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      Association between serum 25-hydroxyvitamin D and diabetic kidney disease in Chinese patients with type 2 diabetes

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          Abstract

          Objective

          The objective was to assess the association between 25-hydroxyvitamin D (25OHD) level and diabetic kidney disease (DKD) in Chinese patients with type 2 diabetes.

          Methods

          Data pertaining to 351 in-patients with type 2 diabetes were collected. Subjects were classified into three groups based on the level of urinary albumin-to-creatinine ratio (UACR). UACR < 30 mg/g was defined as normoalbuminuria, while UACR levels of 30–300 mg/g and ≥ 300 mg/g were defined as microalbuminuria and macroalbuminuria, respectively. Serum 25OHD and other clinical characteristics among various UACR groups were compared. The relationship between albuminuiria and 25OHD was analyzed.

          Results

          The prevalence of 25OHD insufficiency in the microalbuminuria group was significantly higher than that in the normoalbuminuria group (25.1% vs. 19.6%; P < 0.05); patients with macroalbuminuria had the highest prevalence of 25OHD deficiency (37.8%; P < 0.01 versus normoalbuminuria). Logistic regression analyses demonstrated that low 25OHD levels were associated with DKD [odds ratio ( OR) = 1.51, 95% confidence interval ( CI) 1.16–1.97). The association was more robust after adjusting for sex, hypertension, increased systolic blood pressure, glycemic status, and hyperuricemia ( OR = 1.62, 95% CI 1.19–2.20).

          Conclusions

          The prevalence of vitamin D insufficiency/deficiency in patients with albuminuria was overtly higher than that in patients without albuminuria among Chinese adults with type 2 diabetes. Vitamin D insufficiency/deficiency was independently associated with DKD in type 2 diabetes.

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          Most cited references31

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          Inflammatory molecules and pathways in the pathogenesis of diabetic nephropathy.

          Many lines of evidence, ranging from in vitro experiments and pathological examinations to epidemiological studies, show that inflammation is a cardinal pathogenetic mechanism in diabetic nephropathy. Thus, modulation of inflammatory processes in the setting of diabetes mellitus is a matter of great interest for researchers today. The relationships between inflammation and the development and progression of diabetic nephropathy involve complex molecular networks and processes. This Review, therefore, focuses on key proinflammatory molecules and pathways implicated in the development and progression of diabetic nephropathy: the chemokines CCL2, CX3CL1 and CCL5 (also known as MCP-1, fractalkine and RANTES, respectively); the adhesion molecules intercellular adhesion molecule 1, vascular cell adhesion protein 1, endothelial cell-selective adhesion molecule, E-selectin and α-actinin 4; the transcription factor nuclear factor κB; and the inflammatory cytokines IL-1, IL-6, IL-18 and tumor necrosis factor. Advances in the understanding of the roles that these inflammatory pathways have in the context of diabetic nephropathy will facilitate the discovery of new therapeutic targets. In the next few years, promising new therapeutic strategies based on anti-inflammatory effects could be successfully translated into clinical treatments for diabetic complications, including diabetic nephropathy.
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            Trends in Chronic Kidney Disease in China.

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              Diabetic kidney disease: a report from an ADA Consensus Conference.

              The incidence and prevalence of diabetes mellitus have grown significantly throughout the world, due primarily to the increase in type 2 diabetes. This overall increase in the number of people with diabetes has had a major impact on development of diabetic kidney disease (DKD), one of the most frequent complications of both types of diabetes. DKD is the leading cause of end-stage renal disease (ESRD), accounting for approximately 50% of cases in the developed world. Although incidence rates for ESRD attributable to DKD have recently stabilized, these rates continue to rise in high-risk groups such as middle-aged African Americans, Native Americans, and Hispanics. The costs of care for people with DKD are extraordinarily high. In the Medicare population alone, DKD-related expenditures among this mostly older group were nearly $25 billion in 2011. Due to the high human and societal costs, the Consensus Conference on Chronic Kidney Disease and Diabetes was convened by the American Diabetes Association in collaboration with the American Society of Nephrology and the National Kidney Foundation to appraise issues regarding patient management, highlighting current practices and new directions. Major topic areas in DKD included (1) identification and monitoring, (2) cardiovascular disease and management of dyslipidemia, (3) hypertension and use of renin-angiotensin-aldosterone system blockade and mineralocorticoid receptor blockade, (4) glycemia measurement, hypoglycemia, and drug therapies, (5) nutrition and general care in advanced-stage chronic kidney disease, (6) children and adolescents, and (7) multidisciplinary approaches and medical home models for health care delivery. This current state summary and research recommendations are designed to guide advances in care and the generation of new knowledge that will meaningfully improve life for people with DKD.
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                Author and article information

                Contributors
                Role: Formal analysisRole: Project administrationRole: Writing – original draft
                Role: InvestigationRole: Writing – review & editing
                Role: Investigation
                Role: Investigation
                Role: Investigation
                Role: Investigation
                Role: Investigation
                Role: Writing – review & editing
                Role: Editor
                Journal
                PLoS One
                PLoS ONE
                plos
                plosone
                PLoS ONE
                Public Library of Science (San Francisco, CA USA )
                1932-6203
                24 April 2019
                2019
                : 14
                : 4
                : e0214728
                Affiliations
                [1 ] Department of Endocrinology, Jiangsu Province Hospital on Integration of Chinese and Western Medicine, Affiliated to Nanjing University of Chinese Medicine, Nanjing, People’s Republic of China
                [2 ] Department of Endocrinology, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, People’s Republic of China
                University of Mississippi Medical Center, UNITED STATES
                Author notes

                Competing Interests: The authors have declared that no competing interests exist.

                Author information
                http://orcid.org/0000-0001-6121-932X
                Article
                PONE-D-18-29672
                10.1371/journal.pone.0214728
                6481913
                31017918
                26399509-ffa2-44dc-9f03-67ccbe885796
                © 2019 Xie et al

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                : 22 October 2018
                : 19 March 2019
                Page count
                Figures: 0, Tables: 2, Pages: 11
                Funding
                Funded by: A grant from the Bureau of Chinese Medicine, Jiangsu Province, China
                Award ID: FY201706
                Award Recipient :
                This work was supported by a grant from Bureau of Chinese Medicine, Jiangsu Province, China. (FY201716)
                Categories
                Research Article
                Physical sciences
                Chemistry
                Chemical compounds
                Organic compounds
                Vitamins
                Vitamin D
                Physical sciences
                Chemistry
                Organic chemistry
                Organic compounds
                Vitamins
                Vitamin D
                Medicine and Health Sciences
                Endocrinology
                Endocrine Disorders
                Diabetes Mellitus
                Type 2 Diabetes
                Medicine and Health Sciences
                Metabolic Disorders
                Diabetes Mellitus
                Type 2 Diabetes
                Medicine and Health Sciences
                Endocrinology
                Endocrine Disorders
                Diabetes Mellitus
                Medicine and Health Sciences
                Metabolic Disorders
                Diabetes Mellitus
                Biology and life sciences
                Nutrition
                Nutritional deficiencies
                Vitamin D deficiency
                Medicine and health sciences
                Nutrition
                Nutritional deficiencies
                Vitamin D deficiency
                Medicine and Health Sciences
                Nephrology
                Chronic Kidney Disease
                Medicine and Health Sciences
                Vascular Medicine
                Blood Pressure
                Hypertension
                Medicine and Health Sciences
                Vascular Medicine
                Blood Pressure
                Medicine and Health Sciences
                Epidemiology
                Medical Risk Factors
                Custom metadata
                All relevant data are within the manuscript and its Supporting Information files.

                Uncategorized
                Uncategorized

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