Heart rate and blood pressure is associated with renal function in patients with type 1 diabetes in the absence of nephropathy and therapeutical interventions
Abstract
Background. Albuminuria, heart rate (HR) and blood pressure are established predictors of chronic kidney disease
and cardiovascular disease. The objective of this study was to explore the relationship between HR, systolic blood
pressure (SBP) and diastolic blood pressure (DBP) with renal function parameters in patients with type 1 diabetes
(T1DM) without therapeutical interventions.
Material and methods. Study included 313 normoalbuminuric T1DM. HR was determined using a standard
12-lead ECG and blood pressure with a mercury sphygmomanometer, both after a resting period of 10 minutes.
Urinary albumin excretion rate (UAE) was measured from at least two 24-h urine samples. Data on serum creatinine
levels, age, sex and race were used to calculate the estimated glomerular filtration rate (eGFR) using the Chronic
Kidney Disease Epidemiology Collaboration (CKD-EPI) formula.
Results. eGFR was significantly associated with duration of diabetes, HbA1c, LDL-cholesterol, and HDL-cholesterol
(for the duration of diabetes r = –0.29, p < 0.001). UAE significantly correlated with duration of diabetes,
HDL-cholesterol, triglycerides, HR and DBP (for HR and DBP r = 0.21–0.23, p < 0.001). Subjects in the 4th quartile
of UAE had significantly higher HR rate compared to subjects in 1st, 2nd, and 3rd quartiles (70 ± 11 vs. 74 ± 12
vs. 74 ± 12 vs. 79 ± 13 beats/min, p = 0.001).
Conclusions. Results of our study suggest that interplay between HR with renal function parameters is present even
in T1DM with normal renal function.
Keywords: type 1 diabetesheart raterenal functionalbuminuria
References
- Steigerwalt S. Management of Hypertension in Diabetic Patients With Chronic Kidney Disease. Diabetes Spectrum. 2008; 21(1): 30–36.
- American Diabetes Association. 10. Microvascular Complications and Foot Care: Standards of Medical Care in Diabetes 2018. Diabetes Care. 2018; 41(Suppl 1): S105–S118.
- Inoue T, Iseki K, Iseki C, et al. Heart rate as a risk factor for developing chronic kidney disease: longitudinal analysis of a screened cohort. Clin Exp Nephrol. 2009; 13(5): 487–493.
- Schmieder RE, Bramlage P, Haller H, et al. ROADMAP Investigators. The effect of resting heart rate on the new onset of microalbuminuria in patients with type 2 diabetes: a subanalysis of the ROADMAP study. Medicine (Baltimore). 2016; 95(15): e3122.
- Hillis GS, Hata J, Woodward M, et al. Resting heart rate and the risk of microvascular complications in patients with type 2 diabetes mellitus. J Am Heart Assoc. 2012; 1(5): e002832.
- Cho YHi, Craig ME, Davis EA, et al. Adolescent Type 1 Diabetes Cardio-Renal Intervention Trial. Cardiac autonomic dysfunction is associated with high-risk albumin-to-creatinine ratio in young adolescents with type 1 diabetes in AdDIT (adolescent type 1 diabetes cardio-renal interventional trial). Diabetes Care. 2015; 38(4): 676–681.
- Gillman MW, Kannel WB, Belanger A, et al. Influence of heart rate on mortality among persons with hypertension: the Framingham Study. Am Heart J. 1993; 125(4): 1148–1154.
- Paul L, Hastie CE, Li WS, et al. Resting heart rate pattern during follow-up and mortality in hypertensive patients. Hypertension. 2010; 55(2): 567–574.
- Diaz A, Bourassa MG, Guertin MC, et al. Long-term prognostic value of resting heart rate in patients with suspected or proven coronary artery disease. Eur Heart J. 2005; 26(10): 967–974.
- Fox K, Ford I, Steg PG, et al. BEAUTIFUL investigators. Heart rate as a prognostic risk factor in patients with coronary artery disease and left-ventricular systolic dysfunction (BEAUTIFUL): a subgroup analysis of a randomised controlled trial. Lancet. 2008; 372(9641): 817–821.
- Levey AS, Astor BC, Stevens LA, et al. Chronic kidney disease, diabetes, and hypertension: what's in a name? Kidney Int. 2010; 78(1): 19–22.
- Stojceva-Taneva O, Selim G, Stojkovski L, et al. Hypertension and progression of nephropathy in diabetic and non-diabetic chronic kidney disease patients. Hippokratia. 2007; 11(2): 72–76.
- Di Iorio B, Pota A, Sirico ML, et al. Blood pressure variability and outcomes in chronic kidney disease. Nephrol Dial Transplant. 2012; 27(12): 4404–4410.
- Ravera M, Re M, Deferrari L, et al. Importance of blood pressure control in chronic kidney disease. J Am Soc Nephrol. 2006; 17(4 Suppl 2): S98–103.
- Pálsson R, Patel UD. Cardiovascular complications of diabetic kidney disease. Adv Chronic Kidney Dis. 2014; 21(3): 273–280.
- Dunger DB, Schwarze CP, Cooper JD, et al. Can we identify adolescents at high risk for nephropathy before the development of microalbuminuria? Diabet Med. 2007; 24(2): 131–136.
- Piscitelli P, Viazzi F, Fioretto P, et al. Predictors of chronic kidney disease in type 1 diabetes: a longitudinal study from the AMD Annals initiative. Sci Rep. 2017; 7(1): 3313.
- Levey AS, Stevens LA, Schmid CH, et al. CKD-EPI (Chronic Kidney Disease Epidemiology Collaboration). A new equation to estimate glomerular filtration rate. Ann Intern Med. 2009; 150(9): 604–612.
- Vučić Lovrenčić M, Radišić Biljak V, Božičević S, et al. Estimating glomerular filtration rate (GFR) in diabetes: the performance of MDRD and CKD-EPI equations in patients with various degrees of albuminuria. Clin Biochem. 2012; 45(18): 1694–1696.
- Wachtell K, Ibsen H, Olsen MH, et al. Albuminuria and cardiovascular risk in hypertensive patients with left ventricular hypertrophy: the LIFE study. Ann Intern Med. 2003; 139(11): 901–906.
- Rachmani R, Levi Z, Lidar M, et al. Considerations about the threshold value of microalbuminuria in patients with diabetes mellitus: lessons from an 8-year follow-up study of 599 patients. Diabetes Res Clin Pract. 2000; 49(2–3): 187–194.
- Ruggenenti P, Remuzzi G. Time to abandon microalbuminuria? Kidney Int. 2006; 70(7): 1214–1222.
- Ritz E, Viberti GC, Ruilope LM, et al. Determinants of urinary albumin excretion within the normal range in patients with type 2 diabetes: the Randomised Olmesartan and Diabetes Microalbuminuria Prevention (ROADMAP) study. Diabetologia. 2010; 53(1): 49–57.
- Fox KM. Current status: heart rate as a treatable risk factor. European Heart Journal Supplements. 2011; 13(Suppl C): C30–C36.
- Hillis GS, Woodward M, Rodgers A, et al. Resting heart rate and the risk of death and cardiovascular complications in patients with type 2 diabetes mellitus. Diabetologia. 2012; 55(5): 1283–1290.
- Böhm M, Reil JC, Danchin N, et al. Association of heart rate with microalbuminuria in cardiovascular risk patients: data from I-SEARCH. J Hypertens. 2008; 26(1): 18–25.
- Pfister R, Erdmann E, Schneider CA. Association and prognostic impact of heart rate and micro- albuminuria in patients with type 2 diabetes and cardiovascular disease: results from the PROactive trial. J Atheroscler Thromb. 2011; 18(1): 65–71.
- DiBona GF. Physiology in perspective: The Wisdom of the Body. Neural control of the kidney. Am J Physiol Regul Integr Comp Physiol. 2005; 289(3): R633–R641.
- Koomans HA, Blankestijn PJ, Joles JA. Sympathetic hyperactivity in chronic renal failure: a wake-up call. J Am Soc Nephrol. 2004; 15(3): 524–537.
- Joles JA, Koomans HA. Causes and consequences of increased sympathetic activity in renal disease. Hypertension. 2004; 43(4): 699–706.
- Johns EJ, Kopp UC, DiBona GF, et al. Neural control of renal function. Physiol Rev. 1997; 77(1): 75–197.
- Pavenstädt H, Kriz W, Kretzler M. Cell biology of the glomerular podocyte. Physiol Rev. 2003; 83(1): 253–307.
- Menown IBA, Davies S, Gupta S, et al. Resting heart rate and outcomes in patients with cardiovascular disease: where do we currently stand? Cardiovasc Ther. 2013; 31(4): 215–223.
- Astrup AS, Tarnow L, Rossing P, et al. Cardiac autonomic neuropathy predicts cardiovascular morbidity and mortality in type 1 diabetic patients with diabetic nephropathy. Diabetes Care. 2006; 29(2): 334–339.
- Mancia G, Parati G. Ambulatory blood pressure monitoring and organ damage. Hypertension. 2000; 36(5): 894–900.