Progression of diabetic nephropathy Role of plasma homocysteine and plasminogen activator inhibitor-1
article
Among patients with diabetic nephropathy, the decline in glomerular filtration rate (GFR) varies substantially, ranging from 2 to 20 mL/min per year. Identification of predictors of progression in diabetic nephropathy is important. Plasma total homocysteine (tHcy) rises with urinary albumin excretion rate in diabetes, and plasminogen activator inhibitor-1 (PAI-1) has been correlated with increased matrix accumulation in various glomerulopathies. In this prospective observational cohort study, we evaluated the importance of baseline tHcy and PAI-1 as predictors of the rate of decline in GFR. Baseline tHcy and PAI-1 were measured in 157 type 1 diabetic patients with diabetic nephropathy (92 men; mean age, 41 ±: 10 years; mean diabetes duration, 27 ± 8 years; median GFR, 80 mL/min/1.73 m2 [range, 23 to 143 mL/min/1.73 m2]). Hereafter, GFR was measured yearly with a plasma clearance technique for at least 3 years (median, 7 years [range, 3.0 to 8.3 years]). The mean rate of decline in GFR was 3.7 ± 0.3 mL/min per year. A linear regression analysis revealed a borderline significant relationship between rate of decline in GFR and tHcy (P = 0.069) and PAI-1 (P = 0.087). Analysis of the rate of decline in GFR and tertiles of tHcy and PAI-1 revealed that increasing levels of tHcy were correlated with a significantly faster decline in GFR (P = 0.025), whereas increasing levels of PAI-1 were not. After adjustment for other well-established risk factors for progression of nephropathy in a multiple linear regression analysis, however, neither tHcy levels nor PAI-1 levels were independent predictors of rate of decline in GFR. © 2001 by the National Kidney Foundation, Inc. Chemicals / CAS hemoglobin A1c, 62572-11-6; homocysteine, 454-28-4, 6027-13-0; plasminogen activator inhibitor 1, 140208-23-7
Topics
Diabetic nephropathyHomocysteinePlasminogen activator inhibitor-1Type 1 diabetesalbuminhemoglobin A1chomocysteineplasminogen activator inhibitor 1adultblood levelconference paperdiabetic nephropathydisease courseenzyme linked immunosorbent assayfemaleglomerulus filtration ratehigh performance liquid chromatographyhumanmajor clinical studymalepredictionrisk factor
TNO Identifier
953570
ISSN
02726386
Source
American Journal of Kidney Diseases, 38(6), pp. 1376-1380.
Pages
1376-1380
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