Gert Mayer - Academia.edu (original) (raw)

Papers by Gert Mayer

Diabetes Care, Jul 6, 2018

Diabetes and Vascular Disease Research, Sep 21, 2018

Background: The number of patients with type 2 diabetes mellitus and diabetes mellitus-associated... more Background: The number of patients with type 2 diabetes mellitus and diabetes mellitus-associated chronic kidney disease varies considerably between countries. Next to differences in genetic as well as life style risk factors, varying practices in medical care delivery might cause this diversity. Method: The PROVALID study recruited 4000 patients with type 2 diabetes mellitus at the primary level of healthcare in five European countries (Austria, Hungary, The Netherlands, Poland and Scotland). Baseline data were used to describe patient characteristics and compare the adherence to ADA (American Diabetes Association) and KDIGO (Kidney Disease: Improving Global Outcomes) guidelines with respect to metabolic and blood pressure control, use of renin-angiotensin system-blocking agents, statins and acetylsalicylic acid between the countries. Results: About 34.8% of the population had evidence of diabetes mellitus-associated chronic kidney disease. The median HbA1c level of the cohort was 6.8% (ranging from 6.5 in Poland to 7.0% in Scotland). Mean blood pressure was 136/79 (±17/10) and significantly higher in subjects with elevated albuminuria. These individuals also were more often treated with renin-angiotensin system-blocking agents (74.1% vs 84.6%), whereas the use of statins was driven by cardiovascular comorbidity. Acetylsalicylic acid was used in only 28.9% subjects. Despite similar cardiovascular comorbidities and renal function, the use of renin-angiotensin system-blocking agents varied significantly between the countries from 66.7% to 87.4%. An even higher variability was observed for patients >40 years of age using statins (39.8%-82.7%) and administration of acetylsalicylic acid in patients older than 50 years (5.2%-43.8%). Conclusion: Our study shows that medical practice in type 2 diabetes mellitus patients with and without renal disease is different in European countries. Longitudinal follow-up will reveal if this diversity affects clinical endpoints.

Kidney International, Dec 1, 2019

R. (2019). Integrative analysis of prognostic biomarkers derived from multiomics panels helps dis... more R. (2019). Integrative analysis of prognostic biomarkers derived from multiomics panels helps discrimination of chronic kidney disease trajectories in people with type 2 diabetes.

Kidney & Blood Pressure Research, 2023

Introduction: Type 2 diabetes and its complications represent a huge burden to public health. Wit... more Introduction: Type 2 diabetes and its complications represent a huge burden to public health. With this prospective, observational cohort study, we aimed to estimate and to compare the incidence rate (IR) of renal and cardiovascular outcomes and all-cause mortality in patients with type 2 diabetes in different European countries. Methods: The renal endpoint was a composite of a sustained decline in estimated GFR of at least 40%, a sustained increase in albuminuria of at least 30% including a transition in albuminuria class, progression to kidney failure with replacement therapy, or death from renal causes. The cardiovascular endpoint was a composite of death from cardiovascular causes, nonfatal myocardial infarction, or nonfatal stroke. Results: 3,131 participants from four European countries (Austria, Hungary, The Netherlands, and Scotland) with a median follow-up time of 4.4 years were included. IRs were adjusted for several risk factors including sex, age, estimated GFR, albuminuria, HbA 1c , blood pressure, and duration of type 2 diabetes. Across countries, the adjusted IR for the renal endpoint was significantly higher in Hungary and Austria, and the adjusted IR for the cardiovascular endpoint was significantly higher in Scotland and Austria. All-cause mortality was significantly higher in Scotland compared to all other countries. Conclusion: Our findings show how the longitudinal outcome of patients with type 2 diabetes varies significantly across European countries even after accounting for the distribution of underlying risk factors.

Diabetes Care, 2022

OBJECTIVE Finerenone significantly improved cardiorenal outcomes in patients with chronic kidney ... more OBJECTIVE Finerenone significantly improved cardiorenal outcomes in patients with chronic kidney disease (CKD) and type 2 diabetes (T2D) in the Finerenone in Reducing Kidney Failure and Disease Progression in Diabetic Kidney Disease trial. We explored whether baseline HbA1c level and insulin treatment influenced outcomes. RESEARCH DESIGN AND METHODS Patients with T2D, urine albumin-to-creatinine ratio (UACR) of 30–5,000 mg/g, estimated glomerular filtration rate (eGFR) of 25 to <75 mL/min/1.73 m2, and treated with optimized renin–angiotensin system blockade were randomly assigned to receive finerenone or placebo. Efficacy outcomes included kidney (kidney failure, sustained decrease ≥40% in eGFR from baseline, or renal death) and cardiovascular (cardiovascular death, nonfatal myocardial infarction, nonfatal stroke, or hospitalization for heart failure) composite endpoints. Patients were analyzed by baseline insulin use and by baseline HbA1c <7.5% (58 mmol/mol) or ≥7.5%. RESULTS...

Journal of the American Society of Nephrology, 1993

The effects of blood pressure reduction on cyclosporine nephrotoxicity were studied over 12 month... more The effects of blood pressure reduction on cyclosporine nephrotoxicity were studied over 12 months in four groups of rats. Group 1 received no drugs and served as controls. Groups 2, 3, and 4 received cyclosporine (CyA), approximately 9 mg/kg.day, in their food. In addition, Group 3 received enalapril and Group 4 received minoxidil, hydrochlorothiazide, and reserpine. Time-averaged monthly systolic blood pressure was equal in Groups 1 and 2 (136 +/- 1 and 135 +/- 1 mm Hg, respectively). Antihypertensive agents reduced average systolic blood pressure in Groups 3 and 4 (116 +/- 1 and 117 +/- 1 mm Hg, respectively). Morphometric studies showed that 12 months of CyA treatment caused interstitial fibrosis with an increase in the fractional volume of cortical interstitium (VvInt: Group 2, 20 +/- 1%; Group 1, 11 +/- 1%) and a reduction in mean glomerular volume (VG. Group 2, (2.00 +/- 0.06) x 10(6) mu 3; Group 1, (2.48 +/- 0.06) x 10(6) mu 3). These structural changes were accompanied by a...

Nephrology Dialysis Transplantation, 2013

Kidney & Blood Pressure Research, 2018

This article is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 I... more This article is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License (CC BY-NC-ND) (http://www.karger.com/Services/OpenAccessLicense). Usage and distribution for commercial purposes as well as any distribution of modified material requires written permission.

PubMed, Feb 28, 2002

Background: Proteinuria in Heymann's nephritis, an experimental rat model disease corresponding t... more Background: Proteinuria in Heymann's nephritis, an experimental rat model disease corresponding to membranous nephropathy, has been shown to be due to lipid peroxidation. Since the pathophysiology might be similar to idiopathic membranous nephropathy in humans, we performed a prospective multicenter trial to investigate the efficacy of the lipid peroxidation scavenger, probucol. Methods: Fifteen patients with biopsy-proven idiopathic membranous nephropathy resistant to conventional immunosuppressive therapy (n = 7) and/or ACEI treatment (n = 12) were recruited. Probucol (1 g/d orally) was administered for three months, followed by a washout period of four weeks, whereon lovastatin (10-20 mg/d orally) was administered for additional three months. Results: A significant reduction in proteinuria was seen during the probucol treatment (median (range): 6.4 (3.8-9.1) g/d vs. 4.7 (1.3-16) g/d; P < 0.05), with partial remission achieved in four patients. Three of these patients had previously been resistant to immunosuppressive therapy. Median protein excretion increased to pretreatment values during the washout period (6.2 (1.9-15) g/d; P < 0.05) and was not significantly different after the intake of lovastatin (4.9 (1.8-19) g/d; P = NS). None of the patients achieved partial remission during lovastatin therapy (P < 0.05 vs. probucol). Conclusion: The present study led us to conclude that proteinuria can be reduced by probucol in some patients with idiopathic membranous nephropathy. A randomized multicenter study to further elucidate the influence of lipid peroxidation scavengers on membranous nephropathy is warranted.

Nephrology Dialysis Transplantation, Aug 1, 2003

Background. Regional variability in the incidence of end-stage renal disease (ESRD) in Austria is... more Background. Regional variability in the incidence of end-stage renal disease (ESRD) in Austria is reported. Our aim was to investigate the reason for low rates in the state of Tyrol. Methods. ESRD incidence data were obtained from the Austrian Dialysis and Transplantation Registry. Additional sources were two health interview surveys, the Hospital Discharge Registry, the Mortality Registry and the Drug Wholesale Registry. Results. Between 1995 and 1999, 4811 new cases of ESRD were recorded; the state of Tyrol (T) had a mean annual, age-adjusted incidence of 97.9/1 000 000 population [95% confidence interval (CI) 86.9-109.1], a number significantly lower than that for the rest of Austria [(RA), 120.9 (95% CI 116.9-124.5); P < 0.001]. This was due mainly to a difference in the incidence of ESRD patients with type 2 diabetes mellitus [(DM-2) T ¼ 12.2 (95% CI 8.2-16.2) vs RA ¼ 28.9 (95% CI 27.2-30.6); P < 0.001]. When these patients were excluded, the difference in the overall ESRD incidence disappeared. When data from various registries were analysed for the prevalence of DM, a highly significant correlation was found between ESRD incidence and DM. Conclusion. We conclude that the variability in the ESRD incidence in Austria is explained mainly by regional differences in DM-2. Data from similar studies might be useful for predictions concerning resource allocation for ESRD programmes in the future.

International Journal of Molecular Sciences

Type II diabetes mellitus (T2DM) accounts for approximately 90% of all diabetes mellitus cases in... more Type II diabetes mellitus (T2DM) accounts for approximately 90% of all diabetes mellitus cases in the world. Glucagon-like peptide-1 receptor (GLP-1R) agonists have established an increased capability to target directly or indirectly six core defects associated with T2DM, while the underlying molecular mechanisms of these pharmacological effects are not fully known. This exploratory study was conducted to analyze the effect of treatment with GLP-1R agonists on the urinary peptidome of T2DM patients. Urine samples of thirty-two T2DM patients from the PROVALID study (“A Prospective Cohort Study in Patients with T2DM for Validation of Biomarkers”) collected pre- and post-treatment with GLP-1R agonist drugs were analyzed by CE-MS. In total, 70 urinary peptides were significantly affected by GLP-1R agonist treatment, generated from 26 different proteins. The downregulation of MMP proteases, based on the concordant downregulation of urinary collagen peptides, was highlighted. Treatment al...

Journal of Clinical Medicine, 2021

Most trials on mRNA vaccines against SARS-CoV-2 did not include patients with chronic kidney dise... more Most trials on mRNA vaccines against SARS-CoV-2 did not include patients with chronic kidney disease (CKD), hemodialysis (HD) patients, or kidney transplant recipients (KTR). However, those patients have a higher risk for a severe course of COVID-19 disease and mortality. Available literature has demonstrated a reduced efficacy of mRNA vaccines in HD patients and KTR, while data on CKD patients is scarce. Additionally, factors associated with non-response are poorly understood and not well characterized. We assessed antibody (AB) response (n = 582, 160 CKD patients, 206 patients on HD, 216 KTR) after the administration of two doses of a mRNA-vaccine with either BNT162b2 or mRNA-1273. AB measurements were carried out after a median of 91 days after first vaccinations, demonstrating non-response in 12.5% of CKD patients, 12.1% of HD patients, and 50% of KTR. AB titers were significantly higher in CKD patients than in HD patients or KTR. Factors associated with non-response were treate...

Diagnostic and Prognostic Research, 2021

Background Chronic kidney disease (CKD) is a well-established complication in people with diabete... more Background Chronic kidney disease (CKD) is a well-established complication in people with diabetes mellitus. Roughly one quarter of prevalent patients with diabetes exhibit a CKD stage of 3 or higher and the individual course of progression is highly variable. Therefore, there is a clear need to identify patients at high risk for fast progression and the implementation of preventative strategies. Existing prediction models of renal function decline, however, aim to assess the risk by artificially grouped patients prior to model building into risk strata defined by the categorization of the least-squares slope through the longitudinally fluctuating eGFR values, resulting in a loss of predictive precision and accuracy. Methods This study protocol describes the development and validation of a prediction model for the longitudinal progression of renal function decline in Caucasian patients with type 2 diabetes mellitus (DM2). For development and internal-external validation, two prospec...

Nephrology Dialysis Transplantation, 2018

with medical conservative therapy. Dividing the population according to the presence or absence o... more with medical conservative therapy. Dividing the population according to the presence or absence of lesion in coronary angiography and comparing them it was verified that the only statistically significant difference between the two groups was previous dialysis modality. While only 36% of patients on hemodialysis had a significant lesion on coronary angiography (16 of 44 patients), 81 % of patients on peritoneal dialysis had a significant lesion on coronary angiography (9 of 11 patients) (p¼0.03). Of 10 patients with negative Myocardial Perfusion Scintigraphy (MPS), 5 had a significant lesion on coronary angiography. Abdominal CT was performed in 71 patients, identifying a vascular lesion in 52% (n ¼ 37). Older age was the only factor predicting existence of Abdominal CT vascular lesions (34.7 years vs. 39 years; t¼0.01). Among patients with PAD (n¼16, 22%), 63% (n¼10) underwent doppler ultrasonography of the lower limbs. Doppler abnormalities showed abnormal results only in 60% of patients. The median follow-up time was 2.6 years without major cardiovascular events occurring after the initial transplantation hospitalization. Preemptive patients have no differences regearding age, PAD, coronary disease and amputations. CONCLUSIONS: Our data suggests that the high prevalence of coronary disease of SPKT candidates and the rate of false negative results of MPS favours coronary angiography as the initial approach for cardiovascular evaluation of these patients. The size of our sample was limited which may have negatively affected the validity of our observations. Further investigations and long-term follow-up studies are warranted to evaluate the effects of pretransplant selection on morbidity and survival rates.

Journal of Clinical Medicine, 2019

Belatacept is an attractive option for immunosuppression after renal transplantation. Renal allog... more Belatacept is an attractive option for immunosuppression after renal transplantation. Renal allograft function is superior when compared to calcineurin inhibitor (CNI) based therapy in “de novo” treated patients and it has also been proposed that individuals at high cardiovascular (CV) risk may benefit most. In this retrospective cohort study, we assessed the efficacy and safety of treating patients at high cardiovascular risk with Belatacept (n = 34, for 1194 observation months) when compared to a matched control group of 150 individuals under CNI immunosuppression (for 7309 months of observation). The estimated glomerular filtration rate (eGFR) increased for patients taking Belatacept but decreased during CNI-based therapy (+2.60 vs. −0.89 mL/min/1.73 m2/year, p = 0.006). In a multivariate Cox regression model, Belatacept remained the only significant factor associated with the improvement of eGFR (HR 4.35, 95%CI 2.39–7.93). Belatacept treatment was not a significant risk factor f...

Wiener klinische Wochenschrift, 2019

Diabetische Nierenerkrankung (Update 2019) leitlinien für die praxis Diabetic kidney disease (Upd... more Diabetische Nierenerkrankung (Update 2019) leitlinien für die praxis Diabetic kidney disease (Update 2019) Position paper of the Austrian Diabetes Association and the Austrian Society for Nephrology Summary Recent epidemiological investigations have shown that approximately 2-3% of all Austrians suffer from diabetes with renal involvement, i. e. 250,000 people in Austria are affected. The risk of occurrence and progression of this disease can be ameliorated by life style interventions as well as optimization of blood pressure, blood glucose levels and special drug classes. The present article represents the joint recommendations of the Austrian Diabetes Association and the Austrian Society for Nephrology for the diagnostics and treatment strategies of diabetic kidney disease.

Blood, Jan 30, 2015

Recent genetic analyses of large populations have revealed that somatic mutations in hematopoieti... more Recent genetic analyses of large populations have revealed that somatic mutations in hematopoietic cells leading to clonal expansion are commonly acquired during human aging. Clonally restricted hematopoiesis is associated with an increased risk of subsequent diagnosis of myeloid or lymphoid neoplasia and increased all-cause mortality. While myelodysplastic syndromes (MDS) are defined by cytopenias, dysplastic morphology of blood and marrow cells, and clonal hematopoiesis, most individuals who acquire clonal hematopoiesis during aging will never develop MDS. Therefore, acquisition of somatic mutations that drive clonal expansion in the absence of cytopenias and dysplastic hematopoiesis can be considered "clonal hematopoiesis of indeterminate potential" (CHIP), analogous to monoclonal gammopathy of undetermined significance and monoclonal B-cell lymphocytosis, which are precursor states for hematologic neoplasms but are usually benign and do not progress. Since mutations ar...

Clinical journal of the American Society of Nephrology : CJASN, Jan 20, 2015

The calcimimetic cinacalcet reduced the risk of death or cardiovascular (CV) events in older, but... more The calcimimetic cinacalcet reduced the risk of death or cardiovascular (CV) events in older, but not younger, patients with moderate to severe secondary hyperparathyroidism (HPT) who were receiving hemodialysis. To determine whether the lower risk in younger patients might be due to lower baseline CV risk and more frequent use of cointerventions that reduce parathyroid hormone (kidney transplantation, parathyroidectomy, and commercial cinacalcet use), this study examined the effects of cinacalcet in older (≥65 years, n=1005) and younger (<65 years, n=2878) patients. Evaluation of Cinacalcet HCl Therapy to Lower Cardiovascular Events (EVOLVE) was a global, multicenter, randomized placebo-controlled trial in 3883 prevalent patients on hemodialysis, whose outcomes included death, major CV events, and development of severe unremitting HPT. The age subgroup analysis was prespecified. Older patients had higher baseline prevalence of diabetes mellitus and CV comorbidity. Annualized rat...

Kidney International, 2002

Cigarette smoking and vascular pathology in renal biopsies. ulation [1, 2]. In recent years smoki... more Cigarette smoking and vascular pathology in renal biopsies. ulation [1, 2]. In recent years smoking has been pin-Background. In recent years cigarette smoking has been pointed as a progression factor for chronic nephropaidentified as a progression factor in chronic nephropathies such thies. Tobacco abuse is highly associated with clinically as glomerulonephritis or diabetic nephropathy. The exact paimportant reduction in renal function in elderly people thomechanism of nicotine-induced renal damage is, however, [3] and with albuminuria in patients with hypertension unknown. Autopsy studies and functional investigations suggest that the renal vasculature is primarily affected by smoking. [4]. The Multiple Risk Factor Intervention Trial found Methods. Renal vascular pathology, that is, glomerulosclesmoking to be a significant risk factor for end-stage rerosis, hyalinosis of arterioles and myointimal hyperplasia of nal disease (abstract; Whelton et al, J Am Soc Nephrol small arteries, was determined in 135 biopsies of patients over 6:408a, 1995). In patients with kidney disease, smoking thirty years of age. A questionnaire about smoking habits was returned by 107 of the patients. For glomerular sclerosis the is associated with elevated serum creatinine levels in percentage of sclerotic glomeruli was determined, whereas archronic glomerulonephritis [5] and speeds up loss of gloteriolar hyalinosis and myointimal hyperplasia of small arteries merular filtration in lupus nephritis [6] and diabetic newere described as present or absent without further quantificaphropathy in type I and type II diabetes [7-9]. In patients tion. A univariate analysis was performed for existence of vaswith autosomal dominant polycystic kidney disease and cular changes and ever-smoking status. In addition, a multivariate analysis for glomerular sclerosis and logistic regression IgA nephropathy nicotine abuse increases the risk of analysis for arteriolar hyalinosis and myointimal hyperplasia end-stage renal disease [10]. and the variables ever-smoking, age, body mass index, creati-Despite these clinical data the mechanism by which nine clearance, blood pressure and lipids were performed. smoking and nicotine exert their deleterious effects on Results.