Influence of non-alcoholic steatohepatitis on the renal functional status in patients with type 2 diabetes and diabetic kidney disease

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Background. State of carbohydrate metabolism and severity of insulin resistance in the comorbid course of non-alcoholic steatohepatitis (NASH) and diabetic kidney disease (DKD) in patients with type 2 diabetes mellitus (DM2) is due to the cascade of possible transformation of NASH into liver cirrhosis. The purpose is to study the interaction of changes in glucose and insulin homeostasis, the degree of insulin resistance and insulin sensitivity, the degree of hemoglobin glycosylation on the clinical course of NASH associated with DM depending on the presence of DKD and its stage. Materials and methods. One hundred and eight patients with NASH and comorbid DM2 were examined. The average age of patients was 58.2 ± 6.1 years. There were 63 women (58.3 %) and 45 men (41.7 %). Depending on the presence of DKD, 4 groups of patients were formed, who were randomized by age, sex, activity of cytolytic syndrome. The comparison group consisted of 30 healthy individuals of the appropriate age and sex. The degree of hepatic steatosis and its nature were determined using SteatoTest, ASH and NASH-Test kits (BioPredictive, France). The stage of liver fibrosis was determined using FibroTest (BioPredictive, France), a set of markers for quantitative biochemical evaluation of fibrosis. Results. In patients with NASH, DM2 and DKD stage I–II, we found a significant decrease in serum albumin by 9.0 % (p < 0.05); glomerular filtration rate (GFR) and urine albumin, on the contrary, increased significantly, by 1.5 times (p < 0.05) compared to those in the control group, which indicates the phenomenon of hyperfiltration and is specific to the initial stage of DKD. When NASH is combined with DM2 and DKD stage III, a significant decrease in serum albumin by 1.2 times (p < 0.05) is reported; GFR and albuminuria were significantly increased, by 1.4 and 11.7 times (p < 0.05), respectively, compared to the control group. In patients with NASH, DM2 and DKD stage IV, we found a significant decrease in serum albumin by 1.4 times (p < 0.05), it was significantly increased by 30.2 times (p < 0.05) compared to the indicator in the control group, and the GFR, on the contrary, was significantly reduced by 1.7 times (p < 0.05), which indicates the progression of DKD. Conclusions. Disorders of glucose homeostasis due to insulin resistance are one of the probable risk factors for the progression of non-alcoholic steatohepatitis and type 2 diabetes mellitus in the presence of stage I–IV diabetic kidney disease.

Section: Discussionmentioning

confidence: 99%

The glycemic profile in patients with non-alcoholic steatohepatitis and type 2 diabetes depending on diabetic kidney disease

Kotsiubiichuk,

Antoniv,

Khukhlina

2023

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Correction of endothelial dysfunction in patients with type 2 diabetes mellitus, diabetic kidney disease and non-alcoholic steatohepatitis

Kotsiubiichuk,

Antoniv,

Kanovska

et al. 2024

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Background. Non-alcoholic fatty liver disease and chronic kidney disease are public health concerns worldwide due to their increasing prevalence, adverse prognosis, and health care burden. The purpose of the study was to determine the probable effect of a combination of metformin, rosuvastatin, essential phospholipids and quercetin on the blood lipids, endothelial function, fibrinolysis system and platelet hemostasis, which are factors for the progression of nonalcoholic steatohepatitis. Materials and methods. Studies were performed on the dynamics of treatment in 60 patients with non-alcoholic fatty liver disease, type 2 diabetes mellitus and diabetic kidney disease (stage I–III). Depending on the prescribed treatment at random, the examined patients were divided into 2 groups. Twenty-eight persons of the first group received a low-calorie diet with dietary restrictions, essential phospholipids, metformin hydrochloride, rosuvastatin. Thirty-two patients from the second group received quercetin in addition to similar dietary recommendations, essential phospholipids, hypoglycemic and hypolipidemic therapy. The mean age of patients was 53.80 ± 3.52 years. The comparison group consisted of 30 healthy individuals of the corresponding age. Results. To evaluate the degree of endothelial-protective effect of quercetin on the background of the recommended protocol therapy, markers of endothelial dysfunction, fibrinolysis and platelet hemostasis were studied. NO content significantly reduced (1.7 times) in patients of group 2 before treatment, increased by 1.5 times (p < 0.05). This can be explained by the effect of quercetin, as well as the use of metformin, which reduces the degree of insulin resistance and the level of hyperlipidemia. Conclusions. The effectiveness of a combination therapy for non-alcoholic steatohepatitis and type 2 diabetes mellitus with diabetic kidney disease using essential phospholipids, statins and metformin with the addition of quercetin is higher than that of traditional therapy, as it significantly restores the functional state of the endothelium, eliminates the phenomena of hypercoagulation syndrome without the additional prescription of antiplatelet agents.

Role of proadrenomedullin in the progression of diabetic kidney disease in patients with type 2 diabetes mellitus

Urbanovych,

Vereshchynska

2024

Background. Type 2 diabetes mellitus (T2DM) is a chronic disease with increasing prevalence. Metabolic changes and inflammation caused by hyperglycemia in T2DM lead to deterioration of kidney function. Diabetic kidney disease (DKD), a common complication of T2DM, is a leading cause of end-stage renal disease. We investigated the prognostic value of proadrenomedullin (Pro-ADM) as an unconventional biomarker of renal impairment progression in patients with T2DM. The purpose was to investigate the role of proadrenomedullin in the progression of DKD in people with T2DM. Materials and methods. Eighty-six patients with T2DM and DKD were examined. The study was conducted at the Lviv Regional State Clinical Medical and Diagnostic Endocrinological Center, a clinical base of the Department of Endocrinology of the Danylo Halytsky Lviv National Medical University. Patients were divided into 3 groups according to the degrees of DKD risk progression. In addition to standardized clinical and laboratory tests, the concentration of Pro-ADM in blood serum was evaluated. The obtained data were processed statistically with an assessment of probability and correlation. Results. The level of Pro-ADM in patients with T2DM and DKD varied statistically significant depending on the risk of DKD progression. In group 1, its average content was 19.65 ± 0.98 pmol/l, in group 2 — 35.15 ± 2.46 pmol/l, and in group 3 — 72.02 ± 2.82 pmol/l. The results showed a significant increase in Pro-ADM with DKD progression (p < 0.001). A correlation analysis was performed between Pro-ADM and patients’ age, duration of disease, HbA1c, total cholesterol, urea, creatinine, estimated glomerular filtration rate (eGFR) levels, and albumin-creatinine ratio (ACR). In group 1, a positive weak correlation was found between Pro-ADM and age (R = 0.02; p < 0.01); cholesterol (R = 0.03; p > 0.05); urea (R1 = 0.17; p < 0.01); creatinine levels (R = 0.12; p < 0.01); and ACR (R = 0.16; p < 0.01). There was a positive moderate correlation with the duration of T2DM (R = 0.39; p < 0.05) and HbA1c level (R = 0.31; p < 0.05) and a moderate negative correlation with eGFR (R = –0.51; p < 0.01). In group 2, a positive weak correlation of Pro-ADM with age (R = 0.12; p < 0.01); duration of T2DM (R = 0.28; p < 0.05); cholesterol (R = 0.06; p > 0.05), and urea levels (R = 0.06; p > 0.05) was observed. There was a positive moderate correlation with HbA1c (R = 0.31; p < 0.05); creatinine (R = 0.47; p < 0.01) levels, and ACR (R = 0.32; p < 0.01). A moderate inverse correlation with eGFR was also found (R = –0.33; p < 0.01). In group 3, a positive weak correlation of Pro-ADM with the duration of T2DM (R = 0.24; p < 0.05), and total cholesterol level (R = 0.19; p > 0.05) was observed. A positive moderate correlation with age (R = 0.53; p < 0.01); HbA1c (R = 0.33; p < 0.05), urea (R = 0.42; p > 0.05), creatinine levels (R = 0.34; p < 0.01), and ACR (R = 0.36; p < 0.01) was found. There was also a negative strong correlation with eGFR (R = –0.71; p < 0.01). Conclusions. We found a significant increase in Pro-ADM level in patients with T2DM depending on the progression of DKD. The revealed correlations between Pro-ADM and clinical parameters of T2DM and the functional state of the kidneys indicate that the level of Pro-ADM is associated with the progression of DKD. These results show the importance of identifying Pro-ADM as a potential marker for assessing the progression of renal impairment in patients with T2DM.