Glucose Control Influences Glomerular Filtration Rate and Its Prediction in Diabetic Subjects

Rigalleau, Vincent; Lasseur, Catherine; Raffaitin, C.; Perlemoine, Caroline; Barthe, Nicole; Chauveau, Philippe; Combe, Christian; Gin, H.

doi:10.2337/dc06-0407

Cited by 46 publications

(33 citation statements)

References 31 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Jin et al indicated a similar finding to ours; glomerular hyperfiltrators exist among Japanese subjects with type 2 diabetes without proteinuria or hypertension, and they were characterized by higher HbA 1C than normofiltrators (18). A significant linear correlation of HbA 1C with estimated/measured GFR was shown (19,20). It is likely that chronic hyperglycemia may act through a mechanism that involves increased nitric oxide generation and/or action, leading to an increase in GFR (21).…”

Section: Variables Affecting the Gfr Slope: Baseline Gfr And Hba 1csupporting

confidence: 69%

Determinants of Decline in Glomerular Filtration Rate in Nonproteinuric Subjects with or without Diabetes and Hypertension

Yokoyama¹,

Kanno²,

Takahashi³

et al. 2009

Clinical Journal of the American Society of Nephrology

View full text Add to dashboard Cite

Background and objectives: This study investigated whether the slope of estimated GFR is different between nonproteinuric subjects with and without diabetes, and what clinical factors are associated with the GFR slope.Design, setting, participants, & measurements: An observational cohort study was performed in 923 subjects, and the predictive value of baseline variables on the GFR slope was investigated.Results: On the basis of the median 3-yr follow-up and 7 measurements of GFR, GFR slope (%/yr, median and interquartile range) was significantly larger in subjects with diabetes (؊2.39 (؊4.86 to 0.15), n ‫؍‬ 729) than in those without diabetes (؊1.02 (؊4.28 to 1.37), n ‫؍‬ 194), and this difference remained significant with or without presence of hypertension. After adjustments for confounding factors, predictors of GFR decline were found to be baseline high values of glycosylated hemoglobin A 1C (HbA 1C ), GFR, systolic blood pressure, and low plasma total protein in subjects with diabetes, whereas only the latter two were significant in subjects without diabetes. In subjects with diabetes, the high GFR was accounted for by high HbA 1C at baseline, and the predictors of GFR decline differed between those with and without hypertension, or with high and low baseline GFR. Any combination of the predictors showed increased risk for GFR decline.Conclusions: GFR slope is substantially affected by multiple factors at various stages. The degree of chronic hyperglycemia is likely to play a crucial role in elevating GFR and accelerating the decline in patients with type 2 diabetes even from the normoalbuminuric stage.

show abstract

Section: Variables Affecting the Gfr Slope: Baseline Gfr And Hba 1csupporting

confidence: 69%

Determinants of Decline in Glomerular Filtration Rate in Nonproteinuric Subjects with or without Diabetes and Hypertension

Yokoyama¹,

Kanno²,

Takahashi³

et al. 2009

Clinical Journal of the American Society of Nephrology

View full text Add to dashboard Cite

show abstract

“…Increases in blood glucose can impair functions of the glomerulus (filtration, permeability, and renal regulation of blood pressure) and drive fluid and sodium loss when glucose exceeds ≈150 mg/dL 41, 42, 43, 44. In the current study, as shown previously, myostatin deletion increases muscle mass and reduces plasma glucose levels significantly 25.…”

Section: Discussionsupporting

confidence: 82%

Increased Muscle Mass Protects Against Hypertension and Renal Injury in Obesity

Butcher

Mintz

Larion

et al. 2018

JAHA

View full text Add to dashboard Cite

BackgroundObesity compromises cardiometabolic function and is associated with hypertension and chronic kidney disease. Exercise ameliorates these conditions, even without weight loss. Although the mechanisms of exercise's benefits remain unclear, augmented lean body mass is a suspected mechanism. Myostatin is a potent negative regulator of skeletal muscle mass that is upregulated in obesity and downregulated with exercise. The current study tested the hypothesis that deletion of myostatin would increase muscle mass and reduce blood pressure and kidney injury in obesity.Methods and ResultsMyostatin knockout mice were crossed to db/db mice, and metabolic and cardiovascular functions were examined. Deletion of myostatin increased skeletal muscle mass by ≈50% to 60% without concomitant weight loss or reduction in fat mass. Increased blood pressure in obesity was prevented by the deletion of myostatin, but did not confer additional benefit against salt loading. Kidney injury was evident because of increased albuminuria, which was abolished in obese mice lacking myostatin. Glycosuria, total urine volume, and whole kidney NOX‐4 levels were increased in obesity and prevented by myostatin deletion, arguing that increased muscle mass provides a multipronged defense against renal dysfunction in obese mice.ConclusionsThese experimental observations suggest that loss of muscle mass is a novel risk factor in obesity‐derived cardiovascular dysfunction. Interventions that increase muscle mass, either through exercise or pharmacologically, may help limit cardiovascular disease in obese individuals.

show abstract

“…In accordance with the National Kidney Foundation guidelines (5), this has led the American Diabetes Association to recommend the screening of CKD in diabetic patients based both on the AER (threshold: 30 mg/24 h) and the Cockcroft and Gault equation or modification of diet in renal disease (MDRD) equation estimated GFR (threshold: 60 ml/min per 1.73 m 2 ) (6). The MDRD equation is superior to the Cockcroft and Gault equation: it is more accurate (7,8), more robust when glucose control is poor (9), and not biased by body weight (10), which is of considerable importance because of the frequent association of type 2 diabetes, and CKD (11), with obesity. Most of the recent reports on CKD in diabetic patients rely on MDRD e-GFR (12)(13)(14)(15)(16).…”

mentioning

confidence: 99%

Normoalbuminuric Renal-Insufficient Diabetic Patients

et al. 2007

Self Cite

View full text Add to dashboard Cite

OBJECTIVE -About 20% of diabetic patients with chronic kidney disease (CKD) detected from the new American Diabetes Association recommendations (albumin excretion rate Ͼ30 mg/24 h or estimated glomerular filtration rate [GFR] Ͻ60 ml/min per 1.73 m 2 ) may be normoalbuminuric. Do the characteristics and outcome differ for subjects with and without albuminuria?RESEARCH DESIGN AND METHODS -A total of 89 patients with diabetes and a modification of diet in renal disease (MDRD) estimated GFR (e-GFR) Ͻ60 ml/min per 1.73 m 2 underwent a 51Cr-EDTA B-isotopic GFR determination and were followed up for 38 Ϯ 11 months.RESULTS -The mean MDRD e-GFR (41.3 Ϯ 13.1 ml/min per 1.73 m 2 ) did not significantly differ from the i-GFR (45.6 Ϯ 29.7). Of the subjects, 15 (17%) were normoalbuminuric. Their i-GFR did not differ from the albuminuric rate and from their MDRD e-GFR, although their serum creatinine was lower (122 Ϯ 27 vs. 160 Ϯ 71 mol/l, P Ͻ 0.05): 71% would not have been detected by measuring serum creatinine (sCr) alone. They were less affected by diabetic retinopathy, and their HDL cholesterol and hemoglobin were higher (P Ͻ 0.05 vs. albuminuric). None of the CKD normoalbuminuric subjects started dialysis (microalbuminuric: 2/36, macroalbuminuric: 10/38) or died (microalbuminuric: 3/36, macroalbuminuric: 7/38) during the follow-up period (log-rank test: P Ͻ 0.005 for death or dialysis), and their albumin excretion rate and sCr values were stable after 38 months, whereas the AER increased in the microalbuminuric patients (P Ͻ 0.05), and the sCr increased in the macroalbuminuric patients (P Ͻ 0.01).CONCLUSIONS -Although their sCr is usually normal, most of the normoalbuminuric diabetic subjects with CKD according to an MDRD e-GFR below 60 ml/min per 1.73 m 2 do really have a GFR below 60 ml/min per 1.73 m 2 . However, as expected, because of normoalbuminuria and other favorable characteristics, their risk for CKD progression or death is lower. Diabetes Care 30:2034-2039, 2007T wenty-five to forty percent of patients with diabetes have kidney damage (1), and diabetes is the first cause of end-stage renal disease in most countries (2). The early detection of chronic kidney disease (CKD) in diabetic patients is therefore of critical importance. The conventional approach for screening is the determination of the albumin excretion rate (AER). However, a substantial proportion of normoalbuminuric diabetic patients may present with a reduced glomerular filtration rate (GFR): their rates have been reported to be ϳ20% based on GFR Ͻ60 ml/min per 1.73 m 2 in type 2 diabetes (3) and in type 1 diabetes based on GFR Ͻ90 ml/min per 1.73 m 2 with more advanced glomerular lesions (4). In accordance with the National Kidney Foundation guidelines (5), this has led the American Diabetes Association to recommend the screening of CKD in diabetic patients based both on the AER (threshold: 30 mg/24 h) and the Cockcroft and Gault equation or modification of diet in renal disease (MDRD) equation estimated GFR (threshold: 60 ml/min per 1.73 m 2 ) (6...

show abstract

Glucose Control Influences Glomerular Filtration Rate and Its Prediction in Diabetic Subjects

Cited by 46 publications

References 31 publications

Determinants of Decline in Glomerular Filtration Rate in Nonproteinuric Subjects with or without Diabetes and Hypertension

Determinants of Decline in Glomerular Filtration Rate in Nonproteinuric Subjects with or without Diabetes and Hypertension

Increased Muscle Mass Protects Against Hypertension and Renal Injury in Obesity

Normoalbuminuric Renal-Insufficient Diabetic Patients

Contact Info

Product

Resources

About