidence of CVD, cerebrovascular disease, and PAD were compared among the three groups.Results: The rate of reduction in eGFR per year was 1.47 ± 6.61 mL/min/1.73 m2 in the mildly increased albuminuria, 4.10 ± 8.98 mL/min/1.73 m2 in the moderately increased albuminuria, and 9.19 ± 10.39 mL/min/1.73 m2 in the severely increased albuminuria (p < 0.001). More severe albuminuria was associated with higher rates of progression to CKD (p < 0.001) and >50% reduction in eGFR from baseline (p < 0.001). There was a statistically significant difference in the rate of PCI with angina or myocardial infarction (p = 0.030). However, cerebrovascular disease and PAD did not significantly differ among the three groups.Conclusion: Among patients with DN who maintained a relatively preserved renal function with an eGFR > 60 mL/min/1.73 m2, the rates of renal deterioration and progression to CKD were significantly more frequent in those with more severe albuminuria.

show abstract

“…reduction in eGFR) [134]. Even, if changes in albuminuria and eGFR were associated with a greater risk of experiencing clinical outcomes [135], clinicians are waiting for clear-cut data on more relevant hard endpoints, such as avoiding the progression to ESRD or renal death. Some well-known agents (RAAS inhibitors) and, more recently, new antidiabetic medications (SGLT2is) have shown renoprotective effects, not only on surrogate endpoints but also on hard clinical outcomes, independently of their blood pressure-lowering activity and glucose-lowering activity, respectively.…”

Section: Expert Opinionmentioning

confidence: 99%

Preventing and treating kidney disease in patients with type 2 diabetes

Delanaye

Scheen

2018

Expert Opinion on Pharmacotherapy

View full text Add to dashboard Cite

Introduction: Chronic kidney disease (CKD) represents a huge burden in patients with type 2 diabetes (T2DM). This review therefore has the aim of assessing the add-on value of new glucose-lowering agents compared or combined with inhibitors of the renin angiotensin aldosterone system (RAAS) on renal outcomes in T2DM patients. Areas covered: This article first summarizes the results reported with RAAS inhibitors, mainstay of nephroprotection in T2DM with albuminuria. Second, it describes the positive results with glucagon-like peptide-1 receptor agonists (GLP-1RAs) and, even more impressive, sodium-glucose cotransporter type 2 inhibitors (SGLT2is). Third, besides the potential of combined therapies, it briefly considers some new approaches currently in development. Expert opinion: RAAS inhibitors exert renoprotective effects beyond their blood pressure lowering effects while SGLT2is, and possibly GLP-1RAs, exert nephroprotection independently of their glucoselowering activity. These effects were demonstrated not only on surrogate endpoints such as albuminuria and estimated glomerular filtration rate decline, but also on hard endpoints, including progression to end-stage renal disease requiring replacement therapy. The underlying mechanisms are different and potentially complementary on glomerular hemodynamics, arguing for combined therapies. Nevertheless, there is still room for new emerging drugs to tackle CKD in T2DM.

show abstract

Albuminuria, serum creatinine, and estimated glomerular filtration rate as predictors of cardio-renal outcomes in patients with type 2 diabetes mellitus and kidney disease: a systematic literature review

Cited by 67 publications

References 75 publications

Urinary epidermal growth factor, monocyte chemoattractant protein-1 or their ratio as predictors for rapid loss of renal function in type 2 diabetic patients with diabetic kidney disease

Urinary epidermal growth factor, monocyte chemoattractant protein-1 or their ratio as predictors for rapid loss of renal function in type 2 diabetic patients with diabetic kidney disease

Progression to Chronic Kidney Disease According to Albuminuria in Diabetic Nephropathy Patients With Preserved Renal Function

Preventing and treating kidney disease in patients with type 2 diabetes

Contact Info

Product

Resources

About