Glycosuria amount in response to hyperglycaemia and risk for diabetic kidney disease and related events in Type 1 diabetic patients
© The Author(s) 2018. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved..
BACKGROUND: Hyperglycaemia impairs tubulo-glomerular feedback. We tested whether variable tubulo-glomerular feedback during hyperglycaemia contributes to renal risk heterogeneity seen in Type 1 diabetes.
METHODS: During the period 1990-92, we studied the tubulo-glomerular feedback in Type 1 diabetic patients at high or low renal risk [21 of 54 with glomerular hyperfiltration and/or microalbuminuria against 11 of 55 with normal glomerular filtration rate (GFR) and urinary albumin despite uncontrolled diabetes]. The GFR, effective renal plasma flow, mean arterial pressure and fractional reabsorptions of glucose, osmols, sodium and lithium were measured sequentially during normo- and hyperglycaemia. All patients were followed up until 2016 for incident proteinuria, estimated GFR <60 mL/min/1.73 m2, doubling of serum creatinine, end-stage renal disease or all-cause death.
RESULTS: Glycaemia increased from 6.1 ± 1.3 to 15.1 ± 1.9 mmol/L in both high-risk and low-risk patients. Glycosuria was lower in the high- versus low-risk patients: 0.34 ± 0.25 versus 0.64 ± 0.44 mmol/min (P = 0.03). Both groups displayed similar kidney function during normoglycaemia. Hyperglycaemia increased more importantly GFR and fractional reabsorptions, and pre-glomerular vasodilatation in the high- than in the low-risk patients (all P < 0.05). Over 21 years, 31.5% high- versus 12.7% low-risk patients developed endpoints (adjusted P = 0.006). In a multi-adjusted survival analysis of patients having undergone renal tests, each 0.10 mmol/min glycosuria during hyperglycaemia reduced the outcome risk by 0.72 (95% confidence interval 0.49-0.97, P = 0.03).
CONCLUSIONS: Reduced tubulo-glomerular feedback and glycosuria during hyperglycaemia indicate high renal risk for Type 1 diabetic patients. Inter-individual variability in tubulo-glomerular feedback activity determines renal risk in Type 1 diabetes.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2019 |
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| Erschienen: |
2019 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:34 |
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| Enthalten in: |
Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association - 34(2019), 10 vom: 01. Okt., Seite 1731-1738 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Carpentier, Charlyne [VerfasserIn] |
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| Links: |
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| Themen: |
Blood Glucose |
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| Anmerkungen: |
Date Completed 09.04.2020 Date Revised 09.04.2020 published: Print Citation Status MEDLINE |
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| doi: |
10.1093/ndt/gfy197 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM286253305 |
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| 100 | 1 | |a Carpentier, Charlyne |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Glycosuria amount in response to hyperglycaemia and risk for diabetic kidney disease and related events in Type 1 diabetic patients |
| 264 | 1 | |c 2019 | |
| 336 | |a Text |b txt |2 rdacontent | ||
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| 500 | |a Date Completed 09.04.2020 | ||
| 500 | |a Date Revised 09.04.2020 | ||
| 500 | |a published: Print | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a © The Author(s) 2018. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved. | ||
| 520 | |a BACKGROUND: Hyperglycaemia impairs tubulo-glomerular feedback. We tested whether variable tubulo-glomerular feedback during hyperglycaemia contributes to renal risk heterogeneity seen in Type 1 diabetes | ||
| 520 | |a METHODS: During the period 1990-92, we studied the tubulo-glomerular feedback in Type 1 diabetic patients at high or low renal risk [21 of 54 with glomerular hyperfiltration and/or microalbuminuria against 11 of 55 with normal glomerular filtration rate (GFR) and urinary albumin despite uncontrolled diabetes]. The GFR, effective renal plasma flow, mean arterial pressure and fractional reabsorptions of glucose, osmols, sodium and lithium were measured sequentially during normo- and hyperglycaemia. All patients were followed up until 2016 for incident proteinuria, estimated GFR <60 mL/min/1.73 m2, doubling of serum creatinine, end-stage renal disease or all-cause death | ||
| 520 | |a RESULTS: Glycaemia increased from 6.1 ± 1.3 to 15.1 ± 1.9 mmol/L in both high-risk and low-risk patients. Glycosuria was lower in the high- versus low-risk patients: 0.34 ± 0.25 versus 0.64 ± 0.44 mmol/min (P = 0.03). Both groups displayed similar kidney function during normoglycaemia. Hyperglycaemia increased more importantly GFR and fractional reabsorptions, and pre-glomerular vasodilatation in the high- than in the low-risk patients (all P < 0.05). Over 21 years, 31.5% high- versus 12.7% low-risk patients developed endpoints (adjusted P = 0.006). In a multi-adjusted survival analysis of patients having undergone renal tests, each 0.10 mmol/min glycosuria during hyperglycaemia reduced the outcome risk by 0.72 (95% confidence interval 0.49-0.97, P = 0.03) | ||
| 520 | |a CONCLUSIONS: Reduced tubulo-glomerular feedback and glycosuria during hyperglycaemia indicate high renal risk for Type 1 diabetic patients. Inter-individual variability in tubulo-glomerular feedback activity determines renal risk in Type 1 diabetes | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Research Support, Non-U.S. Gov't | |
| 650 | 4 | |a Type 1 diabetes | |
| 650 | 4 | |a diabetic nephropathy | |
| 650 | 4 | |a glycosuria | |
| 650 | 4 | |a proteinuria | |
| 650 | 4 | |a tubulo-glomerular feedback | |
| 650 | 7 | |a Blood Glucose |2 NLM | |
| 700 | 1 | |a Dubois, Séverine |e verfasserin |4 aut | |
| 700 | 1 | |a Mohammedi, Kamel |e verfasserin |4 aut | |
| 700 | 1 | |a Belhatem, Narimène |e verfasserin |4 aut | |
| 700 | 1 | |a Bouhanick, Béatrice |e verfasserin |4 aut | |
| 700 | 1 | |a Rohmer, Vincent |e verfasserin |4 aut | |
| 700 | 1 | |a Briet, Claire |e verfasserin |4 aut | |
| 700 | 1 | |a Bumbu, Anisoara |e verfasserin |4 aut | |
| 700 | 1 | |a Hadjadj, Samy |e verfasserin |4 aut | |
| 700 | 1 | |a Roussel, Ronan |e verfasserin |4 aut | |
| 700 | 1 | |a Potier, Louis |e verfasserin |4 aut | |
| 700 | 1 | |a Velho, Gilberto |e verfasserin |4 aut | |
| 700 | 1 | |a Marre, Michel |e verfasserin |4 aut | |
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