Diabetes mellitus Worsens Intrarenal Hemodynamic Abnormalities in Nondialyzed Patients with Chronic Renal Failure

Abstract

Duplex Doppler sonography has been reported to be useful in examining the intrarenal hemodynamic abnormalities in various renal diseases. We investigated the impact of diabetes on intrarenal hemodynamics in patients with chronic renal failure (CRF). The resistive index and pulsatility index of the renal interlobar arteries were measured using duplex Doppler sonography in 90 CRF patients (serum creatinine >130 and <800 mmol/l, mean age 59 ± 11 years). Forty-eight patients had type 2 diabetes and 42 did not. Twenty-nine age-matched, healthy subjects served as controls. Both resistive index and pulsatility index were greater in CRF patients than in the controls (p < 0.0001). No significant differences existed in age, sex, body mass index, total serum cholesterol, serum creatinine, estimated creatinine clearance, or mean blood pressure between the diabetic CRF and nondiabetic CRF groups. Resistive index and pulsatility index were significantly increased in the diabetic CRF patients compared to the nondiabetic CRF patients (p < 0.0001). Multiple regression analysis of all CRF patients revealed that resistive index was independently affected by the presence of type 2 diabetes (F = 44.535), as well as decreased creatinine clearance (F = 18.157) and age (F = 15.160) (R² = 0.559, p < 0.0001). These results clearly demonstrated that intrarenal arterial resistance is significantly increased in CRF patients with type 2 diabetes compared to similar patients without diabetes. The impact of diabetes mellitus and advanced age on intrarenal hemodynamics may be due to intrarenal arteriosclerosis and interstitital lesions. Measurements of RI values in addition to conventional ultrasound imaging may add further information on such renal lesions.

Natural History of Kidney Graft Survival, Hypertrophy, and Vascular Function in End-Stage Renal Disease Type 1 Diabetic Kidney-Transplanted Patients

“…RI was determined as follows: the peak systolic velocity minus the end diastolic velocity divided by the peak systolic velocity. The usefulness of RI as a noninvasive hemodynamic assessment of the transplanted kidney was previously pointed out (7)(8)(9)(10). Our technique for CDU to evaluate RI is reproducible (coefficient of variation [CV], 3-5%) and precise.…”

“…Kidney graft cumulative survival Cumulative survival of renal allografts was estimated in the different groups of transplant patients by the need for dialysis treatment, as previously described (10). Kidney graft survival was evaluated at the time of hospital discharge, according to the quartile values of the most important parameters (RI, UAE, and creatinine levels).…”

“…Initially, diabetic nephropathy encompasses both functional changes (i.e., reduced renal vasodilatory reserve and reduced ability to respond to pathogen) and slight morphological alterations (with basal membrane thickness). Finally, diabetic nephropathy results in clear morphological alterations (3,9,10).…”

“…Nephrosclerosis or glomerulosclerosis of the transplanted kidney in end-stage renal disease (ESRD) type 1 diabetic kidney transplant patients may result from the interaction of diabetes, hypertension, obesity, smoking, and dyslipidemia and from nephrotoxicity of certain immunosuppressive drugs (calcineurin inhibitors but not only) (5-6), leading to a reduction in the intrarenal vascular surface area and an increase in vascular resistance (7)(8)(9)(10).…”

Association between Left Ventricular Diastolic Dysfunction and Renal Hemodynamic Change in Patients with Treated Essential Hypertension

“…Interstitial accumulation of advanced-glycated end products, which include collagen, elastin, and other connective tissue proteins, may be responsible for alterations of the diastolic properties of the heart in persons with hyperglycemia (30,31). On the other hand, glomerular dysfunction, intrarenal arteriosclerosis, interstitial fibrosis, and interstitial edema are related to the alteration in intrarenal hemodynamics in diabetic patients (32)(33)(34)(35)(36). Furthermore, many studies have reported that hyperinsulinemia and insulin resistance may contribute to both LV diastolic dysfunction (37)(38)(39) and glomerular hyperten- , diastolic-to-systolic ratio; RI, resistance index; A/E, peak velocity ratio of the atrial filling wave-to-early diastolic filling wave; DcT, deceleration time of the E wave; GT, glucose tolerance.…”