1,5-Anhydroglucitol predicts CKD progression in macroalbuminuric diabetic kidney disease: results from non-targeted metabolomics.

INTRODUCTION: Metabolomics allows exploration of novel biomarkers and provides insights on metabolic pathways associated with disease. To date, metabolomics studies on CKD have been largely limited to Caucasian populations and have mostly examined surrogate end points. OBJECTIVE: In this study, we evaluated the role of metabolites in predicting a primary outcome defined as dialysis need, doubling of serum creatinine or death in Brazilian macroalbuminuric DKD patients. METHODS: Non-targeted metabolomics was performed on plasma from 56 DKD patients. Technical triplicates were done. Metabolites were identified using Agilent Fiehn GC/MS Metabolomics and NIST libraries (Agilent MassHunter Work-station Quantitative Analysis, version B.06.00). After data cleaning, 186 metabolites were left for analyses. RESULTS: During a median follow-up time of 2.5 years, the PO occurred in 17 patients (30.3%). In non-parametric testing, 13 metabolites were associated with the PO. In univariate Cox regression, only 1,5-anhydroglucitol (HR 0.10; 95% CI 0.01-0.63, p = .01), norvaline and L-aspartic acid were associated with the PO. After adjustment for baseline renal function, 1,5-anhydroglucitol (HR 0.10; 95% CI 0.02-0.63, p = .01), norvaline (HR 0.01; 95% CI 0.001-0.4, p = .01) and aspartic acid (HR 0.12; 95% CI 0.02-0.64, p = .01) remained significantly and inversely associated with the PO. CONCLUSION: Our results show that lower levels of 1,5-anhydroglucitol, norvaline and L-aspartic acid are associated with progression of macroalbuminuric DKD. While norvaline and L-aspartic acid point to interesting metabolic pathways, 1,5-anhydroglucitol is of particular interest since it has been previously shown to be associated with incident CKD. This inverse biomarker of hyperglycemia should be further explored as a new tool in DKD.

Management of diabetes mellitus in individuals with chronic kidney disease: therapeutic perspectives and glycemic control.

The purpose of this study was to evaluate the therapeutic options for diabetes treatment and their potential side effects, in addition to analyzing the risks and benefits of tight glycemic control in patients with diabetic kidney disease. For this review, a search was performed using several pre-defined keyword combinations and their equivalents: "diabetes kidney disease" and "renal failure" in combination with "diabetes treatment" and "oral antidiabetic drugs" or "oral hypoglycemic agents." The search was performed in PubMed, Endocrine Abstracts and the Cochrane Library from January 1980 up to January 2015. Diabetes treatment in patients with diabetic kidney disease is challenging, in part because of progression of renal failure-related changes in insulin signaling, glucose transport and metabolism, favoring both hyperglycemic peaks and hypoglycemia. Additionally, the decline in renal function impairs the clearance and metabolism of antidiabetic agents and insulin, frequently requiring reassessment of prescriptions. The management of hyperglycemia in patients with diabetic kidney disease is even more difficult, requiring adjustment of antidiabetic agents and insulin doses. The health team responsible for the follow-up of these patients should be vigilant and prepared to make such changes; however, unfortunately, there are few guidelines addressing the nuances of the management of this specific population.

Management of diabetes mellitus in individuals with chronic kidney disease: therapeutic perspectives and glycemic control

The purpose of this study was to evaluate the therapeutic options for diabetes treatment and their potential side effects, in addition to analyzing the risks and benefits of tight glycemic control in patients with diabetic kidney disease. For this review, a search was performed using several pre-defined keyword combinations and their equivalents: “diabetes kidney disease” and “renal failure” in combination with “diabetes treatment” and “oral antidiabetic drugs” or “oral hypoglycemic agents.” The search was performed in PubMed, Endocrine Abstracts and the Cochrane Library from January 1980 up to January 2015. Diabetes treatment in patients with diabetic kidney disease is challenging, in part because of progression of renal failure-related changes in insulin signaling, glucose transport and metabolism, favoring both hyperglycemic peaks and hypoglycemia. Additionally, the decline in renal function impairs the clearance and metabolism of antidiabetic agents and insulin, frequently requiring reassessment of prescriptions. The management of hyperglycemia in patients with diabetic kidney disease is even more difficult, requiring adjustment of antidiabetic agents and insulin doses. The health team responsible for the follow-up of these patients should be vigilant and prepared to make such changes; however, unfortunately, there are few guidelines addressing the nuances of the management of this specific population.

Hipertensäo arterial sistêmica e morbidade psiquiátrica em ambulatório de hospital terciário / Systemic arterial hypertension and psychiatric morbidity in outpatient of an tertiary hospital

A hipertensao arterial sistêmica representa um dos principais fatores de risco para as doenças cardiovasculares que sao a principal causa de morte em nosso meio. Hipertensos que frequentam hospital terciário apresentam elevada co-morbidade incluindo distúrbios psiquiátricos. O objetivo deste estudo é avaliar a morbidade psiquiátrica em hipertensos graves. Este estudo foi realizado em ambulatório geral de hospital terciário: 41 pacientes (26 mulheres e 15 homens) foram submetidos a consulta médica com aplicaçao do PRIME-MD, um questionário específico para diagnóstico de alteraçoes psiquiátricas a ser realizado pelo clínico. A frequência de distúrbios psiquiátricos diferiu em homens e mulheres: 63,4 por cento das mulheres na pesquisa apresentavam algum tipo de distúrbio contra 36,6 por cento dos homens (p=0,012). A maior parte dos diagnósticos foi de distúrbios do humor representados pela depressao associada ou nao a distúrbios ansiosos. A média de idade dos pacientes com distúrbio psiquiátrico foi 47,1 anos contra 59,3 anos dos pacientes sem distúrbio psiquiátrico (p=0,0049), mostrando a presença dos distúrbios psiquiátricos em pacientes mais jovens. Outros fatores pesquisados, como a pressao arterial sistólica, a pressao arterial diastólica e índice de massa corpórea nao apresentaram diferenças em funçao dos distúrbios psiquiátricos apresentados. Concluímos que há grande co-morbidade psiquiátrica em hipertensos que frequentam ambulatórios de hospital terciário e que esses distúrbios sao mais frequentes em mulheres e em pacientes jovens.

Validaçäo de questionário para diagnóstico de cefaléia em ambulatório de hospital universitário / Validation of a headache questionnarie in an outpatient clinic of an university hospital

A cefaléia é sintoma de alta prevalência na populaçäo, sendo queixa frequente na prática clínica. Cursa geralmente com exame físico geral e neurológico normais. A triagem de pacientes com cefaléia facilitaria o atendimento em centros médicos näo especializados. No presente estudo utilizou-se um questionário baseado nos critérios da Sociedade Internacional de Cefaléias modificado pelos autores em 204 pacientes de ambulatório do Hospital das Clínicas da FMUSP. Metade destes pacientes foi submetida a conculta clínica. Os resultados do questionário foram entäo comparados com os resultados da consulta clínica (padräo-ouro). As cefaléias encontradas eram primárias (89,6 por cento) na sua maioria. O questionário demonstrou sensibilidade de 90,2 por cento para detecçäo das enxaquecas e especificidade de 57,9 por cento, com coeficiente de comparaçäo (kappa) de 0,47, e valor preditivo positivo (VPP) de 65,7 por cento e um valor preditivo negativo (VPN) de 86,8. A sensibilidade para detecçäo de cefaléia do tipo-tensional foi 60,8 por cento e a especificidade foi 87,1 por cento com kappa de 0,49, e VPP de 77,8 por cento e VPN de 75,9. Concluíram que esse questionário pode ser utilizado como um método de triagem para o diagnóstico de cefaléias, podendo ser aplicado por pessoal nao médico. Futuramente, ele poderá ser utilizado em estudos populacionais.