The Kidney–Heart Connection
Mechanism of disease
Dysregulation of inter-related factors drives disease progression in patients with chronic kidney disease and diabetes
Chronic kidney disease progression in type 2 diabetes is driven by metabolic factors such as poor glycaemic control, haemodynamic factors including elevated blood pressure or intraglomerular pressure, and inflammatory and fibrotic factors. Dysregulation of these processes in the kidney leads to adverse pathophysiological changes associated with chronic kidney disease, which collectively drive chronic kidney disease progression.
Drivers of chronic kidney disease in type 2 diabetes progression
AGE, advanced glycation end-product; BP, blood pressure; CKD, chronic kidney disease; CTGF, connective tissue growth factor; NADPH; reduced nicotinamide adenine dinucleotide phosphate; RAAS, renin–angiotensin–aldosterone system; ROS, reactive oxygen species; SAA, serum amyloid A; TGF-β, transforming growth factor-beta; VEGF-A, vascular endothelial growth factor A
1. Alicic RZ, et al. Clin J Am Soc Nephrol 2017;12:2032–2045
2. Mora-Fernández C, et al. J Physiol 2014;18:3997-4012
3. Bauersachs J, et al. Hypertension 2015;65:257–263
Examples of tubulointerstitial damage, inflammation and renal lesions in advancing chronic kidney disease in type 2 diabetes.
CKD, chronic kidney disease; ESKD, end-stage kidney disease; GBM, glomerular basement membrane; eGFR, estimated glomerular filtration rate; KIM-1, kidney injury molecular 1; KW, Kimmelstiel-Wilson; TNFR, tumor necrosis factor receptor; T2D, type 2 diabetes
Chen Y, et al. Kidney Dis. 2020;6:215–225
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