Blood biomarkers improve the prediction of prevalent and incident severe chronic kidney disease.

BACKGROUND: The prevalence of chronic kidney disease (CKD) is high. Identification of cases with CKD or at high risk of developing it is important to tailor early interventions. The objective of this study was to identify blood metabolites associated with prevalent and incident severe CKD, and to quantify the corresponding improvement in CKD detection and prediction. METHODS: Data from four cohorts were analyzed: Singapore Epidemiology of Eye Diseases (SEED) (n = 8802), Copenhagen Chronic Kidney Disease (CPH) (n = 916), Singapore Diabetic Nephropathy (n = 714), and UK Biobank (UKBB) (n = 103,051). Prevalent CKD (stages 3-5) was defined as estimated glomerular filtration rate (eGFR) < 60 mL/min/1.73 m2; incident severe CKD as CKD-related mortality or kidney failure occurring within 10 years. We used multivariable regressions to identify, among 146 blood metabolites, those associated with CKD, and quantify the corresponding increase in performance. RESULTS: Chronic kidney disease prevalence (stages 3-5) and severe incidence were 11.4% and 2.2% in SEED, and 2.3% and 0.2% in UKBB. Firstly, phenylalanine (Odds Ratio [OR] 1-SD increase = 1.83 [1.73, 1.93]), tyrosine (OR = 0.75 [0.71, 0.79]), docosahexaenoic acid (OR = 0.90 [0.85, 0.95]), citrate (OR = 1.41 [1.34, 1.47]) and triglycerides in medium high density lipoprotein (OR = 1.07 [1.02, 1.13]) were associated with prevalent stages 3-5 CKD. Mendelian randomization analyses suggested causal relationships. Adding these metabolites beyond traditional risk factors increased the area under the curve (AUC) by 3% and the sensitivity by 7%. Secondly, lactate (HR = 1.33 [1.08, 1.64]) and tyrosine (HR = 0.74 [0.58, 0.95]) were associated with incident severe CKD among individuals with eGFR < 90 mL/min/1.73 m2 at baseline. These metabolites increased the c-index by 2% and sensitivity by 5% when added to traditional risk factors. CONCLUSION: The performance improvements of CKD detection and prediction achieved by adding metabolites to traditional risk factors are modest and further research is necessary to fully understand the clinical implications of these findings.

Long-term diabetes outcomes in multi-ethnic Asians living in Singapore.

AIMS: This study aims to assess ethnic and gender disparities on long-term complications among multi-ethnic Asians with Diabetes Mellitus (DM) living in Singapore. METHODS: We conducted a retrospective cohort study involving 3006 patients who attended a diabetes centre in a hospital from 2003 to 2011. Demographics and clinical data were obtained from standardised questionnaire and patient's case records. Age at onset of diabetes was calculated as current age minus duration of DM in years. Outcomes on Acute Myocardial Infarction (AMI), End-Stage Renal Failure (ESRF) and all-cause death were ascertained by data linkage with national registries. RESULTS: The mean duration of diabetes exposure was 15.6 ± 9.1 years for AMI, 15.4 ± 9.0 years for ESRF and 17.0 ± 9.0 years for death. After adjusting for traditional cardiovascular risk factors, Malay and Indian with diabetes remained significantly associated with AMI with HRs 2.81(95%CI, 1.81-4.37) and 2.03 (95%CI, 1.15-3.59), respectively. The effect of Malays on ESRF and death became attenuated post-adjustment. Besides mortality, there was preponderance for other adverse outcomes associated with male. CONCLUSIONS: Ethnic (Malay worse) and gender (male worse) disparities were observed in DM-related outcomes. The results may inform allocation of finite resources and to organize care targeted at high-risk groups.

Riboregulators and metabolic disorders: getting closer towards understanding the pathogenesis of diabetes mellitus?

Type 2 Diabetes occurs as a result of defects in insulin secretion and its function. Although mechanisms of disease are not fully elucidated, it is recognized that a progressive decline in insulin secretory capacity is responsible for its occurrence and natural course. Metabolic syndrome, known to be a precursor of Type 2 diabetes, is characterized by a constellation of vascular risk factors, with obesity playing a central role. Obesity contributes to impaired insulin function and abnormal glucose metabolism. MicroRNAs (miRNA) are highly conserved, small, RNA molecules encoded in the genomes of plants and animals and they regulate the expression of many other genes either by RNA interference (RNAi) or RNA activation (RNAa). miRNAs have been found to regulate multiple genes and seem to be crucial factors in many cellular pathways, including development, cell differentiation, proliferation and apoptosis. Pancreatic islet cell specific miRNAs which regulate insulin secretion, and adipocyte specific miRNAs which regulate adipocyte differentiation, are examples of miRNAs that are predicted to have crucial roles in governing glucose homeostasis. Further understanding of the roles of miRNAs in glucose metabolism may unravel better understanding of pancreatic cell biology and diabetes pathophysiology, allowing for newer therapeutic targets and strategies. In this review, we will be discussing about the role/function of miRNAs in insulin secretion and regulation, lipid metabolism and conditions like hypertension and cardiovascular diseases and the potential use of miRNA in therapy.