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      Kidney cytosine methylation changes improve renal function decline estimation in patients with diabetic kidney disease

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          Abstract

          Epigenetic changes might provide the biological explanation for the long-lasting impact of metabolic alterations of diabetic kidney disease development. Here we examined cytosine methylation of human kidney tubules using Illumina Infinium 450 K arrays from 91 subjects with and without diabetes and varying degrees of kidney disease using a cross-sectional design. We identify cytosine methylation changes associated with kidney structural damage and build a model for kidney function decline. We find that the methylation levels of 65 probes are associated with the degree of kidney fibrosis at genome wide significance. In total 471 probes improve the model for kidney function decline. Methylation probes associated with kidney damage and functional decline enrich on kidney regulatory regions and associate with gene expression changes, including epidermal growth factor ( EGF). Altogether, our work shows that kidney methylation differences can be detected in patients with diabetic kidney disease and improve kidney function decline models indicating that they are potentially functionally important.

          Abstract

          Patients with diabetes commonly develop diabetic kidney disease (DKD). Here Gluck et al. identify a set of probes differentially methylated in renal samples from patients with DKD, and find that inclusion of these methylation probes improves current prediction models of renal function decline.

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          Controlling the False Discovery Rate: A Practical and Powerful Approach to Multiple Testing

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            Diabetic kidney disease

            The kidney is arguably the most important target of microvascular damage in diabetes. A substantial proportion of individuals with diabetes will develop kidney disease owing to their disease and/or other co-morbidity, including hypertension and ageing-related nephron loss. The presence and severity of chronic kidney disease (CKD) identify individuals who are at increased risk of adverse health outcomes and premature mortality. Consequently, preventing and managing CKD in patients with diabetes is now a key aim of their overall management. Intensive management of patients with diabetes includes controlling blood glucose levels and blood pressure as well as blockade of the renin-angiotensin-aldosterone system; these approaches will reduce the incidence of diabetic kidney disease and slow its progression. Indeed, the major decline in the incidence of diabetic kidney disease (DKD) over the past 30 years and improved patient prognosis are largely attributable to improved diabetes care. However, there remains an unmet need for innovative treatment strategies to prevent, arrest, treat and reverse DKD. In this Primer, we summarize what is now known about the molecular pathogenesis of CKD in patients with diabetes and the key pathways and targets implicated in its progression. In addition, we discuss the current evidence for the prevention and management of DKD as well as the many controversies. Finally, we explore the opportunities to develop new interventions through urgently needed investment in dedicated and focused research. For an illustrated summary of this Primer, visit: http://go.nature.com/NKHDzg.
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              Changing epidemiology of type 2 diabetes mellitus and associated chronic kidney disease.

              Chronic kidney disease (CKD) is a common comorbidity in patients with type 2 diabetes mellitus (T2DM) and both conditions are increasing in prevalence. CKD is estimated to affect ∼50% patients with T2DM globally, and its presence and severity markedly influences disease prognosis. CKD is more common in certain patient populations, including the elderly, those with youth-onset diabetes mellitus, those who are obese, certain ethnic groups, and disadvantaged populations. These same settings have also seen the greatest increase in the prevalence of T2DM, as exemplified by the increasing prevalence of T2DM in low-to- middle income countries. Patients from low-to-middle income countries are often the least able to deal with the burden of T2DM and CKD and the health-care facilities of these countries least able to deal with the demand for equitable access to renal replacement therapies. The increasing prevalence of younger individuals with T2DM, in whom an accelerated course of complications can be observed, further adds to the global burden of CKD. Paradoxically, improvements in cardiovascular survival in patients with T2DM have contributed to patients surviving longer, allowing sufficient time to develop renal impairment. This Review explores how the changing epidemiology of T2DM has influenced the prevalence and incidence of associated CKD across different populations and clinical settings.
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                Author and article information

                Contributors
                ksusztak@pennmedicine.upenn.edu
                Journal
                Nat Commun
                Nat Commun
                Nature Communications
                Nature Publishing Group UK (London )
                2041-1723
                5 June 2019
                5 June 2019
                2019
                : 10
                : 2461
                Affiliations
                [1 ]ISNI 0000 0004 1936 8972, GRID grid.25879.31, Department of Medicine, Renal Electrolyte and Hypertension Division, , University of Pennsylvania, ; Philadelphia, 19104 PA USA
                [2 ]ISNI 0000 0004 1936 8972, GRID grid.25879.31, Department of Pediatrics, Division of Nephrology, The Children’s Hospital of Philadelphia, Perelman School of Medicine, , University of Pennsylvania, ; Philadelphia, 19104 PA USA
                [3 ]ISNI 0000 0004 0470 5112, GRID grid.411612.1, Division of Nephrology, Department of Internal Medicine, , Inje University College of Medicine, ; Goyang, 10380 Korea
                [4 ]ISNI 0000 0004 1936 8972, GRID grid.25879.31, Department of Pathology and Laboratory Medicine, Perelman School of Medicine, , University of Pennsylvania, ; Philadelphia, 19104 PA USA
                [5 ]ISNI 0000 0004 1936 8972, GRID grid.25879.31, Department of Genetics, , University of Pennsylvania, ; Philadelphia, 19104 PA USA
                [6 ]ISNI 0000 0001 2203 7304, GRID grid.419635.c, Diabetes Epidemiology and Clinical Research Section, National Institute of Diabetes and Digestive and Kidney Diseases, ; Phoenix, 86014 AZ USA
                [7 ]ISNI 0000 0004 1936 8972, GRID grid.25879.31, Department of Biostatistics, Epidemiology, and Informatics, Center for Clinical Epidemiology and Biostatistics, School of Medicine, , University of Pennsylvania Perelman, ; Philadelphia, 19104 PA USA
                [8 ]ISNI 0000000121791997, GRID grid.251993.5, Department of Medicine, , Albert Einstein College of Medicine, ; Bronx, 10461 NY USA
                [9 ]ISNI 0000 0001 2152 0791, GRID grid.240283.f, Department of Pathology Montefiore Medical Center, ; Bronx, 10467 NY USA
                Author information
                http://orcid.org/0000-0003-1880-2506
                http://orcid.org/0000-0002-6346-8669
                http://orcid.org/0000-0002-5728-912X
                http://orcid.org/0000-0002-0066-358X
                http://orcid.org/0000-0002-4252-7068
                http://orcid.org/0000-0001-7592-7693
                http://orcid.org/0000-0002-2677-945X
                http://orcid.org/0000-0002-1005-3726
                Article
                10378
                10.1038/s41467-019-10378-8
                6549146
                31165727
                68a34a67-0570-498c-8a7f-1812c2e5f458
                © The Author(s) 2019

                Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons license, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons license and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/.

                History
                : 22 November 2017
                : 7 May 2019
                Funding
                Funded by: FundRef https://doi.org/10.13039/100000062, U.S. Department of Health & Human Services | NIH | National Institute of Diabetes and Digestive and Kidney Diseases (National Institute of Diabetes & Digestive & Kidney Diseases);
                Award ID: F32 DK112635
                Award ID: RO1 DK087635
                Award ID: DP3 DK108220
                Award Recipient :
                Categories
                Article
                Custom metadata
                © The Author(s) 2019

                Uncategorized
                epigenetics,chronic kidney disease,diabetic nephropathy
                Uncategorized
                epigenetics, chronic kidney disease, diabetic nephropathy

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