History Of Diabetic Nephropathy Research Articles

A Tubular Vena Cava Conduit Used to Lengthen a Kidney Transplant Renal Artery Injured During Organ Procurement

Organ transplantation is limited by the supply of transplantable organs, and the supply of organs cannot meet the needs of patients on the waiting list. Ensuring transplantation of any procured organ is therefore mandatory. Organ injury, mostly to the organ's vasculature, can occur during multi-organ procurement, preventing subsequent transplantation. In such a context, vascular reconstructions of arterial or venous organ injuries can be useful. This report describes the case of an obese 64 year old female with a history of diabetic nephropathy who underwent a cadaveric kidney transplant (right kidney with one main renal artery, one inferior polar artery, one vein, and one ureter). The ex situ preparation of the graft revealed that the main renal artery was injured and cut close to the renal hilum (0.8 cm length, 6 mm diameter), not allowing graft implantation. In order to increase the length of the main renal artery, the donor inferior vena cava was used to create a tubular conduit, allowing subsequent graft implantation. Cold and warm ischaemic times were respectively 12 hours and 36 minutes, with immediate graft function. The patient was discharged on day 8 (serum creatinine level was 95 μmol/L). Twelve month follow up was uneventful (serum creatinine level was 108 μmol/L and duplex ultrasonography showed homogeneous blood flow throughout the graft). This case report highlights the possibility of overcoming an injured kidney graft artery by creating a tubular vena cava conduit in order to allow subsequent transplantation. Vascular reconstructions of organs injured during procurement should be considered.

Antiepileptic therapy in a patient with star fruit intoxication: A case report.

It is rare for uremia patients to have epileptic seizures after eating star fruit, only a dozen cases are reported worldwide. Such patients usually have poor prognoses. Few patients had good prognoses, all of them were treated with expensive renal replacement therapy. At present, there is no report on the addition of drug therapy to these patients based on the initial renal replacement therapy. A 67-year-old male patient with star fruit intoxication who had a history of diabetic nephropathy, hypertension, polycystic kidney, and chronic kidney disease in the uremic phase, and regular hemodialysis 3 times a week for 2 years. Initial clinical manifestations include hiccups, vomiting, speech disturbances, delayed reactions, and dizziness, which gradually progress to hearing and visual impairment, seizures, confusion, and coma. This patient was diagnosed with seizures caused by star fruit intoxication. The experience of eating star fruit and the electroencephalograms can prove our diagnosis. We performed intensive renal replacement therapy according to the recommendations in the literature. However, his symptoms did not improve significantly until he received an extra dose of levetiracetam and resumed his previous dialysis schedule. The patient was discharged after 21 days without neurologic sequelae. Five months after discharge, he was readmitted due to poor seizure control. To improve the prognosis of these patients and to reduce their financial burden, the use of antiepileptic drugs should be emphasized.

The Impact of Preoperative Risk Factors on Peritoneal Dialysis-Related Peritonitis: A Single-Center Prospective Study in Japan.

Background and Objectives: Peritoneal dialysis (PD)-related peritonitis is a critical problem. However, preoperative risk factors for PD-related peritonitis have not been established. Thus, we aimed to determine the preoperative risk factors for PD-related peritonitis. Materials and Methods: This is a single-center prospective observational study. All peritonitis episodes during the study period were recorded, and preoperative and intraoperative clinical parameters were compared between patients with and without peritonitis to examine risk factors for PD-related peritonitis. Furthermore, subcutaneous and abdominal fat volumes were evaluated using computed tomography. Results: Among a total of 118 patients, 24 patients developed peritonitis. The proportion of male patients (83% vs. 61%, p = 0.04), body mass index (25 vs. 22 kg/m2, p = 0.04), and subcutaneous fat area (120 vs. 102 cm2, p = 0.01) were significantly higher and the proportion of patients living with family members (75% vs. 94%, p = 0.02) was significantly lower in the peritonitis group than in the non-peritonitis group. There were no significant differences in age, operation method, surgeon experience, previous abdominal surgery, medical history of diabetic nephropathy, serum albumin level, and renal function between the two groups. Conclusions: Male patients with high subcutaneous fat who are living alone might be at higher risk of PD-related peritonitis. These characteristics might be useful in risk assessment and patient education before PD induction.

Mycophenolate Mofetil and Clostridium difficile-associated Colitis

Aim.A clinical observation of colitis conditioned by mycophenolate mofetil intake and concomitant Clostridium difficile-associated disease.Key points.Mycophenolate mofetil (MMF) is an active immunosuppressant with side effects affecting gastrointestinal tract (GIT). A 37-yo male patient with type 1 diabetes mellitus was admitted at a gastroenterology unit with clinical signs of diarrhoea with haematochezia. A history of diabetic nephropathy and related-donor pre-dialysis kidney transplantation in 2012, since when MMF intake was 2000 mg daily. Catarrhal ulcerative colitis in colonoscopy, C. difficile toxins in pathogen stool panel. Ulcerative, ischaemic colitises and the graft-versus-host disease were ruled out in examination. A positive clinical and endoscopic trend was observed upon MMF withdrawn and start of vancomycin.Conclusion.The case presented illustrates the clinical picture and diagnostic algorithm in MMF-associated colitis. The case-distinctive is association with C. difficile infection.

MO653RISK FACTORS FOR DIABETIC NEPHROPATHY AMONG NEWLY DIAGNOSED TYPE 2 DIABETIC PATIENTS WITH NORMAL BLOOD PRESSURE

Abstract Background and Aims Diabetes mellitus (DM) is the leading cause of chronic kidney disease; principally resulting from the increasing prevalence of type 2 DM (T2DM). Patients with T2DM pass through pre-diabetic stages and at the time of diagnosis, up to half of the T2DM patients may have different macro- and micro-vascular complications, including diabetic nephropathy. Hypertension has adverse impacts on diabetic nephropathy. This study was designed to evaluate the risk factors for diabetic nephropathy among newly detected T2DM patients with normal blood pressure. Method This case-control study was done at out-patient department of a referral hospital in Dhaka, Bangladesh from January 2018 to June 2019. Newly detected (<3 months), adult (≥18 years), T2DM patients of either sex, who underwent test for urine albumin-to-creatinine ratio (UACR), at least twice (6 weeks apart), within a 6-month period, were included in this study. Patients with hypertension (newly diagnosed or known cases/on antihypertensive medications), known kidney disease, features of glomerulonephritis, systemic diseases including systemic lupus erythematosus and vasculitis, history of recent fever and exercise, urinary tract infection and pregnancy were excluded. Patients with UACR ≥30 mg/g in at least two (of three, if done) samples were cases and those with UACR <30 mg/g were controls. Results Total patients were 135, including 27 cases [moderately increased proteinuria (previously, microalbuminuria) (UACR 30 – 299 mg/g) = 25 and severely increased proteinuria (previously, overt proteinuria) (UACR ≥300 mg/g) = 2] and 108 controls. Mean age was 42.9 years and there was female (64.8%) predominance. Thirteen percent patients were smokers, 12% had dyslipidaemia, 51% had family history of DM and 44.9% had family history of diabetic nephropathy. Besides diabetic nephropathy, other chronic complications of DM were diabetic retinopathy (6.7%), diabetic peripheral neuropathy (0.7%) and coronary artery disease (1.5%). Regarding risk factors for diabetic nephropathy, family history of DM [odds ratio (OR) = 2.31, 95% confidence interval (CI) = 0.923 – 5.415, p = 0.003) and diabetic nephropathy (OR = 3.28, 95% CI = 1.523 – 9.297, p = 0.001), smoking (OR = 3.08, 95% CI = 1.066 – 0.934, p = 0.003), dyslipidaemia (OR = 2.11, 95% CI = 0.241 – 3.464, p = 0.004) and coexisting diabetic retinopathy (OR = 6.51, 95% CI = 1.46 – 11.79, p = 0.003) were significant. On multivariate logistic regression, family history of DM (OR = 2.13, 95% CI = 1.412 – 4.216, p = 0.003) and diabetic nephropathy (OR = 3.31, 95% CI = 2.145 – 5.249, p = 0.001), smoking (OR = 3.11, 95% CI = 2.234 – 4.123, p = 0.003), dyslipidaemia (OR = 2.14, 95% CI = 1.363 – 3.324, p = 0.005) and diabetic retinopathy (OR = 6.23, 95% CI = 4.197 – 9.464, p = 0.004) were significant. Conclusion Family history of DM and diabetic nephropathy, smoking, dyslipidaemia and concomitant diabetic retinopathy were significant risk factors for diabetic nephropathy among newly diagnosed T2DM patients with normal blood pressure.

Jiangsu Diabetic Eye Disease Study：epidemiological survey of blindness and moderate or severe visual impairment in people with type 2 diabetes over 50 years old in Funing County

Objective: To investigate the prevalence, causes and risk factors of moderate or severe visual impairment and blindness in people with type 2 diabetes over 50 years old in Funing County, Yancheng. Methods: This is a cross-sectional study. Using cluster random sampling, 84 survey sites were selected, and eye examination was performed on people with type 2 diabetes over 50 years old who were registered with the chronic disease information center of Funing County Center for Disease Control and Prevention in Yancheng, Jiangsu. The prevalence of moderate or severe visual impairment and blindness were calculated by different ages and genders. The causes of blindness and visual impairment were determined, and their influencing factors were analyzed by univariate and multivarite logistic regression. Results: A total of 2 067 people were investigated in this study, and 1 909 people were included. The response rate was 92.4%. Based on PVA, the prevalence of blindness and moderate to severe visual impairment was 5.29% (95%CI: 4.29%-6.30%) and 18.54% (95%CI: 16.80%-20.29%). The prevalence of blindness was related to age, marital status, education, duration of diabetes, history of diabetic nephropathy, systolic blood pressure and nuclear opacity. The prevalence of moderate or severe visual impairment was related to age, gender, educational level, diabetes treatment, exercise, and glycated hemoglobin. The prevalence of blindness and moderate to severe visual impairment was 3.67% (95%CI: 2.82%-4.51%) and 9.80% (95%CI: 8.46%-11.13%) based on BCVA. The prevalence of blindness was related to age, marital status, education, duration of diabetes, history of diabetic nephropathy, exercise and systolic blood pressure, while the prevalence of moderate or severe visual impairment was related to age, educational level, diabetes treatment and nuclear opacity. The primary cause of blindness and visual impairment is cataract, followed by diabetic retinopathy. Conclusions: The prevalence of moderate or severe visual impairment and blindness in people with type 2 diabetes in Funing County is relatively high. Attention should be paid to the prevention of blindness in this population. (Chin J Ophthalmol, 2020, 56: 593-599).

P1034EVALUATION OF RISK FACTORS FOR DIABETIC NEPHROPATHY AMONG NEWLY DIAGNOSED TYPE 2 DIABETIC SUBJECTS

Abstract Background and Aims Diabetes mellitus (DM) is the leading cause of chronic kidney disease in developed as well as in developing countries, principally resulting from the increasing prevalence of type 2 DM (T2DM). Patients with T2DM pass through pre-diabetic stages and half of the T2DM patients remain undiagnosed. During diagnosis, one-third to half of the T2DM patients may have different macro- and micro-vascular complications including diabetic nephropathy. This study was designed to evaluate risk factors for diabetic nephropathy among newly detected T2DM subjects. Method A case-control study was done at out-patient department of a tertiary care hospital in Dhaka, Bangladesh from October 2016 to June 2017. Newly detected (<3 months) adult (≥18 years) T2DM patients of either sex, who underwent test for urine albumin-to-creatinine ratio (UACR) at least twice, at least 6 weeks apart, within a 6-month period, were included in this study. Patients with diagnosed kidney diseases, features of glomerulonephritis, systemic diseases like systemic lupus erythematosus and vasculitis, history of recent fever and exercise, urinary tract infection and pregnancy were excluded. Patients with UACR ≥30 mg/g in at least two (of three, if done) samples were cases and those with UACR <30 mg/g were controls. Results Total patients were 100, including 35 cases [moderately increased proteinuria (previously, microalbuminuria) (UACR 30-299 mg/g) = 33 and severely increased proteinuria (previously, overt proteinuria) (UACR ≥300 mg/g) = 2] and 65 controls. Mean age was 46.6±12.3 years and there was female predominance (male:female ratio was 1:2). Twenty four percent patients were smokers, 50% were hypertensive and 46% had dyslipidaemia. Seventy five percent of the study participants had positive family history of DM and 39% had family history of diabetic nephropathy. Mean body mass index (BMI) was 26.3±2.9 kg/m2. Mean fasting blood glucose (mmol/L), 2-h post glucose value (mmol/L) and mean glycated haemoglobin (HbA1c) (%) were 9.2±2.9, 14.5±4.1 and 7.9±1.3 respectively. Eighty percent of the patients were asymptomatic regarding DM. Besides nephropathy, other chronic complications of DM were diabetic retinopathy (17%), neuropathy (11%), coronary artery disease (11%) and cerebrovascular disease (4%). Regarding risk factors for diabetic nephropathy, family history of DM (OR 1.62, p 0.0001) and diabetic nephropathy (OR 25.13, p 0.003), presence of hypertension (OR 4.93, p 0.001) and coexisting diabetic retinopathy (OR 14.18, p 0.046) were significant. On multivariate logistic regression, family history of DM (OR 1.77, p 0.001) and diabetic nephropathy (OR 24.31, p 0.001), higher BMI (>25 kg/m2) (OR 2.11, p 0.013), hypertension (OR 4.31, p 0.003) and diabetic retinopathy (OR 14.09, p 0.021) were significant. Conclusion One-third of the newly detected type 2 diabetic subjects had diabetic nephropathy in this study. Family history of DM and diabetic nephropathy, higher BMI, presence of hypertension and diabetic retinopathy were significant risk factors for diabetic nephropathy.

Short-term foot complications in Charcot neuroarthropathy: A retrospective study in tertiary care centres in Spain

ObjectivesTo assess the clinical characteristics of patients with Charcot neuroarthropathy (CN) in Spain and to identify predictors for CN-related complications. Patients and methodsA retrospective study was conducted at five tertiary hospitals with diabetic foot care units in Spain. Data were collected from 83 patients, including demographic profiles, foot factors, diabetes characteristics, and presence of microvascular and macrovascular comorbidity, and a podiatric examination was also performed. Logistic regression analyses were used to determine significant predictors of the predefined clinical events. ResultsSigns of diabetic neuropathy were found in almost all patients (98.9%) at the initial assessment, approximately half of them had diabetic retinopathy or nephropathy (61.5% and 51.8%, respectively), and peripheral artery disease was uncommon (8.6%). Thirty-eight patients (47.5%) experienced one or more relevant clinical events: 22 (27.5%) a new foot ulcer; 7 (8.7%) a major amputation; 20 (25%) were admitted to hospital; and 4 (5%) died. Only the presence of diabetic nephropathy was independently associated to development of any of the complications studied (p = 0.009; odds ratio = 3.37; 95% CI: 1.12-10.1). ConclusionsAlmost half the patients with CN attending specialised foot care units in tertiary hospitals experienced short-term CN-associated complications, and the risk was 3 times higher in those with a history of diabetic nephropathy.

Short-term foot complications in Charcot neuroarthropathy: A retrospective study in tertiary care centres in Spain

ObjectivesTo assess the clinical characteristics of patients with Charcot neuroarthropathy (CN) in Spain and to identify predictors for CN-related complications. Patients and methodsA retrospective study was conducted at five tertiary hospitals with diabetic foot care units in Spain. Data were collected from 83 patients, including demographic profiles, foot factors, diabetes characteristics, and presence of microvascular and macrovascular comorbidity, and a podiatric examination was also performed. Logistic regression analyses were used to determine significant predictors of the predefined clinical events. ResultsSigns of diabetic neuropathy were found in almost all patients (98.9%) at the initial assessment, approximately half of them had diabetic retinopathy or nephropathy (61.5% and 51.8%, respectively), and peripheral artery disease was uncommon (8.6%). Thirty-eight patients (47.5%) experienced one or more relevant clinical events: 22 (27.5%) a new foot ulcer; 7 (8.7%) a major amputation; 20 (25%) were admitted to hospital; and 4 (5%) died. Only the presence of diabetic nephropathy was independently associated to development of any of the complications studied (p = 0.009; odds ratio = 3.37; 95% CI: 1.12-10.1). ConclusionsAlmost half the patients with CN attending specialised foot care units in tertiary hospitals experienced short-term CN-associated complications, and the risk was 3 times higher in those with a history of diabetic nephropathy.

Phenazopyridine‐Induced Hemolytic Anemia in Advanced Kidney Disease

Phenazopyridine‐Induced Hemolytic Anemia in Advanced Kidney Disease

A Case of Acute Promyelocytic Leukemia Concomitant with Plasma Cell Myeloma

A Case of Acute Promyelocytic Leukemia Concomitant with Plasma Cell Myeloma

Albuminurie beim Diabetiker: praktisches Management

Diabetic Nephropathy is the most common cause of end stage renal disease in Western countries. An increased urinary albumin excretion represents a characteristic sign of diabetic kidney damage. Regular screening for microalbuminuria allows early detection and timely intervention. In overt diabetic nephropathy, quantification of albuminuria helps monitoring disease progression. Therapeutic interventions to reduce albuminuria retard progression of nephropathy and reduce cardiovacular mortality, since albuminuria represents an independent cardiovascular risk factor. This review article describes the natural history of diabetic nephropathy and discusses practical issues for the measurement of albuminuria. Available prophylactic and therapeutic measures, particularly glycemic control and inhibition of the renin-angiotensin-aldosteron system, are reviewed using an evidence based approach.

Diabetic nephropathy in a sibling and albuminuria predict early GFR decline: a prospective cohort study

BackgroundDiabetic nephropathy is a growing clinical problem, and the cause for >40% of incident ESRD cases. Unfortunately, few modifiable risk factors are known. The objective is to examine if albuminuria and history of diabetic nephropathy (DN) in a sibling are associated with early DN progression or mortality.MethodsIn this longitudinal study of adults >18 yrs with diabetes monitored for up to 9 yrs (mean 4.6 ± 1.7 yrs), 435 subjects at high risk (DN family history) and 400 at low risk (diabetes >10 yrs, normoalbuminuria, no DN family history) for DN progression were evaluated for rate of eGFR change using the linear mixed effects model and progression to ESRD. All-cause mortality was evaluated by Kaplan-Meier analyses while controlling for baseline covariates in a Cox proportional hazards model. Covariates included baseline eGFR, age, gender, race, diabetes duration, blood pressure, hemoglobin A1c and urine albumin:creatinine ratio. Propensity score matching was used to identify high and low risk group pairs with balanced covariates. Sensitivity analyses were employed to test for residual confounding.ResultsMean baseline eGFR was 74 ml/min/1.73 m2 (86% of cohort >60 ml/min/1.73 m2). Thirty high risk and no low risk subjects developed ESRD. eGFR decline was significantly greater in high compared to low risk subjects. After controlling for confounders, change in eGFR remained significantly different between groups, suggesting that DN family history independently regulates GFR progression. Mortality was also significantly greater in high versus low risk subjects, but after controlling for baseline covariates, no significant difference was observed between groups, indicating that factors other than DN family history more strongly affect mortality. Analyses of the matched pairs confirmed change in eGFR and mortality findings. Sensitivity analyses demonstrated that the eGFR results were not due to residual confounding by unmeasured covariates of a moderate effect size in the propensity matching.ConclusionsDiabetic subjects with albuminuria and family history of DN are vulnerable for early GFR decline, whereas subjects with diabetes for longer than 10 years, normoalbuminuria and negative family history, experience slower eGFR decline, and are extremely unlikely to require dialysis. Although we would not recommend that patients with low risk characteristics be neglected, scarce resources would be more sensibly devoted to vulnerable patients, such as the high risk cases in our study, and preferably prior to the onset of albuminuria or GFR decline.

Olmesartan is More Effective Than Other Angiotensin Receptor Antagonists in Reducing Proteinuria in Patients With Chronic Kidney Disease Other Than Diabetic Nephropathy

BackgroundAngiotensin II receptor antagonists (ARBs) have a protective effect in patients with chronic kidney disease (CKD) by suppressing progression, possibly by controlling hypertension. One marker of progression in such patients is the degree of proteinuria. ObjectiveWe aimed to retrospectively examine the protective effect of ARBs (olmesartan, losartan, candesartan, and valsartan) on CKD patients without a history of diabetic nephropathy. MethodsData were retrieved from medical records of patients with a diagnosis of CKD (serum creatinine [Cre] <3.0 mg/dL [265.2 μmol/L] and urinary protein of 0.3–3.5 g/g Cre) who were treated with ARBs and those with diabetic nephropathy were excluded. Blood pressure, serum Cre, urinary protein, urinary Cre, and estimated glomerular filtration rate were measured before the research began and at 1, 3, 6, 12, and 24 months after the ARB treatment was started. ResultsForty-four patients completed the research protocol. Of these, 10 took olmesartan, 13 took losartan, 9 took candesartan, 9 took valsartan, and 3 took telmisartan. Systolic blood pressure was decreased in all cases. The extent of this decrease 1 month after starting ARB treatment was greater for olmesartan than for candesartan (P < 0.05), and after 2 years, it was greater than for losartan (P < 0.05). Diastolic blood pressure decreased in all patients; this decrease was significantly greater with olmesartan 1 month after treatment started than with candesartan (P < 0.05). Olmesartan significantly decreased daily urinary protein compared with that with the other ARBs during follow-up. This decrease 1 month after starting ARB treatment was greater for olmesartan than losartan, valsartan, and candesartan (P < 0.01, P < 0.01, and P < 0.05, respectively), and after 2 years, this effect was still significant (P < 0.05, P < 0.01, and P < 0.01, respectively). ConclusionsOlmesartan is more effective in reducing urinary protein than other ARBs, suggesting that the renal protective effects of olmesartan may be better than those of other ARBs.

Diabetic nephropathy: Progression and pathophysiology

Diabetic nephropathy is the leading cause of kidney disease in patients starting renal replacement therapy and affects ~30% of type 1 and type 2 diabetic patients. This review focuses on the progression and pathophysiological aspects of the condition. The natural history of diabetic nephropathy is characterized by specific renal morphological and functional alterations. Features of early diabetic renal changes are microalbuminuria (30-300mg/day), glomerular hyperfiltration, glomerular and renal hypertrophy, increased basement membrane thickness, and mesangial expansion with the accumulation of extracellular matrix proteins such as collagen, fibronectin, and laminin. Advanced diabetic nephropathy is characterized by macroalbuminuria ( >300mg/day), a progressive decline in glomerular filtration rate, decreasing creatinine clearance, glomerulosclerosis, and interstitial fibrosis. Although poor glycemic control is an important risk factor, glycemia does not fully explain why only a subset of diabetic patients progress to end stage renal disease. Several decades of extensive research has elucidated various pathways to be implicated in the development of diabetic kidney disease such as systemic and glomerular hypertension, advanced glycation endproducts and the aldose reductase system. Furthermore, hemodynamic factors, the reninangiotensin system, the endothelin system, the intracellular signaling molecule protein kinase C, transforming growth factor-s, growth hormone, insulin like growth factors, vascular endothelial growth factor, and platelet-derived growth factor are believed to be involved in the pathogenesis. Thus, there are clearly many points at which therapeutic approaches could be tried to provide renoprotection in diabetes. It is likely that due to its complexity, targeting multiple points in altered metabolism in the diabetic kidney will be more successful in attenuating the development of diabetic nephropathy, rather than a single approach.

Diabetic Nephropathy

Diabetic nephropathy is the leading cause of renal failure in UK, accounting for 24% of patients with end-stage renal disease (ESRD). In addition, it is a risk factor for cardiovascular disease. Clinical trials have shown that it is possible to alter the natural history of diabetic nephropathy by targeting multiple risk factors. In clinical practice, this includes tight glycaemic control, aggressive antihypertensive therapy and the use of angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin receptor blockers (ARBs). This article aims to describe management of diabetic nephropathy in primary care and provide guidance on when to refer to secondary care.

Another patient with a natural history of diabetic nephropathy: current situation and means of prevention.

Another patient with a natural history of diabetic nephropathy: current situation and means of prevention.

Thiazolidinediones, cardiovascular disease and cardiovascular mortality: translating research into action for diabetes (TRIAD)

Studies have associated thiazolidinedione (TZD) treatment with cardiovascular disease (CVD) and questioned whether the two available TZDs, rosiglitazone and pioglitazone, have different CVD risks. We compared CVD incidence, cardiovascular (CV), and all-cause mortality in type 2 diabetic patients treated with rosiglitazone or pioglitazone as their only TZD. We analyzed survey, medical record, administrative, and National Death Index (NDI) data from 1999 through 2003 from Translating Research Into Action for Diabetes (TRIAD), a prospective observational study of diabetes care in managed care. Medications, CV procedures, and CVD were determined from health plan (HP) administrative data, and mortality was from NDI. Adjusted hazard rates (AHR) were derived from Cox proportional hazard models adjusted for age, sex, race/ethnicity, income, history of diabetic nephropathy, history of CVD, insulin use, and HP. Across TRIAD's 10 HPs, 1,815 patients (24%) filled prescriptions for a TZD, 773 (10%) for only rosiglitazone, 711 (10%) for only pioglitazone, and 331 (4%) for multiple TZDs. In the seven HPs using both TZDs, 1,159 patients (33%) filled a prescription for a TZD, 564 (16%) for only rosiglitazone, 334 (10%) for only pioglitazone, and 261 (7%) for multiple TZDs. For all CV events, CV, and all-cause mortality, we found no significant difference between rosiglitazone and pioglitazone. In this relatively small, prospective, observational study, we found no statistically significant differences in CV outcomes for rosiglitazone- compared to pioglitazone-treated patients. There does not appear to be a pattern of clinically meaningful differences in CV outcomes for rosiglitazone- versus pioglitazone-treated patients.

Urinary Adiponectin Excretion

OBJECTIVEMarkers reliably identifying vascular damage and risk in diabetic patients are rare, and reports on associations of serum adiponectin with macrovascular disease have been inconsistent. In contrast to existing data on serum adiponectin, this study assesses whether urinary adiponectin excretion might represent a more consistent vascular damage marker in type 2 diabetes.RESEARCH DESIGN AND METHODSAdiponectin distribution in human kidney biopsies was assessed by immunohistochemistry, and urinary adiponectin isoforms were characterized by Western blot analysis. Total urinary adiponectin excretion rate was measured in 156 patients with type 2 diabetes who had a history of diabetic nephropathy and 40 healthy control subjects using enzyme-linked immunosorbent assay. Atherosclerotic burden was assessed by common carotid artery intima-media-thickness (IMT).RESULTSA homogenous staining of adiponectin was found on the endothelial surface of glomerular capillaries and intrarenal arterioles in nondiabetic kidneys, whereas staining was decreased in diabetic nephropathy. Low-molecular adiponectin isoforms (∼30–70 kDa) were detected in urine by Western blot analysis. Urinary adiponectin was significantly increased in type 2 diabetes (7.68 ± 14.26 vs. control subjects: 2.91 ± 3.85 μg/g creatinine, P = 0.008). Among type 2 diabetic patients, adiponectinuria was associated with IMT (r = 0.479, P < 0.001) and proved to be a powerful independent predictor of IMT (β = 0.360, P < 0.001) in multivariable regression analyses. In a risk prediction model including variables of the UK Prospective Diabetes Study coronary heart disease risk engine urinary adiponectin, but not the albumin excretion rate, added significant value for the prediction of increased IMT (P = 0.007).CONCLUSIONSQuantification of urinary adiponectin excretion appears to be an independent indicator of vascular damage potentially identifying an increased risk for vascular events.

Lipoprotein (a) as a determinant of arterial stiffness in elderly patients with type 2 diabetes mellitus

Background Lipoprotein (a) [Lp(a)] is known to be a risk factor for atherosclerotic disease. However, the relationship between Lp(a) and arterial stiffness has not been clarified. We investigated whether atherosclerotic risk factors, including serum Lp(a), are associated with aortic stiffness in elderly patients with type 2 diabetes mellitus. Methods Aortic stiffness, evaluated by using aortic pulse wave velocity, and major atherosclerotic risk factors were measured in elderly (≥ 65 years) patients with type 2 diabetes mellitus. Relationships between aortic pulse wave velocity, Lp(a) and other atherosclerotic risk factors were analyzed. Results Among the atherosclerotic risk factors measured, age, pulse pressure, hemoglobin A1c (HbA1c), uric acid, fibrinogen, sialic acid and Lp(a) showed significant positive correlations with aortic pulse wave velocity. Lp(a) also showed significant positive correlations with pulse pressure, fibrinogen, sialic acid, apolipoprotein B and apolipoprotein B/apolipoprotein A-I ratio. The correlation between Lp(a) and aortic pulse wave velocity was independent of age, sex, blood hemoglobin A1c, uric acid and fibrinogen, history of diabetic nephropathy and therapy with lipid-lowering drugs. Apolipoprotein A-II showed a significant negative correlation with both aortic pulse wave velocity and Lp(a). The median level of Lp(a) in the highest tertile group of subjects divided by aortic pulse wave velocity was significantly higher than the median Lp(a) level in the lowest tertile. The middle and highest tertile groups of subjects divided by aortic pulse wave velocity showed significantly high odds ratios of high Lp(a) levels (≥ 30 mg/dl) vs the lowest tertile. Conclusions Lp(a) is an independent determinant of aortic stiffness in elderly patients with type 2 diabetes mellitus.