Natural history and risk factors for diabetic kidney disease in patients with T2D: lessons from the AMD-annals

The Associazione Medici Diabetologi (AMD) annals initiative is an ongoing observational survey promoted by AMD. It is based on a public network of about 700 Italian diabetes clinics, run by specialists who provide diagnostic confirmation and prevention and treatment of diabetes and its complications. Over the last few years, analysis of the AMD annals dataset has contributed several important insights on the clinical features of type-2 diabetes kidney disease and their prognostic and therapeutic implications. First, non-albuminuric renal impairment is the predominant clinical phenotype. Even though associated to a lower risk of progression compared to overt albuminuria, it contributes significantly to the burden of end-stage renal disease morbidity. Second, optimal blood pressure control provides significant but incomplete renal protection. It reduces albuminuria but there may be a J curve phenomenon with eGFR at very low blood pressure values. Third, hyperuricemia and diabetic hyperlipidemia, namely elevated triglycerides and low HDL cholesterol, are strong independent predictors of chronic kidney disease (CKD) onset in diabetes, although the pathogenetic mechanisms underlying these associations remain uncertain. Fourth, the long-term intra-individual variability in HbA1c, lipid parameters, uric acid and blood pressure plays a greater role in the appearance and progression of CKD than the absolute value of each single variable. These data help clarify the natural history of CKD in patients with type 2 diabetes and provide important clues for designing future interventional studies

Validation of a commercial system for the continuous and automated monitoring of dairy cows activity

In order to improve animal welfare and enhance the comfort of dairy cows, the application of information technology (IT) within the intensive livestock farming takes a key role in a proper routine management. This study aims to compare localisation and activity data provided by the CowView system, an automatic indoor localisation system for dairy cattle, with those obtained by a manual labelling procedure, twice within an observation period of minimum 25 hours per dataset. Data from five selected dairy cows were represented by behaviours performed in relation to the occupied zones, and were classified in two categories: activity and localisation. The identified activities performed by the dairy cows were standing, walking (both considered as being in the alley), resting (being in the cubicle) and feeding (being at the feeder). Indeed, the zone considered in the analysis were alley, in bed and feeding zone. Data automatically and manually classified (used as a reference) were compared. Among all the behaviours detected by the automated software, the most reliable results are those related to the activity of feeding (accuracy higher than 95%). The results showed that the CowView automatic monitoring system is able to identify activity zone classification (ALLEY, THROUGH, CUBICLES) with higher reliability compared to the specific activities performed by dairy cows. The results obtained support the CowView system as an innovative and effective solution for an easier management of dairy cows

Sensor data classification for the indication of lameness in sheep

Lameness is a vital welfare issue in most sheep farming countries, including the UK. The pre-detection at the farm level could prevent the disease from becoming chronic. The development of wearable sensor technologies enables the idea of remotely monitoring the changes in animal movements which relate to lameness. In this study, 3D-acceleration, 3D-orientation, and 3D-linear acceleration sensor data were recorded at ten samples per second via the sensor attached to sheep neck collar. This research aimed to determine the best accuracy among various supervised machine learning techniques which can predict the early signs of lameness while the sheep are walking on a flat field. The most influencing predictors for lameness indication were also addressed here. The experimental results revealed that the Decision Tree classifier has the highest accuracy of 75.46%, and the orientation sensor data (angles) around the neck are the strongest predictors to differentiate among severely lame, mildly lame and sound classes of sheep

Cognitive enrichment in piglet rearing : an approach to enhance animal welfare and to reduce aggressive behaviour

It is known that pigs raised in enriched environments express less aggressive behaviour. For this reason, a new method of cognitive environmental enrichment was experimented at the University of Veterinary Medicine Hannover, Germany. In the first phase, 78 suckling piglets were trained to learn the link between a sound given by an electronic feeder and a feed reward in the form of chocolate candies during a period of 8 days. In the second phase, the same piglets were used in resident-intruder tests to verify the potential of the feeding system to interrupt aggressive behaviour. The analysis of all training rounds revealed that piglets learned the commands during 8 days of training and the interest of the piglets increased within training days (P < 0.05). In the residentintruder test, 79.5% of aggressive interactions were broken by feeder activation. In interactions where either the aggressor or the receiver reacted, a high number of fights were stopped (96.7% versus 93.1%) indicating that it was not relevant if the aggressor or the receiver responded to the feeder activation. We conclude that the electronic feeding systemhas the potential to be used as cognitive enrichment for piglets, being suitable for reducing aggressive behaviour in resident-intruder situations

Serum Uric Acid and Kidney Disease Measures Independently Predict Cardiovascular and Total Mortality: The Uric Acid Right for Heart Health (URRAH) Project

Background: Serum uric acid predicts the onset and progression of kidney disease, and the occurrence of cardiovascular and all-cause mortality. Nevertheless, it is unclear which is the appropriate definition of hyperuricemia in presence of chronic kidney disease (CKD). Our goal was to study the independent impact of uric acid and CKD on mortality. Methods: We retrospectively investigated 21,963 patients from the URRAH study database. Hyperuricemia was defined on the basis of outcome specific cut-offs separately identified by ROC curves according to eGFR strata. The primary endpoints were cardiovascular and all-cause mortality. Results: After a mean follow-up of 9.8 year, there were 1,582 (7.20%) cardiovascular events and 3,130 (14.25%) deaths for all causes. The incidence of cardiovascular and all-cause mortality increased in parallel with reduction of eGFR strata and with progressively higher uric acid quartiles. During 215,618 person-years of follow-up, the incidence rate for cardiovascular mortality, stratified based on eGFR (&gt;90, between 60 and 90 and &lt;60 ml/min) was significantly higher in patients with hyperuricemia and albuminuria (3.8, 22.1 and 19.1, respectively) as compared to those with only one risk factor or none (0.4, 2.8 and 3.1, respectively). Serum uric acid and eGFR significantly interact in determining cardiovascular and all-cause mortality. For each SUA increase of 1 mg/dl the risk for mortality increased by 10% even after adjustment for potential confounding factors included eGFR and the presence of albuminuria. Conclusions: hyperuricemia is a risk factor for cardiovascular and all-cause mortality additively to eGFR strata and albuminuria, in patients at cardiovascular risk

Kidney dysfunction and related cardiovascular risk factors among patients with type 2 diabetes.

BACKGROUND: Kidney dysfunction is a strong predictor of end-stage renal disease and cardiovascular (CV) events. The main goal was to study the clinical correlates of diabetic kidney disease in a large cohort of patients with type 2 diabetes mellitus (T2DM) attending 236 Diabetes Clinics in Italy. METHODS: Clinical data of 120 903 patients were extracted from electronic medical records by means of an ad hoc-developed software. Estimated glomerular filtration rate (GFR) and increased urinary albumin excretion were considered. Factors associated with the presence of albuminuria only, GFR < 60 mL/min/1.73 m(2) only or both conditions were evaluated through multivariate analysis. RESULTS: Mean age of the patients was 66.6 \ub1 11.0 years, 58.1% were male and mean duration of diabetes was 11.1 \ub1 9.4 years. The frequency of albuminuria, low GFR and both albuminuria and low GFR was 36.0, 23.5 and 12.2%, respectively. Glycaemic control was related to albuminuria more than to low GFR, while systolic and pulse pressure showed a trend towards higher values in patients with normal kidney function compared with those with both albuminuria and low GFR. Multivariate logistic analysis showed that age and duration of disease influenced both features of kidney dysfunction. Male gender was associated with an increased risk of albuminuria. Higher systolic blood pressure levels were associated with albuminuria, with a 4% increased risk of simultaneously having albuminuria and low GFR for each 5 mmHg increase. CONCLUSIONS: In this large cohort of patients with T2DM, reduced GFR and increased albuminuria showed, at least in part, different clinical correlates. A worse CV risk profile is associated with albuminuria more than with isolated low GFR

Sensor data classification for the indication of lameness in sheep

Lameness is a vital welfare issue in most sheep farming countries, including the UK. The pre-detection at the farm level could prevent the disease from becoming chronic. The development of wearable sensor technologies enables the idea of remotely monitoring the changes in animal movements which relate to lameness. In this study, 3D-acceleration, 3D-orientation, and 3D-linear acceleration sensor data were recorded at ten samples per second via the sensor attached to sheep neck collar. This research aimed to determine the best accuracy among various supervised machine learning techniques which can predict the early signs of lameness while the sheep are walking on a flat field. The most influencing predictors for lameness indication were also addressed here. The experimental results revealed that the Decision Tree classifier has the highest accuracy of 75.46%, and the orientation sensor data (angles) around the neck are the strongest predictors to differentiate among severely lame, mildly lame and sound classes of sheep

Prognostic Value and Relative Cutoffs of Triglycerides Predicting Cardiovascular Outcome in a Large Regional-Based Italian Database

BACKGROUND: Despite longstanding epidemiologic data on the association between increased serum triglycerides and car&#x2;diovascular events, the exact level at which risk begins to rise is unclear. The Working Group on Uric Acid and Cardiovascular Risk of the Italian Society of Hypertension has conceived a protocol aimed at searching for the prognostic cutoff value of triglycerides in predicting cardiovascular events in a large regional-based Italian cohort. METHODS AND RESULTS: Among 14189 subjects aged 18 to 95years followed-up for 11.2 (5.3–13.2) years, the prognostic cutoff value of triglycerides, able to discriminate combined cardiovascular events, was identified by means of receiver operating characteristic curve. The conventional (150mg/dL) and the prognostic cutoff values of triglycerides were used as independent predictors in separate multivariable Cox regression models adjusted for age, sex, body mass index, total and high-density lipoprotein cholesterol, serum uric acid, arterial hypertension, diabetes, chronic renal disease, smoking habit, and use of an&#x2;tihypertensive and lipid-lowering drugs. During 139375 person-years of follow-up, 1601 participants experienced cardiovas&#x2;cular events. Receiver operating characteristic curve showed that 89mg/dL (95% CI, 75.8–103.3, sensitivity 76.6, specificity 34.1, P&lt;0.0001) was the prognostic cutoff value for cardiovascular events. Both cutoff values of triglycerides, the conventional and the newly identified, were accepted as multivariate predictors in separate Cox analyses, the hazard ratios being 1.211 (95% CI, 1.063–1.378, P=0.004) and 1.150 (95% CI, 1.021–1.295, P=0.02), respectively. CONCLUSIONS: Lower (89mg/dL) than conventional (150mg/dL) prognostic cutoff value of triglycerides for cardiovascular events does exist and is associated with increased cardiovascular risk in an Italian cohor

Serum Uric Acid/Serum Creatinine Ratio and Cardiovascular Mortality in Diabetic Individuals—The Uric Acid Right for Heart Health (URRAH) Project

Several studies have detected a direct association between serum uric acid (SUA) and cardiovascular (CV) risk. In consideration that SUA largely depends on kidney function, some studies explored the role of the serum creatinine (sCr)-normalized SUA (SUA/sCr) ratio in different settings. Previously, the URRAH (URic acid Right for heArt Health) Study has identified a cut-off value of this index to predict CV mortality at 5.35 Units. Therefore, given that no SUA/sCr ratio threshold for CV risk has been identified for patients with diabetes, we aimed to assess the relationship between this index and CV mortality and to validate this threshold in the URRAH subpopulation with diabetes; the URRAH participants with diabetes were studied (n = 2230). The risk of CV mortality was evaluated by the Kaplan–Meier estimator and Cox multivariate analysis. During a median follow-up of 9.2 years, 380 CV deaths occurred. A non-linear inverse association between baseline SUA/sCr ratio and risk of CV mortality was detected. In the whole sample, SUA/sCr ratio &gt; 5.35 Units was not a significant predictor of CV mortality in diabetic patients. However, after stratification by kidney function, values &gt; 5.35 Units were associated with a significantly higher mortality rate only in normal kidney function, while, in participants with overt kidney dysfunction, values of SUA/sCr ratio &gt; 7.50 Units were associated with higher CV mortality. The SUA/sCr ratio threshold, previously proposed by the URRAH Study Group, is predictive of an increased risk of CV mortality in people with diabetes and preserved kidney function. While, in consideration of the strong association among kidney function, SUA, and CV mortality, a different cut-point was detected for diabetics with impaired kidney function. These data highlight the different predictive roles of SUA (and its interaction with kidney function) in CV risk, pointing out the difference in metabolic- and kidney-dependent SUA levels also in diabetic individual

Association of uric acid with kidney function and albuminuria: the Uric Acid Right for heArt Health (URRAH) Project

Background: Hyperuricemia is commonly observed in patients with chronic kidney disease (CKD). However, a better understanding of the relationship among uric acid (UA) values, glomerular filtration rate (GFR) and albuminuria may shed light on the mechanisms underlying the excess of cardiovascular mortality associated with both chronic kidney disease and hyperuricemia and lead to better risk stratification. Our main goal was to study the relationships between serum uric acid and kidney disease measures (namely estimated GFR [eGFR] and albuminuria) in a large cohort of individuals at cardiovascular risk from the URic acid Right for heArt Health (URRAH) Project database. Methods: Clinical data of 26,971 individuals were analyzed. Factors associated with the presence of hyperuricemia defined on the basis of previously determined URRAH cutoffs for cardiovascular and all-cause mortality were evaluated through multivariate analysis. Chronic kidney disease was defined as eGFR &lt; 60 ml/min per 1.73 m2 and/or abnormal urinary albumin excretion diagnosed as: (i) microalbuminuria if urinary albumin concentration was &gt; 30 and ≤ 300 mg/L, or if urinary albumin-to-creatinine ratio (ACR) was &gt; 3.4 mg/mmol and ≤ 34 mg/mmol; (ii) macroalbuminuria if urinary albumin concentration was &gt; 300 mg/L, or if ACR was &gt; 34 mg/mmol. Results: Mean age was 58 ± 15 years (51% males, 62% with hypertension and 12% with diabetes), mean eGFR was 81 ml/min per 1.73m22with a prevalence of eGFR &lt; 60 and micro- or macroalbuminuria of 16, 15 and 4%, respectively. Serum uric acid showed a trend towards higher values along with decreasing renal function. Both the prevalence of gout and the frequency of allopurinol use increased significantly with the reduction of eGFR and the increase in albuminuria. Hyperuricemia was independently related to male gender, eGFR strata, and signs of insulin resistance such as body mass index (BMI) and triglycerides. Conclusions: The lower the eGFR the higher the prevalence of hyperuricemia and gout. In subjects with eGFR &lt; 60 ml/min the occurrence of hyperuricemia is about 10 times higher than in those with eGFR &gt; 90 ml/min. The percentage of individuals treated with allopurinol was below 2% when GFR was above 60 ml/min, it increased to 20% in the presence of CKD 3b and rose further to 35% in individuals with macroalbuminuria