Chronic inflammation and progression of chronic kidney disease in patients with type 2 diabetes

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

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

Burdeyna

2022

“…Хворі на ХХНV Д та реципієнти ниркового трансплантату (РНТ) належать до групи високого ризику тяжкого перебігу COVID-19 та формування ПКС [1,3,5,14]. Адже усі вище згадані фактори ризику розвитку ПКС притаманні цій популяції [15][16][17]. Проте, достеменно невідомо, чи є вплив COVID-19 на хворих цієї когорти унікальним, чи є подібним до сепсису, оскільки деякі дослідження свідчать про подібність симптомів ПКС до наслідків сепсису та гострого дистрес-синдрому [1].…”

unclassified

“…Для тяжких пацієнтів хворих на ХХН VД із ПКС можуть застосовуватись три різні види постійного ГД: постійний вено-венозний ГД, постійна веновенозна гемофільтрація та постійна вено-венозна гемодіафільтрація, однак перевагу слід надавати постійному вено-венозному ГД та постійній вено-венозній гемодіафільтрації, оскільки застосування цих методів дає найменшу частоту тромбоутворення у діалізному контурі (враховуючи стан гіперкоагуляції у пацієнтів із COVID-19). Загалом принципи постійної ДНЗТ базуються на рекомендаціях KDIGO [16]. У критичних ситуаціях застосовується високопоточна гемодіафільтрація з метою виведення медіаторів запалення; рекомендована доза > 35 мл/кг/год [27].…”

unclassified

Post-COVID syndrome in dialysis patients and kidney transplant recipients

Kolesnyk

Stepanova

2022

Abstract. Patients on maintenance dialysis treatment and kidney transplant recipients who survive coronavirus disease 2019 (COVID-19) are at higher risk of post-COVID syndrome compared to the general population. However, a detailed assessment of the causes, features, and clinical outcomes of the post-COVID syndrome in this patients’ cohort does not yet been established. In this review, we summarize published research on this issue to use these available data to predict the development, treatment and prevention of the post-COVID syndrome in dialysis patients and kidney transplant recipients.

“…According to International Diabetes Federation, the number of diabetic patients around the world was 463 000 000 in 2019, and 91 % of the patients suffered from diabetes mellitus type 2 (T2DM) [3]. There are more than 1.2 million officially registered patients with DM in Ukraine, and the annual growth in the spreading of DM in Ukraine is about 4.4 % [4]. DM is characterized by early disability and high mortality, mainly due to micro-and macrovascular complications.…”

mentioning

confidence: 99%

“…Kidneys are the target organs that are affected most often at T2DM. Decompensation of DM, duration of the disease, level of proteinuria, obesity, and AH play the main role in the development and progress of diabetic nephropathy [4,13]. Besides, it is known that more than 80% of cases with terminal stage of chronic kidney disease (CKD) are caused by DM, AH, or their Зв'язок сечової кислоти сироватки крові з дисліпідемією та альбумінурією у хворих на цукровий діабет 2 типу з коморбідним ожирінням та/або есенціальною артеріальною гіпертензією combination [14].…”

unclassified

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.