Central hemodynamics, vascular stiffness, and nocturia in patients with type 2 diabetes

Abstract

Recently, studies have shown that the presence of nocturia may not be a benign condition and related with systemic illness and mortality. Elevated blood pressure (BP) was another factor related with nocturia. Type 2 diabetes mellitus (T2DM) is also associated with nocturia. It is now clear that, apart from peripheral BP, central hemodynamic parameters are important for cardiovascular prognosis. However, no previous study in the literature examined the relationship between nocturia and central hemodynamic parameters in patients with T2DM. The current study was designed to examine these relationships. Nocturia was defined as two or more voids per night. Central hemodynamic parameters were assessed from ambulatory BP measurements. In addition to routine biochemistry, 24-h urine collection was performed to measure protein, albumin, and sodium excretion. 158 patients (52.3%) had T2DM and 144 (47.7%) did not have T2DM (control group). The presence of T2DM was independently related with nocturia. Both in whole group and in T2DM patients, most of the hemodynamic parameters are higher in patients with nocturia compared to patients without nocturia. Among patients with T2DM, nocturia was associated with augmentation index and pulse wave velocity. In conclusion, central hemodynamic parameters and markers of vascular stiffness may be related with nocturia in patients with T2DM.

Analysis of the Prevalence and Factors Associated with Nocturia in Adult Korean Men

“…Furthermore, hypertension has been suggested to be related to defects in the nitric-oxide pathway that alter pressure-natriuresis and sodium retention and cause compensatory nocturnal polyuria 29 . Additionally, central haemodynamic parameters, such as central blood pressure, cardiac output, pulse wave velocity and vascular stiffness, have been suggested to be associated with nocturia 30 .…”

Future Considerations in Nocturia and Nocturnal Polyuria

“…In patients with T2DM, age, creatinine clearance, and augmentation index (24 hours) were independently associated with nocturia frequency (linear regression analysis), and nocturia was associated with 24-hour creatinine clearance, hemoglobin, fasting blood glucose, and PWV (24 hours) (logistic regression analysis). 36 Hemodynamic parameters were seen to differ between patients with and without nocturia, and in patients with T2DM, nocturia was associated with central hemodynamic and arterial stiffness parameters including PWV and augmentation index. 36 Therefore, nocturia appears to reflect vascular injury resulting in increased arterial stiffness as well as hyperglycemia in patients with T2DM.…”

“…36 Hemodynamic parameters were seen to differ between patients with and without nocturia, and in patients with T2DM, nocturia was associated with central hemodynamic and arterial stiffness parameters including PWV and augmentation index. 36 Therefore, nocturia appears to reflect vascular injury resulting in increased arterial stiffness as well as hyperglycemia in patients with T2DM. These findings are supported by another study of 303 Japanese men with late-onset hypogonadism, in which nocturia was found to be associated with a higher brachial-ankle PWV on a multivariate linear regression model after adjustment for serum triglycerides, fasting blood sugar, and total testosterone.…”

“…The prevalence of nocturia was higher in patients with T2DM than without T2DM; 104 (70.3%) with T2DM had nocturia (≥2 nightly voids) vs 44 (30.6%) without T2DM (P <.0001). 36 The presence of T2DM, level of creatinine clearance, central systolic blood pressure (24 hours), and PWV (24 hours) was associated with nocturia frequency (linear regression analysis), and the presence of nocturia was associated with the presence of T2DM, creatinine clearance, age, and central diastolic blood pressure (24 hours) (logistic regression analysis). In patients with T2DM, age, creatinine clearance, and augmentation index (24 hours) were independently associated with nocturia frequency (linear regression analysis), and nocturia was associated with 24-hour creatinine clearance, hemoglobin, fasting blood glucose, and PWV (24 hours) (logistic regression analysis).…”

“…The relationship between nocturia and central hemodynamic parameters including central blood pressure, PWV (as a direct measure of arterial stiffness), and augmentation index (an indirect measure of arterial stiffness 33 ) was investigated in patients with T2DM. 36 A total of 302 patients were studied; of these, 158 (52.3%) had T2DM and 144 (47.7%) did not (control group). The prevalence of nocturia was higher in patients with T2DM than without T2DM; 104 (70.3%) with T2DM had nocturia (≥2 nightly voids) vs 44 (30.6%) without T2DM (P <.0001).…”