Glycemic control in diabetic kidney disease patients

Yadav, Subhash Chandra

doi:10.1016/s2211-9477(12)70002-x

Cited by 5 publications

(3 citation statements)

References 35 publications

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“…Given that metabolic and haemodynamic changes are central pathogenic drivers of DN, approaches to target these mechanisms have become standards of care. However, it has become clear that the management of hypertension [ 20 ] and the pursuit of tight glycaemic control [ 21 ] are ineffective in stopping the inevitable renal deterioration in many patients. As a result, researchers are continuing to advance the understanding of DN, and as such, a wealth of novel therapeutic targets are being identified.…”

Section: Diabetic Nephropathy Pathogenesismentioning

confidence: 99%

Diabetic Nephropathy: a Tangled Web to Unweave

Magee

Grieve

Watson

et al. 2017

Cardiovasc Drugs Ther

156

112

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Diabetic nephropathy (DN) is currently the leading cause of end-stage renal disease globally. Given the increasing incidence of diabetes, many experts hold the view that DN will eventually progress toward pandemic proportions. Whilst hyperglycaemia-induced vascular dysfunction is the primary initiating mechanism in DN, its progression is also driven by a heterogeneous set of pathological mechanisms, including oxidative stress, inflammation and fibrosis. Current treatment strategies for DN are targeted against the fundamental dysregulation of glycaemia and hypertension. Unfortunately, these standards of care can delay but do not prevent disease progression or the significant emotional, physical and financial costs associated with this disease. As such, there is a pressing need to develop novel therapeutics that are both effective and safe. Set against the genomic era, numerous potential target pathways in DN have been identified. However, the clinical translation of basic DN research has been met with a number of challenges. Moreover, the notion of DN as a purely vascular disease is outdated and it has become clear that DN is a multi-dimensional, multi-cellular condition. The review will highlight the current therapeutic approaches for DN and provide an insight into how the inherent complexity of DN is shaping the research pathways toward the development and clinical translation of novel therapeutic strategies.

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Section: Diabetic Nephropathy Pathogenesismentioning

confidence: 99%

Diabetic Nephropathy: a Tangled Web to Unweave

Magee

Grieve

Watson

et al. 2017

Cardiovasc Drugs Ther

156

112

View full text Add to dashboard Cite

show abstract

“…Additionally, affected patients have an increased risk of complications, such as hypertension, anemia, malnutrition, bone and mineral disorders, retinopathy and neuropathy, and thus suffer extra morbidity and mortality [9,10]. There is also an even higher prevalence of hypoglycemia due to decreased clearance of antidiabetic agents or impaired renal gluconeogenesis, and progressive renal dysfunction reduces drug elimination and prolongs exposure to higher drug levels [11]. Patients in Southern Ethiopia Routine screening for CKD based on estimated GFR (eGFR) derived from serum creatinine measurements is recommended for diabetes care [12], as reduced eGFR is an independent predictor of cardiovascular and renal events and mortality in people with diabetes [6,8].…”

Section: Introductionmentioning

confidence: 99%

Prevalence of Chronic Kidney Disease and Associated Risk Factors among Diabetic Patients in Southern Ethiopia

Fiseha¹

2014

AJHR

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Abstract:Background: Chronic kidney disease (CKD) in diabetes is associated with an increased risk of premature mortality, kidney failure and cardiovascular disease. No studies are available on the prevalence of CKD among diabetics in Ethiopia. The aim of this study was to determine the prevalence of CKD and its associated risk factors among diabetic adults attending Butajira hospital of Southern Ethiopia based on estimated glomerular filtration rate (GFR). Methods: A facility based cross sectional study was conducted in Butajira hospital, southern Ethiopia among 214 randomly selected diabetic adults. Demographic, clinical, and laboratory data were collected from September 1, 2013 to October 31, 2013. The simplified Modification of Diet in Renal Disease (MDRD) and Cockroft-Gault (CG) equations were used to estimate GFR (eGFR) from serum creatinine value. SPSS 20.0 Software was used for data analysis. Results: 39 (18.2%) and 51 (23.8%) of the study participants were found to have CKD, as defined by eGFR < 60 ml/min/1.73 m 2 , according to the MDRD and Cockroft-Gault equations, respectively. Of these; 17.3 and 22.9% have stage 3 CKD, and 0.9% have stage 4 CKD, respectively. Significant risk factors for CKD in the study subjects when using either the MDRD or C-G equation were older age, longer duration of diabetes, family history of kidney disease, and poor glucose control (P < 0.05). Additionally, female sex (P < 0.008) and obesity (P < 0.038) were independent risk factors for CKD when defined by the MDRD, and type 2 diabetes was when defined by C-G (P < 0.03). Conclusion: CKD was present in not less than 18.2% diabetic adults attending the follow up clinic at Butajira hospital, in southern Ethiopia. Risk factors for CKD were similar to those reported in developed country studies. Using the MDRD equation led to a lower prevalence of CKD and a better risk categorization than did by C-G equation, thus contributing to better management of clinical outcomes in diabetic care.

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“…For patients with diabetes and CKD, the risk of hypertension, anemia, malnutrition, bone and mineral disorders, and retinopathy is higher as compared to patients with normal renal function [ 4 , 5 ]. There is an even higher prevalence of hypoglycemia due to decreased clearance of hypoglycemic agents or impaired renal gluconeogenesis [ 6 ].…”

Section: Introductionmentioning

confidence: 99%

Chronic kidney disease and underdiagnosis of renal insufficiency among diabetic patients attending a hospital in Southern Ethiopia

2014

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BackgroundDiabetic patients with chronic kidney disease (CKD), as defined by a reduced glomerular filtration rate (GFR), are at greater risk for cardiovascular and renal events and mortality. The aim of this study was to determine the prevalence of CKD among diabetic patients attending a hospital in southern Ethiopia, and to assess underdiagnosis of renal insufficiency among those with normal serum creatinine.MethodsA total of 214 randomly selected diabetics attending the follow-up clinic at Butajira hospital of southern Ethiopia participated in this study during the period from September 1 to October 31, 2013. All patients completed an interviewer-administered questionnaire and underwent clinical assessment. The simplified Modification of Diet in Renal Disease (MDRD) and Cockroft-Gault (C-G) equations were used to estimate GFR (eGFR) from serum creatinine.ResultsCKD, defined as eGFR < 60 ml/min/1.73 m2, was present in 18.2% and 23.8% of the study participants according to the MDRD and Cockcroft-Gault (C-G) equations, respectively. Only 9.8% of the total participants, and 48.7% (for the MDRD) and 37.3% (for C-G) of those with eGFR <60 ml/min/1.73 m2 had abnormal serum creatinine values, i.e. > 1.5 mg/dl. Normal serum creatinine was observed in 90.2% of participants attending the hospital. A large proportion of participants ranging from 38.9-56.5% have shown to have mild to moderate renal insufficiency (stage 2–3 CKD) despite normal creatinine levels. CKD, eGFR < 60 ml/min/1.73 m2, was found in 10.4 and 16.9% of participants with normal serum creatinine using the MDRD and C-G equations, respectively.ConclusionCKD is present in no less than 18% of diabetics attending the hospital, but it is usually undiagnosed. A significant number of diabetics have renal insufficiency corresponding to stages 2–3 CKD despite normal creatinine levels. Therefore, GFR should be considered as an estimate of renal insufficiency, regardless of serum creatinine levels being in normal range.

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Glycemic control in diabetic kidney disease patients

Cited by 5 publications

References 35 publications

Diabetic Nephropathy: a Tangled Web to Unweave

Diabetic Nephropathy: a Tangled Web to Unweave

Prevalence of Chronic Kidney Disease and Associated Risk Factors among Diabetic Patients in Southern Ethiopia

Chronic kidney disease and underdiagnosis of renal insufficiency among diabetic patients attending a hospital in Southern Ethiopia

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