Hyperfiltration in Normoalbuminuric Type 1 Diabetic Patients: Relationship with Urinary Albumin Excretion Rate

Hyperfiltration has been documented in type 1 diabetes and may contribute to the high risk for development of albuminuria and progression of nephropathy. However, recent studies suggest that the risk of progression to albuminuria in type 1 diabetes was not increased by hyperfiltration. We investigated associations of estimated glomerular filtration rate (eGFR) and urinary albumin excretion rate (UAE) in normoalbuminuric type 1 diabetic patients. Study included 313 normoalbuminuric patients with type 1 diabetes, none showed signs of adrenal, renal, or cardiovascular diseases. GFR was estimated using the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) formula. Glomerular hyperfiltration was defined as eGFR ³ 125 mL min–1 1.73 m–2. Renal hyperfiltration was present in 12% of the study group. Subjects with eGFR ³ 125 mL min–1 1.73 m–2 were younger, had shorter duration of diabetes, lower levels of total and LDL cholesterol, and higher HbA1c than subjects with an eGFR below 125 mL min–1 1.73 m–2. Type 1 diabetic patients with hyperfiltration also had significantly lower UAE. In a multiple logistic regression analysis, higher eGFR was associated with lower UAE. Our results indicate that normoalbuminuric type 1 diabetic patients with hyperfiltration have lower UAE than those with renal function in the normal range. Together with other recent studies this may suggest that creatinine-based estimates of GFR indicating hyperfiltration is not associated with higher UAE and subsequent development of microalbuminuria

Total and LDL Cholesterol are Associated with Glomerular Filtration Rate in Normoalbuminuric Type 1 Diabetic Patients

Studies have generally suggested a positive association between dyslipidemia and chronic kidney disease, but sparse data are available on the relation of lipids and glomerular filtration rate in patients with normal renal function. We in- vestigated the associations of serum lipids, including total, LDL, HDL, VLDL cholesterol, and triglyceride levels with es- timated glomerular filtration rate (eGFR) in type 1 diabetic patients. Study included 313 normoalbuminuric type 1 diabetic patients with normal or mild decrease (eGFR > 60 mL/min per 1.73 m 2 ) renal function and before any interventions with statins, ACE inhibitors or angiotensin II receptor blockers. eGFR was significantly associated with total, LDL, and HDL cholesterol (r= –0.21, –0.18, and –0.17, respectively, for all p <0.05). Stratifying serum lipids for degree of eGFR, levels of total, LDL, and HDL cholesterol were inversely related to eGFR, but trends were significant only for total (5.1 vs 5.0 and 4.6 mmol/L) and LDL cholesterol (2.9 vs 2.8 and 2.4 mmol/L). We have detected an association between eGFR and lipid abnormalities in type 1 diabetes in early stages. The study was conducted in patients with no therapeutic inter- vention. This may suggest that lipid abnormalities may play a role in the pathogenesis of renal impairment in type 1 diabetic patients

Randomizirano dvostruko-slijepo ispitivanje učinkovitosti oktreotid acetata u sprječavanju abdominalne boli nakon terapijske endoskopske retrogradne kolangiopankreatografije

Abdominal pain is a complication of endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic sphincterotomy (EST). The aim of this trial was to investigate the effects of octreotide acetate in the prevention of abdominal pain in patients undergoing therapeutic ERCP. A double-blind study was carried out in 209 subjects who were randomly allocated to two groups (A and B). Group A (104 patients) received 0.5 mg of octreotide acetate subcutaneously one hour prior to ERCP; and group B (105 patients) were given placebo. Patients were assessed 2 and 24 hours following endoscopy for the following parameters: presence and character of abdominal pain, requirements of analgetics. Thirty-nine (18%) patients complained of post-ERCP pain, i.e. ten in group A and 29 in group B, all of them treated with analgetics. Of the ten group A patients, symptoms of acute pancreatitis were identified in four (3.85%) patients versus ten (9.52%) patients in the control group B. The results obtained in the study seem to indicate that octreotide pretreatment significantly reduced the development of post-ERCP pain.Abdominalna bol je česta komplikacija endoskopske retrogradne kolangiopankreatografije (ERCP) i endoskopske sfinkterotomije (EST). Cilj ovoga ispitivanja bio je istražiti učinke oktreotid acetata u prevenciji abdominalne boli u bolesnika podvrgnutih ERCP-u. U ovu dvostruko-slijepu studiju bilo je uključeno 209 bolesnika koji su nasumce podijeljeni u dvije skupine (A i B). Bolesnici skupine A (n=104) primili su 0,5 mg oktreotid acetata supkutano jedan sat prije ERCP-a, dok su bolesnici skupine B (n=105) dobili placebo. Procjena kliničkih parametara (prisutnost i težina abdominalne boli te potreba za analgeticima) provedena je u bolesnika 2 i 24 sata nakon endoskopije. Ukupno se 39 (18%) bolesnika žalilo na bol nakon ERCP-a, tj. desetoro u skupini A i 29 u skupini B, a svi su oni liječeni analgeticima. Od desetoro bolesnika iz skupine A simptomi akutnog pankreatitisa zabilježeni su u četvoro (3,85%) bolesnika, u usporedbi s desetoro (9,52%) bolesnika u kontrolnoj skupini B. Rezultati ovoga ispitivanja pokazali su da je prethodno davanje oktreotida značajno smanjilo nastup abdominalne boli nakon ERCP-a

Bacterial but no SARS-CoV-2 contamination after terminal disinfection of tertiary care intensive care units treating COVID-19 patients

BACKGROUND In intensive care units (ICUs) treating patients with Coronavirus disease 2019 (COVID-19) invasive ventilation poses a high risk for aerosol and droplet formation. Surface contamination of severe acute respiratory syndrome Coronavirus 2 (SARS-CoV-2) or bacteria can result in nosocomial transmission. METHODS Two tertiary care COVID-19 intensive care units treating 53 patients for 870 patient days were sampled after terminal cleaning and preparation for regular use to treat non-COVID-19 patients. RESULTS A total of 176 swabs were sampled of defined locations covering both ICUs. No SARS-CoV-2 ribonucleic acid (RNA) was detected. Gram-negative bacterial contamination was mainly linked to sinks and siphons. Skin flora was isolated from most swabbed areas and Enterococcus faecium was detected on two keyboards. CONCLUSIONS After basic cleaning with standard disinfection measures no remaining SARS-CoV-2 RNA was detected. Bacterial contamination was low and mainly localised in sinks and siphons

Hyperfiltration in normoalbuminuric type 1 diabetic patients: relationship with urinary albumin excretion rate [Utjecaj hiperfiltracije na razinu albumina u urinu u normoalbuminuričnih bolesnika s tipom 1 šećerne bolesti]

Hyperfiltration has been documented in type 1 diabetes and may contribute to the high risk for development of albuminuria and progression of nephropathy. However, recent studies suggest that the risk of progression to albuminuria in type 1 diabetes was not increased by hyperfiltration. We investigated associations of estimated glomerular filtration rate (eGFR) and urinary albumin excretion rate (UAE) in normoalbuminuric type 1 diabetic patients. Study included 313 normoalbuminuric patients with type 1 diabetes, none showed signs of adrenal, renal, or cardiovascular diseases. GFR was estimated using the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) formula. Glomerular hyperfiltration was defined as eGFR > or = 125 mL min(-1) 1.73 m(-2). Renal hyperfiltration was present in 12% of the study group. Subjects with eGFR > or = 125 mL min(-1) 1.73 m(-2) were younger, had shorter duration of diabetes, lower levels of total and LDL cholesterol, and higher HbA1c than subjects with an eGFR below 125 mL min(-1) 1.73 m(-2). Type 1 diabetic patients with hyperfiltration also had significantly lower UAE. In a multiple logistic regression analysis, higher eGFR was associated with lower UAE. Our results indicate that normoalbuminuric type 1 diabetic patients with hyperfiltration have lower UAE than those with renal function in the normal range. Together with other recent studies this may suggest that creatinine-based estimates of GFR indicating hyperfiltration is not associated with higher UAE and subsequent development of microalbuminuria

Alkaline phosphatase is independently associated with renal function in normoalbuminuric type 1 diabetic patients

Nonalcoholic fatty liver disease (NAFLD) is associated with an increased prevalence of chronic kidney disease in patients with type 1 diabetes. The aim of this study was to explore the relationship between markers of NAFLD, namely concentrations of aspartate aminotransferase (AST), alanine aminotransferase (ALT), alkaline phosphatase (ALK), γ-glutamyltransferase (GGT), bilirubin, and renal function in type 1 diabetic patients. This study included 313 normoalbuminuric type 1 diabetic patients with estimated glomerular filtration rate (eGFR) >60 mL/min/1.73 m(2), without clinical evidence of cirrhosis or other causes of chronic liver disease and before any interventions with statins, angiotensin-converting enzyme (ACE) inhibitors or angiotensin II receptor blockers. ALT, GGT, and bilirubin levels were significantly higher in subjects in the highest quartile of serum creatinine compared to those in lowest quartile (21 vs. 20 U/L, 18 vs. 14 U/L, and 14 vs. 10 µmol/L, respectively, for all p < 0.05). ALK levels were significantly higher in subjects in the highest quartile of urinary albumin excretion rate compared to those in lowest quartile (71 vs. 69 U/L, p = 0.03), as well as in hyperfiltrating subjects compared to those with normal or mildly impaired eGFR (81 vs. 68 and 64 U/L, p < 0.001). In a multiple logistic regression model adjusted for age, sex, duration of diabetes, HbA1c, and body mass index (BMI), only ALK levels were significantly associated with disturbances in serum creatinine and eGFR in our subjects (p ≤ 0.007), with odds ratios of 0.98-1.02. NAFLD associated markers, particularly ALK, are associated with renal function in normoalbuminuric type 1 diabetic patients

Total and LDL cholesterol are associated with glomerular filtration rate in normoalbuminuric type 1 diabetic patients [Ukupni i LDL kolesterol su povezani s glomerularnom flitracijom u normoalbuminuričnih bolesnika sa tipom 1 šećerne bolesti]

Studies have generally suggested a positive association between dyslipidemia and chronic kidney disease, but sparse data are available on the relation of lipids and glomerular filtration rate in patients with normal renal function. We investigated the associations of serum lipids, including total, LDL, HDL, VLDL cholesterol, and triglyceride levels with estimated glomerular filtration rate (eGFR) in type 1 diabetic patients. Study included 313 normoalbuminuric type 1 diabetic patients with normal or mild decrease (eGFR > 60 mL/min per 1.73 m2) renal function and before any interventions with statins, ACE inhibitors or angiotensin II receptor blockers. eGFR was significantly associated with total, LDL, and HDL cholesterol (r = -0.21, -0.18, and -0.17, respectively, for all p < 0.05). Stratifying serum lipids for degree of eGFR, levels of total, LDL, and HDL cholesterol were inversely related to eGFR, but trends were significant only for total (5.1 vs 5.0 and 4.6 mmol/L) and LDL cholesterol (2.9 vs 2.8 and 2.4 mmol/L). We have detected an association between eGFR and lipid abnormalities in type 1 diabetes in early stages. The study was conducted in patients with no therapeutic intervention. This may suggest that lipid abnormalities may play a role in the pathogenesis of renal impairment in type 1 diabetic patients

Total and LDL Cholesterol are Associated with Glomerular Filtration Rate in Normoalbuminuric Type 1 Diabetic Patients

Studies have generally suggested a positive association between dyslipidemia and chronic kidney disease, but sparse data are available on the relation of lipids and glomerular filtration rate in patients with normal renal function. We in- vestigated the associations of serum lipids, including total, LDL, HDL, VLDL cholesterol, and triglyceride levels with es- timated glomerular filtration rate (eGFR) in type 1 diabetic patients. Study included 313 normoalbuminuric type 1 diabetic patients with normal or mild decrease (eGFR > 60 mL/min per 1.73 m 2 ) renal function and before any interventions with statins, ACE inhibitors or angiotensin II receptor blockers. eGFR was significantly associated with total, LDL, and HDL cholesterol (r= –0.21, –0.18, and –0.17, respectively, for all p <0.05). Stratifying serum lipids for degree of eGFR, levels of total, LDL, and HDL cholesterol were inversely related to eGFR, but trends were significant only for total (5.1 vs 5.0 and 4.6 mmol/L) and LDL cholesterol (2.9 vs 2.8 and 2.4 mmol/L). We have detected an association between eGFR and lipid abnormalities in type 1 diabetes in early stages. The study was conducted in patients with no therapeutic inter- vention. This may suggest that lipid abnormalities may play a role in the pathogenesis of renal impairment in type 1 diabetic patients

Ukupni i LDL kolesterol su povezani s glomerularnom flitracijom u normoalbuminuričnih bolesnika sa tipom 1 šećerne bolesti

Studies have generally suggested a positive association between dyslipidemia and chronic kidney disease, but sparse data are available on the relation of lipids and glomerular filtration rate in patients with normal renal function. We investigated the associations of serum lipids, including total, LDL, HDL, VLDL cholesterol, and triglyceride levels with estimated glomerular filtration rate (eGFR) in type 1 diabetic patients. Study included 313 normoalbuminuric type 1 diabetic patients with normal or mild decrease (eGFR > 60 mL/min per 1.73 m2) renal function and before any interventions with statins, ACE inhibitors or angiotensin II receptor blockers. eGFR was significantly associated with total, LDL, and HDL cholesterol (r = -0.21, -0.18, and -0.17, respectively, for all p < 0.05). Stratifying serum lipids for degree of eGFR, levels of total, LDL, and HDL cholesterol were inversely related to eGFR, but trends were significant only for total (5.1 vs 5.0 and 4.6 mmol/L) and LDL cholesterol (2.9 vs 2.8 and 2.4 mmol/L). We have detected an association between eGFR and lipid abnormalities in type 1 diabetes in early stages. The study was conducted in patients with no therapeutic intervention. This may suggest that lipid abnormalities may play a role in the pathogenesis of renal impairment in type 1 diabetic patients.Mnoga istraživanja su potvrdila značaj dislipidemije u kroničnoj bubrežnoj bolesti, ali malo toga je poznato o utjecaju serumskih lipida na glomerularnu filtraciju u osoba sa normalnom bubrežnom funkcijom. Istraživali smo povezanost serumskih lipida (ukupnog, LDL, HDL, HDL2, HDL3, VLDL kolesterola i triglicerida) te glomerularne filtracije (GF) u bolesnika sa tipom 1 šećerne bolesti. Istraživanje je obuhvatilo 313 normoalbuminuričnih bolesnika sa tipom 1 šećerne bolesti s urednom ili blago sniženom bubrežnom funkcijom (GF >60 mL/min/ 1.73 m2) i prije terapije statinima, ACE-inhibitorima ili blokatorima angiotenzinskih receptora. GF procijenjena CKD-EPI iMDRD formulom bila je statistički značajno povezana s ukupnim, LDL, HDL, HDL2, i HDL3 kolesterolom (r= –0.21, –0.18, –0.17, –0.21, i –0.14, za sve p<0.05). Nakon podjele bolesnika prema stupnju GF, razina ukupnog, LDL, HDL i HDL2 kolesterola je bila u negativnoj povezanosti s razinom GF, ali je statistički značajna povezanost dokazana samo za razinu ukupnog (5.1 prema 5.0 i 4.6 mmol/L) i LDL kolesterola (2.9 prema 2.8 i 2.4 mmol/L). Rezultati istraživanja ukazuju da je lipidni poremećaj prisutan već u stanju normalne bubrežne funkcije u normoalbuminuričnih bolesnika sa tipom 1 šećerne bolesti i da je viša razina ukupnog i LDL kolesterola povezana s pogoršanjem GF. Prospektivne studije će pokazati da li navedeni lipidni poremećaji doprinose progresiji bubrežne bolesti u bolesnika sa tipom 1 šećerne bolesti

Ukupni i LDL kolesterol su povezani s glomerularnom flitracijom u normoalbuminuričnih bolesnika sa tipom 1 šećerne bolesti

Studies have generally suggested a positive association between dyslipidemia and chronic kidney disease, but sparse data are available on the relation of lipids and glomerular filtration rate in patients with normal renal function. We investigated the associations of serum lipids, including total, LDL, HDL, VLDL cholesterol, and triglyceride levels with estimated glomerular filtration rate (eGFR) in type 1 diabetic patients. Study included 313 normoalbuminuric type 1 diabetic patients with normal or mild decrease (eGFR > 60 mL/min per 1.73 m2) renal function and before any interventions with statins, ACE inhibitors or angiotensin II receptor blockers. eGFR was significantly associated with total, LDL, and HDL cholesterol (r = -0.21, -0.18, and -0.17, respectively, for all p < 0.05). Stratifying serum lipids for degree of eGFR, levels of total, LDL, and HDL cholesterol were inversely related to eGFR, but trends were significant only for total (5.1 vs 5.0 and 4.6 mmol/L) and LDL cholesterol (2.9 vs 2.8 and 2.4 mmol/L). We have detected an association between eGFR and lipid abnormalities in type 1 diabetes in early stages. The study was conducted in patients with no therapeutic intervention. This may suggest that lipid abnormalities may play a role in the pathogenesis of renal impairment in type 1 diabetic patients.Mnoga istraživanja su potvrdila značaj dislipidemije u kroničnoj bubrežnoj bolesti, ali malo toga je poznato o utjecaju serumskih lipida na glomerularnu filtraciju u osoba sa normalnom bubrežnom funkcijom. Istraživali smo povezanost serumskih lipida (ukupnog, LDL, HDL, HDL2, HDL3, VLDL kolesterola i triglicerida) te glomerularne filtracije (GF) u bolesnika sa tipom 1 šećerne bolesti. Istraživanje je obuhvatilo 313 normoalbuminuričnih bolesnika sa tipom 1 šećerne bolesti s urednom ili blago sniženom bubrežnom funkcijom (GF >60 mL/min/ 1.73 m2) i prije terapije statinima, ACE-inhibitorima ili blokatorima angiotenzinskih receptora. GF procijenjena CKD-EPI iMDRD formulom bila je statistički značajno povezana s ukupnim, LDL, HDL, HDL2, i HDL3 kolesterolom (r= –0.21, –0.18, –0.17, –0.21, i –0.14, za sve p<0.05). Nakon podjele bolesnika prema stupnju GF, razina ukupnog, LDL, HDL i HDL2 kolesterola je bila u negativnoj povezanosti s razinom GF, ali je statistički značajna povezanost dokazana samo za razinu ukupnog (5.1 prema 5.0 i 4.6 mmol/L) i LDL kolesterola (2.9 prema 2.8 i 2.4 mmol/L). Rezultati istraživanja ukazuju da je lipidni poremećaj prisutan već u stanju normalne bubrežne funkcije u normoalbuminuričnih bolesnika sa tipom 1 šećerne bolesti i da je viša razina ukupnog i LDL kolesterola povezana s pogoršanjem GF. Prospektivne studije će pokazati da li navedeni lipidni poremećaji doprinose progresiji bubrežne bolesti u bolesnika sa tipom 1 šećerne bolesti