Preventing chronic kidney disease in special populations

Jamerson, Kenneth

doi:10.1016/j.amjhyper.2004.11.018

Cited by 30 publications

(18 citation statements)

References 36 publications

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“…33,36 In type 1 diabetes, clinical trial data suggest the regression and even long-term remission of nephropathy with hypertension control. 37,38 Also, animal models have suggested synergistic effects between hypertension and hyperglycemia in inducing structural and functional changes 39,40 supporting the plausibility 2,3 of additional renal protection by further lowering BP among those with diabetes than the general population.…”

Section: Discussionmentioning

confidence: 99%

Relationship Between Low-Normal Blood Pressure and Kidney Disease in Type 1 Diabetes

Shankar

Klein²,

Klein³

et al. 2007

Hypertension

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Abstract-Current recommendations, largely based on studies in type 2 diabetes, suggest lower target blood pressures (BPs) for individuals with diabetes than for the general population. However, the effect of lower BP on renal outcomes in type 1 diabetes is uncertain. In a population-based cohort of type 1 diabetes adults (mean age: 33.1 years) based in Wisconsin, of which the distribution of baseline BP was in the low-normal range, we examined the relationship between decreasing categories of systolic and diastolic BP and the 16-year incidence of proteinuria (nϭ232 of 604) and estimated glomerular filtration rate of Ͻ60 mL/min/1.73 m 2 (nϭ158 of 547). Decreasing BP categories had lower relative risk (RR) of developing incident proteinuria (RR comparing decreasing quartiles of systolic BP: 1.00, 0.76, 0.58, 0.73; P for trendϭ0.03; RR comparing decreasing quartiles of diastolic BP: 1.00, 0.81, 0.66, 0.42; P for trend Ͻ0.0001) and incident estimated glomerular filtration rate Ͻ60 mL/min/1.73 m 2 (RR comparing decreasing quartiles of systolic BP: 1.00, 0.83, 0.61, 0.65; P for trendϭ0.03; RR comparing decreasing quartiles of diastolic BP: 1.00, 0.84, 0.82, 0.43; P for trendϭ0.001). These associations were independent of glycemic control and several putative confounding factors.

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Section: Discussionmentioning

confidence: 99%

Relationship Between Low-Normal Blood Pressure and Kidney Disease in Type 1 Diabetes

Shankar

Klein²,

Klein³

et al. 2007

Hypertension

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“…Combination antihypertensive therapy for patients with diabetes or known CKD should include renoprotection with an agent acting on the renin-angiotensin system [3]. …”

Section: Clinical Management Of Ckd and Anemiamentioning

confidence: 99%

“…Decline of renal function is fueled by diabetes and hypertension, risk factors widespread in the African-American population [3]. Compared with Caucasians, African-Americans show an incrementally larger prevalence across advancing stages of CKD progression [4,5,6], and a 3- to 4-fold greater incidence of end-stage renal disease (ESRD) [2, 4, 7].…”

Section: Introductionmentioning

confidence: 99%

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The Role of Anemia Management in Improving Outcomes for African-Americans with Chronic Kidney Disease

2008

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Chronic kidney disease (CKD) is a serious threat to African-American public health. In this population CKD progresses to end-stage renal disease (ESRD) at quadruple the rate in Caucasians. Factors fueling progression to ESRD include diabetes and hypertension, which show high prevalences and accelerated renal damage in African- Americans, as well as possible nutritional, socioeconomic, and genetic factors. Anemia, a common and deleterious complication of CKD, is more prevalent and severe in African-American than Caucasian patients at each stage of the disease. Proactive management of diabetes, hypertension, anemia, and other complications throughout the course of CKD can prevent or delay disease progression and alleviate the burden of ESRD for the African-American community. Currently, African-Americans with CKD are less likely than Caucasian patients to receive anemia treatment before and after the onset of dialysis. Although African-Americans often require higher doses of erythropoiesis-stimulating agents, this may result from late treatment initiation, lower hemoglobin levels, or the presence of comorbidities such as diabetes and inflammation, although racial differences in response cannot be excluded. This review explores racial-specific challenges and potential solutions in renal anemia management to improve outcomes in African-American patients.

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“…Patients with diabetes and hypertension have a higher risk of end-stage renal failure [ESRD (end-stage renal disease)] than patients with hypertension alone [3]. Raised BP is often paralleled by clinical albuminuria, the earliest manifestation of systemic microvascular damage [4].…”

Section: Two Hits One Disease: Interaction Between Metabolic and Haementioning

confidence: 99%

Molecular mechanisms of proteinuria in diabetes

Gnudi

2008

Biochemical Society Transactions

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The epidemic of Type 2 diabetes, and the parallel rising incidence of end-stage renal disease, is progressively increasing worldwide. Kidney disease is one of the major chronic microvascular complications of diabetes, and both metabolic and haemodynamic perturbations participate in its development and progression towards end-stage renal disease. Hypertension and poor metabolic control seem to interact in causing the relentless decline in renal function seen in diabetic patients. Both high circulating glucose levels and increased glomerular capillary pressure act in conjunction in stimulating the different cellular pathways leading to kidney disease. It has been suggested that mechanical forces at the glomerular level may aggravate the metabolic insult by stimulating excessive cellular glucose uptake by up-regulating the facilitative GLUT-1 (glucose transporter-1). We propose the existence of a self-maintaining cellular mechanism whereby a haemodynamic stimulus on glomerular cells induces the up-regulation of GLUT-1, an event followed by greater glucose uptake and activation of intracellular metabolic pathways, resulting in excess TGF-beta1 (transforming growth factor-beta1) production. TGF-beta1, one of the major prosclerotic cytokines in diabetic kidney disease, maintains the up-regulation of GLUT-1, perpetuating a series of cellular events that result, as their ultimate effect, in increased extracellular matrix synthesis and altered permeability of the glomerular filtration barrier. Mechanical and metabolic coupling could represent an important mechanism of injury in the diabetic kidney.

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Preventing chronic kidney disease in special populations

Cited by 30 publications

References 36 publications

Relationship Between Low-Normal Blood Pressure and Kidney Disease in Type 1 Diabetes

Relationship Between Low-Normal Blood Pressure and Kidney Disease in Type 1 Diabetes

The Role of Anemia Management in Improving Outcomes for African-Americans with Chronic Kidney Disease

Molecular mechanisms of proteinuria in diabetes

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