Breaking News
January 17, 2018 - Lactation May Lower T2D Risk in Younger Women
January 17, 2018 - New Atopic Dermatitis Yardstick provides practical guidance and management insights
January 17, 2018 - New biodegradable pressure sensor could help monitor serious health conditions
January 17, 2018 - HSS orders Sectra’s 3D pre-operative planning solution for improving patient outcomes
January 17, 2018 - Study identifies six new genes regions associated with diabetes
January 17, 2018 - Women do not receive timely diagnosis for heart disease
January 17, 2018 - AbbVie’s Upadacitinib Shows Positive Results as Monotherapy in Phase 3 Rheumatoid Arthritis Study, Meeting All Primary and Key Secondary Endpoints
January 17, 2018 - Should President Trump’s Physical Include a Cognitive Screen?
January 17, 2018 - Could gene therapy someday eliminate HIV?
January 17, 2018 - Researchers identify new anti-inflammatory drug target
January 17, 2018 - Loxo Oncology Initiates Rolling Submission of New Drug Application to U.S. Food and Drug Administration for Larotrectinib for the Treatment of TRK Fusion Cancers
January 17, 2018 - Trunk Imaging Tied to Higher Nephrectomy Risk
January 17, 2018 - Campaigners incensed at failings in Africa AIDS war
January 17, 2018 - Research opens door to development of new treatment for type 2 diabetes
January 17, 2018 - Bariatric surgery extends lifespan in obese patients, shows study
January 17, 2018 - Bristol-Myers Squibb Receives FDA Approval for Opdivo (nivolumab) as Adjuvant Therapy in Patients with Completely Resected Melanoma with Lymph Node Involvement or Metastatic Disease
January 17, 2018 - Ewww Moments in the ER: That’s Improbable!
January 17, 2018 - Methods from optogenetics, machine learning should help improve treatment options for stroke patients
January 17, 2018 - Booze may help or harm the heart, but income matters
January 17, 2018 - Three-dimensional organization of genome plays key role in gene expression, cell fate
January 17, 2018 - Scientists identify six new gene regions that may help treat type 1 diabetes
January 17, 2018 - Top nutrients needed to boost mood and energy levels on Blue Monday
January 17, 2018 - Scientists develop unique technique to map elasticity of cell components
January 17, 2018 - Obesity surgery reduces the risk of death by half finds new study
January 17, 2018 - Raw Meat Not the Safest Choice for Your Dog or for You
January 17, 2018 - Men who lack HSD17B4 gene may be more susceptible to treatment-resistant prostate cancer
January 17, 2018 - High-Dose Aspirin Preferred for Kawasaki’s
January 17, 2018 - Study suggests risk management approach to combat EMS fatigue
January 17, 2018 - A new therapy against obesity
January 17, 2018 - Doctors warn against holding your nose and closing your mouth to contain a sneeze
January 17, 2018 - Measles outbreak alarms public health officials
January 17, 2018 - FDA Slaps Class Warning on Gadolinium Contrast Agents
January 17, 2018 - Distinct human mutations can alter the effect of medicine
January 17, 2018 - ASIT biotech’s new article presents clinical results of gp
January 17, 2018 - Alternative tobacco use by adolescents associated with greater odds of future cigarette smoking
January 17, 2018 - A High-Salt Diet Produces Dementia In Mice
January 17, 2018 - Scientists provide insights into crucial interaction for DNA repair
January 17, 2018 - Sanofi and Regeneron Announce Positive Topline Pivotal Results for PD-1 Antibody Cemiplimab in Advanced Cutaneous Squamous Cell Carcinoma
January 17, 2018 - Morning Break: Pfizer Kills AD/PD Pipeline; Trump Affirms His Mental Health; Humira Pricing Strategy
January 17, 2018 - Researchers see gene influencing performance of sleep-deprived people
January 17, 2018 - Fast food triggers the immune system making it hyperactive
January 17, 2018 - Scientists find increased risk of HIV outbreaks in Ukraine due to war-related migration
January 17, 2018 - New universal flu vaccine moves to clinical trial phase and could be a reality soon
January 17, 2018 - Cocaine de-addiction breakthrough shows promise
January 17, 2018 - FDA Accepts New Drug Application for Seysara (sarecycline) for the Treatment of Moderate to Severe Acne
January 17, 2018 - Robotic Telestenting; BP Cuff Smartwatch; Medicare Bundled Care
January 17, 2018 - New cellular approach found to control progression of chronic kidney disease
January 17, 2018 - Lamprey genes provide clues to repair spinal cord damage, finds study
January 17, 2018 - Tissue-based soft robot could lead to advances in bio-inspired robotics
January 17, 2018 - Mostly the healthy and wealthy Americans use mobile phone apps to track sleep habits
January 17, 2018 - FDA Alert: Varubi (rolapitant) Injectable Emulsion: Health Care Provider Letter
January 16, 2018 - NeuroBreak: Rough Days for Neuroscience Research; Another Migraine Drug Advances
January 16, 2018 - The ‘greatest pandemic in history’ was 100 years ago – but many of us still get the basic facts wrong
January 16, 2018 - Serena Williams Shares Childbirth Ordeal
January 16, 2018 - The Artificial Brain as Doctor
January 16, 2018 - Type 2 diabetes has hepatic origins
January 16, 2018 - Expert discusses how to identify, support individuals with drug or alcohol addiction in workplace
January 16, 2018 - Starting menstruation early increases risk of cardiovascular disease and stroke in later life
January 16, 2018 - CapsoVision receives CE Mark approval for use of CapsoCam Plus System in pediatric patients
January 16, 2018 - Researchers develop new dynamic statistical model to follow gene expressions over time
January 16, 2018 - Alzheimer’s ‘looks like me, it looks like you’
January 16, 2018 - By the Numbers: Physicians’ Economic Impact
January 16, 2018 - Sound Health | NIH News in Health
January 16, 2018 - Modifying baby formula doesn’t prevent type 1 diabetes in children
January 16, 2018 - Energy drinks dangerous for kids
January 16, 2018 - When you need a breast screening, should you get a 3-D mammogram?
January 16, 2018 - Johns Hopkins gets approval to perform HIV positive to HIV positive living donor kidney transplants
January 16, 2018 - The Salk Institute and Indivumed collaborate for cutting-edge cancer research
January 16, 2018 - Study reveals negative long-term effects of heavy cannabis use on brain function and behavior
January 16, 2018 - Many gym-goers injure themselves by pushing harder to be better than friends
January 16, 2018 - Risankizumab Meets All Primary Endpoints Reporting Positive Results in Fourth Pivotal Phase 3 Psoriasis Study
January 16, 2018 - Federal Junk Food Tax Feasible, Study Says
January 16, 2018 - Do girls have stronger teeth than boys?
January 16, 2018 - New high-sensitivity blood tests could aid faster diagnosis and treatment for heart attack
January 16, 2018 - How fatal mitochondrial diseases may strike offspring of families with no history of the conditions
January 16, 2018 - TherapeuticsMD Announces FDA Acceptance of New Drug Application and Prescription Drug User Fee Act (PDUFA) Date for TX-004HR
January 16, 2018 - Morning Break: Food Pharmacies; Obamacare Sign-ups Dip; Top Pot Studies
January 16, 2018 - Blood pressure declines 14 to 18 years before death
January 16, 2018 - ViLim Ball technology helps reduce uncontrollable shaking hands
January 16, 2018 - Researchers use immune-mimicking biomaterial scaffolds to fast track T cell therapies
High Blood Urea Nitrogen Levels Tied to T2D Risk

High Blood Urea Nitrogen Levels Tied to T2D Risk

image_pdfDownload PDFimage_print

Action Points

  • Kidney function may be an effective predictor of type 2 diabetes risk — in those with normal estimated glomerular filtration rate (eGFR) levels, high levels of blood urea nitrogen was tied to an increased risk for diabetes.
  • There was no association with incident diabetes risk across any eGFR groups in individuals with lower BUN levels (≤25 mg/dL).

Kidney function may be an effective predictor of type 2 diabetes risk, researchers reported.

In those with normal estimated glomerular filtration rate (eGFR) levels (≥60 ml/min per 1.73 m2), high levels of blood urea nitrogen (BUN) — >25 mg/dL — was tied to an increased risk for diabetes (hazard ratio 1.27, 95% CI 1.24-1.31), according to Yan Xie, MPH, of the VA Saint Louis Health Care System in Missouri, and colleagues.

The highest risk for incident diabetes was among those with BUN >25 mg/dL paired with an eGFR <15 ml/min per 1.72 m2 (HR 1.68, 95% CI 1.51-1.87), they wrote in Kidney International.

“We have known for a long time that diabetes is a major risk factor for [chronic kidney disease or CKD], but now we have a better understanding that kidney disease, through elevated levels of urea, also raises the risk of diabetes,” said co-author Ziyad Al-Aly, MD, of Washington University in St. Louis, in a press release.

“When urea builds up in the blood because of kidney dysfunction, increased insulin resistance and impaired insulin secretion often result,” he added.

Al-Aly pointed out that “Our results were almost an exact replica of the mouse study. The results showed a clear relationship between urea levels and risk of diabetes.”

The analysis included 1,337,452 individuals from the U.S. Department of Veterans Affairs database, none of whom had diabetes at baseline. Over the median follow-up period of 4.93 years, there were 172,913 (12.93%) incident cases of diabetes. In a weighted analysis, there were 210,873 incident diabetes cases — 23,649 of which occurred in those with a BUN >25 mg/dL (19.85%) versus 18,224 cases in those with a BUN ≤25 (15.32%).

In addition to normal and the highest levels of eGFR, all other groups with elevated BUN levels (>25 mg/dL) also reported an increased incidence for diabetes:

  • 60>eGFR≥45 ml/min per 1.73 m2: HR 1.23 (95% CI 1.20-1.27)
  • 45>eGFR≥30 ml/min per 1.73 m2: 1.18 (1.15-1.22)
  • 30>eGFR≥15 ml/min per 1.73 m2: 1.22 (1.17-1.27)

Younger individuals with high BUN levels in the cohort had a stronger associated diabetes risk compared with those older than the median of age 65 (HR 1.35, 95% CI 1.33-1.37 vs HR 1.20, 1.16-1.24). High BUN levels tied to diabetes risk was also stronger in black individuals compared with other races (HR 1.38, 95% CI 1.34-1.43 vs. HR 1.21, 1.20-1.22).

There was no association with incident diabetes risk across any eGFR groups in individuals with lower BUN levels (≤25 mg/dL).

In an independent assessment of time-updated eGFR levels, those in the lowest two categories of eGFR — 30>eGFR≥ 15 and <15 -- had an increased risk for incident diabetes (HR 1.17, 1.12-1.22; HR 1.64, 1.48-1.82, respectively).

In a two-stage residual inclusion analysis, the research group confirmed an elevated BUN concentration was independently linked with an increased diabetes risk, with every 10 mg/dL increase tied to an increased diabetes risk (HR 1.09, 95% CI 1.08–1.10). However, each 10 ml/min per 1.73 m2 increase in eGFR had no significant impact in diabetes risk (HR 0.99, CI 0.99–1.00).

“Although increased insulin resistance in CKD is now a universally recognized concept, the notion of beta-cell dysfunction (and possibly an insulin secretory defect) in CKD is still not yet widely accepted,” the authors wrote, highlighting how prior study findings paired with their current findings “lends validity and provides epidemiologic evidence in humans of an association between circulating levels of urea and the risk of the development of diabetes in patients with nondiabetic kidney disease.”

“However, our studies cannot attribute the effect seen to decreased insulin secretion (and beta-cell dysfunction) or increased insulin resistance or a combination of both,” they noted. They called for additional research to validate the findings, and to assess potential interventions, such as pharmacology, manipulation of the microbiome, or through other methods.

Click here for the American Association of Clinical Endocrinologists’ type 2 diabetes management algorithm and resource center for the management of diabetes comorbidities including CKD.

The study was funded by a grant from the U.S. Department of Veterans Affairs.

Xie and co-authors disclosed no relevant relationships with industry.

  • Reviewed by
    Robert Jasmer, MD Associate Clinical Professor of Medicine, University of California, San Francisco and Dorothy Caputo, MA, BSN, RN, Nurse Planner

2017-12-11T09:30:00-0500

Tagged with:

About author

Related Articles