Adrenomedullin in patients with type 2 diabetes and kidney disease

Abstract

Secreting vasoactive factors such asadrenomedullin (AM) has been intensivelyinvestigated due to its vascular protective propertiesand promising potential as a therapeutic target. Therelationship between adrenomedullin and type (2)diabetes needs to be elucidated as it is associatedwith significant elevation in plasma adrenomedullinlevels. The aim of this study was to evaluate therole of adrenomedullin in the development ofvasculopathy and its significance as a markerdenoting renal affection in type 2 diabetic patients. Materials and Methods: This study was conductedon 60 diabetic patients, 20 without nephropathy, 20with nephropathy & 20 with diabetic nephropathy(DN) on haemodialysis as well as 20 age- and sex matchedhealthy controls. All were subjected to fullhistory, Echocardiography, lipid profile analysisand plasma adrenomedullin using ELISA method. Results: plasma AM concentration was elevated inall groups of diabetic patients and increment wasdependent on the severity of DN (P<0.0001,P<0.0001, P<0.0001 respectively). There werepositive correlation between adrenomedullin andleft ventricular internal dimensions both in diastole& systole (P<0.001, P<0.005) and negativecorrelation between AM and ejection fraction (EF)P<0.0001. There was positive correlation betweenadrenomedullin and cholesterol, triglycerides andLDL (p<0.002, p<0.001and p<0.003 respectively)and a negative correlation with HDL (P<0.004). Conclusion: Adrenomedullin is supposed to play arole in the pathogenesis of diabeticmicrovasculopathy in renal patients. So it can beused to identify high-risk subjects and modulatingits action would have therapeutic potential in the prevention of diabetic nephropathy.