Hemorheological approach for early detection of diabetic nephropathy

Abstract

Hemorheological Approach for Early Detection of DiabeticNephropathySeohui LeeDepartment of MedicineThe Graduate School, Yonsei University(Directed by Professor Chul Woo Ahn )Background: Hemorheologic alterations or changes in blood viscosityhave been suggested to play a role in the pathogenesis of diabeticmicrovascular complications. We measured various hemorheologicparameters in type 2 diabetes patients at different stages of chronic kidneydisease (CKD) and assessed their possible role as early markers ofdiabetic nephropathy and renal insufficiency.Methods: One hundred-five patients with type 2 diabetes were dividedinto four groups according to glomerular filtration rate (GFR).Hemorheologic parameters, including erythrocyte deformability,fibrinogen/elongation index (EI), and aggregation index (AI) weremeasured using microfluidic hemorheometer. Various metabolicparameters were assessed from fasting blood samples and urinealbumin/creatinine ratio (ACR) was calculated from first morning voidedurine.2Results: There were significant differences in RBC deformability, AI,critical stress, fibrinogen/EI, and albumin/creatinine ratio among patientsin different stages of CKD (all p<0.05), RBC deformability andFibrinogen/EI significantly differed between normal and CKD 2 patientswhile there was no such difference in ACR. In multiple regressionanalysis, Fibrinogen/EI at 3Pa was an independent predictor of GFR(ß=-0.328, p<0.05). Also, AI, critical stress, and CSS/EI at 3 Pa,CSS*ESR were significantly different among patients at different stagesof diabetic nephropathy, with a significant difference in CSS*ESRbetween normal and microalbuminuric patients (all p< 0.05).Conclusions: CSS*ESR are sensitive parameters measured viapoint-of-care testing for detecting erythrocyte alterations in early CKDand nephropathy in patients with type 2 diabetes. Further studies arewarranted to verify their use as screening tools for diabetic nephropathyand renal impairment.