Exercise-induced albuminuria and circadian blood pressure abnormalities in type 2 diabetes

Abstract

AIMTo investigate the relationship between circadian variations in blood pressure (BP) and albuminuria at rest, and during exercise in non-hypertensive type 2 diabetes (T2D) patients.METHODSWe conducted a cross-sectional study in well controlled T2D patients, non-hypertensive, without clinical proteinuria and normal creatinine clearance. In each participant, we recorded the BP using ambulatory blood pressure monitoring (ABPM) for 24-h, and albuminuria at rest and after a standardized treadmill exercise.RESULTSWe enrolled 27 type 2 patients with a median age of 52; and a mean duration of diabetes and HbA1c of 3.6 ± 0.8 years and 6.3% ± 0.5% respectively. Using a 24-h ABPM, we recorded a mean diurnal systolic blood pressure (SBP) of 128 ± 17 mmHg vs nocturnal of 123 ± 19 mmHg (P = 0.004), and mean diurnal diastolic blood pressure (DBP) of 83 ± 11 mmHg vs nocturnal 78 ± 14 mmHg (P = 0.002). There was a significant difference between albuminuria at rest [median = 23 mg, interquartile range (IQR) = 10-51] and after exercise (median = 35 mg, IQR = 23-80, P < 0.001). Patients with exercise induced albuminuria had an increase in nocturnal BP values on all three components (128 mmHg vs 110 mmHg, P = 0.03 for SBP; 83 mmHg vs 66 mmHg, P = 0.04; 106 vs 83, P = 0.02 for mean arterial pressure), as well as albuminuric patients at rest. Moreover, exercise induced albuminuria detect a less increase in nocturnal DBP (83 vs 86, P = 0.03) than resting albuminuria.CONCLUSIONExercise induced albuminuria is associated with an increase in nocturnal BP values in T2D patients.

11. Microvascular Complications and Foot Care: Standards of Medical Care in Diabetes—2021

“…Furthermore, because of high biological variability of .20% between measurements in urinary albumin excretion, two of three specimens of UACR collected within a 3-to 6-month period should be abnormal before considering a patient to have high or very high albuminuria (1,2,11,12). Exercise within 24 h, infection, fever, congestive heart failure, marked hyperglycemia, menstruation, and marked hypertension may elevate UACR independently of kidney damage (13).…”

Exercise-induced albuminuria increases over time in individuals with impaired glucose metabolism

“…Metabolic dysfunction was associated with consistent elevated levels of exercise induced albuminuria in a cohort of young and apparently healthy individuals without overt kidney disease. Excessive urinary albumin excretion following exercise has been reported in patients with metabolic syndrome [7], including patients with hypertension [8] and type 2 diabetes [9,10]. We present here, for the first time, a prospective study that characterizes EiA variation over time in patients with and without metabolic dysfunction.…”

“…Exercise induced albuminuria (EiA) appears earlier and may be a more sensitive biomarker for kidney endothelial damage [6]. We and others have shown that elevated EiA levels are associated with metabolic syndrome [7], hypertension [8], and diabetes [9,10]. However, the change in an individual's EiA levels over time and its interaction with metabolic dysfunction has never been studied.…”

Short‐term effects of perindopril‐amlodipine vs perindopril‐indapamide on blood pressure control in sub‐Saharan type 2 diabetic individuals newly diagnosed for hypertension: A double‐blinded randomized controlled trial

“…Biological work‐up included fasting glycemia, glycated hemoglobin, lipid profile, serum creatinine and uric acid, ALT and serum potassium. Exercise‐induced albuminuria was measured as previously described …”

“…Twenty‐four‐hour BP measurement was done using a portable, light weight monitor device (CONTEC ABPM 50 ® ) following the standard protocol of the service as previously described . The purpose of the examination and practical modalities including the measurement procedure and related constraints was explained to the patients.…”