Kidney international
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Kidney international · Oct 2014
ReviewSodium-glucose linked transporter-2 inhibitors: potential for renoprotection beyond blood glucose lowering?
The proximal tubule's sodium-glucose linked transporter-2 (SGLT2) accounts for the vast majority of glucose reabsorption by the kidney. Its selective inhibition, accordingly, leads to substantial glycosuria, lowering blood glucose, and facilitating weight loss in individuals with diabetes. During the past year, two SGLT2 inhibitors, canagliflozin and dapagliflozin, have been approved for the treatment of type 2 diabetes. ⋯ Additional potentially beneficial effects of SGLT2 inhibition include modest reductions in blood pressure and plasma uric acid. Finally, cell culture studies indicate that glucose uptake from the tubular lumen, as well as from the basolateral compartment, can contribute to proximal tubular production of extracellular matrix proteins. Whether such attributes will translate into reducing the progression of chronic kidney disease will require the undertaking of long-term, dedicated studies.
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Knowing a person's fracture risk according to their kidney function, gender, and age may influence clinical management and decision-making. Using healthcare databases from Ontario, Canada, we conducted a cohort study of 679,114 adults of 40 years and over (mean age 62 years) stratified at cohort entry by estimated glomerular filtration rate ((eGFR) 60 and over, 45-59, 30-44, 15-29, and under 15 ml/min per 1.73 m(2)), gender, and age (40-65 and over 65 years). The primary outcome was the 3-year cumulative incidence of fracture (proportion of adults who fractured (hip, forearm, pelvis, or proximal humerus) at least once within 3-years of follow-up). ⋯ Similar graded relationships were found for falls with hospitalization and additional analyses. Thus, many adults with chronic kidney disease will fall and fracture. Results can be used for prognostication and guidance of sample size requirements for fracture prevention trials.
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Kidney international · Sep 2014
ReviewThe role of bioimpedance and biomarkers in helping to aid clinical decision-making of volume assessments in dialysis patients.
Bioimpedance analysis (BIA) derives two main pieces of information--total tissue fluid content, which when referring to the whole patient is equivalent to the total body water (TBW), and cell mass, which in the limbs mainly reflects muscle. The relationship between these measures, expressed in different ways, is abnormal in dialysis patients due to muscle wasting combined with tissue overhydration. In both dialysis modalities this is associated with aging, comorbidity, and inflammation, and there is a conflict between achieving euvolemia to improve blood pressure control and prevent left ventricular hypertrophy on one hand, but risking episodes of hypovolemia and loss of residual renal function on the other. ⋯ In longitudinal studies BIA can identify changes in hydration following a defined intervention, and spontaneous loss in TBW consequent on muscle wasting not appreciated clinically, resulting in a failure to sufficiently reduce the dry weight. Cardiac biomarkers provide additional information but it is not clear whether this reflects fluid status or underlying structural organ damage. Intervention studies are now needed that show how this information is best used to improve patient outcomes, including meaningful end points such as hospitalization and survival.