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      Exercise-induced albuminuria and circadian blood pressure abnormalities in type 2 diabetes

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          Abstract

          AIM

          To investigate the relationship between circadian variations in blood pressure (BP) and albuminuria at rest, and during exercise in non-hypertensive type 2 diabetes (T2D) patients.

          METHODS

          We conducted a cross-sectional study in well controlled T2D patients, non-hypertensive, without clinical proteinuria and normal creatinine clearance. In each participant, we recorded the BP using ambulatory blood pressure monitoring (ABPM) for 24-h, and albuminuria at rest and after a standardized treadmill exercise.

          RESULTS

          We enrolled 27 type 2 patients with a median age of 52; and a mean duration of diabetes and HbA1c of 3.6 ± 0.8 years and 6.3% ± 0.5% respectively. Using a 24-h ABPM, we recorded a mean diurnal systolic blood pressure (SBP) of 128 ± 17 mmHg vs nocturnal of 123 ± 19 mmHg ( P = 0.004), and mean diurnal diastolic blood pressure (DBP) of 83 ± 11 mmHg vs nocturnal 78 ± 14 mmHg ( P = 0.002). There was a significant difference between albuminuria at rest [median = 23 mg, interquartile range (IQR) = 10-51] and after exercise (median = 35 mg, IQR = 23-80, P < 0.001). Patients with exercise induced albuminuria had an increase in nocturnal BP values on all three components (128 mmHg vs 110 mmHg, P = 0.03 for SBP; 83 mmHg vs 66 mmHg, P = 0.04; 106 vs 83, P = 0.02 for mean arterial pressure), as well as albuminuric patients at rest. Moreover, exercise induced albuminuria detect a less increase in nocturnal DBP (83 vs 86, P = 0.03) than resting albuminuria.

          CONCLUSION

          Exercise induced albuminuria is associated with an increase in nocturnal BP values in T2D patients.

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          Most cited references16

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          Statistics review 4: Sample size calculations

          The present review introduces the notion of statistical power and the hazard of under-powered studies. The problem of how to calculate an ideal sample size is also discussed within the context of factors that affect power, and specific methods for the calculation of sample size are presented for two common scenarios, along with extensions to the simplest case.
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            Biomarkers in diabetic nephropathy: Present and future.

            Diabetic nephropathy (DN) is the leading cause of end stage renal disease in the Western world. Microalbuminuria (MA) is the earliest and most commonly used clinical index of DN and is independently associated with cardiovascular risk in diabetic patients. Although MA remains an essential tool for risk stratification and monitoring disease progression in DN, a number of factors have called into question its predictive power. Originally thought to be predictive of future overt DN in 80% of patients, we now know that only around 30% of microalbuminuric patients progress to overt nephropathy after 10 years of follow up. In addition, advanced structural alterations in the glomerular basement membrane may already have occurred by the time MA is clinically detectable.Evidence in recent years suggests that a significant proportion of patients with MA can revert to normoalbuminuria and the concept of nonalbuminuric DN is well-documented, reflecting the fact that patients with diabetes can demonstrate a reduction in glomerular filtration rate without progressing from normo-to MA. There is an unmet clinical need to identify biomarkers with potential for earlier diagnosis and risk stratification in DN and recent developments in this field will be the focus of this review article.
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              Risks of rapid decline renal function in patients with type 2 diabetes.

              Progressive rising population of diabetes and related nephropathy, namely, diabetic kidney disease and associated end stage renal disease has become a major global public health issue. Results of observational studies indicate that most diabetic kidney disease progresses over decades; however, certain diabetes patients display a rapid decline in renal function, which may lead to renal failure within months. Although the definition of rapid renal function decline remained speculative, in general, it is defined by the decrease of estimated glomerular filtration rate (eGFR) in absolute rate of loss or percent change. Based on the Kidney Disease: Improving Global Outcomes 2012 clinical practice guidelines, a rapid decline in renal function is defined as a sustained decline in eGFR of > 5 mL/min per 1.73 m(2) per year. It has been reported that potential factors contributing to a rapid decline in renal function include ethnic/genetic and demographic causes, smoking habits, increased glycated hemoglobin levels, obesity, albuminuria, anemia, low serum magnesium levels, high serum phosphate levels, vitamin D deficiency, elevated systolic blood pressure, pulse pressure, brachial-ankle pulse wave velocity values, retinopathy, and cardiac autonomic neuropathy. This article reviews current literatures in this area and provides insight on the early detection of diabetic subjects who are at risk of a rapid decline in renal function in order to develop a more aggressive approach to renal and cardiovascular protection.
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                Author and article information

                Journal
                World J Nephrol
                WJN
                World Journal of Nephrology
                Baishideng Publishing Group Inc
                2220-6124
                6 July 2017
                6 July 2017
                : 6
                : 4
                : 209-216
                Affiliations
                Aurel T Tankeu, François Folefack Kaze, Mesmin Yefou Dehayem, Eugene Sobngwi, Department of Internal Medicine and Specialties, Faculty of Medicine and Biomedical Sciences, Yaoundé 1364, Cameroon
                Aurel T Tankeu, Mesmin Yefou Dehayem, Eugene Sobngwi, National Obesity Center, Yaoundé Central Hospital, Yaoundé 1364, Cameroon
                François Folefack Kaze, Division of Nephrology, University Teaching Hospital, Yaoundé 1364, Cameroon
                Jean Jacques Noubiap, Department of Medicine, Groote Schuur Hospital and University of Cape Town, Cape Town 7925, South Africa
                David Chelo, Mother and Child Center of the Chantal Biya Foundation, Yaoundé 1364, Cameroon
                Author notes

                Author contributions: Tankeu AT, Kaze FF, Dehayem MY and Sobngwi E designed and performed the research; Tankeu AT, Noubiap JJ and Sobngwi E contributed to analytic tools and analyzed the data and drafted the manuscript; Tankeu AT, Kaze FF, Noubiap JJ, Chelo D and Dehayem MY and Sobngwi E critically discussed, revised and adopted the manuscript; all the authors approved the final version of the manuscript.

                Correspondence to: Eugene Sobngwi, MD, MPhil, PhD, Professor of Endocrinology and Metabolic Diseases, National Obesity Center, Yaoundé Central Hospital, Yaoundé 1364, Cameroon. sobngwieugene@ 123456yahoo.fr

                Telephone: +237-67-5088750

                Article
                jWJN.v6.i4.pg209
                10.5527/wjn.v6.i4.209
                5500458
                28729969
                66f600a0-bf54-4fcd-99f5-096025becfb7
                ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.

                Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

                History
                : 4 March 2017
                : 15 May 2017
                : 30 May 2017
                Categories
                Observational Study

                albuminuria,ambulatory measurement of blood pressure,exercise,type 2 diabetes mellitus

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