Vascular defect beyond the endothelium in type II diabetic patients with overt nephropathy and moderate renal insufficiency

W. B. Chan, N. N. Chan, Wai Keung Christopher Lai, W. Y. So, M. K.W. Lo, K. F. Lee, C. C. Chow, C. Metreweli, J. C.N. Chan

Research output: Journal article publicationJournal articleAcademic researchpeer-review

22 Citations (Scopus)

Abstract

There is a paucity of data on the effects of overt nephropathy and moderate renal impairment on endothelial function in diabetic patients. A total of 26 type II diabetic (DM) patients with nephropathy (DMN+) (mean±s.d. age: 63.7±6.3 years), 32 diabetic patients without nephropathy (DMN-) (59.4±10.1 years), and 52 non-diabetic subjects (54.9±8.2 years) were recruited. High-resolution ultrasound scan was used to measure carotid intima media thickness (IMT) and flow-mediated dilation (FMD) of the brachial artery. Endothelium-independent dilation was determined by maximal vascular dilation after sublingual nitroglycerine (glyceryl trinitrate (GTN)-induced dilation). The mean carotid IMT increased progressively from non-DM to DMN- to DMN+ groups (0.74±0.23 vs 0.80±0.25 vs 1.03±0.38 mm; P=0.001 for trend) whereas FMD- (4.3±2.5 vs 3.9±1.7 vs 1.9±2.0%, P<0.001 for trend) and GTN-induced dilation (14.7±4.0 vs 14.5±3.9 vs 10.3±3.2%; P<0.001 for trend) declined in an opposite manner. On multivariate analysis, age (Β=0.257, P=0.009), glomerular filtration rate (Β=-0.364, P<0.001), and smoking (Β=0.25, P=0.013) were independently associated with carotid IMT (F=15.76, R2=0.340, P<0.001). After adjustment for baseline brachial arterial diameter, history of smoking (Β=-0.039, P<0.001), fasting plasma glucose (Β=-0.033, P=0.002), and total cholesterol (Β=-0.023, P=0.024) were independently associated with vessel diameter after FMD (F=2446.5, R2=0.992, P<0.001); whereas age (Β=-0.069, P=0.001) and urinary albumin excretion (Β=-0.048, P=0.018) were independently associated with vessel diameter after GTN (F=851.6, R2=0.967, P<0.001). Type II diabetic patients with overt nephropathy and moderate renal impairment had both structural and functional vascular abnormalities beyond the endothelium.
Original languageEnglish
Pages (from-to)711-716
Number of pages6
JournalKidney International
Volume70
Issue number4
DOIs
Publication statusPublished - 28 Aug 2006
Externally publishedYes

Keywords

  • Chinese
  • Diabetes
  • Endothelial function
  • Nephropathy

ASJC Scopus subject areas

  • Nephrology

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