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Increased Renal Arterial Resistance Predicts the Course of Renal Function in Type 2 Diabetes With Microalbuminuria

¹ Department of Endocrinology and Metabolic Diseases, University of Sassari, Sassari, Italy
² Diabetic Clinic, Ospedale Civile di Monfalcone, Gorizia, Italy
³ Diabetic Clinic of Abano, Padova, Italy
⁴ Nephrology Department, Castelfranco Veneto, Treviso, Italy
⁵ Department of Internal Medicine, University of Sassari, Sassari, Italy
⁶ Diabetic Clinic, Porto Viro, Rovigo, Italy
⁷ Urology Department, University of Sassari, Sassari, Italy
⁸ Patologia Medica, Department of Internal Medicine, Specialisation School of Nephrology, University of Sassari, Sassari, Italy
⁹ Wallenberg Laboratory, Department of Endocrinology, University Hospital MAS, Lund, Malmo, Sweden
¹⁰ Diabetic Clinic, Clinica Medica, University of Sassari, Sassari, Italy

Address correspondence and reprint requests to R. Nosadini, MD, Via C. De Brosses 1, 35128 Padova, Italy. E-mail: noscia{at}tin.it or nosadini{at}libero.it

Abbreviations: AER, albumin excretion rate; ESRD, end-stage renal disease; GFR, glomerular filtration rate; R/I, renal arterial resistance index; UKPDS, U.K. Prospective Diabetes Study

Type 2 diabetic patients often die because of end-stage renal failure, but no definitive reliable factor predicting long-term renal outcome has been identified. We tested whether a renal arterial resistance index (R/I) 80, using Doppler ultrasound technique, was predictive of worsening renal function. The primary end points of the study were 1) the course of glomerular filtration rate (GFR) and 2) the albumin excretion rate in 157 microalbuminuric, hypertensive, type 2 diabetic patients after a 7.8-year follow-up period (range 7.1–9.2). Kaplan-Meier curves for the primary end point (decrease of GFR –3.0 ml/min per 1.73 m² per year) was two to three times more frequently observed in patients with R/I 80. Four- to fivefold fewer patients showed a regression to normoalbuminuria during the follow-up period from baseline microalbuminuria in the cohort with R/I 80. Overt proteinuria did develop in 24% of patients with R/I 80 and in 5% of patients with R/I <80 (P < 0.01). In conclusion, intrarenal arterial resistance appears to play a nontrivial role in deteriorating renal function in type 2 diabetic patients. R/I is a noninvasive diagnostic procedure, which strongly predicts the outcome of renal function in type 2 diabetic patients, even when GFR patterns are still normal.

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