Glomerular Hyperfiltration Is Associated With Blood Pressure Abnormalities in Normotensive Normoalbuminuric IDDM Patients

Pecis, Miriam; Azevedo, Mirela Jobim de; Gross, Jorge Luiz

doi:10.2337/diacare.20.8.1329

Cited by 38 publications

(41 citation statements)

References 22 publications

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“…in pharmacological RAAS inhibition (40,41). Importantly, and consistent with previous work in this area, blood pressure was higher in T1D-H (4,42,43). Although this blood pressure elevation within the normal range in T1D-H could be attributed to an elevated systemic sympathetic tone (43), our results suggest that decreased FE Na in euglycemic states may also contribute through increases in total body sodium (44).…”

Section: Discussionsupporting

confidence: 79%

Renal Hyperfiltration Is Associated With Glucose-Dependent Changes in Fractional Excretion of Sodium in Patients With Uncomplicated Type 1 Diabetes

et al. 2014

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OBJECTIVERenal hyperfiltration is a common abnormality associated with diabetic nephropathy in patients with type 1 diabetes (T1D). In animal models, increased proximal tubular sodium reabsorption results in decreased distal sodium delivery, tubuloglomerular feedback activation, afferent vasodilatation, and hyperfiltration. The role of tubular factors is less well understood in humans. The aim of the current study was therefore to compare the fractional sodium excretion (FE Na ) in hyperfiltering (T1D-H) versus normofiltering (T1D-N) patients and healthy control (HC) subjects, as well as the role of ambient hyperglycemia on FE Na . RESEARCH DESIGN AND METHODSBlood pressure, renal function (inulin for glomerular filtration rate [GFR], and paraaminohippurate for effective renal plasma flow), FE Na , and circulating neurohormones were measured in T1D-H (n = 28, GFR ‡135 mL/min/1.73 m 2 ), T1D-N (n = 30), and HC (n = 35) subjects during clamped euglycemia. Studies were repeated in a subset of patients during clamped hyperglycemia. RESULTSDuring clamped euglycemia, T1D-H exhibited lower FE Na than T1D-N and HC subjects (0.64 6 0.06% vs. 0.91 6 0.12% and 0.90 6 0.10%, P < 0.05). During clamped hyperglycemia, FE Na increased (D + 0.88 6 0.22% vs. D + 0.02 6 0.21%; betweengroup effect, P = 0.01) significantly in T1D-H, whereas FE Na did not change in T1D-N. When treated as continuous variables, elevated GFR values were associated with hyperglycemia-induced increases in FE Na (R 2 = 0.20, P = 0.007). CONCLUSIONSPatients with uncomplicated T1D-H exhibit lower FE Na under euglycemic conditions, which may help to identify patients with hyperfiltration outside of a controlled laboratory setting. Increased FE Na in T1D-H but not T1D-N under clamped hyperglycemic conditions suggests that the mechanisms responsible for increased sodium reabsorption leading to hyperfiltration can be saturated.

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Section: Discussionsupporting

confidence: 79%

Renal Hyperfiltration Is Associated With Glucose-Dependent Changes in Fractional Excretion of Sodium in Patients With Uncomplicated Type 1 Diabetes

et al. 2014

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“…The association between DN and an increase in absolute BP values in ABPM was demonstrated even during early stages of renal injury 12 . One study carried out by our group in Type 1 DM subjects showed that normoalbuminuric and hyperfiltrating individuals (glomerular filtration >134 ml/ ) presented higher levels of diastolic nocturnal BP when compared to normofiltrating patients 12 .…”

Section: Mean Pressure Values and Diabetes Mellitusmentioning

confidence: 99%

“…SAH is prevalent in patients with Type 2 DM, and is currently present in 30% of cases at the time of DM diagnosis and in up to 73% during the clinical course 1,11 . However, pressure homeostasis modifications can occur in DM patients with no evidence of renal disease 12,13 .…”

Section: Arterial Pressure and Diabetes Mellitusmentioning

confidence: 99%

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Monitorização ambulatorial da pressão arterial e diabete melito tipo 2

Leitão¹,

Canani²,

Silveiro³

et al. 2007

Arq. Bras. Cardiol.

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SummaryHypertension is one of the main risk factors for the onset and progression of chronic complications in type 2 diabetes mellitus (DM).Ambulatory blood pressure (BP) monitoring (ABPM) provides a better correlation with target organ lesions than BP obtained in the office. Furthermore, it allows the evaluation of distinct BP parameters such as the 24-h, daytime and nighttime systolic and diastolic BP means, BP loads and the absence of nocturnal drop of BP, as well as the identification of white-coat and masked hypertension.DM patients have higher daytime and nighttime BP means than non-DM patients. In addition, one third of normotensive type 2 DM patients have masked hypertension, which is associated with an increase in albuminuria and in left ventricle wall thickness. On the other hand, the prevalence and effect of white-coat hypertension in type 2 DM patients have not yet been properly evaluated. The absence of nocturnal drop of BP does not add information to the 24 h, daytime or nighttime BP measurements, but the nighttime BP means seem to be relevant in DM retinopathy.In conclusion, BP determination by ABPM allows better patient risk stratification for the development of DM chronic complications and is an essential instrument for effective BP control in these patients. Arterial pressure and diabetes mellitusType 2 diabetes mellitus (DM) is associated with the development of chronic microvascular and macrovascular complications with high rates of morbidity and mortality 1,2 . The classic and most analyzed risk factors for the development and progression of chronic DM complications are DM duration, hyperglycemia, arterial hypertension (AH), dyslipidemia, and smoking, besides genetic factors [3][4][5][6][7][8] . The treatment of hyperglycemia and SAH results in primary prevention and reduction of the progression of diabetic retinopathy (DR) and diabetic nephropathy (DN) 9,10

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“…Although the mechanism(s) responsible for these associations have not been fully elucidated, subjects with uncomplicated type 1 diabetes and high N/D ratio exhibit higher values for GFR in comparison to subjects with a normal N/D ratio (21), and renal hyperfiltration is a risk factor for diabetic nephropathy (22)(23)(24)(25). In one study (26) high N/D ratio was corrected by ACE inhibition, suggesting a role for renin angiotensin system (RAS) activation in this phenomenon.…”

mentioning

confidence: 99%

Relationship Between Diurnal Blood Pressure, Renal Hemodynamic Function, and the Renin-Angiotensin System in Type 1 Diabetes

2003

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In patients with diabetes, altered diurnal blood pressure (BP) regulation (high night-to-day [N/D] ratio, or "nondipping") is associated with increases in albumin excretion and a decline in the glomerular filtration rate (GFR) by an unknown mechanism. Because it is known that renin angiotensin system (RAS) activation and defective glucose control contribute to adverse renal outcomes, we examined renal responses to high glucose and to manipulation of the RAS in adolescents (mean age 14 ؎ 2 years) with uncomplicated type 1 diabetes, segregated into two groups on the basis of the presence or absence of normal N/D BP ratio. In the first experiment, renal hemodynamic comparisons were made during euglycemia (4 -6 mmol/l) and hyperglycemia (9 -11 mmol/l), maintained by modified clamp techniques. The induction of hyperglycemia resulted in a significant increase in GFR and filtration fraction (FF) in the high N/D ratio group. In the second experiment, we examined the renal response to graded angiotensin II (Ang II) infusion while subjects were euglycemic and salt replete. High N/D ratio was associated with an enhanced FF response to Ang II. In the third experiment, the N/D ratio and GFR were assessed after 3 weeks of ACE inhibition. This maneuver corrected the high N/D ratio, but it had no effect on glomerular hyperfiltration. These results suggest that RAS activation does not explain the hyperfiltration state, nor can it explain the poor outcomes, at least in this population. However, the observed deleterious hemodynamic responses to high glucose and Ang II and the insensitivity to ACE inhibition may, taken together, provide an explanation for the adverse renal outcomes in patients with type 1 diabetes and high N/D ratio. A mbulatory blood pressure monitoring (ABPM) has been used in the investigation and management of blood pressure (BP) problems for many years. Studies have shown that there is a normal diurnal pattern of BP variation that is characterized by an approximate 10% decrease in BP values during the night (1). Altered diurnal BP regulation, with a tendency for elevated nighttime BP (high night-to-day [N/D] ratio), is referred to as the "nondipping" pattern of BP, and it may be a risk factor for poor clinical outcome, possibly predicting the progression of renal disease (2), increased target organ damage (3-8), and increased cardiovascular morbidity (9 -11). Moreover, high N/D ratios are found more commonly in patients with diabetes (12), African Americans (13), and patients with renal disease (14).In type 1 diabetic patients, a high N/D ratio is associated with several undesirable outcomes, including early morphologic changes in the glomerulus (15), increased albumin excretion (16 -19), and an increased rate of decline of the glomerular filtration rate (GFR) in patients with overt diabetic nephropathy (20). Although the mechanism(s) responsible for these associations have not been fully elucidated, subjects with uncomplicated type 1 diabetes and high N/D ratio exhibit higher values for GFR in comparison to su...

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Glomerular Hyperfiltration Is Associated With Blood Pressure Abnormalities in Normotensive Normoalbuminuric IDDM Patients

Abstract: Glomerular hyperfiltration is associated with higher nocturnal diastolic blood pressure and with a blunted nocturnal decrease in diastolic blood pressure levels in normotensive and normoalbuminuric IDDM patients.

Cited by 38 publications

References 22 publications

Renal Hyperfiltration Is Associated With Glucose-Dependent Changes in Fractional Excretion of Sodium in Patients With Uncomplicated Type 1 Diabetes

Renal Hyperfiltration Is Associated With Glucose-Dependent Changes in Fractional Excretion of Sodium in Patients With Uncomplicated Type 1 Diabetes

Monitorização ambulatorial da pressão arterial e diabete melito tipo 2

Relationship Between Diurnal Blood Pressure, Renal Hemodynamic Function, and the Renin-Angiotensin System in Type 1 Diabetes

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