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      Tumor Necrosis Factor (TNF-α) and C-reactive Protein (CRP) are Positively Associated with the Risk of Chronic Kidney Disease in Patients with Type 2 Diabetes


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          Chronic low-grade inflammation may induce chronic kidney disease in patients with type 2 diabetes. This study investigated the relation between inflammatory biomarkers and chronic kidney disease in patients with type 2 diabetes, which has not yet been reported in Asian populations.

          Materials and Methods

          A cross-sectional study was performed in 543 patients recruited from diabetic clinics for an ongoing, prospective study. Multivariate logistic regression was used to evaluate the association between inflammatory biomarkers and the presence of chronic kidney disease (estimated glomerular filtration rate < 60 mL/min per 1.73 m 2 by the simplified Modification of Diet in Renal Disease equation using plasma creatinine).


          The risk of chronic kidney disease increased in the highest quartiles of C-reactive protein (CRP) [multivariate odds ratio (OR) = 3.73; 95% CI = 1.19-1.70] and tumor necrosis factor-α (multivariate OR = 4.45; 95% CI = 1.63-12.11) compared to the lowest quartiles after adjustments for age, sex, zinc intake, and other putative risk factors for chronic kidney disease.


          Our results suggest that CRP and tumor necrosis factor-α may be independent risk factors for chronic kidney disease in patients with type 2 diabetes. A causal mechanism of this association should be evaluated in a follow-up study of Korean patients with type 2 diabetes.

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          Most cited references19

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          Elevations of inflammatory and procoagulant biomarkers in elderly persons with renal insufficiency.

          Renal insufficiency has been associated with cardiovascular disease events and mortality in several prospective studies, but the mechanisms for the elevated risk are not clear. Little is known about the association of renal insufficiency with inflammatory and procoagulant markers, which are potential mediators for the cardiovascular risk of kidney disease. The cross-sectional association of renal insufficiency with 8 inflammatory and procoagulant factors was evaluated using baseline data from the Cardiovascular Health Study, a population-based cohort study of 5888 subjects aged > or =65 years. C-reactive protein, fibrinogen, factor VIIc, and factor VIIIc levels were measured in nearly all participants; interleukin-6, intercellular adhesion molecule-1, plasmin-antiplasmin complex, and D-dimer levels were measured in nearly half of participants. Renal insufficiency was defined as a serum creatinine level > or =1.3 mg/dL in women and > or =1.5 mg/dL in men. Multivariate linear regression was used to compare adjusted mean levels of each biomarker in persons with and without renal insufficiency after adjustment for other baseline characteristics. Renal insufficiency was present in 647 (11%) of Cardiovascular Health Study participants. After adjustment for baseline differences, levels of C-reactive protein, fibrinogen, interleukin-6, factor VIIc, factor VIIIc, plasmin-antiplasmin complex, and D-dimer were significantly greater among persons with renal insufficiency (P<0.001). In participants with clinical, subclinical, and no cardiovascular disease at baseline, the positive associations of renal insufficiency with these inflammatory and procoagulant markers were similar. Renal insufficiency was independently associated with elevations in inflammatory and procoagulant biomarkers. These pathways may be important mediators leading to the increased cardiovascular risk of persons with kidney disease.
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            Dietary Reference Intakes for Koreans

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              Factors affecting the relationship between childhood and adult cholesterol levels: the Muscatine Study.

              A group of 2,446 subjects initially examined at 8 to 18 years of age were reexamined as young adults of 20 to 25 or 26 to 30 years of age. Measurements of cholesterol, height, weight, and triceps skinfold thickness were obtained during childhood. Lipids, lipoprotein fractions, and family history, as well as medication, alcohol, and tobacco use, were determined during the adult examination. Elevated levels of cholesterol during childhood were associated with elevation in adult life. Obesity acquired in adolescence and the young adult years, oral contraceptive use, and cigarette smoking had deleterious effects on adult cholesterol levels and lipoprotein fractions.

                Author and article information

                Yonsei Med J
                Yonsei Medical Journal
                Yonsei University College of Medicine
                01 July 2010
                24 May 2010
                : 51
                : 4
                : 519-525
                [1 ]Department of Nutritional Science and Food Management, Ewha Womans University, Seoul, Korea.
                [2 ]Huh's Diabetes Clinic & the 21C Diabetes and Vascular Research Institute, Seoul, Korea.
                Author notes
                Corresponding author: Dr. Kap Bum Huh, Huh's Diabetes Clinic & the 21C Diabetes and Vascular Research Institute, 40-9 Nogosan-Dong, Mapo-Gu, Seoul 121-806, Korea. Tel: 82-2-718-1827, Fax: 82-2-704-5750, huh7181827@ 123456hanmail.net and Dr. Wha Young Kim, Department of Nutritional Science and Food Management, Ewha Womans University, 11-1 Daehyeon-dong, Seodaemun-gu, Seoul 120-750, Korea. Tel: 82-2-3277-3093, Fax: 82-2-3277-3103, wykim@ 123456ewha.ac.kr

                *These authors contributed equally to this work.

                © Copyright: Yonsei University College of Medicine 2010

                This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted noncommercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

                Original Article
                Endocrinology & Metabolism

                type 2 diabetes,chronic kidney disease,c-reactive protein,inflammation,tumor necrosis factor-α


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