Abstract
Background Patients with chronic kidney disease (CKD) and type 2 diabetes mellitus (DM) have increased risk of endothelial dysfunction, cardiovascular disease, and mortality. Several studies have separately analyzed endothelial function in these populations. However, data of patients with both CKD and DM are scarce. The aim of this study was to evaluate whether the presence of DM has any additional effect on the endothelial dysfunction of CKD patients. Methods We measured endothelial progenitor cells (EPCs), stromal-derived factor 1 alpha (SDF-1α), serum and urinary nitric oxide (NO), flow-mediated dilation (FMD), and pulse wave velocity (PWV) in 37 CKD patients with DM (CKD-DM group) and in 37 without DM (CKD group). Results CKD-DM group had a higher prevalence of obesity (P < 0.01), previous myocardial infarction (P = 0.02), myocardial revascularization (P = 0.04), and a trend for more peripheral artery disease (P = 0.07). Additionally, CKD-DM group had higher EPC (P = 0.001) and PWV (P < 0.001) values. On the other hand, no difference in SDF-1α and serum or urinary NO and FMD was observed between the groups. Conclusions Endothelial dysfunction is frequent in CKD patients, and an additive effect of diabetes cannot be implicated, suggesting the predominant role of uremia in this condition.
Highlights
The Global Burden Disease 2010 study had highlighted chronic kidney disease (CKD) as an important cause for global mortality [1]
Several factors are associated with endothelial dysfunction in these populations [13, 14], such as uremic toxins and hyperglycemia, that are related to the depletion of endothelial nitric oxide (NO) [12, 14,15,16]
Characteristics of the CKD patients according to the presence (CKD-diabetes mellitus (DM) group) or absence (CKD group) of diabetes are listed in Tables 1 and 2
Summary
The Global Burden Disease 2010 study had highlighted chronic kidney disease (CKD) as an important cause for global mortality [1]. It is estimated that 10–15% of the adult population has CKD at various stages of severity [2] This rate has grown [3] in parallel with the increasing incidence and prevalence of type 2 diabetes mellitus (DM) [3, 4], one of the main causes of CKD [4]. Cardiovascular disease (CVD) is the most important cause of mortality in CKD as well as in DM patients [6, 7]. Patients with chronic kidney disease (CKD) and type 2 diabetes mellitus (DM) have increased risk of endothelial dysfunction, cardiovascular disease, and mortality. Endothelial dysfunction is frequent in CKD patients, and an additive effect of diabetes cannot be implicated, suggesting the predominant role of uremia in this condition
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