The Impact of Diabetes Mellitus on Vascular Biomarkers in Patients with End-Stage Renal Disease

Abstract

PurposeDiabetes mellitus (DM) is the most common cause of end-stage renal disease (ESRD) and an important risk factor for cardiovascular (CV) disease. We investigated the impact of DM on subclinical CV damage by comprehensive screening protocol in ESRD patients.Materials and MethodsEchocardiography, coronary computed tomography angiogram, 24-h ambulatory blood pressure monitoring, and central blood pressure with pulse wave velocity (PWV) were performed in 91 ESRD patients from the Cardiovascular and Metabolic disease Etiology Research Center-HIgh risk cohort.ResultsThe DM group (n=38) had higher systolic blood pressure than the non-DM group (n=53), however, other clinical CV risk factors were not different between two groups. Central aortic systolic pressure (148.7±29.8 mm Hg vs. 133.7±27.0 mm Hg, p= 0.014), PWV (12.1±2.7 m/s vs. 9.4±2.1 m/s, p<0.001), and early mitral inflow to early mitral annulus velocity (16.7±6.4 vs. 13.7±5.9, p=0.026) were higher in the DM group. Although the prevalence of coronary artery disease (CAD) was not different between the DM and the non-DM group (95% vs. 84.4%, p=0.471), the severity of CAD was higher in the DM group (p=0.01). In multivariate regression analysis, DM was an independent determinant for central systolic pressure (p=0.011), PWV (p<0.001) and the prevalence of CAD (p=0.046).ConclusionDiabetic ESRD patients have higher central systolic pressure and more advanced arteriosclerosis than the non-DM control group. These findings suggest that screening for subclinical CV damage may be helpful for diabetic ESRD patients.

Loss of nighttime blood pressure dipping as a risk factor for coronary artery calcification in nondialysis chronic kidney disease

“…[20] Of the 1958 participants who were enrolled into the CMERC-HI cohort between November 2013 and May 2016, participants with CKD, defined as an increased urine albumin-to-creatinine ratio (UACR) (≥17 for men and ≥25 mg/g for women) and eGFR ≥60 mL/min/1.73 m 2 or eGFR <60 mL/min/1.73 m 2 , were enrolled in this study. Participants with atrial fibrillation or those who underwent dialysis or kidney transplantation were excluded (Fig.…”

“…Participants in the Cardiovascular and Metabolic Disease Etiology Research Center High-Risk Cohort [(CMERC-HI): Individualized prevention strategy for high-risk patients in CVD: prospective cohort study NCT02003781; ClinicalTrial.gov] were screened. [ 20 ] Of the 1958 participants who were enrolled into the CMERC-HI cohort between November 2013 and May 2016, participants with CKD, defined as an increased urine albumin-to-creatinine ratio (UACR) (≥17 for men and ≥25 mg/g for women) and eGFR ≥60 mL/min/1.73 m 2 or eGFR <60 mL/min/1.73 m 2 , were enrolled in this study. Participants with atrial fibrillation or those who underwent dialysis or kidney transplantation were excluded (Fig.…”

The Association Between the Decline of eGFR and a Reduction of Hemoglobin A1c in Type 2 Diabetic Patients

“…Diabetic kidney disease (DKD) is one of the most common complications of diabetes ( 2 , 3 ), which, in turn, is the main cause of chronic kidney disease (CKD) and can eventually lead to end-stage renal disease and death. According to statistics ( 4 ), 25%–40% of patients with type 2 diabetes (T2D) will eventually develop diabetic nephropathy. The diagnosis of DKD is typically based on the presence of albuminuria and/or a reduced estimated glomerular filtration rate (eGFR) in the absence of signs or symptoms of other primary causes of kidney damage ( 5 , 6 ).…”

Therapeutic Potential of Ursolic Acid in Cancer and Diabetic Neuropathy Diseases

“…Diabetic neuropathy (DN) is a common and challenging complication of DM, leading to the most morbidity and mortality, resulting in a vast economic burden to diabetes care [41][42][43]. Neuropathy is generally widespread; distal symmetric polyneuropathy is very general, leading to sensory disturbances [42][43][44][45]. DN is a failure of sensory function starting distally in the lower extremities, which is considered via pain and substantial morbidity.…”