Prevalence and determinants of the metabolic syndrome among subjects with advanced nondiabetes-related chronic kidney disease in Gran Canaria, Spain.

BACKGROUND: The relationship between the metabolic syndrome and mild chronic kidney disease (CKD) has been extensively studied. This study was aimed to estimate the prevalence and factors associated with the metabolic syndrome among subjects with advanced stages of nondiabetes-related CKD. METHODS: Study population was composed of incident patients with advanced CKD not related to diabetes in a tertiary hospital from Gran Canaria (Spain) since February 2011 to December 2014. Participants fulfilled a survey questionnaire and underwent physical examination and biochemical evaluation. RESULTS: The sample was composed of 167 subjects (mean age 63.9 ± 13.7 years; estimated glomerular filtration rate 21.9 ± 6.6 mL/min/1.73 m(2)). The prevalence of the metabolic syndrome was 68.9% (65.2% in men and 73.3% in women). Highest rates were observed in groups with chronic interstitial nephropathy (80%), CKD of uncertain etiology (76.7%) and CKD related to vascular causes (76.2%). Subjects with metabolic syndrome were older, had higher values of C-reactive protein and more often reported to have first-degree relatives with diabetes and to be physically inactive. In multivariate analyses, age (OR: 1.034 [CI 95%: 1.004-1.065]; p = 0.024) and family history of diabetes (OR: 2.550 [1.159-5.608]; p = 0.020) were independently associated with the metabolic syndrome. CONCLUSIONS: The prevalence of the metabolic syndrome among subjects with advanced nondiabetes-related CKD is high, and greater than that observed in general Canarian population of similar age groups. Age and family history of diabetes are the two factors more strongly associated with the metabolic syndrome in this population.

The specific relationship between vitamin D deficiency and diabetic nephropathy among patients with advanced chronic kidney disease: a cross-sectional study in Gran Canaria, Spain.

AIMS: Vitamin D deficiency is highly prevalent in subjects with advanced chronic kidney disease (CKD), but diabetes, the most common cause of CKD, has also been linked to low levels of serum 25-hydroxyvitamin D [25(OH)D]. We compare vitamin D status between subjects with type 2 diabetes-related advanced CKD and subjects with either advanced CKD without diabetes or type 2 diabetes without advanced CKD. METHODS: Subjects were patients with advanced CKD (estimated glomerular filtration rate (eGFR) < 30 mL/min/1.73 m2) from February 2011 to November 2013 (113 with diabetes-related CKD and 80 without diabetes) and 61 patients with long-lasting type 2 diabetes without advanced CKD, simultaneously enrolled from our center. Participants fulfilled a survey questionnaire and underwent physical examination, blood samples, and 24-h urine collection. Kidney disease was assessed using eGFR and 24-h urinary protein excretion. Serum 25(OH)D was measured by chemiluminescence immunoassay. RESULTS: The prevalence of vitamin D deficiency (25(OH)D < 20 ng/mL) was 70.8% in subjects with diabetes-related CKD, 38.8% in subjects with non-diabetic CKD and 41% in subjects with diabetes without advanced CKD. Adjusted means (95% confidence interval (CI)) of 25(OH)D in participants with diabetes-related CKD, in nondiabetic participants with CKD, and in participants with diabetes without advanced CKD were, respectively, 17.5 (14.2 - 20.7), 23.6 (19.4 - 27.8), and 23.5 (16.8 - 30.3) ng/mL (p = 0.023). CONCLUSIONS: Low vitamin D status is characteristically associated with advanced diabetic nephropathy. This relationship is not entirely attributable to the individual effects of CKD or long-lasting diabetes.

Non-albuminuric renal disease among subjects with advanced stages of chronic kidney failure related to type 2 diabetes mellitus.

Urinary albumin excretion has been consistently found to be normal in a significant number of subjects with early stages of diabetic kidney disease. This study was aimed to estimate the prevalence and characteristics of non-albuminuric chronic kidney disease associated with type 2 diabetes mellitus among subjects who reach advanced stages of renal failure. Study population was composed of incident patients with advanced chronic kidney disease (glomerular filtration rate <30 mL/min) related to type 2 diabetes in a tertiary hospital from Gran Canaria (Spain) during a period of 2 years. Subjects were classified as normoalbuminuric (urinary albumin-to-creatine ratio [UACR] <30 mg/g), microalbuminuric (UACR ≥30 and <300 mg/g), or proteinuric (UACR ≥300 mg/g). Of 78 eligible patients, 21.8% had normoalbuminuria, 20.5% had microalbuminuria, and 57.7% had proteinuria. Individuals with normoalbuminuria were mostly women and had a lower prevalence of smoking and polyneuropathy than subjects with microalbuminuria or proteinuria. They also presented greater measures of body mass index and waist circumference, higher values of total and LDL cholesterol, and lower values of HbA1c and serum creatinine than subjects with microalbuminuria or proteinuria. Multivariate analysis demonstrated that female sex (positively) and HbA1c and polyneuropathy (negatively) were independently associated with absence of albuminuria. In conclusion, around 20% of subjects with diabetes-related advanced chronic kidney disease, characteristically women, have normal urinary albumin excretion. HbA1c and polyneuropathy are inversely related to this non-albuminuric form of nephropathy.

Association between polymorphism rs2032487 in the non-muscle myosin heavy chain IIA gene (MHY9) and chronic kidney disease secondary to type 2 diabetes mellitus in a population of the Canary Islands. / Asociación entre el polimorfismo rs2032487 del gen de la cadena pesada de la miosina no muscular tipo IIA (MHY9) y la enfermedad renal crónica secundaria a diabetes tipo 2 en población de las Islas Canarias.

INTRODUCTION: Certain polymorphisms in the non-muscle myosin IIA (MYH9) and apolipoprotein L1 (APOL1) genes have been associated to chronic kidney disease (CKD) in different populations. This study examined the association between the MHY9 rs2032487 and APOL1 rs73885319 polymorphisms and advanced CKD related to type 2 diabetes mellitus (T2DM) in a population of Gran Canaria (Canary Islands, Spain). PATIENTS AND METHODS: Polymorphisms were genotyped in 152 patients with advanced CKD (estimated glomerular filtration rate [eGFR]<30mL/min/1.73 m2) secondary to T2DM, 110 patients with T2DM onset ≥ 20 years before without advanced CKD (eGFR ≥ 45mL/min/1.73 m2 and no proteinuria), and 292 healthy blood donors over 50 years of age without CKD or diabetes. RESULTS: The frequency of the risk allele for rs2032487 was 10.7% in patients with diabetes and advanced CKD, 7.1% in those with diabetes but without advanced CKD, and 6.1% in healthy subjects, with significant differences between the first and third groups (P=.015). Among subjects with advanced CKD, 78.5% were homozygous for the protective allele, as compared to 87.9% in the other two groups (P=.015 and P=.016 respectively). The frequency of the risk allele for the rs73885319 polymorphism did not exceed 0.5% in any of the three groups. CONCLUSIONS: These data suggest that polymorphism rs2032487 is associated to advanced CKD related to T2DM in the population of Gran Canaria.

Relationship between Anemia and Serum Concentrations of Calcium and Phosphorus in Advanced Non-Dialysis-Dependent Chronic Kidney Disease.

BACKGROUND/AIMS: Different biochemical abnormalities of metabolic bone disease have been associated with anemia of chronic kidney disease (CKD), mainly in hemodialysis patients. However, all of these abnormalities are closely inter-related and their individual effect on the development of anemia is uncertain. This study was aimed to assess the relationship between anemia and a set of metabolic bone disease biomarkers in a cohort of adult patients with advanced non-dialysis-dependent CKD. METHODS: The sample consisted of 382 patients submitted to a Nephrology Unit for evaluation of advanced CKD in a tertiary hospital from Gran Canaria during 3 years. Associations between anemia and serum levels of calcium (albumin-corrected), phosphorus, PTH, 25-hydroxivitamin D (25(OH)D3) and alkaline phosphatase were analyzed by using logistic regression models with adjustment for other demographic, clinical and biochemical covariates potentially related to anemia and to bone mineral metabolism. RESULTS: Serum levels of calcium and 25(OH)D3 (negatively) and phosphorus (positively) were significantly associated with anemia in an unadjusted logistic regression model. In a fully adjusted multivariable model, the OR for anemia was 0.29 (95% CI 0.16-0.49; p < 0.0001) for every 1 mg/dl increase in serum calcium and 2.19 (95% CI 1.55-3.15; p < 0.001) for every 1 mg/dl increase in serum phosphorus. Female sex and lower serum albumin levels were also independently associated with anemia. The inclusion of albumin in the adjusted model displaced the significance of 25(OH)D3. CONCLUSIONS: Circulating levels of calcium and phosphorus are strongly linked to anemia in patients with advanced non-dialysis CKD.

Potential implications of the choice among three alternative treatment targets for apolipoprotein B100 in the management of patients with type 2 diabetes and chronic kidney disease.

This study analyses discordance rates between attainment of therapeutic goals for apolipoprotein B100 (apoB) and both low-density lipoprotein-cholesterol (LDL-C) and non-high-density lipoprotein-cholesterol (non-HDL-C) in a sample of 152 patients with type 2 diabetes and chronic kidney disease from Gran Canaria (Spain), using treatment targets recommended by the American Diabetes Association/American College of Cardiology (ADA/ACC), the European Society of Cardiology/European Atherosclerosis Society (ESC/EAS) and by a Spanish population-based study. Among subjects with LDL-C levels at therapeutic goal, apoB was above target in 16.3% (ADA/ACC), 6.5% (ESC/EAS) and 39.1% (population-based criteria), and among subjects with non-HDL-C levels at therapeutic goal, apoB was above target in 10.5% (ADA/ACC), 1.2% (ESC/EAS) and 29.6% (population-based criteria). These findings show that clinical management would be very differently altered depending on the criteria used to set treatment targets for apoB. Cut-off points derived from population data identify a greater number of subjects suitable for a more intensive lipid-lowering therapy.

Asociación entre el polimorfismo rs2032487 del gen de la cadena pesada de la miosina no muscular tipo IIA (MHY9) y la enfermedad renal crónica secundaria a diabetes tipo 2 en población de las Islas Canarias / Association between polymorphism rs2032487 in the non-muscle myosin heavy chain IIA gene (MHY9) and chronic kidney disease secondary to type 2 diabetes mellitus in a population of the Canary Islands

Introducción: Ciertos polimorfismos de los genes de la miosina no muscular de tipo IIA (MYH9) y de la apolipoproteína L1 (APOL1) se han asociado con la enfermedad renal crónica (ERC) en distintas poblaciones. Este estudio evaluó la asociación entre los polimorfismos rs2032487 de MYH9 y rs73885319 de APOL1 con la ERC avanzada asociada a diabetes tipo 2 en una población de Gran Canaria. Material y métodos: Los polimorfismos se genotiparon en 152 pacientes con ERC avanzada (filtrado glomerular estimado [FGe] < 30 ml/min/1,73 m2) secundaria a diabetes tipo 2, 110 pacientes con diabetes tipo 2 con evolución ≥ 20 años sin ERC avanzada (FGe ≥ 45 ml/min/1,73 m2 y ausencia de proteinuria) y 292 hemodonantes sanos de más de 50 años sin ERC ni diabetes. Resultados: La frecuencia del alelo de riesgo de rs2032487 fue de 10,7% entre pacientes con diabetes y ERC avanzada, 7,1% en aquellos con diabetes sin ERC avanzada y 6,1% en los sujetos sanos, alcanzándose diferencias significativas entre el primer y el tercer grupo (P = 0,015). El 78,5% de los sujetos con ERC avanzada eran homocigotos para el alelo protector, frente al 87,9% en los otros dos grupos (P = 0,015 y P = 0,016, respectivamente). La frecuencia del alelo de riesgo del polimorfismo rs73885319 no superó el 0,5% en ninguno de los tres grupos. Conclusiones: Estos datos sugieren que el polimorfismo rs2032487 se asocia con la ERC avanzada asociada a diabetes tipo 2 en la población de Gran Canaria

Introduction: Certain polymorphisms in the non-muscle myosin IIA (MYH9) and apolipoprotein L1 (APOL1) genes have been associated to chronic kidney disease (CKD) in different populations. This study examined the association between the MHY9 rs2032487 and APOL1 rs73885319 polymorphisms and advanced CKD related to type 2 diabetes mellitus (T2DM) in a population of Gran Canaria (Canary Islands, Spain). Patients and methods: Polymorphisms were genotyped in 152 patients with advanced CKD (estimated glomerular filtration rate [eGFR] < 30 mL/min/1.73 m2) secondary to T2DM, 110 patients with T2DM onset ≥ 20 years before without advanced CKD (eGFR ≥ 45 mL/min/1.73 m2 and no proteinuria), and 292 healthy blood donors over 50 years of age without CKD or diabetes. Results: The frequency of the risk allele for rs2032487 was 10.7% in patients with diabetes and advanced CKD, 7.1% in those with diabetes but without advanced CKD, and 6.1% in healthy subjects, with significant differences between the first and third groups (P = .015). Among subjects with advanced CKD, 78.5% were homozygous for the protective allele, as compared to 87.9% in the other two groups (P = .015 and P = .016 respectively). The frequency of the risk allele for the rs73885319 polymorphism did not exceed 0.5% in any of the three groups. Conclusions: These data suggest that polymorphism rs2032487 is associated to advanced CKD related to T2DM in the population of Gran Canaria