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Excess body weight, duration of insulin and antihypertensive therapy slow down the rate of progression of chronic kidney disease in type 2 diabetes

https://doi.org/10.31146/1682-8658-ecg-222-2-22-30

Abstract

Objective: to study and clinically substantiate the relationship between overweight and the dynamics of CKD progression in patients with type 2 diabetes of different age groups using the diagnostic parameter Index of glomerular filtration rate reduction. Material and methods: a single-stage cross-sectional observational study of clinical indicators in a population sample of patients with type 2 diabetes of different age groups was performed, patterns of relationships, significance of differences in mean values and measures of influence (OR (95%CI)) were studied between the indicators of BMI, the stage of obesity and the presence of a diagnosis of obesity in the anamnesis and the original calculated diagnostic parameter, the Index of glomerular filtration rate reduction (RI_GFR), which allows to give an objective quantitative characteristic of the rate of progression of CKD. Results: significant correlations were established between RI_GFR and indicators of age, BMI, DM experience and duration of insulin therapy, a significant inverse relationship with BMI was noted only in the older group; when analyzing differences in the average values of clinical indicators in the groups of rapid and slow progression of CKD, divided by the threshold value of RI_GFR, significant factors affecting the rate of progression were determined CKD: DM experience, duration of insulin therapy, BMI; the logistic regression analysis determined the measure of the influence of the above factors on the dynamics of GFR reduction, confirmed its significance; when analyzing the factors of drug treatment in the elderly group, it was revealed that an integrated approach to the appointment of antihypertensive therapy (prescribing drugs of three or more groups) significantly reduces the risk of rapid progression of CKD. Conclusions: the most significant risk factors for the high rate of progression of CKD in patients with type 2 diabetes and overweight in the general sample and in patients of the older age group are the length of diabetes and duration of insulin therapy; the dynamics of GFR reduction in patients with type 2 diabetes of different age groups is interrelated with BMI, and in patients with overweight CKD progresses more slowly; an integrated approach to prescribing antihypertensive therapy (prescribing drugs of three or more groups) in elderly patients with type 2 diabetes significantly reduces the risk of rapid progression of CKD.

About the Authors

N. A. Pervyshin
Samara State Medical University
Russian Federation


S. V. Bulgakova
Samara State Medical University
Russian Federation


V. N. Vasilkova
Educational Institution “Gomel State Medical University”
Russian Federation


L. A. Sharonova
Samara State Medical University
Russian Federation


R. A. Galkin
Samara State Medical University
Russian Federation


E. A. Lebedeva
Samara State Medical University
Russian Federation


References

1. Denic A., Glassock R. J., Rule A. D. Structural and Functional Changes With the Aging Kidney. Adv Chronic Kidney Dis. 2016 Jan;23(1):19-28. doi: 10.1053/j.ackd.2015.08.004.

2. Levey A. S., Coresh J. Chronic kidney disease. Lancet. 2012 Jan 14;379(9811):165-80. doi: 10.1016/S0140-6736(11)60178-5.

3. Redon J., Lurbe E. The kidney in obesity. Curr Hypertens Rep. 2015 Jun;17(6):555. doi: 10.1007/s11906-015-0555-z.

4. Guan Z., Makled M. N., Inscho E. W. Purinoceptors, renal microvascular function and hypertension. Physiol Res. 2020 Jul 16;69(3):353-369. doi: 10.33549/physiolres.934463.

5. Oshima M., Shimizu M., Yamanouchi M., Toyama T., Hara A., Furuichi K., Wada T. Trajectories of kidney function in diabetes: a clinicopathological update. Nat Rev Nephrol. 2021 Nov;17(11):740-750. doi: 10.1038/s41581-021-00462-y.

6. Ejerblad E., Fored C. M., Lindblad P., Fryzek J., McLaughlin J. K., Nyrén O. Obesity and risk for chronic renal failure. J Am Soc Nephrol. 2006 Jun;17(6):1695-702. doi: 10.1681/ASN.2005060638.

7. Hsu C. Y., McCulloch C. E., Iribarren C., Darbinian J., Go A. S. Body mass index and risk for end-stage renal disease. Ann Intern Med. 2006 Jan 3;144(1):21-8. doi: 10.7326/0003-4819-144-1-200601030-00006.

8. Kwakernaak A. J., Zelle D. M., Bakker S. J., Navis G. Central body fat distribution associates with unfavorable renal hemodynamics independent of body mass index. J Am Soc Nephrol. 2013 May;24(6):987-94. doi: 10.1681/ASN.2012050460.

9. Wickman C., Kramer H. Obesity and kidney disease: potential mechanisms. Semin Nephrol. 2013 Jan;33(1):14-22. doi: 10.1016/j.semnephrol.2012.12.006.

10. Park J., Ahmadi S. F., Streja E. et al. Obesity paradox in end-stage kidney disease patients. Prog Cardiovasc Dis. 2014 Jan-Feb;56(4):415-25. doi: 10.1016/j.pcad.2013.10.005.

11. Feldman A. M., Combes A., Wagner D. et al. The role of tumor necrosis factor in the pathophysiology of heart failure. J Am Coll Cardiol. 2000 Mar 1;35(3):537-44. doi: 10.1016/s0735-1097(99)00600-2.

12. Rauchhaus M., Coats A. J., Anker S. D. The endotoxin-lipoprotein hypothesis. Lancet. 2000 Sep 9;356(9233):930-3. doi: 10.1016/S0140-6736(00)02690-8.

13. Stenvinkel P., Zoccali C., Ikizler T. A. Obesity in CKD - what should nephrologists know? J Am Soc Nephrol. 2013 Nov;24(11):1727-36. doi: 10.1681/ASN.2013040330.

14. Muntner P., Bowling C. B., Gao L. et al. Age-specific association of reduced estimated glomerular filtration rate and albuminuria with all-cause mortality. Clin J Am Soc Nephrol. 2011 Sep;6(9):2200-7. doi: 10.2215/CJN.02030311.

15. Pervyshin NA, Zelenko LS, Galkin RA, Spivakov DA. Certificate of state registration of computer programs No. 2018619024 dated July 27, 2018. [Automated workplace of an endocrinologist for the admission of patients with diabetes mellitus (ARME SD)]. Accessed June 7, 2023. (in Russ.)@@ Первышин Н. А., Зеленко Л. С., Галкин Р. А., Спиваков Д. А. Свидетельство о государственной регистрации программ для ЭВМ № 2018619024 от 27 июля 2018 г. Автоматизированное рабочее место врача-эндокринолога для приема пациентов с сахарным диабетом (АРМЭ СД). Ссылка активна на 07.06.2023.

16. Pervyshin N. A., Galkin R. A. Formalized protocol of outpatient admission of patients with diabetes mellitus by an endocrinologist. Preventive medicine. 2018;6(21):87-92. (In Russ.) doi: 10.17116/profmed20182106187.@@ Первышин Н. А., Галкин Р. А. Формализованный протокол амбулаторного приема пациентов с сахарным диабетом врачом-эндокринологом. Профилактическая медицина. 2018;6(21):87-92. doi: 10.17116/profmed20182106187.

17. Pervyshin N. A. A diagnostic criterion for the dynamics of chronic kidney disease in patients with diabetes. Aspirantskiy Vestnik Povolzhiya. 2023;23(1):65-72. (in Russ.) doi: 10.55531/2072-2354.2023.23.1.65-72.@@ Первышин Н. А. Диагностический критерий динамики прогрессирования хронической болезни почек при сахарном диабете // Аспирантский вестник Поволжья. - 2023. - Т. 23. - № 1. - C. 65-72. doi: 10.55531/2072-2354.2023.23.1.65-72.

18. Dedov I. I., Shestakova M. V., Galstyan G. R. The prevalence of type 2 diabetes mellitus in the adult population of Russia (NATION study). Diabetes Mellitus. 2016;19(2):104-112. (in Russ.) doi: 10.14341/DM2004116-17.@@ Дедов И. И., Шестакова М. В., Галстян Г. Р. Распространенность сахарного диабета 2 типа у взрослого населения России (исследование NATION). Сахарный диабет. - 2016. - Т. 19. - № 2. - С. 104-112. doi: 10.14341/DM2004116-17

19. Lu J. L., Kalantar-Zadeh K., Ma J. Z. et al. Association of body mass index with outcomes in patients with CKD. J Am Soc Nephrol. 2014 Sep;25(9):2088-96. doi: 10.1681/ASN.2013070754.

20. Kovesdy C. P., Furth S. L., Zoccali C.; World Kidney Day Steering Committee. Obesity and kidney disease: hidden consequences of the epidemic. Future Sci OA. 2017 Feb 6;3(3): FSO159. doi: 10.4155/fsoa-2016-0081.

21. Bashkinov R. A., Batluk T. I., Melnikov E. S., Trubnikova M. A., Arutyunov A. G. In uence of metabolic disorders on the development of renal pathology. South Russian Journal of Therapeutic Practice. 2022;3(2):7-18. (In Russ.) doi: 10.21886/2712-8156-2022-3-2-7-18.@@ Башкинов Р. А., Батлук Т. И., Мельников Е. С., Трубникова М. А., Арутюнов А. Г. Влияние метаболических нарушений на формирование патологии почек. Южно-Российский журнал терапевтической практики. 2022;3(2):7-18. doi: 10.21886/2712-8156-2022-3-2-7-18.

22. Panwar B., Hanks L. J., Tanner R. M., Muntner P., Kramer H., McClellan W. M. et al. Obesity, metabolic health, and the risk of end-stage renal disease. Kidney Int. 2015;87(6):1216-22. doi: 10.1038/ki.2014.384

23. Herrington W. G., Smith M., Bankhead C., Matsushita K., Stevens S., Holt T. et al. Body-mass index and risk of advanced chronic kidney disease: Prospective analyses from a primary care cohort of 1.4 million adults in England. PLoS One. 2017;12(3): e0173515. doi: 10.1371/journal.pone.0173515.

24. Kovesdy C. P., Furth S. L., Zoccali C.; World Kidney Day Steering Committee. Obesity and kidney disease: hidden consequences of the epidemic. Future Sci OA. 2017 Feb 6;3(3): FSO159. doi: 10.4155/fsoa-2016-0081.


Review

For citations:


Pervyshin N.A., Bulgakova S.V., Vasilkova V.N., Sharonova L.A., Galkin R.A., Lebedeva E.A. Excess body weight, duration of insulin and antihypertensive therapy slow down the rate of progression of chronic kidney disease in type 2 diabetes. Experimental and Clinical Gastroenterology. 2024;(2):22-30. (In Russ.) https://doi.org/10.31146/1682-8658-ecg-222-2-22-30

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