The independent relationship between creatinine clearance, microalbuminuria and circadian blood pressure levels in newly diagnosed essential hypertensive and type 2 diabetic patients

Department of Nephrology, Zonguldak Atatürk State Hospital
Journal of diabetes and its complications (Impact Factor: 3.01). 07/2012; 26(6). DOI: 10.1016/j.jdiacomp.2012.05.016
Source: PubMed


Background and objectives:
Increased evidence suggests that apart from patients with increased albumin excretion and decreased glomerular filtration rate (GFR); there are also patients with type 2 diabetes with decreased GFR but without albuminuria. The exact pathophysiologic mechanisms regarding these clinical conditions are not known. We suggest that different blood pressure (BP) levels may be one the factors for these different clinical conditions. However, before labeling BP as a causative factor; one must show whether BP levels are different in these patients. Thus the current study was performed to analyze the relationship between creatinine clearance, microalbuminuria and circadian blood pressure levels in newly diagnosed essential hypertensive and type 2 diabetic patients.

Medical history, physical examination, laboratory analysis and ambulatory blood pressure measurements (ABPMs) were analyzed. 24-h urine specimens were collected to measure creatinine clearance and albumin excretion

In total 216 patients were included which were divided into 4 groups: group 1 composed of 90 patients with normal GFR and without microalbuminuria (MA), group 2 composed of 50 patients with normal GFR and with MA, group 3 composed of 36 patients with decreased GFR and without MA and group 4 composed of 40 patients with both decreased GFR and MA. The ratio of dippers vs. non dippers was not different between group 1, group 2 and group 3 patients. However ratio of dippers was higher in group 1 when compared to group 4 (P: 0.003) and group 4 patients have an odds of 7.678 (CI: 1.657-35.576, P: 0.009) for non-dapping status when compared to patients in group 1.

In conclusion, ABPM measurements were highest in patients with both decreased GFR and MA, whereas they are lowest in patients with normal GFR and normal UAE.

13 Reads
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Abstract Background: Microalbuminuria is an important risk factor for cardiovascular diseases. Microalbuminuria may be seen due to hypoxemia in patients with chronic obstructive pulmonary disease (COPD). Objectives: In this study, we investigated prevalence and relationship of microalbuminuria with clinical and physiological parameters in patients with COPD. Method: During the research, 66 consecutive patients with COPD and 40 cases smokers with normal spirometry were included. The urinary albumin creatinin ratio (UACR) was calculated according to previously described formula. The presence of microalbuminuria was defined as UACR being ≥20 in men and ≥30 in women. The severity index of chronic diseases was evaluated by using MCIRS. Results: The rate of presence of microalbuminuria and UACR were higher in patients with COPD than smokers with normal spirometry. Pearson correlation analysis showed a significant inverse relationship between UACR and PaO2, FEV1%, FVC%. On the other hand, there was a positive relationship between UACR and BODE index. There was a significant relationship between the presence of microalbuminuria with PaO2 and BODE index. In the linear regression model, there was a negative relationship between UARC and PaO2 yet there was a significantly positive relationship between UARC and MCIRS score, BODE index. In the logistic regression model, the presence of microalbuminuria showed significant associations with PaO2, BODE index. Conclusion: Microalbuminuria may be seen in patients with COPD, depending on the severity of disease and hypoxemia. Microalbuminuria in patients with severe COPD should be examined in regular periods for risk of cardiovascular morbidity or mortality.
    Full-text · Article · Apr 2013 · COPD Journal of Chronic Obstructive Pulmonary Disease
  • [Show abstract] [Hide abstract]
    ABSTRACT: Aims The current study aimed to investigate the relationship between morning blood pressure surge (MBPS), hemodynamic parameters, glycemic control and 24-hour urinary sodium excretion (USE) in patients with type 2 diabetes mellitus (T2DM). Materials and Methods MBPS and central hemodynamic parameters were assessed from ambulatory blood pressure measurements. In addition to routine biochemistry, 24 hour urine collection was performed to measure protein, albumin and sodium excretion. Results There were 146 (38%) patients with T2DM and 238 (72%) patients without T2DM (control group). Patients with T2DM had statistically higher MBPS compared with patients without T2DM (P < 0.0001). In patients with T2DM, MBPS was correlated with HbA1c (rho =0.311, P: < 0.0001), 24 hour urinary sodium excretion (rho = 0.292, P = 0.004) and various hemodynamic parameters. Additionaly, regression analysis showed that being male (P = 0.006), the presence of coronary artery disease (P = 0.023), HbA1c (P = 0.012), 24 hour USE (P = 0.001) were independently related with log MBPS in T2DM patients. Conclusion This study demonstrated that T2DM was an independent risk factor for increased MBPS and MBPS was associated with central hemodynamic parameters. Additionally poor glycemic control and sodium intake were associated with worse MBPS in T2DM.
    No preview · Article · Jun 2014 · Diabetes research and clinical practice
  • [Show abstract] [Hide abstract]
    ABSTRACT: Background: To investigate the clinical characteristics and predictive factors of subclinical diabetic nephropathy in type 2 diabetes patients. Methods: A total of 298 type 2 diabetes patients were divided into 3 groups based on 24-h urinary microalbumin and estimated glomerular filtration rate: patients with normal albuminuria and glomerular filtration rate (NC), patients with normoalbuminuria and glomerular hyperfiltration (SDN) and patients with microalbuminuria (EDN). The renal size, tubular injury markers and ambulatory blood pressure were analyzed. Results: Renal size increased in the SDN and EDN groups compared to the NC group (P<0.05), while renal length in the SDN group was greater than the EDN group (P<0.05). Patients in the SDN and EDN groups had higher level of urine retinol binding protein and N-acetyl-β-D-glucosaminidase and most of them developed proximal tubular dysfunction. The SDN group had higher 24-h mean and nocturnal diastolic blood pressure than the NC group (P<0.05), while the EDN group had higher systolic blood pressure and pulse pressure than the SDN group (P<0.01). More patients developed abnormal blood pressure rhythm in the SDN and EDN groups. The likelihood of a decrease in nocturnal systolic blood pressure was lower as the microalbuminuria increased. Increased renal size, more abnormal tubular injury markers and higher 24-h mean and nocturnal blood pressure were all risk factors of subclinical diabetic nephropathy. Conclusion: Patients with subclinical diabetic nephropathy had increased renal size, abnormal tubular injury markers, high blood pressure and abnormal circadian rhythm. © Georg Thieme Verlag KG Stuttgart · New York.
    No preview · Article · Jan 2015 · Experimental and Clinical Endocrinology & Diabetes