Prevention Of Kidney Disease Research Articles

Combination of canagliflozin and puerarin alleviates the lipotoxicity to diabetic kidney in mice

Diabetic kidney disease is one of the most serious complications of diabetes. Although diabetic kidney disease can be effectively controlled through strict blood glucose management and corresponding symptomatic treatment, these therapies cannot reduce its incidence in diabetic patients. The sodium-glucose cotransporter 2 (SGLT2) inhibitors and the traditional Chinese herb "Gegen" have been widely used in diabetes-related therapy. However, it remains unclear whether the combined use of these two kinds of medicines contributes to an increased curative effect on diabetic kidney disease. In this study, we examined this issue by evaluating the efficacy of the combination of puerarin, an active ingredient of Gegen, and canagliflozin, an SGLT2 inhibitor for a 12-week intervention using a mouse model of diabetes. The results indicated that the combination of puerarin and canagliflozin was superior to canagliflozin alone in improving the metabolic and renal function parameters of diabetic mice. Our findings suggested that the renoprotective effect of combined puerarin and canagliflozin in diabetic mice was achieved by reducing renal lipid accumulation. This study provides a new strategy for the clinical prevention and treatment of diabetic kidney disease. The puerarin and SGLT2 inhibitor combination therapy at the initial stage of diabetes may effectively delay the occurrence of diabetic kidney injury, and significantly alleviate the burden of renal lipotoxicity.

Epidemiological research progress in the effects of metal exposure on kidney.

Chronic kidney disease (CKD) is suffered progressive loss of kidney function lasting more than 3 months and is classified according to the degree of kidney damage (level of proteinuria) and the decreased glomerular filtration rate (GFR). The most severe form of CKD is end-stage renal disease. The prevalence of CKD is high with fast growth rate and the disease burden has become increasingly serious. CKD has become an important public health problem threatening human health. The etiology of CKD is complex. In addition to genetic factors, environmental factors are an important cause of CKD. With the development of industrialization, environmental metal pollution has become increasingly severe, and its impact on human health has received widespread attention. A large number of studies have shown that metals such as lead, cadmium, and arsenic can accumulate in the kidney, which can cause damage to the structure and function of the kidney, and play an important role in the development of CKD. Therefore, summarizing the epidemiological research progress in the relationship between arsenic, cadmium, lead, and other metal exposures and kidney diseases can provide new ideas for the prevention and control of kidney diseases caused by metal exposure.

The Pillars for Renal Disease Treatment in Patients with Type 2 Diabetes.

The diabetes epidemic and the increasing number of patients with diabetic chronic vascular complications poses a significant challenge to health care providers. Diabetic kidney disease is a serious diabetes-mediated chronic vascular complication and represents a significant burden for both patients and society in general. Diabetic kidney disease not only represents the major cause of end stage renal disease but is also paralleled by an increase in cardiovascular morbidity and mortality. Any interventions to delay the development and progression of diabetic kidney disease are important to reduce the associated cardiovascular burden. In this review we will discuss five therapeutic tools for the prevention and treatment of diabetic kidney disease: drugs inhibiting the renin-angiotensin-aldosterone system, statins, the more recently recognized sodium-glucose co-transporter-2 inhibitors, glucagon-like peptide 1 agonists, and a novel non-steroidal selective mineralocorticoid receptor antagonist.

Management of traditional risk factors for the development and progression of chronic kidney disease.

Chronic kidney disease (CKD) and its downstream complications (i.e. cardiovascular) are a major source of morbidity worldwide. Additionally, deaths due to CKD or CKD-attributable cardiovascular disease account for a sizeable proportion of global mortality. However, the advent of new pharmacotherapies, diagnostic tools, and global initiatives are directing greater attention to kidney health in the public health agenda, including the implementation of effective strategies that (i) prevent kidney disease, (ii) provide early CKD detection, and (iii) ameliorate CKD progression and its related complications. In this Review, we discuss major risk factors for incident CKD and CKD progression categorized across cardiovascular (i.e. hypertension, dyslipidemia, cardiorenal syndrome), endocrine (i.e. diabetes mellitus, hypothyroidism, testosterone), lifestyle (i.e. obesity, dietary factors, smoking), and genetic/environmental (i.e. CKDu/Mesoamerican nephropathy, APOL1, herbal nephropathy) domains, as well as scope, mechanistic underpinnings, and management.

Prevention and Screening for Cardiometabolic Disease Following Hypertensive Disorders in Pregnancy in Low-Resource Settings: A Systematic Review and Delphi Study.

Hypertensive disorders in pregnancy (HDP) and cardiometabolic and kidney diseases are rising in low- and middle-income countries (LMICs). While HDP are risk factors for cardiometabolic and kidney diseases, cost-effective, scalable strategies for screening and prevention in women with a history of HDP are lacking. Existing guidelines and recommendations require adaptation to LMIC settings. This article aims to generate consensus-based recommendations for the prevention and screening of cardiometabolic and kidney diseases tailored for implementation in LMICs. We conducted a systematic review of guidelines and recommendations for prevention and screening strategies for cardiometabolic and chronic kidney diseases following HDP. We searched PubMed/Medline, Embase and Cochrane Library for relevant articles and guidelines published from 2010 to 2021 from both high-income countries (HICs) and LMICs. No other filters were applied. References of included articles were also assessed for eligibility. Findings were synthesized narratively. The summary of guiding recommendations was subjected to two rounds of Delphi consensus surveys with experts experienced in LMIC settings. Fifty-four articles and 9 guidelines were identified, of which 25 were included. Thirty-five clinical recommendations were synthesized from these and classified into six domains: identification of women with HDP (4 recommendations), timing of first counseling and provision of health education (2 recommendations), structure and care setting (12 recommendations), information and communication needs (5 recommendations), cardiometabolic biomarkers (8 recommendations) and biomarkers thresholds (4 recommendations). The Delphi panel reached consensus on 33 final recommendations. These recommendations for health workers in LMICs provide practical and scalable approaches for effective screening and prevention of cardiometabolic disease following HDP. Monitoring and evaluation of implementation of these recommendations provide opportunities for reducing the escalating burden of noncommunicable diseases in LMICs.

MANAGING A PATIENT WITH RENAL OSTEODYSTROPHY AND MULTIPLE FRACTURES: A MULTIDISCIPLINARY APPROACH

Renal Osteodystrophy is a type of metabolic bone disease characterized by bone mineralization deficiency due to electrolyte and endocrine abnormalities. Patients with chronic kidney disease (CKD) are more likely to experience falls and fractures due to renal osteodystrophy and the high prevalence of risk factors for falls. Treatment involves medical management to resolve the etiology of the underlying renal condition, as well as management (and prevention) of pathological fractures.A 66-year-old female patient, with severe osteoporosis and chronic kidney disease undergoing haemodialysis, has presented with multiple fractures along the years. She was submitted to bilateral proximal femoral nailing as fracture treatment on the left and prophylactically due to pathological bone injury on the right, followed by revision of the left nail with a longer one after varus angulation and fracture distal to the nail extremity. Meanwhile, the patient suffered a pathological fracture of the radial and cubital diaphysis and was submitted to conservative treatment with cast, with consolidation of the fracture. Posteriorly, she re-fractured these bones after a fall and repeated the conservative treatment.Clinical management: There is a multidisciplinary approach to manage the chronic illness of the patient, including medical management to resolve the etiology and consequences of her chronic kidney disease, pain control, conservative or surgical fracture management and prevention of falls.The incidence of chronic renal disease is increasing and the patients with this condition live longer than previously and are more physically active. Thus, patients may experience trauma as a direct result of increased physical activity in a setting of weakened pathologic bone. Their quality of life is primarily limited by musculoskeletal problems, such as bone pain, muscle weakness, growth retardation, and skeletal deformity. A multidisciplinary approach is required to treat these patients, controlling their chronic diseases, managing fractures and preventing falls.

The Importance of Lifestyle Interventions in the Prevention and Treatment of Chronic Kidney Disease

Chronic kidney disease (CKD) is a global health problem, with a prevalence of approximately 13 [...]

199 A Statewide Approach to Chronic Kidney Disease Prevention and Management

199 A Statewide Approach to Chronic Kidney Disease Prevention and Management

Ginsenoside Rg3 has effects comparable to those of ginsenoside re on diabetic kidney disease prevention in db/db mice by regulating inflammation, fibrosis and PPARγ.

Ginsenoside Rg3 (Rg3) is an adjuvant antitumor drug, while ginsenoside Re (Re) is an adjuvant antidiabetic drug. Our previous studies demonstrated that Rg3 and Re both have hepatoprotective effects in db/db mice. The present study aimed to observe the renoprotective effects of Rg3 on db/db mice, with Re as the control. The db/db mice were randomly assigned to receive daily oral treatment with Rg3, Re or vehicle for 8weeks. Body weight and blood glucose were examined weekly. Blood lipids, creatinine, and BUN were examined by biochemical assay. Hematoxylin and eosin and Masson staining were used for pathological examination. The expression of peroxisome proliferator‑activated receptor gamma (PPARγ) and inflammation and fibrosis biomarkers was examined by immunohistochemical and reverse transcription‑quantitative PCR. Although neither had a significant effect on body weight, blood glucose or lipids, Rg3 and Re were both able to decrease the creatinine and blood urea nitrogen levels of db/db mice to levels similar to those of wild type mice and inhibit pathological changes. The expression of PPARγ was upregulated and biomarkers of inflammation and fibrosis were downregulated by Rg3 and Re. The results showed that the potential of Rg3 as a preventive treatment of diabetic kidney disease was similar to that of Re.

Mediterranean Dietary Pattern Adjusted for CKD Patients: The MedRen Diet.

A number of studies in the general population showed that healthy dietary patterns, such as the Mediterranean Diet, can improve or prevent the development of several chronic diseases and are associated with a significant reduction in all-cause and cardiovascular mortality. The Mediterranean diet may also have favorable effects for the prevention of chronic kidney disease (CKD), but no evidence of renoprotection exists in CKD patients. The Mediterranean Renal (MedRen) diet is an adaptation of the Mediterranean diet recommendations comprising a quantitative reduction in the RDA values of protein, salt and phosphate intake for the general population. Hence, MedRen supplies 0.8 g/Kg of protein, 6 g of salt and less than 800 mg of phosphate daily. Obviously, there is a preference for products of plant origin, which contain more alkali, fibers, unsaturated fatty acids than animal-based food. The MedRen diet can be implemented easily in mild-to-moderate stages of CKD with good results, both in terms of adherence to prescriptions and metabolic compensation. In our opinion, it should be the first step of CKD stage 3 nutritional management. This paper describes the features and reports our experience in the implementation of the MedRen diet as an early nutritional approach to CKD.

Interventions for preventing and treating kidney disease in IgA vasculitis.

Interventions for preventing and treating kidney disease in IgA vasculitis.

FACTORS AFFECTING THE QUALITY OF LIFE OF PATIENTS’ USING HEMODIALYSIS AT TGK CHIK DITIRO HOSPITAL, SIGLI

Background: Chronic Kidney Disease (CKD) is a condition of progressive and permanent decline of kidney function resulting in various diseases. CKD patients may be at risk of their lives if they do not undergo periodic hemodialysis or kidney transplantation to replace severely damaged kidneys. The aim of this study is to analyze the Factors Influencing the Quality of Life of Patients Using Hemodialysis Therapy at Tgk Chik Ditiro Sigli Hospital in 2020. Method: This research is descriptive with a cross-sectional approach using a questionnaire as the data collection instrument. The study population consists of all patients undergoing Hemodialysis at Tgk Chik Ditiro Sigli Hospital in 2020. The sample consisted of 60 patients using total sampling technique. Data collection was conducted in November 2020. The quality of life assessment questionnaire used was the WHOQOL-BREF. Results: There is a relationship between self-efficacy (p value 0.040), motivation (p value 0.001), family support (p value 0.006), anxiety (p value 0.000) and the quality of life of hemodialysis patients. Recommendations: Pidie District Government may facilitate improvement of self-efficacy. self-motivation. and reduce the level of anxiety among patients. The Pidie District Health Office may implement socialization regarding kidney disease prevention efforts. Tgk Chik Ditiro Sigli Hospital may to provide excellent care in improving the quality of life of patients using hemodialysis therapy.

Plasma Galectin-3 Biomarkers in Chronic Kidney Disease

Assessment of renal function is based on determination of serum creatinine and creatinine-based equations to assess GFR. However, this marker is not perfect or accurate, especially for longitudinal monitoring of kidney function in Chronic Kidney Disease (CKD patients). Decreased kidney function can be slowed or even anticipated with early detection, so as to avoid secondary complications. So it is important to find new biomarkers that can identify individuals at risk as early as possible. Plasma galectin-3 is a ?-galactoside-binding lectin expressed in monocytes, which plays an important role in inflammation, immunity, cancer, and is involved in the pathogenesis of atherosclerosis, diabetes, renal fibrosis and asthma. Higher galectin-3 levels were associated with reduced eGFR in a cross-sectional study. Galectin-3 is essential in various biological activities including cell growth, cell proliferation, differentiation, apoptosis, pre-mRNA splicing, transformation, angiogenesis, inflammation, fibrosis, fibrogenesis and host defense. Galectin-3 is a stable biomarker and is not associated with age, body mass index or sex. Galectin-3 is also useful for detecting the early stages of some diseases. Galectin-3 shows no circadian variation and increases slightly after exercise, returning to normal levels after 1-3 hours. Higher concentrations of galectin-3 may be associated with CKD development, indicating the potential for new mechanisms related to galectin-3 expression that may contribute to CKD development. Galectin-3 has also been reported to play an important role in renal interstitial fibrosis. Thus, galectin-3 inhibition may be a promising therapeutic strategy to prevent kidney disease progression.

β-Cryptoxanthin Maintains Mitochondrial Function by Promoting NRF2 Nuclear Translocation to Inhibit Oxidative Stress-Induced Senescence in HK-2 Cells.

The mechanisms of acute kidney injury and chronic kidney disease remain incompletely revealed, and drug development is a pressing clinical challenge. Oxidative stress-induced cellular senescence and mitochondrial damage are important biological events in a variety of kidney diseases. As a type of carotenoid, β-Cryptoxanthin (BCX) has various biological functions, which means it is a potential therapeutic candidate for the treatment of kidney disease. However, the role of BCX in the kidney is unclear, and the effect of BCX on oxidative stress and cellular senescence in renal cells is also unknown. Therefore, we conducted a series of studies on human renal tubular epithelial (HK-2) cells in vitro. In the present study, we investigated the effect of BCX pretreatment on H2O2-induced oxidative stress and cellular senescence and explored the potential mechanism of BCX action. The results showed that BCX attenuated H2O2-induced oxidative stress and cellular senescence in HK-2 cells. Moreover, BCX promoted NRF2 nuclear expression, maintained mitochondrial function, and reduced mitochondrial damage in HK-2 cells. In addition, silencing NRF2 altered the protective effect of BCX on mitochondria and significantly reversed the anti-oxidative stress and anti-senescence effects of BCX in HK-2 cells. We concluded that BCX maintained mitochondrial function by promoting NRF2 nuclear translocation to inhibit oxidative stress-induced senescence in HK-2 cells. In light of these findings, the application of BCX might be a promising strategy for the prevention and treatment of kidney diseases.

Treatment and prevention of chronic kidney disease

Treatment and prevention of chronic kidney disease

Kidney dysfunction: prevalence and associated risk factors in a community-based study from the North West Province of South Africa

BackgroundGlobally, the World Health Organization ranks chronic kidney disease (CKD) as one of the top 10 causes of mortality. In South Africa, where noncommunicable diseases have become leading causes of mortality, the true population prevalence of CKD is unknown and associated risk factors remain understudied. This study aimed to describe the prevalence of kidney dysfunction and associated risk factors in a community from the North West province of South Africa.MethodsThis cross-sectional study included 1999 participants older than 30 years. Kidney dysfunction was defined as (i) estimated glomerular filtration rate (eGFR) < 90 ml/min/1.73m2, or (ii) urine albuminuria-to-creatinine ratio (uACR) ≥ 3.0 mg/mmol, or a combination (i and ii). Risk factors included age, sex, urban/rural locality, body mass index (BMI), blood pressure (BP), lipid profile, haemoglobin A1c (HbA1C), C-reactive protein (CRP), gamma-glutamyl transferase (GGT), tobacco use, and HIV status.ResultsMean age of participants was 48 (42;56) years, and 655/1999 (33%) had eGFR < 90 ml/min/1.73m2 and/or uACR ≥ 3.0 mg/mmol. Compared to those with normal kidney function, participants with eGFR < 90 ml/min/1.73m2 and/or uACR ≥ 3.0 mg/mmol were older, female, had higher measures of adiposity, systolic, diastolic, and mean arterial blood pressure, serum lipids and C-reactive protein (CRP) (all p ≤ 0.024). In multiple regression analyses eGFR was associated with systolic BP (β = 0.11) and HIV infection (β = -0.09), and albuminuria was associated with elevated CRP (β = 0.12) and HIV infection (β = 0.11) (all p < 0.026). In both groups (individuals with and without kidney dysfunction respectively), eGFR was associated with age (β = -0.29, β = -0.49), male sex (β = 0.35, β = 0.28), BMI (β = -0.12, β = -0.09), low-density/high-density lipoprotein cholesterol ratio (β = -0.17, β = -0.09) and CRP (β = 0.10, β = 0.09) (all p < 0.005); and uACR was associated with female sex (β = 0.10, β = -0.14), urban locality (β = -0.11, β = -0.08), BMI (β = -0.11, β-0.11), and systolic BP (β = 0.27, β = 0.14) (all p < 0.017).ConclusionIn this study from the North West province, South Africa, eGFR < 90 ml/min/1.73m2 and/or uACR ≥ 3.0 mg/mmol was prevalent and associated with modifiable risk factors. The findings may inform screening strategies for kidney disease prevention, focusing on women, obesity, blood pressure control, dyslipidaemia, identifying and treating inflammation, and HIV diagnosis and treatment.

Risk of kidney disease following a pregnancy complicated by diabetes: a longitudinal, population-based data-linkage study among Aboriginal women in the Northern Territory, Australia

Aims/hypothesisThe aim of this work was to investigate the risk of developing chronic kidney disease (CKD) or end-stage kidney disease (ESKD) following a pregnancy complicated by gestational diabetes mellitus (GDM) or pre-existing diabetes among Aboriginal women in the Northern Territory (NT), Australia.MethodsWe undertook a longitudinal study of linked healthcare datasets. All Aboriginal women who gave birth between 2000 and 2016 were eligible for inclusion. Diabetes status in the index pregnancy was as recorded in the NT Perinatal Data Collection. Outcomes included any stage of CKD and ESKD as defined by ICD-10 coding in the NT Hospital Inpatient Activity dataset between 2000 and 2018. Risk was compared using Cox proportional hazards regression.ResultsAmong 10,508 Aboriginal women, the mean age was 23.1 (SD 6.1) years; 731 (7.0%) had GDM and 239 (2.3%) had pre-existing diabetes in pregnancy. Median follow-up was 12.1 years. Compared with women with no diabetes during pregnancy, women with GDM had increased risk of CKD (9.2% vs 2.2%, adjusted HR 5.2 [95% CI 3.9, 7.1]) and ESKD (2.4% vs 0.4%, adjusted HR 10.8 [95% CI 5.6, 20.8]). Among women with pre-existing diabetes in pregnancy, 29.1% developed CKD (adjusted HR 10.9 [95% CI 7.7, 15.4]) and 9.9% developed ESKD (adjusted HR 28.0 [95% CI 13.4, 58.6]).Conclusions/interpretationAboriginal women in the NT with GDM or pre-existing diabetes during pregnancy are at high risk of developing CKD and ESKD. Pregnancy presents an important opportunity to identify kidney disease risk. Strategies to prevent kidney disease and address the social determinants of health are needed.Graphical abstract

Natural products from plants and microorganisms: Novel therapeutics for chronic kidney disease via gut microbiota regulation.

Dysbiosis of gut microbiota plays a fundamental role in the pathogenesis and development of chronic kidney disease (CKD) and its complications. Natural products from plants and microorganisms can achieve recognizable improvement in renal function and serve as an alternative treatment for chronic kidney disease patients with a long history, yet less is known on its beneficial effects on kidney injury by targeting the intestinal microbiota. In this review, we summarize studies on the effects of natural products from plants and microorganisms, including herbal medicines and their bioactive extracts, polysaccharides from plants and microorganisms, and phytochemicals, on the prevention and treatment of chronic kidney disease through targeting gut microflora. We describe the strategies of these anti-CKD effects in animal experiments including remodulation of gut microbiota structure, reduction of uremic toxins, enhancement of short-chain fatty acid (SCFA) production, regulation of intestinal inflammatory signaling, and improvement in intestinal integrity. Meanwhile, the clinical trials of different natural products in chronic kidney disease clinical practice were also analyzed and discussed. These provide information to enable a better understanding of the renoprotective effects of these effective natural products from plants and microorganisms in the treatment of chronic kidney disease. Finally, we propose the steps to prove the causal role of the intestinal microflora in the treatment of chronic kidney disease by natural products from plants and microorganisms. We also assess the future perspective that natural active products from plants and microorganisms can beneficially delay the onset and progression of kidney disease by targeting the gut flora and highlight the remaining challenges in this area. With the continuous deepening of studies in recent years, it has been proved that gut microbiota is a potential target of natural active products derived from plants and microorganisms for chronic kidney disease treatment. Fully understanding the functions and mechanisms of gut microbiota in these natural active products from plants and microorganisms is conducive to their application as an alternative therapeutic in the treatment of chronic kidney disease.

Knowledge, Attitudes, and Practices of High-Risk Patients towards Prevention and Early Detection of Chronic Kidney Disease (CKD) in Saudi Arabia

Chronic kidney disease (CKD) is characterized by the presence of kidney damage or decreased kidney function. In the Kingdom of Saudi Arabia, the prevalence of CKD is at 5.7%, which represents a high burden on health care systems. This study aimed to assess the knowledge, attitudes, and practices of high-risk patients towards prevention and early detection of chronic kidney disease in Saudi Arabia. Descriptive cross-sectional study in Saudi Arabia. This study was designed using a newly developed instrument, the CKD Screening Index. It was conducted from December 2021 to May 2022 by a self-administered questionnaire. The questionnaire has three parts: socio-demographic data, clinical factors, and the CKD screening index tool. Independent t-test, One-Way ANOVA, LSD, Games-Howell tests. Knowledge of kidney function had a significant difference across patient groups with varying employment status. Monthly income is a significant factor for the patient attitude on healthcare towards preventing kidney disease. On the other hand, educational level significantly affects the overall attitude of patients towards preventing kidney disease. Understanding knowledge, attitudes, and practices associated with CKD is vital to informing optimal policy and public health responses in the country.

Investigating the knowledge, attitude, and practice of the people towards prevention and early detection of chronic kidney disease, and their association with demographic variables

Chronic kidney disease (CKD) is a worldwide public health problem related to adverse results of end-stage renal disease (ESRD), kidney failure, cardiovascular disease (CVD), and premature death. The study is aimed to investigate the knowledge, attitude, and practice toward the prevention and early detection of chronic kidney disease. Two ordinal variables and one nominal response variable with 20 predictor variables were independently fitted. Ordinal multicategories , such as proportional odds, continuation ratio, and partial proportional models for attitude and practice, whereas the baseline multicategory logit model for knowledge was fitted. The findings implied that some predictors have a significant effect on attitude, whereas other covariates have a significant effect on practice. Moreover, as there are two independent logit models for the nominal response, in the first logit model Monthly income and Diabetes2, whereas in the second logit model, Smo_R_CKD3 and Diabetes2 have a significant effect on knowledge. In conclusion, more educated ones have more knowledge and attitude toward the prevention and early detection of chronic kidney disease, also more likely to perform preventive and early detecting practices. People are inadequately informed on the prevention and early detection of CKD, especially those who are with low income, are at risk of developing CKD and its complications.