The Role of Aldosterone in the Development of Chronic Kidney Disease in Individuals with Type 2 Diabetes
Abstract
modern statistics confirm that diabetes has become an epidemic of the 21st century. According to the forecasts of the International Diabetes Federation, by 2045, the number of people with diabetes is expected to reach 784 million. Approximately 90% of cases involve type 2 diabetes, which is a major contributor to the development of chronic kidney and cardiovascular diseases. The role of aldosterone in the progression of persistent kidney filtration rate disorders is particularly important due to the high prevalence of microvascular complications in individuals with type 2 diabetes, especially diabetic nephropathy. The activation of the renin-angiotensin-aldosterone system, alongside inflammatory processes, fibrotic changes in the kidneys, endothelial dysfunction, and disturbances in carbohydrate metabolism, are key pathogenetic factors in the development and progression of cardio-renal-metabolic syndrome. This syndrome, officially recognized by the American Heart Association, encompasses chronic kidney disease, which significantly worsens the clinical condition and prognosis of individuals with type 2 diabetes. Understanding the relationship between aldosterone levels and irreversible changes in kidney filtration rate in patients with type 2 diabetes is essential for exploring the mechanisms of the renin-angiotensin-aldosterone system's impact on kidney function in diabetic nephropathy. This study analyzed a range of parameters, including age, anthropometric indicators, carbohydrate metabolism, physical data, aldosterone levels, vitamin D (25OH) levels, and the albumin-to-creatinine ratio in daily urine. Participants were grouped according to their glomerular filtration rate, with a rate of <60 ml/min/1.73 m² indicating persistent pathological changes in the kidneys among individuals with type 2 diabetes. The results revealed a negative correlation between aldosterone levels and glomerular filtration rate in individuals with persistent kidney changes caused by diabetic nephropathy. These changes serve as risk factors for cardiovascular diseases. Elevated aldosterone levels, albuminuria, decreased glomerular filtration rate, and reduced vitamin D (25OH) levels were identified as early indicators of chronic kidney disease in individuals with type 2 diabetes.
References
Sun H, Saeedi P, Karuranga S, Pinkepank M, Ogurtsova K, Duncan BB et al. IDF Diabetes Atlas: Global, regional and country-level diabetes prevalence estimates for 2021 and projections for 2045. Diabetes Res Clin Pract. 2022;183:109119. doi: 10.1016/j.diabres.2021.109119
Diabetes is "a pandemic of unprecedented magnitude" now affecting one in 10 adults worldwide. Diabetes Res Clin Pract. 2021;181:109133. doi: 10.1016/j.diabres.2021.109133
Ahmad E, Lim S, Lamptey R, Webb DR, Davies MJ. Type 2 diabetes. Lancet. 2022;400(10365):1803-1820. doi: 10.1016/S0140-6736(22)01655-5
Zheng Y, Ley SH, Hu FB. Global aetiology and epidemiology of type 2 diabetes mellitus and its complications. Nat Rev Endocrinol. 2018;14(2):88-98. doi: 10.1038/nrendo.2017.151
Morales J, Handelsman Y. Cardiovascular Outcomes in Patients With Diabetes and Kidney Disease: JACC Review Topic of the Week. J Am Coll Cardiol. 2023;82(2):161-170. doi: 10.1016/j.jacc.2023.04.052
Wang Z, do Carmo JM, da Silva AA, Fu Y, Hall JE. Mechanisms of Synergistic Interactions of Diabetes and Hypertension in Chronic Kidney Disease: Role of Mitochondrial Dysfunction and ER Stress. Curr Hypertens Rep. 2020;22(2):15. doi: 10.1007/s11906-020-1016-x
Conti S, Perico N, Novelli R, Carrara C, Benigni A, Remuzzi G. Early and late scanning electron microscopy findings in diabetic kidney disease. Sci Rep. 2018;8(1):4909. doi: 10.1038/s41598-018-23244-2
Watanabe K, Sato E, Mishima E, Miyazaki M, Tanaka T. What's New in the Molecular Mechanisms of Diabetic Kidney Disease: Recent Advances. Int J Mol Sci. 2022;24(1):570. doi: 10.3390/ijms24010570
Sawaf H, Thomas G, Taliercio JJ, Nakhoul G, Vachharajani TJ, Mehdi A. Therapeutic Advances in Diabetic Nephropathy. J Clin Med. 2022;11(2):378. doi: 10.3390/jcm11020378
Leoncini G, Viazzi F, De Cosmo S, Russo G, Fioretto P, Pontremoli R. Blood pressure reduction and RAAS inhibition in diabetic kidney disease: therapeutic potentials and limitations. J Nephrol. 2020;33(5):949-963. doi: 10.1007/s40620-020-00803-3
Jia G, Lockette W, Sowers JR. Mineralocorticoid receptors in the pathogenesis of insulin resistance and related disorders: from basic studies to clinical disease. Am J Physiol Regul Integr Comp Physiol. 2021;320(3):R276-R286. doi: 10.1152/ajpregu.00280.2020
Marassi M, Fadini GP. The cardio-renal-metabolic connection: a review of the evidence. Cardiovasc Diabetol. 2023;22(1):195. doi: 10.1186/s12933-023-01937-x
Fenta ET, Eshetu HB, Kebede N, Bogale EK, Zewdie A, Kassie TD, Anagaw TF, Mazengia EM, Gelaw SS. Prevalence and predictors of chronic kidney disease among type 2 diabetic patients worldwide, systematic review and meta-analysis. Diabetol Metab Syndr. 2023;15(1):245. doi: 10.1186/s13098-023-01202-x
Zhao X, An X, Yang C, Sun W, Ji H, Lian F. The crucial role and mechanism of insulin resistance in metabolic disease. Front Endocrinol (Lausanne). 2023;14:1149239. doi: 10.3389/fendo.2023.1149239
Podkowińska A, Formanowicz D. Chronic Kidney Disease as Oxidative Stress- and Inflammatory-Mediated Cardiovascular Disease. Antioxidants (Basel). 2020;9(8):752. doi: 10.3390/antiox9080752
Gao J, Song X, Ou H, Cheng X, Zhang L, Liu C, Dong Y, Wang X. The association between vitamin D and the progression of diabetic nephropathy: insights into potential mechanisms. Front Med (Lausanne). 2024;11:1388074. doi: 10.3389/fmed.2024.1388074
Ganimusa I, Chew E, Lu EM. Vitamin D Deficiency, Chronic Kidney Disease and Periodontitis. Medicina (Kaunas). 2024;60(3):420. doi: 10.3390/medicina60030420
This work is licensed under a Creative Commons Attribution 4.0 International License.
ISSN 
ISSN 
