Kidney dysfunction is a common complication of diabetes that can increase the risk of heart failure and death. A new study reveals the mechanisms behind this link and how anti-obesity drugs can help prevent it.
Kidney dysfunction and heart failure in diabetes
Diabetes is a chronic condition that affects how the body regulates blood sugar levels. High blood sugar can damage various organs and tissues, including the kidneys. The kidneys are responsible for filtering waste and excess fluid from the blood. When the kidneys are damaged, they cannot perform this function properly, leading to a condition called kidney dysfunction or chronic kidney disease (CKD).
Kidney dysfunction can have a serious negative impact on cardiovascular health. Studies have shown that it can lead to hardening of the arteries, known as atherosclerosis. This can reduce the blood flow to the heart and other vital organs, increasing the risk of heart attack, stroke, and heart failure. Heart failure is a condition where the heart cannot pump enough blood to meet the body’s needs.
According to a recent study published in the Journal of the American Heart Association, kidney dysfunction may increase the risk and predict sudden cardiac arrest among Hispanic/Latino adults with diabetes. Sudden cardiac arrest is a life-threatening emergency that occurs when the heart suddenly stops beating. It can cause death within minutes if not treated promptly.
The study analyzed data from more than 16,000 participants of the Hispanic Community Health Study/Study of Latinos (HCHS/SOL), the largest and most comprehensive study of Hispanic/Latino health in the United States. The researchers found that participants with diabetes and kidney dysfunction had a higher risk of sudden cardiac arrest than those with diabetes and normal kidney function. They also found that kidney dysfunction was a better predictor of sudden cardiac arrest than other factors, such as age, sex, body mass index, obesity, hypertension, high blood cholesterol, smoking, and history of heart disease.
The role of GLP-1 and RAGE receptors in kidney dysfunction and heart failure
The researchers also explored the possible mechanisms behind the link between kidney dysfunction and heart failure in diabetes. They focused on two receptors that are involved in glucose metabolism and inflammation: the glucagon-like peptide-1 (GLP-1) receptor and the receptor for advanced glycation end products (RAGE).
GLP-1 is a hormone that stimulates insulin secretion and lowers blood sugar levels. It also has anti-inflammatory and cardioprotective effects. GLP-1 receptor agonists are a class of drugs that mimic the action of GLP-1 and are used to treat type 2 diabetes and obesity. Some examples of GLP-1 receptor agonists are semaglutide, liraglutide, and exenatide.
RAGE is a receptor that binds to advanced glycation end products (AGEs), which are harmful substances that accumulate in the body as a result of high blood sugar and oxidative stress. AGEs can trigger inflammation and oxidative stress, leading to tissue damage and organ dysfunction. RAGE is expressed in various tissues, including the kidneys and the heart. RAGE activation can promote kidney injury and heart failure in diabetes.
The researchers found that GLP-1 receptor signaling modifies the extent of diabetic kidney disease through dampening the RAGE-induced inflammation. They showed that GLP-1 receptor agonists can reduce the expression and activation of RAGE in the kidneys and the heart of diabetic mice. They also showed that blocking the interaction between GLP-1 receptor agonists and RAGE can prevent the beneficial effects of GLP-1 receptor agonists on kidney and heart function.
The implications of the study for the prevention and treatment of kidney dysfunction and heart failure in diabetes
The study provides new insights into the pathophysiology of kidney dysfunction and heart failure in diabetes. It also reveals how anti-obesity drugs like Ozempic, which is a brand name of semaglutide, actually work to protect the kidneys and the heart. Ozempic is a GLP-1 receptor agonist that was developed to treat type 2 diabetes and obesity. It has been shown to lower blood sugar levels, reduce body weight, and improve cardiovascular outcomes in clinical trials.
The study suggests that the protective effects of Ozempic and other GLP-1 receptor agonists on the kidneys and the heart are mediated by the inhibition of RAGE signaling. This opens up new therapeutic drug targets for the prevention and treatment of kidney dysfunction and heart failure in diabetes. By targeting RAGE, it may be possible to enhance the efficacy of GLP-1 receptor agonists or develop new drugs that can block RAGE activation.
The study also highlights the importance of screening and monitoring kidney function in diabetic patients, especially those who are at high risk of sudden cardiac arrest. Kidney dysfunction can be detected by measuring the estimated glomerular filtration rate (eGFR), which is a widely accepted measure of how well the kidneys are working. A normal eGFR value is expected to be above 90 mL/min per 1.73 m2 body surface area, while a low eGFR indicates kidney dysfunction.
Early detection and treatment of kidney dysfunction can help prevent or delay the progression of kidney disease and reduce the risk of cardiovascular complications. Diabetic patients with kidney dysfunction may benefit from taking GLP-1 receptor agonists or other drugs that can improve kidney and heart function. However, these drugs should be used with caution and under medical supervision, as they may have side effects or interactions with other medications.