Factors associated with diabetic nephropathy in subjects with proliferative retinopathy

Magri, Caroline Jane; Calleja, Neville; Buhagiar, Gerald; Fava, Stephen; Vassallo, Josanne

doi:10.1007/s11255-011-9958-1

Cited by 16 publications

(13 citation statements)

References 31 publications

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“…In support of this hypothesis is the finding that platelet activation is associated with cardiovascular autonomic dysfunction in type 1 diabetic subjects [29] and with sympathetic stimulation in patients with acute myocardial infarction [30]. Interestingly, our group has previously shown that a rise in platelet count is also an independent predictor of diabetic nephropathy in type 2 diabetic subjects [31]. Undoubtedly, further studies are needed to assess the role of platelets in circadian HR rhythm in diabetic patients.…”

Section: Discussionmentioning

confidence: 86%

Non-Dipping Heart Rate and Microalbuminuria in Type 2 Diabetes Mellitus

Magri¹,

Xuereb²,

Fava³

2014

Cardiology

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Objectives: The aim of this study was to identify factors which are independently associated with non-dipping heart rate (HR) in a type 2 diabetic population at high risk of cardiovascular disease. Methods: The study recruited 179 type 2 diabetic subjects with a mean diabetes duration of 18.3 years and with proliferative retinopathy. All underwent 24-hour blood pressure and HR monitoring, and were assessed for markers of inflammation, insulin resistance, albuminuria, presence of peripheral neuropathy and peripheral vascular disease. Subjects whose night-time HR did not decrease by more than 10% as compared to daytime readings were classified as non-dippers. Results: Univariate analysis revealed that non-dippers had significantly higher logarithmic albumin-creatinine ratio (ACR; p = 0.001) and higher platelet count (p = 0.014). Also, non-dippers were more likely to be on β-blockers (p = 0.037). Binary logistic regression analysis showed that logarithmic ACR (p = 0.001) and platelet count (p = 0.026) were independent predictors of non-dipping HR, even when correcting for β-blocker use. Conclusions: In this high-risk type 2 diabetic population, non-dipping HR was independently associated with ACR and platelet count, suggesting that non-dipping HR might give an indication of underlying generalised atherosclerosis in diabetic patients. Also, non-dipping HR may represent a novel mechanism explaining the association of nephropathy with cardiovascular events. This merits further study.

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Section: Discussionmentioning

confidence: 86%

Non-Dipping Heart Rate and Microalbuminuria in Type 2 Diabetes Mellitus

Magri¹,

Xuereb²,

Fava³

2014

Cardiology

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“…Multivariate analysis revealed that nocturnal diastolic BP, platelet count and eGFR were independent predictors of DN development (P=0.002, P=0.018 and P<0.001, respectively) as well as microalbuminuria (P=0.029, P=0.045 and P=0.001, respectively) [49]. Interestingly, retinopathy progressed in all diabetic patients with enough hyperglycemic exposure, in contrast to DN that developed in only a subgroup of diabetic patients, proving that DN is influenced by other factors in addition to hyperglycemic exposure [49]. In conclusion, growing evidence is suggesting that increased nocturnal diastolic BP, nocturnal systolic BP, and/or lower nocturnal BPF might predict the development of micro or macroalbuminuria.…”

Section: Hypertensionmentioning

confidence: 99%

“…The role of HTN is highlighted even more in a recent study of 196 individuals, including 85 with normoalbuminuria, 66 with microalbuminuria, and 45 with macroalbuminuria [49]. Multivariate analysis revealed that nocturnal diastolic BP, platelet count and eGFR were independent predictors of DN development (P=0.002, P=0.018 and P<0.001, respectively) as well as microalbuminuria (P=0.029, P=0.045 and P=0.001, respectively) [49].…”

Section: Hypertensionmentioning

confidence: 99%

Predictors of diabetic nephropathy

Gaballa

Farag

2013

Open Medicine

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AbstractDiabetic nephropathy (DN) is a leading cause of morbidity and mortality in diabetic patients representing a huge health and economic burden. Alarming recent data described diabetes as an unprecedented worldwide epidemic, with a prevalence of ∼6.4% of the world population in 2010, while the prevalence of CKD among diabetics was approximately 40%. With a clinical field hungry for novel markers predicting DN, several clinical and laboratory markers were identified lately with the promise of reliable DN prediction. Among those are age, gender, hypertension, smoking, sex hormones and anemia. In addition, eccentric left ventricular geometric patterns, detected by echocardiography, and renal hypertrophy, revealed by ultrasonography, are promising new markers predicting DN development. Serum and urinary markers are still invaluable elements, including serum uric acid, microalbuminuria, macroalbuminuria, urinary liver-type fatty acid-binding protein (u-LFABP), and urinary nephrin. Moreover, studies have illustrated a tight relationship between obstructive sleep apnea and the development of DN. The purpose of this review is to present the latest advances in identifying promising predictors to DN, which will help guide the future research questions in this field. Aiming at limiting this paramount threat, further efforts are necessary to identify and control independent modifiable risk factors, while developing an integrative algorithm for utilization in DN future screening programs.

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“…8–12 A longer duration of diabetes, hypertension, and elevated glycosylated hemoglobin, have been identified as consistent risk factors. 10–13 The Early Treatment Diabetic Retinopathy Study group has reported that the type of diabetes, body weight, and the age of the patient are also important risk factors for developing PDR in particular. 8 Risk factors for progression to PDR in particular are of importance, given the risk for severe vision loss in patients with advanced disease.…”

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confidence: 99%

Risk Factors for Proliferative Diabetic Retinopathy in a Latino American Population

Nittala

Keane

Zhang

et al. 2014

Retina

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Objective To assess the personal and demographic risk factors for proliferative diabetic retinopathy (PDR) in Latino Americans in Los Angeles County. Design A prospective, non-interventional, cross-sectional case control study. Participants Seven hundred and twenty nine subjects from Los Angeles County University of Southern California Medical Center (LAC+USC), Los Angeles, CA, were enrolled. Methods All patients were recruited prospectively from the LAC+USC Medical Center and affiliated clinics between June 2008 and June 2011. Complete personal data and results from systemic and ophthalmic examinations were collected for all enrolled subjects. Laboratory tests such as glycosylated hemoglobin, creatinine levels, and cholesterol levels were collected prospectively by drawing blood at the time of each patient’s clinic visit. Main Outcome Measures Age, gender, type of diabetes mellitus (DM I or II) duration of DM, history of hypertension, history of insulin use, height, weight, and body mass index, smoking history, glycosylated hemoglobin, creatinine levels, and cholesterol levels. Results The mean age of subjects with no diabetic retinopathy was 56.38 years (standard deviation [SD], 10.16), while that of patients with PDR was 57.43 years (SD, 9.63). Parameters that conferred a statistically significant increased risk for PDR in the multivariate model included gender (men were at higher risk: odds ratio (OR), 4.11; 95% confidence interval (CI), 2.56–6.58), insulin use (OR, 1.85; 95% CI, 1.13 – 3.03), history of hypertension (OR, 1.64; 95% CI, 1.02 – 2.63), and duration (>25 years versus 10 to 15 years) of diabetes (OR, 22.00; 95%CI, 9.76 – 49.60). Conclusions In this case-control study in a Latino population, duration of diabetes and male gender were the strongest risk factor for the development of PDR followed by insulin use, and hypertension. Interestingly, smoking and glycosylated hemoglobin levels did not confer additional significant risk in this cohort.

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Factors associated with diabetic nephropathy in subjects with proliferative retinopathy

Abstract: By analysing factors associated with diabetic nephropathy rather than microvascular disease in general, this study provides evidence that night-time diastolic BP and a relative increase in platelet count are associated with incipient diabetic nephropathy.

Cited by 16 publications

References 31 publications

Non-Dipping Heart Rate and Microalbuminuria in Type 2 Diabetes Mellitus

Non-Dipping Heart Rate and Microalbuminuria in Type 2 Diabetes Mellitus

Predictors of diabetic nephropathy

Risk Factors for Proliferative Diabetic Retinopathy in a Latino American Population

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