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Factors associated with diabetic nephropathy in subjects with proliferative retinopathy

  • Nephrology – Original Paper
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Abstract

Aim

The purpose was to compare the phenotype of subjects with type 2 diabetes mellitus having both retinopathy and nephropathy with that of subjects having retinopathy but no nephropathy.

Methods

We recruited 196 subjects; 85 were normoalbuminuric (controls), whilst cases consisted of patients with micro- (n = 66) or macroalbuminuria (n = 45). Both groups underwent 24-h blood pressure (BP) monitoring and were analysed regarding markers of the metabolic syndrome, inflammation (erythrocyte sedimentation rate [ESR] and high-sensitivity CRP [hsCRP]) and insulin resistance (HOMA-IR).

Results

Cases had significantly higher white cell count (P = 0.02), ESR (P < 0.001), platelets (P = 0.02), triglycerides (P = 0.001), uric acid (P < 0.001), daytime and night-time systolic BP (P = 0.001 & P = 0.001, respectively), diastolic BP (P = 0.007 & P = 0.001), pulse pressure (P = 0.02 & 0.055) and mean arterial pressure (P = 0.001 & P < 0.001) in univariate analysis. Cases had a lower haemoglobin level (P = 0.01) and estimated glomerular filtration rate (eGFR) (P = 0.002) in comparison with controls. Multivariate analysis showed that night-time diastolic BP (P = 0.002, B = 1.057), platelet count (P = 0.018, B = 1.007) and eGFR (P < 0.001, B = 0.097) are independent predictors of diabetic nephropathy. Platelet count (P = 0.045, B = 1.006), night-time mean diastolic BP (P = 0.029, B = 1.042) and eGFR (P = 0.001, B = 0.975) were also found to be independent predictors of the occurrence of microalbuminuria.

Conclusions

By analysing factors associated with diabetic nephropathy rather than microvascular disease in general, this study provides evidence that night-time diastolic BP and a relative increase in platelet count are associated with incipient diabetic nephropathy.

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Acknowledgments

The authors would like to like to thank all the staff at Diabetes Centre, Cardiac Laboratory, Biochemistry and Immunology Laboratory, Mater Dei Hospital, for their continuous help and support whilst carrying out this study.

Conflict of interest

Nothing to declare.

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Authors and Affiliations

  1. Department of Cardiac Services, Mater Dei Hospital & University of Malta Medical School, Msida, Malta

    Caroline Jane Magri

  2. “Jesmel”, Imdina Road, Zebbug, ZBG05, Malta

    Caroline Jane Magri

  3. Department of Health Information & Research, G’Mangia, Malta

    Neville Calleja

  4. Department of Pathology, Mater Dei Hospital, Msida, Malta

    Gerald Buhagiar

  5. Department of Medicine, Division of Diabetes and Endocrinology, Mater Dei Hospital & University of Malta Medical School, Msida, Malta

    Stephen Fava & Josanne Vassallo

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  1. Caroline Jane Magri
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  2. Neville Calleja
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  3. Gerald Buhagiar
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  4. Stephen Fava
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  5. Josanne Vassallo
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Correspondence to Caroline Jane Magri.

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Magri, C.J., Calleja, N., Buhagiar, G. et al. Factors associated with diabetic nephropathy in subjects with proliferative retinopathy. Int Urol Nephrol 44, 197–206 (2012). https://doi.org/10.1007/s11255-011-9958-1

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  • DOI: https://doi.org/10.1007/s11255-011-9958-1

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