Kidney hemodynamic function in men and postmenopausal women with type 2 diabetes and preserved kidney function

2021 ◽  
Author(s):  
Daan M van Velzen ◽  
Mark M Smits ◽  
Erik JM van Bommel ◽  
Marcel H.A. Muskiet ◽  
Lennart Tonneijck ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Postmenopausal Women ◽  
Kidney Function ◽  
Vascular Resistance ◽  
Renal Plasma Flow ◽  
Hydraulic Pressure ◽  
Linear Regression Models ◽  
Overt Nephropathy ◽  
Hemodynamic Function

Background Progression of kidney disease may differ between sexes in type 2 diabetes (T2D), with studies reporting slower decline in women. Glomerular hyperfiltration is a key factor driving kidney function decline. The current study aims to investigate the differences in kidney hemodynamic function between men and women with T2D. Methods A cross-sectional analysis of pooled data from three studies comparing kidney hemodynamic function between men and postmenopausal women with T2D without overt nephropathy. The outcome measures were GFR (inulin clearance), effective renal plasma flow (ERPF; para-aminohippurate clearance), filtration fraction (GFR/ERPF) and renal vascular resistance (RVR; mean arterial pressure/RBF). Glomerular hydraulic pressure (PGLO), afferent and efferent vascular resistance were estimated by Gomez-formulae. Sex differences were assessed with linear regression models adjusted for systolic blood pressure, glucose, use of renin-angiotensin-system blockers and body mass index. Results 101 men (age: 63[58-68] years; BMI 31.5±3.9 kg/m2; GFR 111±18 mL/min; HbA1c 7.4±0.7%) and 27 women (age: 66[62-69] years; BMI 30.9±4.5 kg/m2; GFR 97±11 mL/min; HbA1c 7.1±0.5%) were included. GFR was higher in men versus women (11.0 mL/min; [95%CI; 3.6;18.4]). Although statistically non-significant, PGLO trended higher in men (1.9 mmHg [95%CI; -0.1;4.0], while RVR (-0.012 mmHg/L/min [95%CI; -0.022;-0.002]) and afferent vascular resistance were lower (-361 dyne/sec/cm5 [95%CI;-801;78]). Conclusions In adults without overt nephropathy, GFR was higher in men compared to women. PGLO also trended to be higher in men. Both findings are possibly related to afferent vasodilation and suggest greater prevalence of hyperfiltration. This could contribute to accelerated GFR loss over time in men with T2D.

scholarly journals Glucagon-like peptide-1 receptors in the kidney: impact on renal autoregulation

2020 ◽  
Vol 318 (2) ◽  
pp. F443-F454 ◽  
Author(s):  
Aleksander Vauvert R. Hviid ◽  
Charlotte M. Sørensen
Keyword(s):  
Type 2 Diabetes ◽  
Renal Function ◽  
Glomerular Filtration Rate ◽  
Kidney Function ◽  
Filtration Rate ◽  
Renal Plasma Flow ◽  
Glucagon Like Peptide ◽  
Glucagon Like Peptide 1 ◽  
Study Participants

Glucagon-like peptide-1 (GLP-1) and strategies based on this blood sugar-reducing and appetite-suppressing hormone are used to treat obesity and type 2 diabetes. However, the GLP-1 receptor (GLP-1R) is also present in the kidney, where it influences renal function. The effect of GLP-1 on the kidney varies between humans and rodents. The effect of GLP-1 on kidney function also seems to vary depending on its concentration and the physiological or pathological state of the kidney. In studies with rodents or humans, acute infusion of pharmacological doses of GLP-1 stimulates natriuresis and diuresis. However, the effect on the renal vasculature is less clear. In rodents, GLP-1 infusion increases renal plasma flow and glomerular filtration rate, suggesting renal vasodilation. In humans, only a subset of the study participants exhibits increased renal plasma flow and glomerular filtration rate. Differential status of kidney function and changes in renal vascular resistance of the preglomerular arterioles may account for the different responses of the human study participants. Because renal function in patients with type 2 diabetes is already at risk or compromised, understanding the effects of GLP-1R activation on kidney function in these patients is particularly important. This review examines the distribution of GLP-1R in the kidney and the effects elicited by GLP-1 or GLP-1R agonists. By integrating results from acute and chronic studies in healthy individuals and patients with type 2 diabetes along with those from rodent studies, we provide insight into how GLP-1R activation affects renal function and autoregulation.

scholarly journals Renal hemodynamic effects differ between antidiabetic combination strategies: randomized controlled clinical trial comparing empagliflozin/linagliptin with metformin/insulin glargine

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Christian Ott ◽  
Susanne Jung ◽  
Manuel Korn ◽  
Dennis Kannenkeril ◽  
Agnes Bosch ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Insulin Glargine ◽  
Vascular Resistance ◽  
Renal Plasma Flow ◽  
Renal Perfusion ◽  
Renal Hemodynamics ◽  
Controlled Clinical Trial ◽  
Combination Therapies ◽  
Combination Strategies

Abstract Background Type 2 diabetes causes cardio-renal complications and is treated with different combination therapies. The renal hemodynamics profile of such combination therapies has not been evaluated in detail. Methods Patients (N = 97) with type 2 diabetes were randomized to receive either empagliflozin and linagliptin (E+L group) or metformin and insulin glargine (M+I group) for 3 months. Renal hemodynamics were assessed with para-aminohippuric acid and inulin for renal plasma flow (RPF) and glomerular filtration rate (GFR). Intraglomerular hemodynamics were calculated according the Gomez´ model. Results Treatment with E+L reduced GFR (p = 0.003), but RPF remained unchanged (p = 0.536). In contrast, M+I not only reduced GFR (p = 0.001), but also resulted in a significant reduction of RPF (p < 0.001). Renal vascular resistance (RVR) decreased with E+L treatment (p = 0.001) but increased with M+I treatment (p = 0.001). The changes in RPF and RVR were different between the two groups (both padjust < 0.001). Analysis of intraglomerular hemodynamics revealed that E+L did not change resistance of afferent arteriole (RA) (p = 0.116), but diminished resistance of efferent arterioles (RE) (p = 0.001). In M+I group RA was increased (p = 0.006) and RE remained unchanged (p = 0.538). The effects on RA (padjust < 0.05) and on RE (padjust < 0.05) differed between the groups. Conclusions In patients with type 2 diabetes and preserved renal function treatment with M+I resulted in reduction of renal perfusion and increase in vascular resistance, in contrast to treatment with E+I that preserved renal perfusion and reduced vascular resistance. Moreover, different underlying effects on the resistance vessels have been estimated according to the Gomez model, with M+I increasing RA and E+L predominantly decreasing RE, which is in contrast to the proposed sodium-glucose cotransporter 2 inhibitor effects. Trial registration: The study was registered at www.clinicaltrials.gov (NCT02752113) on April 26, 2016

Hemodynamic Function of Forearm Muscle in Postmenopausal Women With Type 2 Diabetes

2020 ◽  
Vol 28 (5) ◽  
pp. 723-730
Author(s):  
Luca Pollonini ◽  
Lauren Gulley Cox ◽  
Stacey L. Gorniak
Keyword(s):  
Type 2 Diabetes ◽  
Postmenopausal Women ◽  
Near Infrared ◽  
Cardiovascular Health ◽  
Force Production ◽  
Causal Mechanism ◽  
Health State ◽  
Hemodynamic Function ◽  
Flexor Digitorum

Changes in the hemodynamic function of muscle are speculated as a causal mechanism for reduced motor capabilities with aging in Type 2 diabetes mellitus (DM). The focus of this study was to evaluate changes in muscle oxygenation during sustained force production in postmenopausal women with DM compared with controls. Near-infrared spectroscopy was used to monitor deoxyhemoglobin and oxyhemoglobin in the flexor digitorum superficialis. Sensorimotor function and health state covariates were also assessed. Increased deoxyhemoglobin was found during force production, whereas oxyhemoglobin remained constant. Changes were found in the time structure of the hemodynamic data during force production. No between-group differences were found; instead, measures covaried with the health state. Sex-based differences in the manifestation of DM-related sensorimotor dysfunction are likely. These data indicate that basic cardiovascular health measures may be more beneficial to monitoring hyperemic status and muscle function in postmenopausal women with DM, compared with DM diagnosis.

High serum miRNA 550a-5p levels are risk factors for incident fractures in older postmenopausal women with type 2 diabetes

2016 ◽  
Author(s):  
Ursula Heilmeier ◽  
Matthias Hackl ◽  
Susanna Skalicky ◽  
Sylvia Weilner ◽  
Fabian Schroeder ◽  
...  
Keyword(s):  
Risk Factors ◽  
Type 2 Diabetes ◽  
Postmenopausal Women ◽  
High Serum ◽  
Serum Mirna

1983-P: WNT Pathway and Bone Fragility in Postmenopausal Women with Type 2 Diabetes

Diabetes ◽  
2019 ◽  
Vol 68 (Supplement 1) ◽  
pp. 1983-P
Author(s):  
ALESSANDRA PICCOLI ◽  
FRANCESCA CANNATA ◽  
FABRIZIO RUSSO ◽  
VALENTINA L. GRETO ◽  
CAMILLA ISGRÒ ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Postmenopausal Women ◽  
Wnt Pathway ◽  
Bone Fragility

356-OR: Effect of Dulaglutide on Kidney Function–Related Outcomes in Type 2 Diabetes: Post Hoc Analysis from the REWIND Trial

Diabetes ◽  
2020 ◽  
Vol 69 (Supplement 1) ◽  
pp. 356-OR
Author(s):  
JONATHAN E. SHAW ◽  
FADY T. BOTROS ◽  
RALEIGH MALIK ◽  
CHARLES ATISSO ◽  
HELEN M. COLHOUN ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Kidney Function ◽  
Post Hoc Analysis ◽  
Post Hoc

scholarly journals Associations between multimorbidity and glycaemia (HbA1c) in people with type 2 diabetes: cross-sectional study in Australian general practice

BMJ Open ◽  
2020 ◽  
Vol 10 (11) ◽  
pp. e039625
Author(s):  
Jason I Chiang ◽  
John Furler ◽  
Frances Mair ◽  
Bhautesh D Jani ◽  
Barbara I Nicholl ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
General Practice ◽  
Cross Sectional Study ◽  
Secondary Outcome ◽  
Linear Regression Models ◽  
Sectional Study ◽  
Cross Sectional ◽  
Long Term Conditions ◽  
Australian General Practice

ObjectivesTo explore the prevalence of multimorbidity as well as individual and combinations of long-term conditions (LTCs) in people with type 2 diabetes (T2D) attending Australian general practice, using electronic health record (EHR) data. We also examine the association between multimorbidity condition count (total/concordant(T2D related)/discordant(unrelated)) and glycaemia (glycated haemoglobin, HbA1c).DesignCross-sectional study.SettingAustralian general practice.Participants69 718 people with T2D with a general practice encounter between 2013 and 2015 captured in the MedicineInsight database (EHR Data from 557 general practices and >3.8 million Australian patients).Primary and secondary outcome measuresPrevalence of multimorbidity, individual and combinations of LTCs. Multivariable linear regression models used to examine associations between multimorbidity counts and HbA1c (%).ResultsMean (SD) age 66.42 (12.70) years, 46.1% female and mean (SD) HbA1c 7.1 (1.4)%. More than 90% of participants with T2D were living with multimorbidity. Discordant conditions were more prevalent (83.4%) than concordant conditions (69.9 %). The three most prevalent discordant conditions were: painful conditions (55.4%), dyspepsia (31.6%) and depression (22.8%). The three most prevalent concordant conditions were hypertension (61.4%), coronary heart disease (17.1%) and chronic kidney disease (8.5%). The three most common combinations of conditions were: painful conditions and hypertension (38.8%), painful conditions and dyspepsia (23.1%) and hypertension and dyspepsia (22.7%). We found no associations between any multimorbidity counts (total, concordant and discordant) or combinations and HbA1c.ConclusionsMultimorbidity was common in our cohort of people with T2D attending Australian general practice, but was not associated with glycaemia. Although we did not explore mortality in this study, our results suggest that the increased mortality in those with multimorbidity and T2D observed in other studies may not be linked to glycaemia. Interestingly, discordant conditions were more prevalent than concordant conditions with painful conditions being the second most common comorbidity. Better understanding of the implications of different patterns of multimorbidity in people with T2D will allow more effective tailored care.

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