Increased Renal Arterial Resistance Predicts the Course of Renal Function in Type 2 Diabetes With Microalbuminuria
- Romano Nosadini1,
- Mario Velussi2,
- Enrico Brocco3,
- Cataldo Abaterusso4,
- Andrea Carraro5,
- Francesco Piarulli6,
- Giuseppe Morgia7,
- Andrea Satta8,
- Rossana Faedda8,
- Avinash Abhyankar9,
- Holgher Luthman9 and
- Giancarlo Tonolo10
- 1Department of Endocrinology and Metabolic Diseases, University of Sassari, Sassari, Italy
- 2Diabetic Clinic, Ospedale Civile di Monfalcone, Gorizia, Italy
- 3Diabetic Clinic of Abano, Padova, Italy
- 4Nephrology Department, Castelfranco Veneto, Treviso, Italy
- 5Department of Internal Medicine, University of Sassari, Sassari, Italy
- 6Diabetic Clinic, Porto Viro, Rovigo, Italy
- 7Urology Department, University of Sassari, Sassari, Italy
- 8Patologia Medica, Department of Internal Medicine, Specialisation School of Nephrology, University of Sassari, Sassari, Italy
- 9Wallenberg Laboratory, Department of Endocrinology, University Hospital MAS, Lund, Malmo, Sweden
- 10Diabetic 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
Abstract
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.
- 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
Footnotes
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The costs of publication of this article were defrayed in part by the payment of page charges. This article must therefore be hereby marked “advertisement” in accordance with 18 U.S.C. Section 1734 solely to indicate this fact.
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- Accepted September 26, 2005.
- Received July 11, 2005.
- DIABETES
