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Khalil MAM, Sadagah NM, Tan J, Syed FO, Chong VH, Al-Qurashi SH. Pros and cons of live kidney donation in prediabetics: A critical review and way forward. World J Transplant 2024; 14:89822. [PMID: 38576756 PMCID: PMC10989475 DOI: 10.5500/wjt.v14.i1.89822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 12/11/2023] [Accepted: 01/16/2024] [Indexed: 03/15/2024] Open
Abstract
There is shortage of organs, including kidneys, worldwide. Along with deceased kidney transplantation, there is a significant rise in live kidney donation. The prevalence of prediabetes (PD), including impaired fasting glucose and impaired glucose tolerance, is on the rise across the globe. Transplant teams frequently come across prediabetic kidney donors for evaluation. Prediabetics are at risk of diabetes, chronic kidney disease, cardiovascular events, stroke, neuropathy, retinopathy, dementia, depression and nonalcoholic liver disease along with increased risk of all-cause mortality. Unfortunately, most of the studies done in prediabetic kidney donors are retrospective in nature and have a short follow up period. There is lack of prospective long-term studies to know about the real risk of complications after donation. Furthermore, there are variations in recommendations from various guidelines across the globe for donations in prediabetics, leading to more confusion among clinicians. This increases the responsibility of transplant teams to take appropriate decisions in the best interest of both donors and recipients. This review focuses on pathophysiological changes of PD in kidneys, potential complications of PD, other risk factors for development of type 2 diabetes, a review of guidelines for kidney donation, the potential role of diabetes risk score and calculator in kidney donors and the way forward for the evaluation and selection of prediabetic kidney donors.
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Affiliation(s)
- Muhammad Abdul Mabood Khalil
- Center of Renal Diseases and Transplantation, King Fahad Armed Forces Hospital Jeddah, Jeddah 23311, Saudi Arabia
| | - Nihal Mohammed Sadagah
- Center of Renal Diseases and Transplantation, King Fahad Armed Forces Hospital Jeddah, Jeddah 23311, Saudi Arabia
| | - Jackson Tan
- Department of Nephrology, RIPAS Hospital Brunei Darussalam, Brunei Muara BA1710, Brunei Darussalam
| | - Furrukh Omair Syed
- Center of Renal Diseases and Transplantation, King Fahad Armed Forces Hospital Jeddah, Jeddah 23311, Saudi Arabia
| | - Vui Heng Chong
- Division of Gastroenterology and Hepatology, Department of Medicine, Raja Isteri Pengiran Anak Saleha Hospital, Bandar Seri Begawan BA1710, Brunei Darussalam
| | - Salem H Al-Qurashi
- Center of Renal Diseases and Transplantation, King Fahad Armed Forces Hospital Jeddah, Jeddah 23311, Saudi Arabia
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Elevated fasting glucose level increases the risk of fatty liver disease: a 10-year study of 31,154 individuals. BMC Gastroenterol 2022; 22:521. [PMID: 36526962 PMCID: PMC9756490 DOI: 10.1186/s12876-022-02615-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Accepted: 12/12/2022] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVES Dysglycemia promotes the occurrence of fatty liver disease (FLD). However, the process is unclear. This study aimed to analyze the median time-to-onset, cumulative prevalence and influencing factors for the occurrence of FLD in people undergoing routine screening and evaluation. METHODS Data from Karamay Central Hospital (September 2008-April 2017) were analyzed. Survival analysis was performed to calculate the median time and cumulative prevalence of FLD associated with normal and elevated fasting blood glucose (FBG) levels. Cox proportional hazards model was used to determine risk factors. RESULTS A total of 31,154 participants were included in the two cohorts of this study, including 15,763 men. The mean age was 41.1 ± 12.2 years. There were 2230 patients (1725 male) in the elevated FBG group, the median age was 53 years (range 21-85 years), the median time-to-onset of FLD was 5.2 years. The incidence of FLD was 121/1000 person-years, and the 1-, 3-, 5-, and 7-year prevalence rates were 4%, 30%, 49%, and 64%, respectively. The normal FBG group included 28,924 participants (14,038 male), the median age was 40 years (range 17-87 years), and the corresponding values were as follows: 8.3 years, 66/1000 person-years, and 3%, 16%, 28%, and 41%, respectively. The Cox proportional hazards analysis revealed that age, blood pressure, FBG, body mass index and triglycerides were independent influencing factors for FLD in individuals (P < 0.05). CONCLUSIONS Elevated FBG levels increase the risk of FLD and should be treated promptly.
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Zhu L, Huang Q, Li X, Jin B, Ding Y, Chou CJ, Su KJ, Zhang Y, Chen X, Hwa KY, Thyparambil S, Liao W, Han Z, Mortensen R, Jin Y, Li Z, Schilling J, Li Z, Sylvester KG, Sun X, Ling XB. Serological Phenotyping Analysis Uncovers a Unique Metabolomic Pattern Associated With Early Onset of Type 2 Diabetes Mellitus. Front Mol Biosci 2022; 9:841209. [PMID: 35463946 PMCID: PMC9024215 DOI: 10.3389/fmolb.2022.841209] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Accepted: 03/14/2022] [Indexed: 12/12/2022] Open
Abstract
Background: Type 2 diabetes mellitus (T2DM) is a multifaceted disorder affecting epidemic proportion at global scope. Defective insulin secretion by pancreatic β-cells and the inability of insulin-sensitive tissues to respond effectively to insulin are the underlying biology of T2DM. However, circulating biomarkers indicative of early diabetic onset at the asymptomatic stage have not been well described. We hypothesized that global and targeted mass spectrometry (MS) based metabolomic discovery can identify novel serological metabolic biomarkers specifically associated with T2DM. We further hypothesized that these markers can have a unique pattern associated with latent or early asymptomatic stage, promising an effective liquid biopsy approach for population T2DM risk stratification and screening. Methods: Four independent cohorts were assembled for the study. The T2DM cohort included sera from 25 patients with T2DM and 25 healthy individuals for the biomarker discovery and sera from 15 patients with T2DM and 15 healthy controls for the testing. The Pre-T2DM cohort included sera from 76 with prediabetes and 62 healthy controls for the model training and sera from 35 patients with prediabetes and 27 healthy controls for the model testing. Both global and targeted (amino acid, acylcarnitine, and fatty acid) approaches were used to deep phenotype the serological metabolome by high performance liquid chromatography-high resolution mass spectrometry. Different machine learning approaches (Random Forest, XGBoost, and ElasticNet) were applied to model the unique T2DM/Pre-T2DM metabolic patterns and contrasted with their effectiness to differentiate T2DM/Pre-T2DM from controls. Results: The univariate analysis identified unique panel of metabolites (n = 22) significantly associated with T2DM. Global metabolomics and subsequent structure determination led to the identification of 8 T2DM biomarkers while targeted LCMS profiling discovered 14 T2DM biomarkers. Our panel can effectively differentiate T2DM (ROC AUC = 1.00) or Pre-T2DM (ROC AUC = 0.84) from the controls in the respective testing cohort. Conclusion: Our serological metabolite panel can be utilized to identifiy asymptomatic population at risk of T2DM, which may provide utility in identifying population at risk at an early stage of diabetic development to allow for clinical intervention. This early detection would guide ehanced levels of care and accelerate development of clinical strategies to prevent T2DM.
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Affiliation(s)
- Linmin Zhu
- School of Laboratory Medicine, Tianjin Medical University, Tianjin, China
- Tianjin Teda Hospital, Tianjin, China
| | | | - Xiao Li
- Tianjin Yunjian Medical Laboratory Institute Co., Ltd, Tianjin, China
- Binhai Industrial Technology Research Institute, Zhejiang University, Tianjin, China
| | - Bo Jin
- Tianjin Yunjian Medical Laboratory Institute Co., Ltd, Tianjin, China
| | - Yun Ding
- mProbe Inc, Mountain View, CA, United States
| | | | - Kuo-Jung Su
- mProbe Inc, Mountain View, CA, United States
| | - Yani Zhang
- Tianjin Yunjian Medical Laboratory Institute Co., Ltd, Tianjin, China
| | | | | | | | - Weili Liao
- mProbe Inc, Mountain View, CA, United States
| | - Zhi Han
- mProbe Inc, Mountain View, CA, United States
| | | | - Yi Jin
- Tianjin Yunjian Medical Laboratory Institute Co., Ltd, Tianjin, China
| | - Zhen Li
- Shanghai Yunxiang Medical Technology Co., Ltd., Shanghai, China
| | - James Schilling
- mProbe Inc, Mountain View, CA, United States
- Binhai Industrial Technology Research Institute, Zhejiang University, Tianjin, China
| | - Zhen Li
- Tianjin Yunjian Medical Laboratory Institute Co., Ltd, Tianjin, China
- Binhai Industrial Technology Research Institute, Zhejiang University, Tianjin, China
| | - Karl G. Sylvester
- Department of Surgery, Stanford University, School of Medicine, Stanford, CA, United States
| | - Xuguo Sun
- School of Laboratory Medicine, Tianjin Medical University, Tianjin, China
- *Correspondence: Xuguo Sun, ; Xuefeng B. Ling,
| | - Xuefeng B. Ling
- Department of Surgery, Stanford University, School of Medicine, Stanford, CA, United States
- *Correspondence: Xuguo Sun, ; Xuefeng B. Ling,
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Li C, Chou Y, Shen W, Lu F, Yang Y, Wu J, Chang C. Increased risks of different grades of non-alcoholic fatty liver disease in prediabetic subjects with impaired fasting glucose and glucose tolerance, including the isolated glycosylated hemoglobin levels of 5.7-6.4% in a Chinese population. J Diabetes Investig 2020; 11:1336-1343. [PMID: 32270583 PMCID: PMC7477498 DOI: 10.1111/jdi.13268] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Revised: 03/05/2020] [Accepted: 03/24/2020] [Indexed: 12/16/2022] Open
Abstract
AIMS/INTRODUCTION Contrary to the results of the majority of studies on diabetes, there are some conflicting results regarding the relationship between non-alcoholic fatty liver disease (NAFLD) and prediabetes. No study has investigated the relationship between isolated glycated hemoglobin (HbA1c) in the range of 5.7-6.4% (HbA1c 5.7-6.4%) and NAFLD. Our aim was to investigate the effect of different glycemic statuses on NAFLD concomitantly categorized by fasting plasma glucose, 2-h plasma glucose and HbA1c levels. MATERIALS AND METHODS NAFLD was classified into three groups by ultrasonographic examination results: normal, mild and moderate-to-severe. Glycemic status was divided into five groups: normoglycemia, isolated HbA1c 5.7-6.4%, impaired fasting glucose without impaired glucose tolerance (IGT), IGT and newly diagnosed diabetes. For multivariable logistic regression analyses, the outcome variable was the classified three grades of fatty changes in the liver after adjusting for other potential risk covariables. RESULTS In this cross-sectional research, a total of 8,571 eligible individuals were enrolled and divided into three groups: 5,499 without fatty liver, 2,113 with mild NAFLD and 959 with moderate-to-severe NAFLD. Multivariable logistic regression analysis showed that IGT, impaired fasting glucose without IGT and isolated HbA1c 5.7-6.4% were associated with a higher risk of NAFLD in addition to newly diagnosed diabetes. Other positively predictive variables were male sex, obesity, overweight, central obesity, increased triglyceride and C-reactive protein >1 mg/L. Negatively associated factors were elevated high-density lipoprotein cholesterol levels. CONCLUSIONS Besides diabetes, the increased risks of different grades of NAFLD were found for prediabetic individuals categorized by impaired fasting glucose without IGT, IGT and isolated HbA1c 5.7-6.4%.
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Affiliation(s)
- Chung‐Hao Li
- Department of Health Management CenterNational Cheng Kung University HospitalCollege of MedicineNational Cheng Kung UniversityTainanTaiwan
- Department of Family MedicineNational Cheng Kung University HospitalCollege of MedicineNational Cheng Kung UniversityTainanTaiwan
| | - Yu‐Tsung Chou
- Department of Health Management CenterNational Cheng Kung University HospitalCollege of MedicineNational Cheng Kung UniversityTainanTaiwan
- Department of Family MedicineNational Cheng Kung University HospitalCollege of MedicineNational Cheng Kung UniversityTainanTaiwan
| | - Wei‐Chen Shen
- Department of Family MedicineNational Cheng Kung University HospitalCollege of MedicineNational Cheng Kung UniversityTainanTaiwan
| | - Feng‐Hwa Lu
- Department of Family MedicineNational Cheng Kung University HospitalCollege of MedicineNational Cheng Kung UniversityTainanTaiwan
- Department of Family MedicineCollege of MedicineNational Cheng Kung UniversityTainanTaiwan
- Department of Geriatrics and GerontologyNational Cheng Kung University HospitalCollege of MedicineNational Cheng Kung UniversityTainanTaiwan
| | - Yi‐Ching Yang
- Department of Family MedicineNational Cheng Kung University HospitalCollege of MedicineNational Cheng Kung UniversityTainanTaiwan
- Department of Family MedicineCollege of MedicineNational Cheng Kung UniversityTainanTaiwan
| | - Jin‐Shang Wu
- Department of Family MedicineNational Cheng Kung University HospitalCollege of MedicineNational Cheng Kung UniversityTainanTaiwan
- Department of Family MedicineCollege of MedicineNational Cheng Kung UniversityTainanTaiwan
- Department of Family MedicineNational Cheng Kung University HospitalDou-Liou BranchCollege of MedicineNational Cheng Kung UniversityYunlinTaiwan
| | - Chih‐Jen Chang
- Department of Family MedicineNational Cheng Kung University HospitalCollege of MedicineNational Cheng Kung UniversityTainanTaiwan
- Department of Family MedicineDitmanson Medical Foundation Chia-yi Christian HospitalChiayiTaiwan
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