Epidemiological and Metabolic Aspects and Risk Factors of Chronic Kidney Disease in Comorbid Pathology of Type 2 Diabetes Mellitus and Primary Hypothyroidism
- Authors: Berstneva S.V.1, Uryas’yev O.M.1, Dubinina I.I.1, Nikiforov A.A.1
-
Affiliations:
- Ryazan State Medical University
- Issue: Vol 30, No 1 (2022)
- Pages: 63-74
- Section: Original study
- URL: https://journals.rcsi.science/pavlovj/article/view/65190
- DOI: https://doi.org/10.17816/PAVLOVJ65190
- ID: 65190
Cite item
Abstract
INTRODUCTION: The increasing number of patients with diabetes mellitus (DM) and chronic kidney disease (CKD) is one of the most pressing problems of modern medicine. In comorbid pathology — a combination of type 2 DM and thyroid hypofunction — the negative effect of hypothyroidism on carbohydrate metabolism, lipid metabolism, endothelial function, and glomerular filtration rate (GFR) is a risk factor for the formation and progression of diabetic nephropathy and CKD and requires further study.
AIM: To identify risk factors and epidemiological peculiarities of CKD in type 2 DM in combination with thyroid hypofunction and to determine the possibility of using cystatin C levels for the evaluation of the kidney function in this pathology.
MATERIALS AND METHODS: The prospective study involved 203 patients with type 2 DM undergoing inpatient treatment in the endocrinology department of the Ryazan Regional Clinical Hospital: group 1 (n = 76), type 2 DM combined with the primary hypothyroidism, and group 2 (n = 127), type 2 DM without thyroid pathology. Carbohydrate, lipid metabolism, albuminuria (AU), thyroid hormone spectrum, adipokines (leptin, plasminogen activator inhibitor-1, interleukin-6, and tumor necrosis factor-α) were analyzed. The GFR was calculated using the CKD-EPI formula based on the levels of creatinine and cystatin C. Arterial pressure daily monitoring (APDM) was conducted, and intra-abdominal fat thickness was evaluated by ultrasonography.
RESULTS: The incidence of kidney pathology in patients with type 2 DM was 52.22%. In group 1, there was a significant increase in the prevalence of CKD (64.47%, p = 0.006) and of normoalbuminuric CKD (NAU-CKD, 32.89%; p = 0.010). The risk of CKD development in patients with concomitant PH was more than twice that in patients without thyroid pathology with an odds ratio of 2.229 (95% confidence interval (CI) 1.241–4.003) and that for NAU-CKD was 2.474 (95% CI 1.267–4.833). Significant impairment of several metabolic parameters and individual APDM parameters was revealed in group 1 in comparison with group 2. The dependence of AU and GFR on the body mass index and of AU on the intra-abdominal fat thickness was noted. A negative relationship between GFR and leptin was revealed; in group 1, a correlation of interleukin-6 and thyrotropic hormone was found (r = 0.809, p = 0.001). With concomitant PH, cystatin C values were lower, and the GFR (CKD-EPI-cys) was reliably higher.
CONCLUSION: Hypothyroidism is a risk factor for CKD development including NAU-CKD in type 2 DM. Obesity and hormonal activities of the intra-abdominal fatty tissue facilitate AU progression and GFR reduction. The use of cystatin C as a marker of the filtration function of the kidney in patients with hypothyroidism may lead to the underestimation of kidney function; thus, further investigation is required.
Full Text
##article.viewOnOriginalSite##About the authors
Svetlana V. Berstneva
Ryazan State Medical University
Author for correspondence.
Email: berst.ru@mail.ru
ORCID iD: 0000-0002-3141-4199
SPIN-code: 6722-3203
MD, Cand. Sci. (Med.), PhD, Associate Professor, Associate Professor of the Department of Faculty Therapy with a Therapy FAPE Course
Russian Federation, RyazanOleg M. Uryas’yev
Ryazan State Medical University
Email: uryasev08@yandex.ru
ORCID iD: 0000-0001-8693-4696
SPIN-code: 7903-4609
ResearcherId: S-6270-2016
MD, Dr. Sci. (Med.), PhD, Professor, Head of the Department of Faculty Therapy with a Therapy FAPE Course
Russian Federation, RyazanInessa I. Dubinina
Ryazan State Medical University
Email: inessa.dubinina@mail.ru
ORCID iD: 0000-0001-6726-1756
MD, Dr. Sci. (Med.), PhD, Professor, Professor of the Department of Faculty Therapy with a Therapy FAPE Course
Russian Federation, RyazanAleksandr A. Nikiforov
Ryazan State Medical University
Email: a.nikiforov@rzgmu.ru
ORCID iD: 0000-0002-7364-7687
SPIN-code: 8366-5282
MD, Cand. Sci. (Med.), Associate Professor
Russian Federation, RyazanReferences
- Shamkhalova MSh, Yarek-Martynova IR, Trubitcyna NP, et al. Glucose-lowering therapies in patients with diabetes mellitus and chronic kidney disease. Diabetes Mellitus. 2013;(3):97–102. (In Russ). doi: 10.14341/2072-0351-823
- Dedov II, M.V. Shestakova MV, editors. Oslozhneniya sakharnogo diabeta: lecheniye i profilaktika. Moscow: MIA; 2017. (In Russ).
- Klimontov VV, Korbut AI. Normoalbuminuric chronic kidney disease in diabetes. Therapeutic Archive. 2018;90(10):94–8. (In Russ). doi: 10.26442/terarkh201890104-98
- Afkarian M, Zelnick L, Hall Y, et al. Clinical Manifestations of Kidney Disease Among US Adults With Diabetes, 1988–2014. JAMA. 2016;316(6):602–10. doi: 10.1001/jama.2016.10924
- Porrini E, Ruggenenti P, Mogensen C, et al. Non-proteinuric pathways in loss of renal function in patients with type 2 diabetes. The Lancet. Diabetes & Endocrinology. 2015;3(5):382–91. doi: 10.1016/S2213-8587(15)00094-7
- Marshall S.M. Natural history and clinical characteristics of CKD in type 1 and type 2 diabetes mellitus. Advances in Chronic Kidney Disease. 2014;21(3):267–72. doi: 10.1053/j.ackd.2014.03.007
- Orlova MM, Rodionova TI. Sostoyaniye funktsii pochek u patsiyentov s gipotireozom (obzor). Meditsinskiy Al’manakh. 2010;(3):112–4. (In Russ).
- Connor А, Taylor JE. Renal impairment resulting from hypothyroidism. NDT Plus. 2008;1(6):440–1. doi: 10.1093/ndtplus/sfn158
- Gilles R, der Hejier M, Ross AH, et. al. Thyroid function in patient with proteinuria. The Netherlands Journal of Medicine. 2008;66(11):483–5.
- Furukawa S, Yamamoto S, Todo Y, et al. Association between subclinical hypothyroidism and diabetic nephropathy in patients with type 2 diabetes mellitus. Endocrine Journal. 2014;61(10):1011–8. doi: 10.1507/endocrj.ej14-0206
- Dubinina II, Uryasev OM, Berstneva SV, et al. Hypertension and endothelial dysfunction in comorbid pathology: diabetes mellitus and primary hypothyroidism. I.P. Pavlov Russian Medical Biological Herald. 2016;24(4):42–55. (In Russ). doi: 10.23888/PAVLOVJ2016442-55
- Berstneva SV. Epidemiological aspects of comorbid pathology — diabetes mellitus and hypothyroidism. Science of the young (Eruditio Juvenium). 2020;8(2):154–63. (In Russ). doi: 10.23888/HMJ202082154-163
- Maratou E, Hadjidakis DJ, Kollias A, et al. Studies of insulin resistance in patients with clinical and subclinical hypothyroidism. European Journal of Endocrinology. 2009;160(5):785–90. doi: 10.1530/EJE-08-0797
- Zambon A, Bertocco S, Vitturi N, et al. Relevance of hepatic lipase to the metabolism of triacylglycerol rich lipoproteins. Biochemical Society Transactions. 2003;31(Pt 5):1070–4. doi: 10.1042/bst0311070
- Deicher R, Hörl WH. Anaemia as a risk factor for the progression of chronic kidney disease. Current Opinion in Nephrology and Hypertension. 2003;12(2):139–43. doi: 10.1097/00041552-200303000-00003
- Klimontov VV, Eremenko NV, Myakina NE, et al. Cystatin C and collagen type IV in diagnostics of chronic kidney disease in type 2 diabetic patients. Diabetes Mellitus. 2015;18(1):87–93. (In Russ). doi: 10.14341/DM2015187-93
- Udovcic M, Pena RH, Patham B, et al. Hypothyroidism and the Heart. Methodist DeBakey Cardiovascular Journal. 2017;13(2):55–9. doi: 10.14797/mdcj-13-2-55
- Vyalkova AA, Lebedeva EN, Krasikov SI, et al. Clinical and paphogenical aspects of kidney damage in obesity (review). Nephrology. 2014;18(3):24–33. (In Russ).
- Zakharova SM, Savelieva LV, Fadeeva MI. Obesity and hypothyroidism. Obesity and Metabolism. 2013;(2):24–33. (In Russ).
- Sazonova YeG, Mokhort TV. Thyroid functioning in diabetes mellitus complicated with chronic renal disease. Mezhdunarodnyy Endokrinologicheskiy Zhurnal. 2013;(2):62–7. (In Russ).
- Roos JF, Doust J, Tett SE, et al. Diagnostic accuracy of cystatin C compared to serum creatinine for the estimation of renal dysfunction in adults and children-a meta-analysis. Clinical Biochemistry. 2007;40(5–6):383–91. doi: 10.1016/j.clinbiochem.2006.10.026
- Čabarkapa V, Mijović R, Stošić Z, et al. Estimation of glomerular filtration rate from serum cystatin С and creatinine in patients with thyroid dysfunction. Journal of Medical Biochemistry. 2012;31(2):88–93. doi: 10.2478/v10011-011-0044-0
- Wiesli P, Schwegler B, Spinas GA, et al. Serum cystatin C is sensitive to small changes in thyroid function. Clinica Chimica Acta. 2003;338(1–2):87–90. doi: 10.1016/j.cccn.2003.07.022
- Naour N, Fellahi S, Renucci J–F, et al. Potential contribution of adipose tissue to elevated serum cystatin C in human obesity. Obesity. 2009;17(12):2121–6. doi: 10.1038/oby.2009.96