BMJ Sub-Journal: Don't let diabetes hurt your kidneys!

Up to 451 million adults worldwide suffer from diabetes (DM)
.

By 2045, this number will rise to 693 million adults

diabetes

Diabetic nephropathy and most of the excess all-cause mortality and cardiac vascular death
.

In the US National Health and Nutrition Survey (NHANES), the 10-year cumulative standardized mortality rate has changed from 7.

Heart blood vessels

In the Finnish diabetic nephropathy study, the standardized mortality rate of patients with type 1 diabetes and no chronic kidney disease was similar to that of ordinary people.
The more severe diabetic nephropathy was related to the higher all-cause mortality
.

Potential risk factors known to be altered include poorly controlled blood sugar, high blood pressure, high cholesterol, hyperlipidemia, smoking, obesity, poor socio-economic environment, sedentary life>metabolic syndrome , insulin resistance, vitamin D deficiency and acute Renal damage is recurrent, but due to differences in culture, prescriptions, and treatments, these risk factors vary from region to region

Cholesterol Metabolism Syndrome Vitamin D

Recently, a retrospective cohort study of 4606 patients treated at the Irish Diabetes Center between June 2012 and December 2016 was published in a sub-Journal of BMJ.
Among the 4606 patients, type I diabetes accounted for 22.
8% (n= 1051), type II diabetes accounted for 75.
3% (n=3467), other types accounted for 1.
9% (n=86), 42.
0% of people had diabetic nephropathy, of which 23.
4% of type I diabetes DKD patients, type II diabetes DKD patients There are 47.
9% and 32.
6% of DKD patients with other types of diabetes
.

Diabetes compared with type Ⅰ, Ⅱ type diabetes patients have a greater percentage of people suffering from the DKD

Ⅱ type diabetes have a greater proportion of people with DKD

Tomás P Griffin et al.
Burden of chronic kidney disease and rapid decline in renal function among adults attending a hospital-based diabetes center in Northern Europe.
BMJ Open Diabetes Research & Care(2021).
DOI: 10.
1136/bmjdrc-2021-002125

Tomás P Griffin et al.
Burden of chronic kidney disease and rapid decline in renal function among adults attending a hospital-based diabetes center in Northern Europe.
BMJ Open Diabetes Research & Care(2021).
DOI: 10.
1136/bmjdrc-2021-002125

After excluding kidney transplantation and other types of patients, compared with type I diabetes patients, the proportion of diabetic nephropathy at medium-high and very high-risk patients with type II diabetes is greater
.

In different stages of the development of kidney disease, patients with diabetes are more likely to be at risk of end-stage kidney disease, cardiovascular death, and all-cause death

In cohort studies in the United Kingdom, Italy, Spain, France, Finland and the United States, the prevalence of kidney disease in patients with type 2 diabetes ranged from 23% to 69%
.

In cohort studies in the United Kingdom, Italy, Spain, France, Finland and the United States, the prevalence of kidney disease in patients with type 2 diabetes ranged from 23% to 69%
.

In cohort studies in the United Kingdom, Italy, Spain, France, Finland and the United States, the prevalence of kidney disease in patients with type 2 diabetes ranged from 23% to 69%

A) The prevalence of DKD in all DM patients
.

(B) The prevalence of DKD in type 1 DM patients

A) The prevalence of DKD in all DM patients

Increased albuminuria is related to worsening blood sugar, blood pressure, blood lipid parameters, and higher BMI

Increased albuminuria is related to worsening blood sugar, blood pressure, blood lipid parameters, and higher BMI

Albuminuria is a pathological condition in which serum albumin is present in urine
.
It is one of the types of proteinuria
.
When kidney disease progresses to a certain stage, the patient’s kidneys often enlarge, and the glomerular filtration rate also increases
.
When the glomerular filtration rate exceeds 40% of normal, the patient will develop microalbuminuria
.
If not controlled, 50% of people will develop kidney disease within 5 to 10 years
.
Increased albuminuria is related to worsening blood sugar, blood pressure, blood lipid parameters, and higher BMI
.

Increased albuminuria is related to worsening blood sugar, blood pressure, blood lipid parameters, and higher BMI
.
Increased albuminuria is related to worsening blood sugar, blood pressure, blood lipid parameters, and higher BMI
.

Glomerular filtration rate is widely used in clinical practice, mainly to evaluate the detoxification ability of the kidney
.
As the duration of diabetes prolonged, the estimated glomerular filtration rate decreased
.
Patients with type 2 diabetes are older and their renal function declines with age.
These patients are more likely to develop advanced diabetic nephropathy
.

In patients with advanced kidney disease, the estimated glomerular filtration rate decreases, systolic blood pressure rises, and blood pressure control is not ideal
.
Poor systolic blood pressure control may be due to multiple factors, such as poor medication compliance, comorbidities, and inadequate systolic blood pressure control at older ages.
In general, it is very difficult to control blood pressure in the advanced stage of diabetic nephropathy
.

Among patients with type 1 diabetes, glycosylated hemoglobin (HbA1c) was higher than the target value.
The British National Diabetes Auditor found that some participants failed to reach the target of normal blood sugar and blood pressure
.

Decreased renal function is related to multiple risk factors (urinary albumin-creatinine ratio, total cholesterol, high-density lipoprotein cholesterol, age, diastolic blood pressure)
.
In a Japanese general cohort study without diabetes, the variability of systolic blood pressure was an independent factor for the decline of renal function in hypertensive patients
.
In order to slow the decline in renal function, reducing systolic blood pressure variability may be a less recognized intervention
.

Increase in ALP as a sign of gradual renal artery calcification

Increase in ALP as a sign of gradual renal artery calcification

Alkaline phosphatase (ALP) is an enzyme responsible for the hydrolysis of pyrophosphate.
It is found in all tissues of the human body, and has high levels in the kidneys, bones and liver
.
The increase in ALP is related to the rapid decline of renal function and the appearance of albuminuria
.
Serum ALP is a marker of arterial stiffness
.
The increase in arterial stiffness is related to the rapid decline of renal function , and the increase in ALP can be used as a sign of gradual renal artery calcification
.
In patients with T2DM and proteinuria, renal artery calcification can independently predict the occurrence of end-stage renal disease
.
In maintenance hemodialysis patients, higher ALP is associated with increased coronary artery calcification score, which may be a sign of cardiovascular risk
.
In the 6 months before the start of dialysis, the average high serum ALP level was associated with an increase in mortality
.

The increase in ALP is related to the rapid decline in renal function and the appearance of albuminuria.
The increase in ALP is related to the rapid decline in renal function and the appearance of albuminuria.
The increase in arterial stiffness and the rapid decline in renal function are related to the increase in arterial stiffness.
The rapid decline in kidney function is related to

In patients with DKD and nephrotic proteinuria, elevated serum ALP levels are independently associated with poor renal outcome
.
In non-diabetic hypertensive patients, ALP is associated with a decrease in the estimate of glomerular filtration rate, which may be mediated by inflammation, endothelial dysfunction, vascular calcification, and blood pressure regulation
.

In the study of rat aortic calcification model, inhibition of tissue non-specific alkaline phosphatase in serum can lead to reduction of vascular calcification, which indicates that ALP may be a new therapeutic target to prevent renal function decline
.
In contrast to ALP, the decline in alanine aminotransferase (ALT) is related to the rapid decline in renal function
.
Previous studies have found that ALT levels in chronic kidney disease are low
.

Elevated thyroid stimulating hormone (TSH) is associated with decreased renal function

Elevated thyroid stimulating hormone (TSH) is associated with decreased renal function

As the estimate of glomerular filtration rate decreases, the incidence of clinical hypothyroidism increases
.
It is speculated that chronic kidney disease is a risk factor for thyroid dysfunction
.
Patients with hypothyroidism need treatment, and patients with diabetes also need regular thyroid function tests
.
In 24 patients with congenital hypothyroidism, renal function improved after thyroid hormone replacement therapy
.
In 113 patients with hypothyroidism and chronic kidney disease, thyroid hormone replacement therapy reduced the rate of decline in renal function, which suggests that the decline in renal function may be the result of decreased thyroid-stimulating hormone
.

The burden and adverse consequences of diabetic nephropathy are greater than recognized by population studies
.
In addition to common risk factors, changes in renal function are related to changes in serum ALP, TSH, and systolic blood pressure and urine albumin-creatinine ratio
.

Researchers advocate a healthy diet and strengthen physical exercise to prevent type 2 diabetes and its complications.
This way, the greater the chance of reducing the burden of kidney disease
.

prevention

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