The effect of the experimental chronic hyperglycemia on the kidney and myocardium

Abstract. Recent studies demonstrate a large number of non-lipid modifiable effects of statins in various diseases. However, although atherogenic dyslipidemia is a common feature in peritoneal dialysis (PD) patients, statins use is supported by limited data and there is a general lack of research on their pleiotropic effects in this patients’ cohort. The present study aimed to evaluate the possible pleiotropic effects of atorvastatin in PD patients. Methods. A total of 114 PD patients with an average age of 55 (48-65) years and a dialysis vintage of 31 (14-50) months were included in this combined retrospective and prospective multicentre cohort study. PD patients (n = 54) who had started receiving atorvastatin before or after dialysis initiation and been treated with atorvastatin no less than 12 months were included in the Atorvastatin Group. PD patients (n = 60) who have never taken statins consisted of Atorvastatin-free Group. In addition to routine clinical and PD adequacy tests, concentrations of interleukins -6, -10, tumor necrosis factor-alpha, and monocyte chemoattractant protein-1 in PD effluent (PDE) were evaluated in all study participants at the start of the follow-up period. The primary outcomes were the 3-year PD technique survival and the all-cause mortality of PD patients during the follow-up period. Results. Atorvastatin users had lower serum phosphate and parathyroid hormone concentrations, higher weekly creatinine clearance, peritoneal weekly Kt/V urea, and, accordingly, total weekly Kt/V compared to the Atorvastatin-free Group. PDE cytokines assessment demonstrated significantly lower concentrations of all studied cytokines in the Atorvastatin Group compared with the Atorvastatin-free Group. In the Cox regression models, atorvastatin use was significantly associated with better PD technique survival (HR = 0.28 (95% CI 0.15; 0.54), p = 0.003) and mortality reduction in the PD patients regardless of their age, diabetes, anuric status, albumin and C-reactive protein levels, and history of PD peritonitis (HR = 0.24 (95% CI 0.15; 0.44), p < 0.0001). Conclusions. Atorvastatin treatment was associated with the normalization of phosphate-calcium metabolism, low intraperitoneal inflammation and incidence of PD-associated peritonitis, and better dialysis adequacy in our cohort of PD patients. These pleiotropic effects of atorvastatin may be one of the reasons for the lower all‐cause mortality in PD patients. Further studies are needed to determine the necessity of statins prescribing in PD patients.

Section: плейотропні ефекти аторвастатину у пацієнтів які лікуються м...unclassified

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Pleiotropic effects of atorvastatin in peritoneal dialysis patients: A retrospective-prospective observational cohort study

Burdeyna

2022

“…The early changes in the kidneys and heart are explained by the development of microangiopathies, which is a typical feature of the pathogenesis of diabetes [12].…”

mentioning

confidence: 99%

Prescribing patterns of new oral anticoagulants in patients with atrial fibrillation and chronic kidney disease: A narrative review

Chernatska

2023

This study aimed to investigate the prescribing patterns of new oral anticoagulants in atrial fibrillation patients based on creatinine clearance. A thorough analysis of articles published between 2017 and 2021 in databases such as PubMed, Scopus, and Google Scholar was conducted. The review revealed distinctive features in the use of new oral anticoagulants concerning glomerular filtration rate. Apixaban was identified as a judicious choice for individuals with kidney disorders, with approximately 25% of its dose excreted in urine. American guidelines specifically recommend apixaban for those with a creatinine clearance of less than 15 mL/min, while European recommendations contraindicate all new oral anticoagulants for such rates. In instances where the glomerular filtration rate ranges from 15 to 29 mL/min, apixaban or edoxaban may be preferred due to the substantial renal elimination of edoxaban. Reduced dose regimens of rivaroxaban, edoxaban, and apixaban are advised for individuals with chronic kidney disease and a creatinine clearance between 15 and 30 mL/min. Dabigatran, characterized by an 80% renal elimination rate, is recommended for individuals with a creatinine clearance exceeding 30 ml/min according to European guidelines and those with a clearance of at least 15 ml/min according to American guidelines.

“…Discussion. A high prevalence combined with severe outcomes of CKD determines the interest of the researchers in biomarkers and molecular mechanisms of the kidneys' impairment during T2DM [25]. After analysis of the renal panel data in blood biochemical profile of type 2 diabetic patients with comorbid obesity/overweight and AH, we revealed that only serum levels of uric acid and urea were significantly different in the patients from the investigated study groups according to Kruskal-Wallis analysis of variance using ranks (p<0.05).…”

mentioning

confidence: 99%

Association of serum uric acid with albuminuria in type 2 diabetic patients with comorbid obesity and/or essential arterial hypertension

Marushchak

Krynytska

Lepyavko

2022

Abstract. Decompensation of diabetes mellitus type 2 (T2DM), duration of the disease, level of proteinuria, obesity and essential arterial hypertension (AH) play the main role in the development and progress of diabetic nephropathy. The present study aimed to analyze the level of serum uric acid in type 2 diabetic patients with comorbid overweight/obesity and AH and to find its possible correlations with lipid panel data and urinary albumin excretion. Methods. 579 medical records of type 2 diabetic patients treated at the Endocrinological department of the municipal non-profit enterprise "Ternopil University Hospital" of Ternopil Regional Council (Ternopil) in 2018-2019 years were analyzed. Results. The analysis of renal panel data of type 2 diabetic patients with comorbid overweight/obesity and AH found out that only serum levels of urea and uric acid were statistically different in the patients with only T2DM and comorbid course of T2DM. Herewith the maximal changes were established for serum uric acid level, which in type 2 diabetic patients with comorbid obesity exceeded by 175.9 % data of only T2DM patients. Moreover, it was established a significant direct relationship between serum uric acid level and BMI and dyslipidemia in both groups of type 2 diabetic patients - with comorbid obesity and with comorbid obesity and AH. At the same time, a significant direct association between serum uric acid level and albuminuria was established only in type 2 diabetic patients with comorbid obesity and AH. Conclusions. Our retrospective study indicates that serum uric acid level is markedly elevated and positively associated with albuminuria in type 2 diabetic patients with comorbid obesity and AH and can be used as a biomarker allowing further risk stratification for development and/or progress of diabetic nephropathy in this cohort of the patients.