Abstract:
BACKGROUND:Overt albuminuria (urinary albumin-creatinine ratio [ACR] > 300 mg/g) is an established risk factor for progression of nephropathy and total mortality. However, whether a reduction in ACR translates into a reduction in mortality and/or cardiovascular (CV) events among insulin-treated patients with type 2 diabetes (T2D) in routine practice is currently not known. METHODS:We obtained data on a large cohort of insulin users with T2D and nephropathy (baseline ACR ≥300 mg/g) from UK general practices between 2007 and 2014. Their corresponding ACR values after 1year of follow-up were thereafter categorized into: (1) < 300 mg/g (i.e., albuminuria regression) or (2) > 300 mg/g (i.e., nonregression of albuminuria), and the cohort was followed-up for 5 years for all-cause mortality and CV events. Cox proportional hazard models were fitted to estimate the risk of all-cause death. RESULTS:A total of 11,074 patients with insulin-treated T2D met the inclusion criteria. Their mean age was 62.3 (13.6) years; mean HbA1c: 8.7 (1.8) and 53% were male. A total of 682 deaths occurred after a follow-up period of 43,393 person-years with a mortality rate of 16 per 1,000 person-years. Five-year survival was markedly reduced in the group whose proteinuria persisted or progressed (91 vs. 95%; log-rank p value < 0.001). Compared to patients whose ACR levels remained above 300 mg/g, all-cause mortality and CV events were 31 and 27% lower in those whose albuminuria regressed to < 300 mg/g (adjusted hazard ratio [aHR] 0.69; 95% CI 0.52-0.91; p = 0.008 and aHR 0. 73; 95% CI 0.54-0.98; p = 0.041), respectively. CONCLUSION:In patients with insulin-treated T2D and nephropathy in routine practice, a regression in albuminuria (e.g., via better BP or glycemic control) is associated with a significant reduction in all-cause mortality. Thus, albuminuria is not only simply a risk marker of renal and CV disease but also an independent target for therapy. Albuminuria reduction should be viewed as a goal for renal and CV protection.
journal_name
Am J Nephroljournal_title
American journal of nephrologyauthors
Anyanwagu U,Donnelly R,Idris Idoi
10.1159/000496276subject
Has Abstractpub_date
2019-01-01 00:00:00pages
146-155issue
2eissn
0250-8095issn
1421-9670pii
000496276journal_volume
49pub_type
杂志文章abstract::Hepcidin is a key regulator of iron metabolism. In this study, we examined whether measurement of hepcidin is useful in assessing recombinant human erythropoietin (rHuEPO) responsiveness in regular hemodialysis (HD) patients in a cross-sectional fashion. We examined the association between serum prohepcidin, a prohorm...
journal_title:American journal of nephrology
pub_type: 临床试验,杂志文章
doi:10.1159/000109968
更新日期:2008-01-01 00:00:00
abstract::Pasteurella multocida has been reported only once previously as a cause of peritonitis in a patient undergoing chronic peritoneal dialysis. The present report describes findings associated with a case of P. multocida peritonitis in a human immunodeficiency virus (HIV)-positive patient in which renal replacement therap...
journal_title:American journal of nephrology
pub_type: 杂志文章
doi:10.1159/000168274
更新日期:1991-01-01 00:00:00
abstract:BACKGROUND:Predicting the mortality risk of patients un-dergoing hemodialysis (HD) is challenging. Cell-free DNA (cfDNA) is released into circulation from dying cells, and its elevation is predictive of unfavorable outcome. In a pilot study, we found post-HD cfDNA level to be a predictor of all-cause mortality. Thus, t...
journal_title:American journal of nephrology
pub_type: 杂志文章
doi:10.1159/000510771
更新日期:2020-01-01 00:00:00
abstract::Extraskeletal tumoral calcinosis occur in uremic patients with high calcium phosphorus (Ca x P) product and progressive secondary hyperparathyroidism. However, cases are also described in which this association cannot be confirmed. The influence of aluminum, vitamins D and K, alkalosis, magnesium and local lesions is ...
journal_title:American journal of nephrology
pub_type: 杂志文章,评审
doi:10.1159/000169078
更新日期:1997-01-01 00:00:00
abstract::Hepatic dysfunction was observed in 34 patients with nontraumatic rhabdomyolysis. The serum levels of lactic dehydrogenase were markedly elevated in all patients. The peak values occurred within 72 h of hospitalization. There was no significant difference among patients with (9,044 +/- 1,154 U/l) and without acute ren...
journal_title:American journal of nephrology
pub_type: 杂志文章
doi:10.1159/000168053
更新日期:1990-01-01 00:00:00
abstract:BACKGROUND/AIMS:Post-renal transplant recurrent glomerulonephritis (GN) contributes to allograft loss. Rituximab treatment has been used in a multidose strategy with variable efficacy and toxicity. We investigated a novel single-dose approach. METHODS:A single center, retrospective, cohort study was conducted between ...
journal_title:American journal of nephrology
pub_type: 杂志文章
doi:10.1159/000371587
更新日期:2015-01-01 00:00:00
abstract::To determine the effect of multiple dialyzer use on intradialytic symptoms, data from 26,592 successive dialyses on 147 patients were analyzed. Over the 26-month period of study 4,933 new dialyzers were used. All symptoms, considered together, occurred 1.3 times more frequently during the initial than during the subse...
journal_title:American journal of nephrology
pub_type: 杂志文章
doi:10.1159/000167063
更新日期:1986-01-01 00:00:00
abstract::Recent studies have focused attention on the possible role of zinc depletion in the pathogenesis of uremic symptoms such as dysgeusia and impotence. The present studies were undertaken to evaluate the prevalence of zinc deficiency and abnormalities of zinc metabolism in patients with end-stage renal disease. A total o...
journal_title:American journal of nephrology
pub_type: 杂志文章
doi:10.1159/000167247
更新日期:1986-01-01 00:00:00
abstract:BACKGROUND:This study aimed at evaluating the after effects of a single bout of aerobic exercise on muscle sympathetic nerve activity (MSNA), peripheral vascular resistance and blood pressure (BP) in stages 2-3 chronic kidney disease (CKD) patients. We hypothesized that CKD patients present a greater decline in these v...
journal_title:American journal of nephrology
pub_type: 杂志文章,随机对照试验
doi:10.1159/000445443
更新日期:2016-01-01 00:00:00
abstract:BACKGROUND/AIMS:The value of neutrophil-gelatinase-associated lipocalin (NGAL), a novel biomarker in the detection of acute renal failure in children after cardiac surgery, has been highlighted in previous studies. The incidence of percutaneous coronary intervention (PCI) increases, which may possibly result in increas...
journal_title:American journal of nephrology
pub_type: 临床试验,杂志文章
doi:10.1159/000093961
更新日期:2006-01-01 00:00:00
abstract:BACKGROUND:Recent reports have highlighted that diabetic patients with kidney failure are at increased risk of technique failure and transfer to haemodialysis within 90 days of initiating peritoneal dialysis (PD). We wished to determine whether there were differences between diabetic and non-diabetic patients within th...
journal_title:American journal of nephrology
pub_type: 杂志文章
doi:10.1159/000477326
更新日期:2017-01-01 00:00:00
abstract:BACKGROUND:Contemporary prevalence of chronic kidney disease (CKD) and thrombotic cardiovascular (CV) events remains unclear in Veterans enrolled in the Veterans Affairs Health Care System (VA) care. Although oral P2Y12 inhibitors (P2Y12i) are increasingly being prescribed to this patient population, the overall prescr...
journal_title:American journal of nephrology
pub_type: 杂志文章
doi:10.1159/000486647
更新日期:2018-01-01 00:00:00
abstract::Bardoxolone methyl has been reported to cause detrimental cardiovascular events in the terminated BEACON Phase III human clinical trial via modulation of the renal endothelin pathway. However, the effects of bardoxolone methyl administration on the endothelin pathway in the heart are unknown. Our purpose in this persp...
journal_title:American journal of nephrology
pub_type: 杂志文章
doi:10.1159/000368563
更新日期:2014-01-01 00:00:00
abstract::We report the case of a 42-year-old woman with autosomal dominant polycystic kidney disease complicated by primary aldosteronism. She had a history of hypertension for 12 years and was found to have hypokalemia and polycystic renal and hepatic disease. Endocrinological tests revealed hyporeninemia and hyperaldosterone...
journal_title:American journal of nephrology
pub_type: 杂志文章,评审
doi:10.1159/000168725
更新日期:1994-01-01 00:00:00
abstract::A national sample of dialysis physicians was used to obtain data for a comparison of patient characteristics, comorbid conditions and treatment patterns associated with the five leading causes of end-stage renal disease (ESRD). The data are used to assess trends in physician care for ESRD patients and likely changes i...
journal_title:American journal of nephrology
pub_type: 杂志文章
doi:10.1159/000167949
更新日期:1989-01-01 00:00:00
abstract:BACKGROUND/AIMS:Anthropometric measures such as body mass index (BMI) and waist circumference (WC) have differential associations with incident chronic kidney disease (CKD) and mortality. We examined the associations of BMI and WC with various CKD complications. METHODS:We conducted a cross-sectional analysis of 2,853...
journal_title:American journal of nephrology
pub_type: 杂志文章
doi:10.1159/000341862
更新日期:2012-01-01 00:00:00
abstract::The medical history of salt begins in ancient times and is closely related to different aspects of human history. Salt may be extracted from sea water, mineral deposits, surface encrustations, saline lakes and brine springs. In many inland areas, wood was used as a fuel source for evaporation of brine and this practic...
journal_title:American journal of nephrology
pub_type: 历史文章,杂志文章
doi:10.1159/000168759
更新日期:1994-01-01 00:00:00
abstract::This study investigated the possible beneficial effect of intraperitoneal proteolytic enzyme administration on the development of hypertension-induced renal injury in the rat model of 2-kidney 1-clip (2K1C) Goldblatt hypertension. Male Wistar rats (120-150 g) underwent either sham surgery (control, n = 5) or clipping ...
journal_title:American journal of nephrology
pub_type: 杂志文章
doi:10.1159/000013411
更新日期:1998-01-01 00:00:00
abstract::Several medical inventors in Europe and North America brought the artificial kidney (hemodialysis) to practical usefulness in the late 1940s, but there were very few early successes. It was used at first for only desperate cases of acute renal failure. Renal authorities in the 'metabolic' tradition favored newly quant...
journal_title:American journal of nephrology
pub_type: 历史文章,杂志文章
doi:10.1159/000169117
更新日期:1997-01-01 00:00:00
abstract:BACKGROUND:Since low-density lipoprotein (LDL) S-homocysteinylation has been recently reported to enhance atherogenicity of lipoprotein, we have investigated the levels of homocysteine (Hcy) linked to LDL in chronic proteinuric patients in which lipid abnormalities highly contribute to the excess of morbidity and morta...
journal_title:American journal of nephrology
pub_type: 杂志文章
doi:10.1159/000319012
更新日期:2010-01-01 00:00:00
abstract:BACKGROUND:Serum protein profiling patterns can reflect the pathological state of a patient and therefore may be useful for clinical diagnostics. Here, we present results from a pilot study of proteomic expression patterns in hemodialysis patients designed to evaluate the range of serum proteomic alterations in this po...
journal_title:American journal of nephrology
pub_type: 杂志文章
doi:10.1159/000077409
更新日期:2004-03-01 00:00:00
abstract:BACKGROUND:Various medications are cleared by the kidneys, therefore patients with impaired renal function, especially dialysis patients are at risk for adverse drug events (ADEs). There are limited studies on ADEs in maintenance dialysis patients. METHODS:We utilized a nationally representative database, the Nationwi...
journal_title:American journal of nephrology
pub_type: 杂志文章
doi:10.1159/000489703
更新日期:2018-01-01 00:00:00
abstract:BACKGROUND:Serum phosphorus concentrations reflect a dynamic balance between generation, exchanges, and removal. Time-averaged phosphorus concentrations (TAC(phos)) reflect the overall exposure better than single time-point concentrations, especially in dialysis patients treated with an intermittent modality. The prese...
journal_title:American journal of nephrology
pub_type: 杂志文章
doi:10.1159/000336308
更新日期:2012-01-01 00:00:00
abstract::This study describes 10 cases of IgM nephropathy in whom the main morphological findings consisted of diffuse mesangial deposition of IgM and varying degrees of mesangial cell proliferation. In addition, focal segmental sclerosis was present in 1 patient and global sclerosis in another. An ill-defined electron-dense d...
journal_title:American journal of nephrology
pub_type: 杂志文章
doi:10.1159/000167485
更新日期:1987-01-01 00:00:00
abstract::A meeting on the History of Nephrology is an opportunity to discuss the links between science and faith which were split until the 6th century. However, this was changed by Cassiodorus and monasticism. From the times of Abbot Bertario (died 883 AD) in Montecassino, medicine was regarded as an art and a science. Codex ...
journal_title:American journal of nephrology
pub_type: 历史文章,杂志文章
doi:10.1159/000168769
更新日期:1994-01-01 00:00:00
abstract::Left ventricular hypertrophy (LVH) is a common finding in hypertensive autosomal dominant polycystic kidney disease (ADPKD) patients. There are few studies on the influence of blood pressure (BP) and nonhemodynamic factors on LVH in these patients. The aim of this study was to evaluate the relationship between BP, hum...
journal_title:American journal of nephrology
pub_type: 杂志文章
doi:10.1159/000013583
更新日期:2000-05-01 00:00:00
abstract:BACKGROUND:Vascular calcification is seen in most patients on dialysis and is strongly associated with cardiovascular mortality. Vascular calcification is promoted by phosphate, which generally reaches higher levels in hemodialysis than in peritoneal dialysis. However, whether vascular calcification develops less in pe...
journal_title:American journal of nephrology
pub_type: 杂志文章
doi:10.1159/000494665
更新日期:2018-01-01 00:00:00
abstract:BACKGROUND/AIM:Slc26a6 (PAT1, CFEX) is a major chloride/base exchanger located on the apical membrane of the kidney proximal tubule. The purpose of the present study was to examine the effect of Slc26a6 deletion on the apical Na+/H+ exchanger 3 (NHE3) in the straight segment (S3) of the proximal tubule, which is the ma...
journal_title:American journal of nephrology
pub_type: 杂志文章
doi:10.1159/000111826
更新日期:2008-01-01 00:00:00
abstract::This report reviews the features of 149 cases of renal allograft rupture, while adding a detailed description of 3 more cases to the English literature. From November, 1973 to November, 1979, 3 cases of renal allograft rupture occurred in 100 renal transplants performed at Research Medical Center, Kansas City, Mo., an...
journal_title:American journal of nephrology
pub_type: 杂志文章
doi:10.1159/000166577
更新日期:1982-01-01 00:00:00
abstract::To elucidate the prevalence and clinical implications of antineutrophil cytoplasmic antibody (ANCA) in lupus nephritis (LN), we examined ANCA by indirect immunofluorescence and by ELISA against antilactoferrin (anti-LF) and antimyeloperoxidase (anti-MPO) antibody. To discriminate perinuclear ANCA (pANCA) with antinucl...
journal_title:American journal of nephrology
pub_type: 杂志文章
doi:10.1159/000013557
更新日期:2000-01-01 00:00:00