Gender Differences in Diabetic Kidney Disease: Focus on Hormonal, Genetic and Clinical Factors

Giandalia, Annalisa; Giuffrida, Alfio Edoardo; Gembillo, Guido; Cucinotta, Domenico; Squadrito, Giovanni; Santoro, Domenico; Russo, Giuseppina

doi:10.3390/ijms22115808

Cited by 56 publications

(61 citation statements)

References 239 publications

(288 reference statements)

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“…Parker et al [ 63 ], in their meta-analysis, examined the link between 25(OH) vitamin D levels and cardiometabolic disorders: a higher level of this hormone was linked to a 43% reduction in cardiometabolic dysregulation. The results of the study demonstrated that higher levels of vitamin D were associated with a considerable reduction of CVD, type 2 diabetes, and metabolic syndrome [ 64 ]. However, these considerations are speculative, the current literature presents methodological limitations, and it is still uncertain whether vitamin D low levels can have a predictive role in CVD and CRS outcomes.…”

Section: Biomarkers Connecting the Heart And Kidneymentioning

confidence: 99%

Cardiorenal Syndrome: New Pathways and Novel Biomarkers

et al. 2021

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Cardiorenal syndrome (CRS) is a multi-organ disease characterized by the complex interaction between heart and kidney during acute or chronic injury. The pathogenesis of CRS involves metabolic, hemodynamic, neurohormonal, and inflammatory mechanisms, and atherosclerotic degeneration. In the process of better understanding the bi-directional pathophysiological aspects of CRS, the need to find precise and easy-to-use markers has also evolved. Based on the new pathophysiological standpoints and an overall vision of the CRS, the literature on renal, cardiac, metabolic, oxidative, and vascular circulating biomarkers was evaluated. Though the effectiveness of different extensively applied biomarkers remains controversial, evidence for several indicators, particularly when combined, has increased in recent years. From new aspects of classic biomarkers to microRNAs, this review aimed at a 360-degree analysis of the pathways that balance the kidney and the heart physiologies. In this delicate system, different markers and their combination can shed light on the diagnosis, risk, and prognosis of CRS.

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Section: Biomarkers Connecting the Heart And Kidneymentioning

confidence: 99%

Cardiorenal Syndrome: New Pathways and Novel Biomarkers

et al. 2021

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“…The risk of developing DKD has a polygenetic component [20][21][22]. Diabetic patients with a first-degree relative with DKD have a substantially greater risk of developing DKD compared with those who do not have an affected relative [23].…”

Section: Duration Socioeconomic Factors and Familial And Genetic Factorsmentioning

confidence: 99%

Management of Kidney Failure in Patients with Diabetes Mellitus: What Are the Best Options?

Fuster

Craver

Pino

et al. 2021

JCM

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Diabetic kidney disease (DKD) is the most frequent cause of kidney failure (KF). There are large variations in the incidence rates of kidney replacement therapy (KRT). Late referral to nephrology services has been associated with an increased risk of adverse outcomes. In many countries, when patients reach severely reduced glomerular filtration rate (GFR), they are managed by multidisciplinary teams led by nephrologists. In these clinics, efforts will continue to halt chronic kidney disease (CKD) progression and to prevent cardiovascular mortality and morbidity. In patients with diabetes and severely reduced GFR and KF, treating hyperglycemia is a challenge, since some drugs are contraindicated and most of them require dose adjustments. Even more, a decision-making process will help in deciding whether the patient would prefer comprehensive conservative care or KRT. On many occasions, this decision will be conditioned by diabetes mellitus itself. Effective education should cover the necessary information for the patient and family to answer these questions: 1. Should I go for KRT or not? 2. If the answer is KRT, dialysis and/or transplantation? 3. Dialysis at home or in center? 4. If dialysis at home, peritoneal dialysis or home hemodialysis? 5. If transplantation is desired, discuss the options of whether the donation would be from a living or deceased donor. This review addresses the determinant factors with an impact on DKD, aiming to shed light on the specific needs that arise in the management and recommendations on how to achieve a comprehensive approach to the diabetic patient with chronic kidney disease.

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“…Chronic kidney disease (CKD) is a serious complication of type 2 diabetes (T2D) that afflicts between 25 and 40% of all diagnosed patients [ 1 ]. CKD progression differs by factors such as age [ 2 ], gender, and genetic [ 3 ] characteristics and entails compromised kidney function or kidney injury attributed to persistent uncontrolled hyperglycemia, the presence and/or release of pro-inflammatory proteins and pro-fibrotic proteins, and hypertension or high intra-glomerular pressure associated with elevated rates of cardiovascular disease (CVD) compared to T2D alone [ 4 ]. This elevated cardiovascular (CV) risk is partially responsible for the heightened mortality risk among patients with CKD, which is markedly higher compared to the general population or patients with T2D alone [ 5 ].…”

Section: Introductionmentioning

confidence: 99%

Predictors of cardio-kidney complications and treatment failure in patients with chronic kidney disease and type 2 diabetes treated with SGLT2 inhibitors

Kövesdy

Schmedt

Folkerts

et al. 2022

BMC Med

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Background Clinical practice guidelines recommend sodium-glucose co-transporter 2 inhibitors (SGLT2is) to mitigate adverse kidney and cardiovascular outcomes in patients with type 2 diabetes (T2D), including patients with comorbid chronic kidney disease (CKD), also referred to as diabetic kidney disease (DKD), who are at even higher risk. In this study, we sought to identify predictors of cardio-kidney events, cardio-kidney complications, and treatment failure (i.e., addition/initiation of a new T2D class, insulin, or discontinuation of SGLT2is) after new initiation of SGLT2is in patients with CKD and T2D (DKD). Methods In this retrospective cohort study, we identified adult patients with DKD who initiated SGLT2is between April 1, 2012, and June 30, 2019, in Optum claims data. Outcome rates per 1000 person-years (PY) are reported with 95% confidence intervals (CIs). Cox proportional hazards regression identified patient characteristics associated with each outcome. Results The study population consisted of 6389 initiators of SGLT2is. The rate of CV hospitalization was 26.0 (95% CI 21.6, 30.4) per 1000 PY. Baseline characteristics associated with higher risk of CV hospitalization included age, atrial fibrillation, peripheral vascular disease (PVD), and cancer. The rate of kidney hospitalization was 12.0 (95% CI 9.0, 15.0) per 1000 PY. The risk increased significantly with baseline evidence of heart failure, hyperkalemia, respiratory failure, depression, and use of loop diuretics. In total, 55.0% of all SGLT2i initiators discontinued treatment during the follow-up period. The rate of treatment failure was 510.5 (95% CI 492.9, 528.1) per 1000 PY. Analysis of key time-dependent SGLT2i-associated adverse events showed that experiencing diabetic ketoacidosis and volume depletion were associated with risk of treatment failure. Conclusions Our study demonstrated high rates of residual cardio-kidney outcomes and treatment failure in patients with DKD treated with SGLT2is. Patients with high baseline CV risk and the presence of certain conditions, such as atrial fibrillation, PVD, and heart failure, were at higher risk for cardio-kidney events. Further research is needed to assess the potential relationship between adverse events and SGLT2i treatment failure.

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Gender Differences in Diabetic Kidney Disease: Focus on Hormonal, Genetic and Clinical Factors

Cited by 56 publications

References 239 publications

Cardiorenal Syndrome: New Pathways and Novel Biomarkers

Cardiorenal Syndrome: New Pathways and Novel Biomarkers

Management of Kidney Failure in Patients with Diabetes Mellitus: What Are the Best Options?

Predictors of cardio-kidney complications and treatment failure in patients with chronic kidney disease and type 2 diabetes treated with SGLT2 inhibitors

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