Ten-year comparative analysis of incidence, prognosis, and associated factors for dialysis and renal transplantation in type 1 and type 2 diabetes versus non-diabetes

Giorda, Carlo; Carnà, Paolo; Mario, Salomone; Picariello, Roberta; Costa, Giuseppe; Tartaglino, Barbara; Gnavi, Roberto

doi:10.1007/s00592-018-1142-y

Cited by 43 publications

(36 citation statements)

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“…In the 2016 European Renal Association (ERA)—European Dialysis and Transplant Association (EDTA) registry annual report, 25% of patients starting renal replacement therapy (RRT) were affected by diabetes [ 2 ]. The development of DKD in both type 1 and type 2 diabetes is the main predictor of mortality, and is associated with a worst prognosis in diabetic compared to non-diabetic subjects [ 3 ]. DKD is strongly associated with increased cardiovascular risk; indeed a large majority of patients with DKD die of cardiovascular complications before reaching ESRD [ 4 ].…”

Section: Introductionmentioning

confidence: 99%

Renal structure in type 2 diabetes: facts and misconceptions

et al. 2020

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The clinical manifestations of diabetic nephropathy are similar in type 1 and type 2 diabetes, while the renal lesions may differ. Indeed, diabetic glomerulopathy is the predominant renal lesion in type 1 diabetes, although also tubular, interstitial and arteriolar lesions are present in the advanced stages of renal disease. In contrast, in type 2 diabetes renal lesions are heterogeneous, and a substantial number of type 2 diabetic patients with diabetic kidney disease have mild or absent glomerulopathy with tubulointerstitial and/or arteriolar abnormalities. In addition, a high prevalence of non-diabetic renal diseases, isolated or superimposed on classic diabetic nephropathy lesions have been reported in patients with type 2 diabetes, often reflecting the bias of selecting patients for unusual clinical presentations for renal biopsy. This review focuses on renal structural changes in type 2 diabetes, emphasizing the contribution of research kidney biopsy studies to the understanding of the pathogenesis of DKD and of the structural lesions responsible for the different clinical phenotypes. Also, kidney biopsies could provide relevant information in terms of renal prognosis, and help to understand the different responses to different therapies, especially SGLT2 inhibitors, thus allowing personalized medicine.

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Section: Introductionmentioning

confidence: 99%

Renal structure in type 2 diabetes: facts and misconceptions

et al. 2020

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“…This is surprising given that during the past four decades, there have been remarkable improvements in not only surgical techniques but also immunosuppressive medications. Although there have been several improvements in diabetes care, the mortality rates for individuals with T1D after KT have remained higher compared with subjects without diabetes, and this constitutes a major challenge for the health care system due to multiple comorbidities in this patient group (8). Of note, combined kidney and pancreas transplantation provides better survival than KT alone, particularly in the case of deceased donors (9).…”

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confidence: 99%

Long-term Mortality After Kidney Transplantation in a Nationwide Cohort of Patients With Type 1 Diabetes in Finland

et al. 2018

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OBJECTIVETo examine time trends in mortality rates and causes of death in patients with type 1 diabetes and end-stage renal disease on dialysis and after kidney transplantation. RESEARCH DESIGN AND METHODSIn a nationwide retrospective cohort analysis, all patients with type 1 diabetes in Finland who received a kidney transplant alone were compared with patients who remained on dialysis. The main outcome was patient survival after starting dialysis. The cohort was divided into dialysis, functioning kidney transplant, and dialysis after transplant loss. Causes of death were retrieved and standardized mortality ratios calculated. RESULTSWe studied 2,383 patients. Patients survived a median of 15.9 years after a successful transplant, 11.2 years if transplant function was lost, and 2.9 years if they remained on chronic dialysis. Standardized mortality ratio decreased in all subgroups during the past four decades: from 2005 onwards, it was 3.9 in patients receiving a kidney transplant, 11.5 in patients with graft loss, and 32.5 in patients on dialysis. The most common cause of death in all patients was ischemic heart disease (45%) followed by infection (18%), which was more common in patients on dialysis. CONCLUSIONSKidney transplantation is the treatment of choice for patients with type 1 diabetes and end-stage renal disease because it substantially reduces the excess death risk when compared with dialysis. Even when kidney graft function is lost, the excess death risk is still considerably lower. Although overall mortality has decreased over the years, premature death due to ischemic heart disease remains high.Type 1 diabetes (T1D), a common disease in children and young adults, is associated with high risk of both acute and chronic complications. Diabetic nephropathy is a severe complication in patients with T1D, and in Finland, recent data show that 7.0% of the patients progress to end-stage renal disease (ESRD) after 30 years of T1D (1), whereas in the U.S., 25% have been shown to progress to ESRD after 40 years of T1D (2). Moreover, registry data show that between 4 and 17% of patients starting renal replacement treatment (RRT) have T1D (3,4). It is well known that patients with ESRD carry a manifold increased risk of premature mortality when compared with the general population, and this is particularly true for patients with T1D (5,6).

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“…ese free radical scavenging enzymes form a powerful antioxidant defence system. In contrast, NADPH oxidase 4 (NOX4) is one of the NADPH oxidase subunits, the primary sources of free radicals in the cell [17].…”

Section: Discussionmentioning

confidence: 99%

Effects of Compound Centella on Oxidative Stress and Keap1‐Nrf2‐ARE Pathway Expression in Diabetic Kidney Disease Rats

Zhu

Zeng

et al. 2020

Evidence-Based Complementary and Alternative Medicine

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The formula of Compound Centella mainly contains 3 traditional Chinese herbs: Centella asiatica (L.) Urb. (JiXueCao), Astragalus Membranaceus Fish. (HuangQi), and Tripterygium wilfordii Hook. f. (LeiGongTeng). Though this formula is effective for treating diabetic kidney disease (DKD) in clinic, the exact mechanism is still unclear. This study aims to investigate the effect and antioxidant mechanism of Compound Centella on DKD rats. High-performance liquid chromatography (HPLC) was applied to analyse 3 herbs in Compound Centella. Sprague-Dawley rats were divided into the normal group (NG), DKD group (DKDG), Compound Centella group (CCG), and losartan group (LG), with 8 rats in each group. On the first day of the experiment, rats in the NG were fed with ordinary –feed, while the other groups were fed with high-fat and high-sugar feed. On the 29th day, except the NG, the other 3 groups received a single intraperitoneal injection of streptozocin (STZ, 35 mg/kg). Fasting blood glucose (FBG) was measured on the 1st day, 32nd day, 46th day, 56th day, 84th day, and 112th day. Total protein/creatinine ratio of urine was determined by the phenol red assay on the 1st day and 112th day. Serum creatinine (Scr) was determined by an automatic biochemical analyser on the 112th day. Kidneys were collected on the 112th day for analysis and evaluation. Periodic acid-Schiff (PAS) staining, hematoxylin-eosin (HE) staining, and transmission electron microscopy were used to observe kidney pathological changes. The mRNA and protein expressions of Kelch-like ECH-associated protein 1 (Keap1) and nuclear factor-erythroid 2-related factor 2 (Nrf2) in renal tissues were detected by RT-qPCR, Western blot, and immunohistochemistry. Oxidative stress was evaluated by detecting the levels of malondialdehyde (MDA) and heme oxidase-1 (HO-1). The results showed that the content of asiaticoside, astragaloside, and triptolide in the herb was 5960, 809, and 2.42 μg/g and in the Compound Centella was 340, 64, and 0.1403 μg/mL by HPLC. Compound Centella reduced the urine protein/creatinine ratio and improved renal pathology in the kidneys of DKD rats. In addition, the mRNA and protein expressions of Keap1 and Nrf2 in kidneys were upregulated by Compound Centella. The expressions of MDA were downregulated but HO-1 were upregulated by Compound Centella. Therefore, the protective effect of Compound Centella in the kidney of DKD rats may be related to regulating the Keap1-Nrf2-ARE pathway under oxidative stress, suggesting Compound Centella as a promising treatment against DKD.

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Ten-year comparative analysis of incidence, prognosis, and associated factors for dialysis and renal transplantation in type 1 and type 2 diabetes versus non-diabetes

Cited by 43 publications

References 14 publications

Renal structure in type 2 diabetes: facts and misconceptions

Renal structure in type 2 diabetes: facts and misconceptions

Long-term Mortality After Kidney Transplantation in a Nationwide Cohort of Patients With Type 1 Diabetes in Finland

Effects of Compound Centella on Oxidative Stress and Keap1‐Nrf2‐ARE Pathway Expression in Diabetic Kidney Disease Rats

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