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Hemorheological Approach for Early Detection of Chronic Kidney Disease and Diabetic Nephropathy in Type 2 Diabetes

 Lee Seohui  ;  Lee Min Young  ;  Nam Ji Sun  ;  Kang Shinae  ;  Park Jong Suk  ;  Shin Sehyun  ;  Ahn Chul Woo  ;  Kim Kyung Rae 
 DIABETES TECHNOLOGY & THERAPEUTICS, Vol.17(11) : 808-815, 2015 
Journal Title
Issue Date
Albuminuria/urine ; Biomarkers/blood ; Biomarkers/urine ; Creatinine/urine ; Cross-Sectional Studies ; Diabetes Mellitus, Type 2/blood* ; Diabetes Mellitus, Type 2/complications ; Diabetes Mellitus, Type 2/physiopathology ; Diabetic Nephropathies/blood* ; Diabetic Nephropathies/etiology ; Diabetic Nephropathies/physiopathology ; Early Diagnosis ; Erythrocyte Aggregation ; Erythrocyte Deformability ; Fasting/blood ; Female ; Fibrinogen/analysis ; Glomerular Filtration Rate ; Humans ; Male ; Middle Aged ; Regression Analysis ; Renal Insufficiency, Chronic/blood* ; Renal Insufficiency, Chronic/etiology ; Renal Insufficiency, Chronic/physiopathology
BACKGROUND: Hemorheologic alterations or changes in blood viscosity have been suggested to play a role in the pathogenesis of microvascular complications in diabetes. We measured various hemorheologic parameters in type 2 diabetes patients at different stages of chronic kidney disease (CKD) and assessed their possible role as early markers of diabetic nephropathy and renal insufficiency. SUBJECTS AND METHODS: One hundred-five patients with type 2 diabetes were divided into four groups according to glomerular filtration rate (GFR), which represents the kidney function. Hemorheologic parameters, including erythrocyte deformability, fibrinogen/elongation index (EI), and aggregation index (AI) were measured using a microfluidic hemorheometer, and critical shear stress (CSS) was measured using a microfluidic technique. Various metabolic parameters were assessed from fasting blood samples, and the urine albumin-to-creatinine ratio (ACR) was calculated from first morning voided urine. RESULTS: There were significant differences in red blood cell (RBC) deformability, AI, CSS, fibrinogen/EI, and ACR among patients in different stages of CKD (all P<0.05). RBC deformability and fibrinogen/EI significantly differed between normal (GFR >90 mL/min/1.73 m(2)) and CKD stage 2 (GFR 60-90 mL/min/1.73 m(2)) patients, whereas there was no such difference in ACR. In multiple regression analysis, fibrinogen/EI under a moderate shear stress of 3 Pa was an independent predictor of GFR (β=-0.328, P<0.05). Also, AI, CSS, and fibrinogen/EI were significantly different among patients at different stages of diabetic nephropathy, with a significant difference in fibrinogen/EI between normal and microalbuminuric patients (all P<0.05). CONCLUSIONS: RBC deformability and fibrinogen/EI are sensitive parameters measured via point-of-care testing for detecting erythrocyte alterations in early CKD and nephropathy in patients with type 2 diabetes. Further studies are warranted to verify their use as screening tools for diabetic nephropathy and renal impairment.
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1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
Yonsei Authors
Kang, Shin Ae(강신애) ORCID logo https://orcid.org/0000-0002-9719-4774
Kim, Kyung Rae(김경래)
Nam, Ji Sun(남지선) ORCID logo https://orcid.org/0000-0001-8655-5258
Park, Jong Suk(박종숙) ORCID logo https://orcid.org/0000-0002-5385-1373
Ahn, Chul Woo(안철우) ORCID logo https://orcid.org/0000-0003-3733-7486
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