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Risk Prediction and Management of Chronic Kidney Disease in People Living with Type 2 Diabetes Mellitus
Ying-Guat Ooi, Tharsini Sarvanandan, Nicholas Ken Yoong Hee, Quan-Hziung Lim, Sharmila S. Paramasivam, Jeyakantha Ratnasingam, Shireene R. Vethakkan, Soo-Kun Lim, Lee-Ling Lim
Diabetes Metab J. 2024;48(2):196-207.   Published online January 26, 2024
DOI: https://doi.org/10.4093/dmj.2023.0244
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AbstractAbstract PDFSupplementary MaterialPubReader   ePub   
People with type 2 diabetes mellitus have increased risk of chronic kidney disease and atherosclerotic cardiovascular disease. Improved care delivery and implementation of guideline-directed medical therapy have contributed to the declining incidence of atherosclerotic cardiovascular disease in high-income countries. By contrast, the global incidence of chronic kidney disease and associated mortality is either plateaued or increased, leading to escalating direct and indirect medical costs. Given limited resources, better risk stratification approaches to identify people at risk of rapid progression to end-stage kidney disease can reduce therapeutic inertia, facilitate timely interventions and identify the need for early nephrologist referral. Among people with chronic kidney disease G3a and beyond, the kidney failure risk equations (KFRE) have been externally validated and outperformed other risk prediction models. The KFRE can also guide the timing of preparation for kidney replacement therapy with improved healthcare resources planning and may prevent multiple complications and premature mortality among people with chronic kidney disease with and without type 2 diabetes mellitus. The present review summarizes the evidence of KFRE to date and call for future research to validate and evaluate its impact on cardiovascular and mortality outcomes, as well as healthcare resource utilization in multiethnic populations and different healthcare settings.
Original Article
Cardiovascular Risk/Epidemiology
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Glycemic Control and Adverse Clinical Outcomes in Patients with Chronic Kidney Disease and Type 2 Diabetes Mellitus: Results from KNOW-CKD
Ga Young Heo, Hee Byung Koh, Hyung Woo Kim, Jung Tak Park, Tae-Hyun Yoo, Shin-Wook Kang, Jayoun Kim, Soo Wan Kim, Yeong Hoon Kim, Su Ah Sung, Kook-Hwan Oh, Seung Hyeok Han
Diabetes Metab J. 2023;47(4):535-546.   Published online April 25, 2023
DOI: https://doi.org/10.4093/dmj.2022.0112
  • 3,059 View
  • 167 Download
  • 2 Web of Science
  • 3 Crossref
AbstractAbstract PDFSupplementary MaterialPubReader   ePub   
Background
The optimal level of glycosylated hemoglobin (HbA1c) to prevent adverse clinical outcomes is unknown in patients with chronic kidney disease (CKD) and type 2 diabetes mellitus (T2DM).
Methods
We analyzed 707 patients with CKD G1-G5 without kidney replacement therapy and T2DM from the KoreaN Cohort Study for Outcome in Patients With Chronic Kidney Disease (KNOW-CKD), a nationwide prospective cohort study. The main predictor was time-varying HbA1c level at each visit. The primary outcome was a composite of development of major adverse cardiovascular events (MACEs) or all-cause mortality. Secondary outcomes included the individual endpoint of MACEs, all-cause mortality, and CKD progression. CKD progression was defined as a ≥50% decline in the estimated glomerular filtration rate from baseline or the onset of end-stage kidney disease.
Results
During a median follow-up of 4.8 years, the primary outcome occurred in 129 (18.2%) patients. In time-varying Cox model, the adjusted hazard ratios (aHRs) for the primary outcome were 1.59 (95% confidence interval [CI], 1.01 to 2.49) and 1.99 (95% CI, 1.24 to 3.19) for HbA1c levels of 7.0%–7.9% and ≥8.0%, respectively, compared with <7.0%. Additional analysis of baseline HbA1c levels yielded a similar graded association. In secondary outcome analyses, the aHRs for the corresponding HbA1c categories were 2.17 (95% CI, 1.20 to 3.95) and 2.26 (95% CI, 1.17 to 4.37) for MACE, and 1.36 (95% CI, 0.68 to 2.72) and 2.08 (95% CI, 1.06 to 4.05) for all-cause mortality. However, the risk of CKD progression did not differ between the three groups.
Conclusion
This study showed that higher HbA1c levels were associated with an increased risk of MACE and mortality in patients with CKD and T2DM.

Citations

Citations to this article as recorded by  
  • The Beneficial Effect of Glycemic Control against Adverse Outcomes in Patients with Type 2 Diabetes Mellitus and Chronic Kidney Disease
    Dong-Hwa Lee
    Diabetes & Metabolism Journal.2023; 47(4): 484.     CrossRef
  • Prevalence and predictors of chronic kidney disease among type 2 diabetic patients worldwide, systematic review and meta-analysis
    Eneyew Talie Fenta, Habitu Birhan Eshetu, Natnael Kebede, Eyob Ketema Bogale, Amare Zewdie, Tadele Derbew Kassie, Tadele Fentabil Anagaw, Elyas Melaku Mazengia, Sintayehu Shiferaw Gelaw
    Diabetology & Metabolic Syndrome.2023;[Epub]     CrossRef
  • Efficacy and safety of teneligliptin in patients with type 2 diabetes mellitus: a Bayesian network meta-analysis
    Miao Zhu, Ruifang Guan, Guo Ma
    Frontiers in Endocrinology.2023;[Epub]     CrossRef
Sulwon Lecture 2022
Others
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Opening the Precision Diabetes Care through Digital Healthcare
Joonyub Lee, Jin Yu, Kun-Ho Yoon
Diabetes Metab J. 2023;47(3):307-314.   Published online March 29, 2023
DOI: https://doi.org/10.4093/dmj.2022.0386
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  • 255 Download
AbstractAbstract PDFPubReader   ePub   
The national healthcare systems of every country in the world cannot sustain the rise in healthcare expenditure caused by chronic diseases and their complications. To sustain the national healthcare system, a novel system should be developed to improve the quality of care and minimize healthcare costs. For 20 years, our team developed patient-communicating digital healthcare platforms and proved their efficacy. National scale randomized control trials are underway to systematically measure the efficacy and economic benefits of this digital health care system. Precision medicine aims to maximize effectiveness of disease management by considering individual variability. Digital health technologies enable precision medicine at a reasonable cost that was not available before. The government launched the “National Integrated Bio-big Data Project” which will collect diverse health data from the participants. Individuals will share their health information to physicians or researchers at their will by gateway named “My-Healthway.’ Taken together, now we stand in front of the evolution of medical care, so-called “Precision medicine.” led by various kinds of technologies and a huge amount of health information exchange. We should lead these new trends as pioneers, not as followers, to establish and implement the best care for our patients that can help them to withstand their devastating diseases.
Original Articles
Metabolic Risk/Epidemiology
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Novel Asian-Specific Visceral Adiposity Indices Are Associated with Chronic Kidney Disease in Korean Adults
Jonghwa Jin, Hyein Woo, Youngeun Jang, Won-Ki Lee, Jung-Guk Kim, In-Kyu Lee, Keun-Gyu Park, Yeon-Kyung Choi
Diabetes Metab J. 2023;47(3):426-436.   Published online March 6, 2023
DOI: https://doi.org/10.4093/dmj.2022.0099
  • 2,886 View
  • 130 Download
  • 1 Web of Science
  • 2 Crossref
AbstractAbstract PDFSupplementary MaterialPubReader   ePub   
Background
The Chinese visceral adiposity index (CVAI) and new visceral adiposity index (NVAI) are novel indices of visceral adiposity used to predict metabolic and cardiovascular diseases in Asian populations. However, the relationships of CVAI and NVAI with chronic kidney disease (CKD) have not been investigated. We aimed to characterize the relationships of CVAI and NVAI with the prevalence of CKD in Korean adults.
Methods
A total of 14,068 participants in the 7th Korea National Health and Nutrition Examination Survey (6,182 men and 7,886 women) were included. Receiver operating characteristic (ROC) analyses were employed to compare the associations between indices of adiposity and CKD, and a logistic regression model was used to characterize the relationships of CVAI and NVAI with CKD prevalence.
Results
The areas under the ROC curves for CVAI and NVAI were significantly larger than for the other indices, including the visceral adiposity index and lipid accumulation product, in both men and women (all P<0.001). In addition, high CVAI or NVAI was significantly associated with a high CKD prevalence in both men (odds ratio [OR], 2.14; 95% confidence interval [CI], 1.31 to 3.48 in CVAI and OR, 6.47; 95% CI, 2.91 to 14.38 in NVAI, P<0.05) and women (OR, 4.87; 95% CI, 1.85 to 12.79 in CVAI and OR, 3.03; 95% CI, 1.35 to 6.82 in NVAI, P<0.05); this association remained significant after adjustment for multiple confounding factors in men and women.
Conclusion
CVAI and NVAI are positively associated with CKD prevalence in a Korean population. CVAI and NVAI may be useful for the identification of CKD in Asian populations, including in Korea.

Citations

Citations to this article as recorded by  
  • Accessing the relationship between six surrogate insulin resistance indexes and the incidence of rapid kidney function decline and the progression to chronic kidney disease among middle-aged and older adults in China: Results from the China health and ret
    Siti Liu, Honglin Sun, Jia Liu, Guang Wang
    Diabetes Research and Clinical Practice.2024; 212: 111705.     CrossRef
  • Association between Chinese visceral adiposity index and risk of stroke incidence in middle-aged and elderly Chinese population: evidence from a large national cohort study
    Zenglei Zhang, Lin Zhao, Yiting Lu, Xu Meng, Xianliang Zhou
    Journal of Translational Medicine.2023;[Epub]     CrossRef
Complications
Advanced Liver Fibrosis Is Associated with Chronic Kidney Disease in Patients with Type 2 Diabetes Mellitus and Nonalcoholic Fatty Liver Disease
Da Hea Seo, Young Ju Suh, Yongin Cho, Seong Hee Ahn, Seongha Seo, Seongbin Hong, Yong-ho Lee, Young Ju Choi, Eunjig Lee, So Hun Kim
Diabetes Metab J. 2022;46(4):630-639.   Published online January 26, 2022
DOI: https://doi.org/10.4093/dmj.2021.0130
  • 6,064 View
  • 280 Download
  • 15 Web of Science
  • 17 Crossref
AbstractAbstract PDFSupplementary MaterialPubReader   ePub   
Background
Nonalcoholic fatty liver disease (NAFLD) is associated with chronic kidney disease (CKD). However, the causal relationship between NAFLD and CKD is uncertain, particularly in patients with type 2 diabetes mellitus (T2DM). We aimed to investigate the association between the presence and severity of NAFLD and incident CKD in patients with T2DM.
Methods
In this longitudinal cohort study of patients with T2DM, 3,188 patients with preserved renal function were followed up for the occurrence of incident CKD. NAFLD was defined as the presence of hepatic steatosis on ultrasonography, without any other causes of chronic liver disease. Advanced liver fibrosis of NAFLD was defined as a fibrosis-4 index ≥2.67. CKD was defined as an estimated glomerular filtration rate <60 mL/min/1.73 m2.
Results
At baseline, 1,729 (54.2%) patients had NAFLD, of whom 94 (5.4%) had advanced liver fibrosis. During the follow-up of 8.3±3.6 years, 472 (14.8%) patients developed incident CKD: 220 (15.1%) in the non-NAFLD group, 231 (14.1%) in the NAFLD without advanced fibrosis group and 28 (31.1%) in the NAFLD with advanced fibrosis group. There was no increased risk of incident CKD in the NAFLD group compared to the non-NAFLD group (P=0.435). However, among patients with NAFLD, advanced liver fibrosis was associated with an increased risk of CKD (adjusted hazard ratio, 1.75; 95% confidence interval, 1.15 to 2.66; P=0.009).
Conclusion
Advanced liver fibrosis in patients with NAFLD is independently associated with an increased risk of incident CKD in patients with T2DM.

Citations

Citations to this article as recorded by  
  • Esteatosis hepática metabólica y nefropatía diabética: una llamada a la acción
    Salvador Benlloch, Francesc Moncho, Jose Luis Górriz
    Nefrología.2024; 44(2): 129.     CrossRef
  • Longitudinal Outcomes Associated With Metabolic Dysfunction-Associated Steatotic Liver Disease: A Meta-analysis of 129 Studies
    Kai En Chan, Elden Yen Hng Ong, Charlotte Hui Chung, Christen En Ya Ong, Benjamin Koh, Darren Jun Hao Tan, Wen Hui Lim, Jie Ning Yong, Jieling Xiao, Zhen Yu Wong, Nicholas Syn, Apichat Kaewdech, Margaret Teng, Jiong-Wei Wang, Nicholas Chew, Dan Yock Young
    Clinical Gastroenterology and Hepatology.2024; 22(3): 488.     CrossRef
  • Association of NAFLD/NASH, and MAFLD/MASLD with chronic kidney disease: an updated narrative review
    Amedeo Lonardo
    Metabolism and Target Organ Damage.2024;[Epub]     CrossRef
  • Targeting metabolic-associated fatty liver disease in diabetic kidney disease: A call to action
    Salvador Benlloch, Francesc Moncho, Jose Luis Górriz
    Nefrología (English Edition).2024; 44(2): 129.     CrossRef
  • Epidemiology, screening, and co-management of type 2 diabetes mellitus and metabolic dysfunction–associated steatotic liver disease
    Xiaolong Qi, Jie Li, Cyrielle Caussy, Gao-Jun Teng, Rohit Loomba
    Hepatology.2024;[Epub]     CrossRef
  • MAFLD and NAFLD in the prediction of incident chronic kidney disease
    So Yoon Kwon, Jiyun Park, So Hee Park, You-Bin Lee, Gyuri Kim, Kyu Yeon Hur, Janghyun Koh, Jae Hwan Jee, Jae Hyeon Kim, Mira Kang, Sang-Man Jin
    Scientific Reports.2023;[Epub]     CrossRef
  • Associations of non-invasive indices of liver steatosis and fibrosis with progressive kidney impairment in adults with type 2 diabetes
    Mei Chung Moh, Sharon Li Ting Pek, Kenny Ching Pan Sze, Serena Low, Tavintharan Subramaniam, Keven Ang, Wern Ee Tang, Simon Biing Ming Lee, Chee Fang Sum, Su Chi Lim
    Acta Diabetologica.2023; 60(6): 827.     CrossRef
  • Pancreatic beta-cell specific BAG3 knockout results in chronic hyperinsulinemia inducing insulin resistance
    Verena Damiani, Alessia Lamolinara, Ilaria Cicalini, Maria Concetta Cufaro, Francesco Del Pizzo, Federica Di Marco, Piero Del Boccio, Beatrice Dufrusine, Michael Hahne, Rossano Lattanzio, Damiana Pieragostino, Manuela Iezzi, Massimo Federici, Maria Cateri
    Molecular Metabolism.2023; 74: 101752.     CrossRef
  • Utility of non-invasive liver fibrosis markers to predict the incidence of chronic kidney disease (CKD): A systematic review, meta-analysis, and meta-regression
    Rudi Supriyadi, Theo Audi Yanto, Timotius Ivan Hariyanto, Ketut Suastika
    Diabetes & Metabolic Syndrome: Clinical Research & Reviews.2023; 17(8): 102814.     CrossRef
  • Significance of Diabetic Kidney Disease Biomarkers in Predicting Metabolic-Associated Fatty Liver Disease
    Jaehyun Bae, Byung-Wan Lee
    Biomedicines.2023; 11(7): 1928.     CrossRef
  • Hepatic Fibrosis Evaluated in Patients with Type 2 Diabetes with and without Chronic Kidney Disease
    Therese Adrian, Mads Hornum, Filip Krag Knop, Karl Bang Christensen, Thomas Almdal, Peter Rossing, Lisa Í Lídaa, Niels Søndergaard Heinrich, Vincent Oltman Boer, Anouk Marsman, Esben Thade Petersen, Hartwig Roman Siebner, Bo Feldt-Rasmussen
    Nephron.2023; 147(11): 673.     CrossRef
  • Clinical Interest of Serum Alpha-2 Macroglobulin, Apolipoprotein A1, and Haptoglobin in Patients with Non-Alcoholic Fatty Liver Disease, with and without Type 2 Diabetes, before or during COVID-19
    Olivier Deckmyn, Thierry Poynard, Pierre Bedossa, Valérie Paradis, Valentina Peta, Raluca Pais, Vlad Ratziu, Dominique Thabut, Angelique Brzustowski, Jean-François Gautier, Patrice Cacoub, Dominique Valla
    Biomedicines.2022; 10(3): 699.     CrossRef
  • Fibrosis Risk in Nonalcoholic Fatty Liver Disease Is Related to Chronic Kidney Disease in Older Type 2 Diabetes Patients
    Yifan Sun, Liang Hong, Zhe Huang, Lihong Wang, Yanqin Xiong, Shuhang Zong, Rui Zhang, Jun Liu, Shufei Zang
    The Journal of Clinical Endocrinology & Metabolism.2022; 107(9): e3661.     CrossRef
  • Beyond Liver Disease: Non-Alcoholic Fatty Liver Disease and Advanced Liver Fibrosis in Kidney Disease
    Eugene Han
    Diabetes & Metabolism Journal.2022; 46(4): 564.     CrossRef
  • A higher FIB‐4 index is associated with an increased incidence of renal failure in the general population
    Eva Maria Schleicher, Simon Johannes Gairing, Peter Robert Galle, Julia Weinmann‐Menke, Jörn M. Schattenberg, Karel Kostev, Christian Labenz
    Hepatology Communications.2022; 6(12): 3505.     CrossRef
  • Advanced Liver Fibrosis Is Associated with Chronic Kidney Disease in Patients with Type 2 Diabetes Mellitus and Nonalcoholic Fatty Liver Disease (Diabetes Metab J 2022;46:630-9)
    Ji Hye Huh
    Diabetes & Metabolism Journal.2022; 46(6): 953.     CrossRef
  • Advanced Liver Fibrosis Is Associated with Chronic Kidney Disease in Patients with Type 2 Diabetes Mellitus and Nonalcoholic Fatty Liver Disease (Diabetes Metab J 2022;46:630-9)
    Da Hea Seo, So Hun Kim
    Diabetes & Metabolism Journal.2022; 46(6): 956.     CrossRef
Cardiovascular Risk/Epidemiology
Performance of Diabetes and Kidney Disease Screening Scores in Contemporary United States and Korean Populations
Liela Meng, Keun-Sang Kwon, Dae Jung Kim, Yong-ho Lee, Jeehyoung Kim, Abhijit V. Kshirsagar, Heejung Bang
Diabetes Metab J. 2022;46(2):273-285.   Published online September 9, 2021
DOI: https://doi.org/10.4093/dmj.2021.0054
  • 65,535 View
  • 245 Download
  • 3 Web of Science
  • 3 Crossref
AbstractAbstract PDFSupplementary MaterialPubReader   ePub   
Background
Risk assessment tools have been actively studied, and they summarize key predictors with relative weights/importance for a disease. Currently, standardized screening scores for type 2 diabetes mellitus (DM) and chronic kidney disease (CKD)—two key global health problems—are available in United States and Korea. We aimed to compare and evaluate screening scores for DM (or combined with prediabetes) and CKD, and assess the risk in contemporary United States and Korean populations.
Methods
Four (2×2) models were evaluated in the United States-National Health and Nutrition Examination Survey (NHANES 2015–2018) and Korea-NHANES (2016–2018)—8,928 and 16,209 adults. Weighted statistics were used to describe population characteristics. We used logistic regression for predictors in the models to assess associations with study outcomes (undiagnosed DM and CKD) and diagnostic measures for temporal and cross-validation.
Results
Korean adult population (mean age 47.5 years) appeared to be healthier than United States counterpart, in terms of DM and CKD risks and associated factors, with exceptions of undiagnosed DM, prediabetes and prehypertension. Models performed well in own country and external populations regarding predictor-outcome association and discrimination. Risk tests (high vs. low) showed area under the curve >0.75, sensitivity >84%, specificity >45%, positive predictive value >8%, and negative predictive value >99%. Discrimination was better for DM, compared to the combined outcome of DM and prediabetes, and excellent for CKD due to age.
Conclusion
Four easy-to-use screening scores for DM and CKD are well-validated in contemporary United States and Korean populations. Prevention of DM and CKD may serve as first-step in public health, with these self-assessment tools as basic tools to help health education and disparity.

Citations

Citations to this article as recorded by  
  • A meta‐analysis of diabetes risk prediction models applied to prediabetes screening
    Yujin Liu, Sunrui Yu, Wenming Feng, Hangfeng Mo, Yuting Hua, Mei Zhang, Zhichao Zhu, Xiaoping Zhang, Zhen Wu, Lanzhen Zheng, Xiaoqiu Wu, Jiantong Shen, Wei Qiu, Jianlin Lou
    Diabetes, Obesity and Metabolism.2024; 26(5): 1593.     CrossRef
  • Performance Analysis and Assessment of Type 2 Diabetes Screening Scores in Patients with Non-Alcoholic Fatty Liver Disease
    Norma Latif Fitriyani, Muhammad Syafrudin, Siti Maghfirotul Ulyah, Ganjar Alfian, Syifa Latif Qolbiyani, Chuan-Kai Yang, Jongtae Rhee, Muhammad Anshari
    Mathematics.2023; 11(10): 2266.     CrossRef
  • A Comprehensive Analysis of Chinese, Japanese, Korean, US-PIMA Indian, and Trinidadian Screening Scores for Diabetes Risk Assessment and Prediction
    Norma Latif Fitriyani, Muhammad Syafrudin, Siti Maghfirotul Ulyah, Ganjar Alfian, Syifa Latif Qolbiyani, Muhammad Anshari
    Mathematics.2022; 10(21): 4027.     CrossRef
Complications
Article image
High Incidence of Chronic Kidney Disease among Iranian Diabetic Adults: Using CKD-EPI and MDRD Equations for Estimated Glomerular Filtration Rate
Seyyed Saeed Moazzeni, Reyhane Hizomi Arani, Mitra Hasheminia, Maryam Tohidi, Fereidoun Azizi, Farzad Hadaegh
Diabetes Metab J. 2021;45(5):684-697.   Published online March 16, 2021
DOI: https://doi.org/10.4093/dmj.2020.0109
  • 6,251 View
  • 158 Download
  • 14 Web of Science
  • 16 Crossref
AbstractAbstract PDFSupplementary MaterialPubReader   ePub   
Background
To investigate the population based incidence rate of chronic kidney disease (CKD) and its potential risk factors among Iranian diabetic adults during over 14 years of follow-up.
Methods
Two different equations (Chronic Kidney Disease Epidemiology Collaboration [CKD-EPI] and Modification of Diet in Renal Disease [MDRD]) were applied for the calculating the estimated glomerular filtration rate (eGFR). Among a total of 1,374 diabetic Tehranian adults, 797 and 680 individuals were eligible for CKD-EPI and MDRD analyses, respectively. CKD was defined as eGFR lower than 60 mL/min/1.73 m2. Multivariable Cox proportional hazard models were used to estimate the hazard ratios (HRs) and 95% confidence intervals (CI) for all potential risk factors.
Results
The incidence rates (95% CI) of CKD per 1,000 person-years were 43.84 (39.49 to 48.66) and 55.80 (50.29 to 61.91) based on CKD-EPI and MDRD equations, respectively. Being older, a history of cardiovascular disease, and having lower levels of eGFR were significant risk factors in both equations. Moreover, in CKD-EPI, using glucose-lowering medications and hypertension, and in MDRD, female sex and fasting plasma glucose ≥10 mmol/L were also independent risk factors. Regarding the discrimination index, CKD-EPI equation showed a higher range of C-index for the predicted probability of incident CKD in the full-adjusted model, compared to MDRD equation (0.75 [0.72 to 0.77] vs. 0.69 [0.66 to 0.72]).
Conclusion
We found an incidence rate of more than 4%/year for CKD development among our Iranian diabetic population. Compared to MDRD, it can be suggested that CKD-EPI equation can be a better choice to use for prediction models of incident CKD among the Iranian diabetic populations.

Citations

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  • The Effect of the Holy Quran Recitation on Inflammatory Markers in Hemodialysis Patients in Iran: A Randomized Clinical Trial
    Maedeh Teimourzadeh, Hassan Babamohamadi, Maliheh Yarmohamadi, Raheb Ghorbani, Harold G. Koenig
    Journal of Religion and Health.2024;[Epub]     CrossRef
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    Reyhane Hizomi Arani, Farima Fakhri, Mohammad Naeimi Tabiee, Fatemeh Talebi, Zahra Talebi, Negin Rashidi, Maryam Zahedi
    BMC Endocrine Disorders.2023;[Epub]     CrossRef
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    Niloofar Deravi, Yasaman Sharifi, Fatemeh Koohi, Seyed Saeed Tamehri Zadeh, Soroush Masrouri, Fereidoun Azizi, Farzad Hadaegh
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    Jian Wang, Xujin Wu, Li Wang, Chengyong Zhao
    International Heart Journal.2023; 64(3): 409.     CrossRef
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    Osman ERİNÇ, Soner YEŞİLYURT, Meliha NALCACİ
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    Randa I. Farah, Abdulrahman Alhajahjeh, Oraib Al-farahid, Hana Abuzaid, Dana Hiasat, Rama Rayyan, Laith Bdier, Izzat AlAwwa, Kamel Ajlouni
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    Mehrdad Hayati, Razieh Bagherzadeh, Mehdi Mahmudpour, Fatemeh Heidari, Hakimeh Vahedparast
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    Mousa Ghelichi-Ghojogh, Mohammad fararouei, Mozhgan Seif, Bahram Shahryari, Maryam Pakfetrat
    International Urology and Nephrology.2022; 54(7): 1603.     CrossRef
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    Mousa Ghelichi-Ghojogh, Mohammad Fararouei, Mozhgan Seif, Maryam Pakfetrat
    BMC Nephrology.2022;[Epub]     CrossRef
  • Incidence and risk factors of severe non‐proliferative/proliferative diabetic retinopathy: More than a decade follow up in the Tehran Lipids and Glucose Study
    Mahsa Sardarinia, Samaneh Asgari, Reyhane Hizomi Arani, Fatemeh Eskandari, Fereidoun Azizi, Davood Khalili, Farzad Hadaegh
    Journal of Diabetes Investigation.2022; 13(2): 317.     CrossRef
  • Pathophysiologic Mechanisms and Potential Biomarkers in Diabetic Kidney Disease
    Chan-Young Jung, Tae-Hyun Yoo
    Diabetes & Metabolism Journal.2022; 46(2): 181.     CrossRef
  • Prevalence of chronic kidney diseases and its determinants among Iranian adults: results of the first phase of Shahedieh cohort study
    Ali Dehghani, Sadegh Alishavandi, Nader Nourimajalan, Hossein Fallahzadeh, Vahid Rahmanian
    BMC Nephrology.2022;[Epub]     CrossRef
  • Construct a classification decision tree model to select the optimal equation for estimating glomerular filtration rate and estimate it more accurately
    Zhenliang Fan, Qiaorui Yang, Zhuohan Xu, Ke Sun, Mengfan Yang, Riping Yin, Dongxue Zhao, Junfen Fan, Hongzhen Ma, Yiwei Shen, Hong Xia
    Scientific Reports.2022;[Epub]     CrossRef
  • Novel biomarkers for diabetic kidney disease
    Chan-Young Jung, Tae-Hyun Yoo
    Kidney Research and Clinical Practice.2022; 41(Suppl 2): S46.     CrossRef
  • Prevalence and Associated Factors of Kidney Dysfunction in Patients with Hypertension and/or Diabetes Mellitus from a Primary Care Population in Northwest China
    Mengyue Lin, Mulalibieke Heizhati, Lin Wang, Lin Gan, Mei Li, Wenbo Yang, Ling Yao, Zhongrong Wang, Zhikang Yang, Reyila Abudoyreyimu, Zihao Wu, Nanfang Li
    International Journal of General Medicine.2021; Volume 14: 7567.     CrossRef
Brief Report
Complications
Article image
Trends in the Incidence, Prevalence, and Mortality of End-Stage Kidney Disease in South Korea
Min-Jeong Lee, Kyoung Hwa Ha, Dae Jung Kim, Inwhee Park
Diabetes Metab J. 2020;44(6):933-937.   Published online December 23, 2020
DOI: https://doi.org/10.4093/dmj.2020.0156
  • 6,114 View
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  • 15 Web of Science
  • 16 Crossref
AbstractAbstract PDFSupplementary MaterialPubReader   ePub   
Knowledge of the epidemiologic characteristics of end-stage kidney disease (ESKD) patients is essential. The trends in the prevalence, incidence, and mortality rates of ESKD were analyzed retrospectively using the Korean National Health Insurance ServiceNational Sample Cohort database between 2006 and 2015. From 2006 to 2015, the incidence of ESKD decreased from 28.6 to 24.0 per 100,000 people and showed a decreasing pattern with or without diabetes mellitus. However, the incidence of those aged ≥75 years increased, as did the mean age at the onset of ESKD. From 2007 to 2015, the prevalence of ESKD increased in all age groups, but particularly in those aged ≥75 years. The prevalence of ESKD differed by sex and diabetes mellitus status and this gap widened over time. Mortality rates in ESKD patients remained relatively constant throughout the study period. However, mortality rates in ESKD without diabetes decreased over the same period.

Citations

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Reviews
Drug/Regimen
Article image
Evaluating the Evidence behind the Novel Strategy of Early Combination from Vision to Implementation
Päivi Maria Paldánius
Diabetes Metab J. 2020;44(6):785-801.   Published online September 15, 2020
DOI: https://doi.org/10.4093/dmj.2020.0179
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AbstractAbstract PDFPubReader   ePub   
Type 2 diabetes mellitus (T2DM) is a complex and progressive chronic disease characterised by elevating hyperglycaemia and associated need to gradually intensify therapy in order to achieve and maintain glycaemic control. Treating hyperglycaemia with sequential therapy is proposed to allow holistic assessment of the efficacy and risk-to-benefit ratio of each added component. However, there is an array of evidence supporting the scientific rationale for using synergistic, earlier, modern drug combinations to achieve glycaemic goals, delay the deterioration of glycaemic control, and, therefore, potentially preserve or slow down the declining β-cell function. Additionally, implementation of early combination(s) may lead to opportunities to combat clinical inertia and other hurdles to optimised disease management outcomes. This review aims to discuss the latest empirical evidence for long-term clinical benefits of this novel strategy of early combination in people with newly diagnosed T2DM versus the current widely-implemented treatment paradigm, which focuses on control of hyperglycaemia using lifestyle interventions followed by sequentially intensified (mostly metformin-based) monotherapy. The recent reported Vildagliptin Efficacy in combination with metfoRmin For earlY treatment of T2DM (VERIFY) study results have provided significant new evidence confirming long-term glycaemic durability and tolerability of a specific early combination in the management of newly diagnosed, treatment-naïve patients worldwide. These results have also contributed to changes in clinical treatment guidelines and standards of care while clinical implementation and individualised treatment decisions based on VERIFY results might face barriers beyond the existing scientific evidence.
Basic Research
Histone Deacetylase 9: Its Role in the Pathogenesis of Diabetes and Other Chronic Diseases
Siqi Hu, Eun-Hee Cho, Ji-Young Lee
Diabetes Metab J. 2020;44(2):234-244.   Published online March 24, 2020
DOI: https://doi.org/10.4093/dmj.2019.0243
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  • 21 Web of Science
  • 23 Crossref
AbstractAbstract PDFPubReader   

As a member of the class IIa histone deacetylases (HDACs), HDAC9 catalyzes the deacetylation of histones and transcription factors, commonly leading to the suppression of gene transcription. The activity of HDAC9 is regulated transcriptionally and post-translationally. HDAC9 is known to play an essential role in regulating myocyte and adipocyte differentiation and cardiac muscle development. Also, recent studies have suggested that HDAC9 is involved in the pathogenesis of chronic diseases, including cardiovascular diseases, osteoporosis, autoimmune disease, cancer, obesity, insulin resistance, and liver fibrosis. HDAC9 modulates the expression of genes related to the pathogenesis of chronic diseases by altering chromatin structure in their promotor region or reducing the transcriptional activity of their respective transcription factors. This review summarizes the current knowledge of the regulation of HDAC9 expression and activity. Also, the roles of HDAC9 in the pathogenesis of chronic diseases are discussed, along with potential underlying mechanisms.

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Brief Report
Drug/Regimen
Evogliptin, a Dipeptidyl Peptidase-4 Inhibitor, Attenuates Renal Fibrosis Caused by Unilateral Ureteral Obstruction in Mice
Mi-Jin Kim, Na-young Kim, Yun-A Jung, Seunghyeong Lee, Gwon-Soo Jung, Jung-Guk Kim, In-Kyu Lee, Sungwoo Lee, Yeon-Kyung Choi, Keun-Gyu Park
Diabetes Metab J. 2020;44(1):186-192.   Published online October 31, 2019
DOI: https://doi.org/10.4093/dmj.2018.0271
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AbstractAbstract PDFSupplementary MaterialPubReader   

Renal fibrosis is considered to be the final common outcome of chronic kidney disease. Dipeptidyl peptidase-4 (DPP-4) inhibitors have demonstrated protective effects against diabetic kidney disease. However, the anti-fibrotic effect of evogliptin, a DPP-4 inhibitor, has not been studied. Here, we report the beneficial effects of evogliptin on unilateral ureteral obstruction (UUO)-induced renal fibrosis in mice. Evogliptin attenuated UUO-induced renal atrophy and tubulointerstitial fibrosis. Immunohistochemistry and Western blotting demonstrated that evogliptin treatment inhibits pro-fibrotic gene expressions and extracellular matrix production. In vitro findings showed that the beneficial effects of evogliptin on renal fibrosis are mediated by inhibition of the transforming growth factor-β/Smad3 signaling pathway. The present study demonstrates that evogliptin is protective against UUO-induced renal fibrosis, suggesting that its clinical applications could extend to the treatment of kidney disease of non-diabetic origin.

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Original Article
Complications
Higher Prevalence and Progression Rate of Chronic Kidney Disease in Elderly Patients with Type 2 Diabetes Mellitus
Kyung-Soo Kim, Seok Won Park, Yong-Wook Cho, Soo-Kyung Kim
Diabetes Metab J. 2018;42(3):224-232.   Published online May 31, 2018
DOI: https://doi.org/10.4093/dmj.2017.0065
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AbstractAbstract PDFPubReader   
Background

To evaluate the prevalence of chronic kidney disease (CKD) and progression rate to CKD in elderly patients with type 2 diabetes mellitus (T2DM).

Methods

We investigated the medical records of 190 elderly patients (65 years or older) with T2DM from 2005 to 2011 in 6-month increments. Mean follow-up duration was 64.5 months. CKD was defined as estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m2 and/or the presence of albuminuria.

Results

The mean age was 70.4 years and mean diabetes duration was 10.6 years. Among all the participants, 113 patients (59.5%) had CKD. The eGFR was significantly decreased between baseline (65.7±15.0 mL/min/1.73 m2) and the end of follow-up (52.7±17.5 mL/min/1.73 m2, P<0.001). At the end of follow-up, the prevalence of eGFR <60 mL/min/1.73 m2 had increased by 61.6% (at baseline, 44.2%). Furthermore, in patients with eGFR ≥60 mL/min/1.73 m2, the progression rate to more than CKD stage 3 was 39.6% at the end of follow-up; 30.2% of elderly diabetic patients had progressed to albuminuria from normoalbuminuria. Kaplan-Meier analysis showed that the time interval to worsening nephropathy was significantly shorter in elderly patients with diabetes duration ≥10 years than in those with diabetes duration <5 years (P=0.018).

Conclusion

CKD was commonly observed in older patients with T2DM, and the progression rate to CKD is also high. Consequently, it is important to identify and manage CKD as early as possible in elderly patients with T2DM, especially in those with diabetes duration ≥10 years.

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Reviews
Pathophysiology
Role of NO/VASP Signaling Pathway against Obesity-Related Inflammation and Insulin Resistance
Yu Mi Kang, Francis Kim, Woo Je Lee
Diabetes Metab J. 2017;41(2):89-95.   Published online November 15, 2016
DOI: https://doi.org/10.4093/dmj.2017.41.2.89
  • 4,732 View
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AbstractAbstract PDFPubReader   

Obesity has quickly become a worldwide pandemic, causing major adverse health outcomes such as dyslipidemia, type 2 diabetes mellitus, cardiovascular disease and cancers. Obesity-induced insulin resistance is the key for developing these metabolic disorders, and investigation to understand the molecular mechanisms involved has been vibrant for the past few decades. Of these, low-grade chronic inflammation is suggested as a critical concept in the development of obesity-induced insulin resistance, and the anti-inflammatory effect of nitric oxide (NO) signaling has been reported to be linked to improvement of insulin resistance in multiple organs involved in glucose metabolism. Recently, a body of evidence suggested that vasodilatory-stimulated phosphoprotein (VASP), a downstream mediator of NO signaling plays a crucial role in the anti-inflammatory effect and improvement of peripheral insulin resistance. These preclinical studies suggest that NO/VASP signaling could be an ideal therapeutic target in the treatment of obesity-related metabolic dysfunction. In this review, we introduce studies that investigated the protective role of NO/VASP signaling against obesity-related inflammation and insulin resistance in various tissues.

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Diabetic Kidney Disease: From Epidemiology to Clinical Perspectives
Cheol Whee Park
Diabetes Metab J. 2014;38(4):252-260.   Published online August 20, 2014
DOI: https://doi.org/10.4093/dmj.2014.38.4.252
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AbstractAbstract PDFPubReader   

With worldwide epidemic of diabetes mellitus, diabetic nephropathy which is one of the major causes of microvascular complication has become a serious concern in Korea as well as the rest of the world. In view of its significance, there is an urgent and paramount need for proper managements that could either deter or slow the progression of diabetic nephropathy. Despite advances in care, ever increasing number of patients suffering from diabetic kidney disease and from end-stage renal disease implies that the current management is not adequate in many aspects. The reasons for these inadequacies compromise lack of early diagnosis, failure to intervene with timely and aggressive manner, and lack of understanding on the kind of interventions required. Another issue equally important for the adequate care of patients with diabetic nephropathy is an understanding of past, present and future epidemiology of diabetic nephropathy which serves, especially in Korea, as a material determining standard diagnosis and treatment and a national health-policy decision.

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Original Article
Prevalence and Determinants of Diabetic Nephropathy in Korea: Korea National Health and Nutrition Examination Survey
Jae Hee Ahn, Ji Hee Yu, Seung-Hyun Ko, Hyuk-Sang Kwon, Dae Jung Kim, Jae Hyeon Kim, Chul Sik Kim, Kee-Ho Song, Jong Chul Won, Soo Lim, Sung Hee Choi, Kyungdo Han, Bong-Yun Cha, Nan Hee Kim
Diabetes Metab J. 2014;38(2):109-119.   Published online April 18, 2014
DOI: https://doi.org/10.4093/dmj.2014.38.2.109
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AbstractAbstract PDFPubReader   
Background

Diabetic nephropathy is a leading cause of end stage renal disease and is associated with an increased risk of cardiovascular mortality. It manifests as albuminuria or impaired glomerular filtration rate (GFR), and the prevalence of diabetic nephropathy varies with ethnicity. The prevalence of diabetic nephropathy and its determinants in Korean adults have not previously been studied at the national level. This cross-sectional study was undertaken to ascertain the prevalence and determinants of albuminuria and chronic kidney disease (CKD) in Korean patients with diabetes.

Methods

The Korea National Health and Nutrition Examination Survey (KNHANES) V, conducted in 2011, was used to define albuminuria (n=4,652), and the dataset of KNHANES IV-V (2008-2011) was used to define CKD (n=21,521). Selected samples were weighted to represent the entire civilian population in Korea. Albuminuria was defined as a spot urine albumin/creatinine ratio >30 mg/g. CKD was defined as a GFR <60 mL/min/1.73 m2.

Results

Among subjects with diabetes, 26.7% had albuminuria, and 8.6% had CKD. Diabetes was associated with an approximate 2.5-fold increased risk of albuminuria, with virtually no difference between new-onset and previously diagnosed diabetes. Only systolic blood pressure was significantly associated with albuminuria, and old age, high serum triglyceride levels, and previous cardiovascular disease (CVD) were related with CKD in subjects with diabetes.

Conclusion

Korean subjects with diabetes had a higher prevalence of albuminuria and CKD than those without diabetes. Blood pressure was associated with albuminuria, and age, triglyceride level, and previous CVD were independent determinants of CKD in subjects with diabetes.

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