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      Early changes in pulmonary function and intrarenal haemodynamics and the correlation between these sets of parameters in patients with T2DM

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          Abstract

          Purpose

          The main objectives of this study were to assess the early changes in pulmonary function and intrarenal haemodynamics and to determine the correlation between pulmonary function and intrarenal haemodynamics in patients with type 2 diabetes mellitus (T2DM).

          Methods

          96 patients with T2DM (diabetes group) without diabetes kidney disease (DKD) and 33 healthy subjects (control group) were enrolled in studies intended to assess the early changes in pulmonary function and intrarenal haemodynamics associated with diabetes, as well as to determine the correlation between pulmonary function and intrarenal haemodynamics.

          Results

          Pulmonary functional parameters were negatively correlated with HbA1c levels and diabetes duration ( P< 0.05). Moreover, renal functional parameters were positively correlated with HbA1c levels and diabetes duration ( P<0.05). Additionally, pulmonary functional parameters were negatively correlated with renal functional parameters ( P<0.05). Multiple linear regression analysis of the relationship between pulmonary functional parameters and the bilateral kidney arterial resistivity index (RI) showed that all the pulmonary functional parameters were significantly correlated with the arterial RI ( P< 0.05).

          Conclusions

          Patients displayed changes in pulmonary function and intrarenal haemodynamics during the preclinical stages of DKD. Regulating glycaemia may improve intrarenal haemodynamics in the bilateral interlobular renal arteries. Moreover, during the preclinical stages of DKD, the right kidney RI is a effective predictor of early changes in pulmonary function in adult T2DM patients.

          Trial registration

          ClinicalTrials.gov ( NCT02798198); registered 8 June 2016.

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          Most cited references28

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          Type 2 diabetes in East Asians: similarities and differences with populations in Europe and the United States

          There is an epidemic of diabetes in Asia. Type 2 diabetes develops in East Asian patients at a lower mean body mass index (BMI) compared with those of European descent. At any given BMI, East Asians have a greater amount of body fat and a tendency to visceral adiposity. In Asian patients, diabetes develops at a younger age and is characterized by early β cell dysfunction in the setting of insulin resistance, with many requiring early insulin treatment. The increasing proportion of young-onset and childhood type 2 diabetes is posing a particular threat, with these patients being at increased risk of developing diabetic complications. East Asian patients with type 2 diabetes have a higher risk of developing renal complications than Europeans and, with regard to cardiovascular complications, a predisposition for developing strokes. In addition to cardiovascular–renal disease, cancer is emerging as the other main cause of mortality. While more research is needed to explain these interethnic differences, urgent and concerted actions are needed to raise awareness, facilitate early diagnosis, and encourage preventive strategies to combat these growing disease burdens.
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            Estimating GFR using serum cystatin C alone and in combination with serum creatinine: a pooled analysis of 3,418 individuals with CKD.

            Serum cystatin C was proposed as a potential replacement for serum creatinine in glomerular filtration rate (GFR) estimation. We report the development and evaluation of GFR-estimating equations using serum cystatin C alone and serum cystatin C, serum creatinine, or both with demographic variables. Test of diagnostic accuracy. Participants screened for 3 chronic kidney disease (CKD) studies in the United States (n = 2,980) and a clinical population in Paris, France (n = 438). Measured GFR (mGFR). Estimated GFR using the 4 new equations based on serum cystatin C alone, serum cystatin C, serum creatinine, or both with age, sex, and race. New equations were developed by using linear regression with log GFR as the outcome in two thirds of data from US studies. Internal validation was performed in the remaining one third of data from US CKD studies; external validation was performed in the Paris study. GFR was measured by using urinary clearance of iodine-125-iothalamate in the US studies and chromium-51-EDTA in the Paris study. Serum cystatin C was measured by using Dade-Behring assay, standardized serum creatinine values were used. Mean mGFR, serum creatinine, and serum cystatin C values were 48 mL/min/1.73 m(2) (5th to 95th percentile, 15 to 95), 2.1 mg/dL, and 1.8 mg/L, respectively. For the new equations, coefficients for age, sex, and race were significant in the equation with serum cystatin C, but 2- to 4-fold smaller than in the equation with serum creatinine. Measures of performance in new equations were consistent across the development and internal and external validation data sets. Percentages of estimated GFR within 30% of mGFR for equations based on serum cystatin C alone, serum cystatin C, serum creatinine, or both levels with age, sex, and race were 81%, 83%, 85%, and 89%, respectively. The equation using serum cystatin C level alone yields estimates with small biases in age, sex, and race subgroups, which are improved in equations including these variables. Study population composed mainly of patients with CKD. Serum cystatin C level alone provides GFR estimates that are nearly as accurate as serum creatinine level adjusted for age, sex, and race, thus providing an alternative GFR estimate that is not linked to muscle mass. An equation including serum cystatin C level in combination with serum creatinine level, age, sex, and race provides the most accurate estimates.
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              Standards of medical care in diabetes--2007.

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                Author and article information

                Contributors
                Role: Writing – original draft
                Role: Writing – original draft
                Role: Data curation
                Role: Writing – original draft
                Role: Data curationRole: MethodologyRole: Supervision
                Role: Investigation
                Role: Investigation
                Role: Supervision
                Role: Data curationRole: InvestigationRole: Supervision
                Role: InvestigationRole: MethodologyRole: Resources
                Role: Writing – review & editing
                Role: Data curationRole: Formal analysisRole: InvestigationRole: MethodologyRole: SoftwareRole: Writing – original draftRole: Writing – review & editing
                Role: Editor
                Journal
                PLoS One
                PLoS ONE
                plos
                plosone
                PLoS ONE
                Public Library of Science (San Francisco, CA USA )
                1932-6203
                18 December 2019
                2019
                : 14
                : 12
                : e0224923
                Affiliations
                [1 ] Key Laboratory of Ministry of Education for Traditional Chinese Medicine Visera-State Theory and Application, Liaoning University of Traditional Chinese Medicine, Shenyang, China
                [2 ] Department of Endocrinology and Metabolic, Liaoning Provincial Corps Hospital of Chinese People’s Armed Police Forces, Shenyang, China
                [3 ] Chinese and Western Medical Association College, Liaoning University of Traditional Chinese Medicine
                [4 ] Department of Endocrinology and Metabolic, Shenyang the Fourth Hospital of People, Shenyang, China
                [5 ] Department of Geriatrics, Shengjing Hospital of China Medical University, Shenyang, China
                Indiana University School of Medicine, UNITED STATES
                Author notes

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

                Author information
                http://orcid.org/0000-0003-0923-6987
                Article
                PONE-D-19-16612
                10.1371/journal.pone.0224923
                6919602
                31851677
                a78268f0-85d7-47f6-b6f4-ab1e6c5575d4
                © 2019 Tai 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
                : 8 July 2019
                : 24 October 2019
                Page count
                Figures: 0, Tables: 5, Pages: 12
                Funding
                Funded by: funder-id http://dx.doi.org/10.13039/501100001809, National Natural Science Foundation of China;
                Award ID: 81774022
                Award Recipient :
                Funded by: Fund Project of innovation team in Liaoning
                Award ID: LT2016012
                Award Recipient :
                Funded by: Open Fund Project of Key Laboratory of Ministry of Education for Traditional Chinese Medicine Visera-State Theory and Application
                Award ID: xyzx1703
                Award Recipient :
                The study was supported by the Natural Science Foundation of China 81774022.
                Categories
                Research Article
                Medicine and Health Sciences
                Endocrinology
                Endocrine Disorders
                Diabetes Mellitus
                Medicine and Health Sciences
                Metabolic Disorders
                Diabetes Mellitus
                Medicine and health sciences
                Diagnostic medicine
                Diabetes diagnosis and management
                HbA1c
                Biology and life sciences
                Biochemistry
                Proteins
                Hemoglobin
                HbA1c
                Medicine and Health Sciences
                Pulmonology
                Pulmonary Function
                Biology and Life Sciences
                Anatomy
                Renal System
                Medicine and Health Sciences
                Anatomy
                Renal System
                Biology and Life Sciences
                Physiology
                Renal Physiology
                Glomerular Filtration Rate
                Medicine and Health Sciences
                Physiology
                Renal Physiology
                Glomerular Filtration Rate
                Biology and Life Sciences
                Anatomy
                Renal System
                Kidneys
                Medicine and Health Sciences
                Anatomy
                Renal System
                Kidneys
                Medicine and Health Sciences
                Endocrinology
                Endocrine Disorders
                Diabetes Mellitus
                Type 2 Diabetes
                Medicine and Health Sciences
                Metabolic Disorders
                Diabetes Mellitus
                Type 2 Diabetes
                Research and Analysis Methods
                Mathematical and Statistical Techniques
                Statistical Methods
                Forecasting
                Physical Sciences
                Mathematics
                Statistics
                Statistical Methods
                Forecasting
                Custom metadata
                All relevant data are within the Supporting Information files.

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