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Microvascular disease of the brain as seen on MRI is a good predictor of end-stage renal disease in diabetes and might serve as a proxy for hard-to-detect renal vessel damage.
Currently, no established method exists for assessing small vessel disease in the kidney, according to a report by Dr. Takashi Uzu of Shiga University School of Medical Science in Otsu, Japan, and colleagues.
However, “The vascular beds of the kidney and brain have similar hemodynamic properties,” Dr. Uzu and colleagues wrote (J. Am. Soc. Nephrol. 2010 Jan. 28 [doi: 10.1681/ASN.2009050558
The researchers looked at 608 Japanese patients aged 30-75 years with type 2 diabetes who had been hospitalized to control glucose or to examine their diabetic complications. Patients were excluded if they had a past history of cerebrovascular or cardiovascular events, including MI and heart failure.
All patients underwent MRI of the brain at baseline. A total of 177 patients were found to have had a “silent cerebral infarct” (SCI), defined as “evidence of one or more infarcts on MRI, without a history of stroke or transient ischemic attack.”
Compared with the patients who showed no evidence of past SCI (431), the SCI group had longer diabetes duration (mean of 9.8 years vs. 7.6 years), were older (63.3 years vs. 57.3 years), and had higher blood pressure (the SCI patients had a systolic mean pressure of 146.8 mm Hg vs. 136.5 mm Hg in the non-SCI group; their diastolic mean was 81.6 mm Hg vs. 78.8 mm Hg).
“Over the average 7.5-year follow-up period, 58 patients (34 in the SCI group and 24 in the non-SCI group) reached the primary composite end point of ESRD or death,” the authors wrote. That amounted to a hazard ratio of 2.44.
The likelihood of meeting the study's secondary end point—dialysis plus two serum creatinine values that were twice the baseline values—also was significantly greater in the SCI group compared with the non-SCI group (HR 4.79).
The frequency of patients being treated with renin-angiotensin system–blocking agents, which might lead to renal impairment as an adverse effect, was higher in the SCI group.
“However, the frequency of the primary (ESRD or death) and secondary (the composite of any dialysis and doubling of the serum [creatinine] concentration) end points did not differ” between SCI patients who were treated with RAS-blockers and those who were not, they wrote.
The findings suggest that “the presence of extrarenal microvascular diseases” might be a new predictor of renal function in type 2 diabetes patients.
The authors disclosed no conflicts of interest related to this study.
Microvascular disease of the brain as seen on MRI is a good predictor of end-stage renal disease in diabetes and might serve as a proxy for hard-to-detect renal vessel damage.
Currently, no established method exists for assessing small vessel disease in the kidney, according to a report by Dr. Takashi Uzu of Shiga University School of Medical Science in Otsu, Japan, and colleagues.
However, “The vascular beds of the kidney and brain have similar hemodynamic properties,” Dr. Uzu and colleagues wrote (J. Am. Soc. Nephrol. 2010 Jan. 28 [doi: 10.1681/ASN.2009050558
The researchers looked at 608 Japanese patients aged 30-75 years with type 2 diabetes who had been hospitalized to control glucose or to examine their diabetic complications. Patients were excluded if they had a past history of cerebrovascular or cardiovascular events, including MI and heart failure.
All patients underwent MRI of the brain at baseline. A total of 177 patients were found to have had a “silent cerebral infarct” (SCI), defined as “evidence of one or more infarcts on MRI, without a history of stroke or transient ischemic attack.”
Compared with the patients who showed no evidence of past SCI (431), the SCI group had longer diabetes duration (mean of 9.8 years vs. 7.6 years), were older (63.3 years vs. 57.3 years), and had higher blood pressure (the SCI patients had a systolic mean pressure of 146.8 mm Hg vs. 136.5 mm Hg in the non-SCI group; their diastolic mean was 81.6 mm Hg vs. 78.8 mm Hg).
“Over the average 7.5-year follow-up period, 58 patients (34 in the SCI group and 24 in the non-SCI group) reached the primary composite end point of ESRD or death,” the authors wrote. That amounted to a hazard ratio of 2.44.
The likelihood of meeting the study's secondary end point—dialysis plus two serum creatinine values that were twice the baseline values—also was significantly greater in the SCI group compared with the non-SCI group (HR 4.79).
The frequency of patients being treated with renin-angiotensin system–blocking agents, which might lead to renal impairment as an adverse effect, was higher in the SCI group.
“However, the frequency of the primary (ESRD or death) and secondary (the composite of any dialysis and doubling of the serum [creatinine] concentration) end points did not differ” between SCI patients who were treated with RAS-blockers and those who were not, they wrote.
The findings suggest that “the presence of extrarenal microvascular diseases” might be a new predictor of renal function in type 2 diabetes patients.
The authors disclosed no conflicts of interest related to this study.
Microvascular disease of the brain as seen on MRI is a good predictor of end-stage renal disease in diabetes and might serve as a proxy for hard-to-detect renal vessel damage.
Currently, no established method exists for assessing small vessel disease in the kidney, according to a report by Dr. Takashi Uzu of Shiga University School of Medical Science in Otsu, Japan, and colleagues.
However, “The vascular beds of the kidney and brain have similar hemodynamic properties,” Dr. Uzu and colleagues wrote (J. Am. Soc. Nephrol. 2010 Jan. 28 [doi: 10.1681/ASN.2009050558
The researchers looked at 608 Japanese patients aged 30-75 years with type 2 diabetes who had been hospitalized to control glucose or to examine their diabetic complications. Patients were excluded if they had a past history of cerebrovascular or cardiovascular events, including MI and heart failure.
All patients underwent MRI of the brain at baseline. A total of 177 patients were found to have had a “silent cerebral infarct” (SCI), defined as “evidence of one or more infarcts on MRI, without a history of stroke or transient ischemic attack.”
Compared with the patients who showed no evidence of past SCI (431), the SCI group had longer diabetes duration (mean of 9.8 years vs. 7.6 years), were older (63.3 years vs. 57.3 years), and had higher blood pressure (the SCI patients had a systolic mean pressure of 146.8 mm Hg vs. 136.5 mm Hg in the non-SCI group; their diastolic mean was 81.6 mm Hg vs. 78.8 mm Hg).
“Over the average 7.5-year follow-up period, 58 patients (34 in the SCI group and 24 in the non-SCI group) reached the primary composite end point of ESRD or death,” the authors wrote. That amounted to a hazard ratio of 2.44.
The likelihood of meeting the study's secondary end point—dialysis plus two serum creatinine values that were twice the baseline values—also was significantly greater in the SCI group compared with the non-SCI group (HR 4.79).
The frequency of patients being treated with renin-angiotensin system–blocking agents, which might lead to renal impairment as an adverse effect, was higher in the SCI group.
“However, the frequency of the primary (ESRD or death) and secondary (the composite of any dialysis and doubling of the serum [creatinine] concentration) end points did not differ” between SCI patients who were treated with RAS-blockers and those who were not, they wrote.
The findings suggest that “the presence of extrarenal microvascular diseases” might be a new predictor of renal function in type 2 diabetes patients.
The authors disclosed no conflicts of interest related to this study.