Objective: Diabetic kidney disease is the leading cause of end-stage renal disease worldwide. Whether diabetes mellitus (DM) is an additional factor leading to elevated blood pressure (BP) levels and BP variability (BPV) in patients with chronic kidney disease (CKD) is unknown. This study aimed to compare ambulatory BP levels, BP trends and BPV in diabetic and non-diabetic patients with CKD. Design and method: This study included 48 diabetic and 48 non-diabetic adult patients (>18 years) with CKD (eGFR: < 90 and >15 mL/min/1.73m2), matched in a 1:1 ratio for age, sex and eGFR within each CKD stage (2, 3a, 3b and 4). All patients underwent 24-hour ambulatory BP measurement with the Mobil-O-Graph device. To evaluate the effect of diabetes and time on the trajectories of 24-hour BP levels, we performed two-way mixed ANOVA analysis for repeated measurements using hourly means. BPV was calculated using standard deviation (SD), weighted SD (wSD), coefficient of variation (CV) and average real variability (ARV) of BP during the 24-hour, day- and night-time periods. Results: In total, patients with DM had significantly higher 24-hour systolic BP (SBP) (132.13 ± 10.71 vs 124.16 ± 11.45 mmHg, p = 0.001) and similar 24-hour diastolic BP (DBP) (75.00 ± 8.43 vs 74.62 ± 6.86 mmHg, p = 0.809) compared to patients without DM. A similar trend was evident across all CKD stages. The effect of DM on BP trajectories during the recording period was significant for SBP [F = 18.766, p < 0.001, partial h2 = 0.261] and marginally significant for DBP [F = 3.782, p = 0.057, partial h2 = 0.067]. 24hour SBP SD, wSD and ARV (10.94 ± 2.75 vs 9.46 ± 2.10, p = 0.004), as well as 24hour DBP SD, wSD, CV and ARV (8.23 ± 2.10 vs 7.10 ± 1.32, p = 0.002) were significantly higher in diabetic compared to non-diabetic CKD patients. Conclusions: Ambulatory SBP levels are higher and SBP-profile is different in patients with diabetic compared to those with non-diabetic CKD. Systolic and diastolic BPV are also higher in diabetic subjects. These findings may signify a higher cardiovascular risk of diabetic CKD patients.
Background and Aims Arterial stiffness is associated with increased risk for target-organ damage, cardiovascular events and overall mortality in the general population, patients with diabetes mellitus and patients with chronic kidney disease (CKD) of all stages. This is the first study to evaluate in comparison arterial stiffness and arterial wave reflections in diabetic and non-diabetic patients with CKD. Method This study included 48 diabetic and 48 non-diabetic adult patients (>18 years) with CKD (eGFR: <90 και ≥15mL/min/1.73m2), matched in a 1:1 ratio for age, sex and eGFR within each CKD stage (2, 3a, 3b and 4). All patients underwent carotid-femoral pulse wave velocity (PWV), central blood pressure (BP), and wave reflections measurement with applanation tonometry (Sphygmocor, Atcor Medical, Australia). Results Office systolic and diastolic blood pressure was similar between diabetic and non-diabetic subjects with CKD in total and across CKD stages. Office brachial pulse pressure (PP) was significantly lower in non-diabetics (49.00±8.0 vs 52.67±8.7 mmHg, p= 0.034). Office PWV was marginally higher in diabetics compared with non-diabetics (10.89±2.0 vs 10.06±2.2 m/sec, p=0.056). In CKD stages 2 and 4, no significant difference in PWV between the two groups was noted, but PWV was higher for diabetics in CKD stages 3a (11.28±1.4 vs 9.83±1.5 m/sec, p=0.023) and 3b (11.13±1.9 vs 9.46±1.2 m/sec, p=0.016). Heart-rate-adjusted augmentation index [AIx(HR75)] was higher in diabetic compared with non-diabetic subjects only in CKD stage 4 (32.08±4.2 vs 25.92±6.6%, p=0.013). Conclusion Diabetic CKD patients present higher arterial stiffness than non-diabetic counterparts. The additional contribution of diabetes towards increased arterial stiffness is more prominent in patients with moderately impaired renal function (CKD stage 3a and 3b), whereas at stage 4, PWV was increased independent of diabetes presence.
Background and Aims Sexual Dysfunction is a common and often undiagnosed complication in patients with Heart Failure (HF) or Chronic Kidney Disease (CKD). Sexual dysfunction presents a strong association with cardiovascular disease and death. This study aims to evaluate the possible effect of reduced renal function on sexual dysfunction in patients with heart failure. Method This is a prospective case-control study in patients with Hearth Failure (clinical diagnosis based on relevant symptoms and/or signs) with preserved or reduced renal function, defined as estimated glomerular filtration rate (eGFR) ≥60 and <60 ml/min/1.73 m2, matched for age (± 5 years). The eGFR was calculated with the CKD-EPI equation. Sexual dysfunction was evaluated with the validated Female Sexual Function Index Scoring (FSFI) and the International Index of Erectile Function (IIEF) questionnaires in the native language. Results A total of 214 (107 per group) patients were included in this study. Patients’ age 74.10±8.97 vs 75.81±8.66; P = .157), gender (males: 65.4% vs 57.9%; P = .261) and BMI (28.10±4.90 vs 28.99±4.43; P = .164) were not different between the two study groups. In total population, sexual dysfunction was lower in patients with eGFR≥60 compared to <60 ml/min/1.73 m2 (75.7% vs 88.8%; P = .012). In females, no significant differences were evidenced in sexual dysfunction based on FSFI score <26.0 (91.9% vs 95.6%; P = .490). In contrast, males with preserved renal function had lower prevalence of sexual dysfunction (IIEF<22) compared to those with reduced renal function (67.1% vs 83.9%; P = .027). In regression analysis eGFR was an independent factor associated with sexual dysfunction. Conclusion Renal dysfunction may be an important factor predisposing heart failure patients to more frequent sexual dysfunction.
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