Renal disease in obesity and diabetes. Advances in pathogenesis and therapeutics
November 24 - 25, 2017
Obesity and type 2 diabetes (T2DM) are two major risk factors for renal disease. The term Diabesity is used to describe the close relationship between T2DM and obesity and their common metabolic and pathogenic pathways. Worldwide, more than 400 million people have T2DM and about 2 billion subjects are overweight or obese. The fast growing prevalence of both T2DM and obesity makes diabesity an important challenge in nephrology. Obese patients frequently present the two main causes of end stage renal disease in developed countries, T2DM and hypertension. Moreover, obesity itself can cause specific renal diseases (such as obesity-related glomerulopathy) or increase the risk of progression of kidney diseases irrespective of the underlying cause. The pathogenetic pathways through which obesity causes/worsens renal disease are not completely known, although some possible explanations have been put forward. Are we closer to understanding the physiopathology of diabesity? Along with a small number of drugs, weight loss, by surgical and non-surgical interventions, has been tried in patients with diabesity, with some promising results in kidney damage prevention and treatment. Who benefits from these interventions? During the last 2 or 3 years new antidiabetic drugs showed promising results regarding its renal protective effects. What expectations can we have in these new drugs?
DIABETES AND OBESITY IN RENAL DISEASE
CME at the 54th ERA-EDTA Congress
Madrid (Spain) - June 3, 2017
DIABESITY IN RENAL TRANSPLANTATION
Joint CME course of the DIABESITY and the DESCARTES working groups of the ERA-EDTA
Sitges (Spain) - December 2-3, 2016
Post-Transplant Diabetes Mellitus (PTDM) and obesity are frequent complications after renal transplantation. PTDM affects up to 30% of renal transplant recipients, which doubles the prevalence of type 2 diabetes observed in the general population. The consequences of PTDM are severe: it is associated with a reduced patient survival, high risk of infections and cardiovascular disease, diminishes quality of life and increases health care expenditure. Obesity, particularly associated with metabolic syndrome -metabolically unhealthy obesity- is frequent after transplantation and is associated with increased risk for allograft dysfunction. In this CME we will evaluate diverse aspects of PTDM and obesity including: pathogenesis, impact, long-term evolution and treatment, as well as the consequences of obesity and metabolic syndrome in renal transplantation.
EVALUATION OF RENAL FUNCTION AND RENAL RISK IN THE TWENTY-FIRST CENTURY
Ranica, Bergamo, Italy - December 4 and 5, 2015
The second CME course of the DIABESITY working group was held in the Clinical Research Center for Rare Diseases “Aldo e Cele Daccò”, Mario Negri Institute for Pharmacological Research Villa Camozzi, via Camozzi, 3 - 24020 Ranica, Bergamo (Italy). The topic of the CME was: “Evaluation of renal function and renal risk in the twenty-first century”.
In this meeting we analyzed important aspects of renal disease related to diabetes and obesity. For more details you can see the program of the CME (click here to view the program).
We evaluated the error of estimated GFR by formulas either creatinine and/or cystatin-based and the consequences of this error in clinical practice and research. We discussed the lack of accuracy and precision of formulas to detect GFR and GFR decline over time, the fact that formulas rarely detect glomerular hyperfiltration, the published evidence in type 2 diabetes, obesity, renal and non-renal transplant patients, cancer patients who will be treated with toxic drugs and the frequent error in the classification of the stages of CKD. Also, we evaluated the impact of the error of formulas in clinical trials in nephrology.
Finally, we reviewed new possible risk factors for renal disease in diabetes.
Seven abstracts were presented in the meeting (click here to see the abstracts).
More than 90 researchers, clinicians, phD and post-doc students attended the meeting and 8 posters (link) were presented. One of the major achievements of the event was a very active participation of the attendees with questions, comments and interaction with the speakers. Most of the talks will be published in NEPHRON.
DIABESITY organized two CME, the first in the 51th ERA-EDTA congress in Amsterdam, and the second in Tenerife, November 1 and 2, 2014.
To have an idea of the topics, please give a look to the programs: Amsterdam 2014 (program); Tenerife 2014 (program).
The CME course DIABESITY: Diabetes and Obesity in renal Disease organized by the ERA-EDTA DIABESITY Working Group (WG) took place on 1 and 2 November 2014 in Puerto de la Cruz, Tenerife. High-level scientists and experienced physicians from different regions of the world shared their latest findings and experiences on 6 key topics of the impact of diabetes and obesity in renal disease: (a) epidemiological and clinical aspects, (b) pathogenesis, (c) histology, (d) interventions on life style, (e) and novel biomarkers of renal disease. A fruitful poster session was also held on the afternoon of the first day. The event hosted 90 attendees from around the globe, from Australia to Pakistan. Each talk included an extensive Q&A, allowing the audience the opportunity to engage with the speakers and their presentations. Moreover, the course venue, the Las Aguilas Hotel, located on a mountain top with a stunning panoramic view, was the perfect setting to pursue new acquaintances before or after sessions, at breakfast or during lunch and tea breaks.
The CME was a two-day intensive course. On the morning of day 1 the international audience was introduced to the course contents and to the work of DIABESITY. It was especially highlighted the current problem of overweight and obesity which currently affect 2.16 billion people; diabetes which affects over 382 million people, a number that is expected to double by 2035. Such gloomy forecasts portend severe consequences in Nephrology. Obesity is the major risk factor for type 2 diabetes, which in turn is associated with nephropathy in about one third of patients. Overweight and obesity are also independent risk factors for chronic kidney disease, regardless of the association with diabetes. Also, it was indicated that obesity, especially unhealthy obesity, and diabetes, share common markers of renal disease: glomerular hyperfiltration, albuminuria, insulin resistance, chronic subclinical inflammation, alterations in lipid metabolism, among others. Thus, obesity and diabetes may represent a continuum in renal disease. This claims to join forces in order to identify crucial areas for basic and clinical research questions and to share understandings towards long-term population-level health benefits.
Major topics included the (a) risk factors for renal disease in obesity like lipotoxicity, insulin resistance and inflammation, (b) a complete description of obesity related glomerulopathy, (c) the impact of hyperfiltration on renal function decline over time, (e) the impact of overweight/obesity and weight reduction in renal function changes over time, (f) the relevance of measured GFR versus estimated GFR in clinical studies in diabetes, (g) new biomarkers of renal disease beyond albuminuria, and many others.
Also, an initiative of the WG, the creation of and European Nephrectomy Bio-Bank was shown to all the participants of the group. Sources of funding were also addressed and speakers and attendees were asked to take up the challenge.
Finally the day after the CME, a group of 50 patients from the Nephrology Unit of the Hospital Universitario de Canarias (Tenerife) were invited to a conference in the hospital to receive information about some aspects discussed in the course. Also, Manuela Abbate explained the importance of losing weight in the evolution of renal disease.
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