Petter Bjornstad1,2, Julie A Lovshin3,4, Yuliya Lytvyn3, Genevieve Boulet5, Leif E Lovblom5, Omar N Alhuzaim5, Mohammed A Farooqi5, Vesta Lai3, Josephine Tse3, Leslie Cham3, Andrej Orszag5, Daniel Scarr5, Alanna Weisman5, Hillary A Keenan6, Michael H Brent7, Narinder Paul8, Vera Bril9, Bruce A Perkins4,5, David Z I Cherney3,10. 1. Division of Nephrology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada petter.bjornstad@childrenscolorado.org. 2. Division of Endocrinology, Department of Pediatrics, University of Colorado, Aurora, CO. 3. Division of Nephrology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada. 4. Division of Endocrinology and Metabolism, Department of Medicine, University of Toronto, Toronto, Ontario, Canada. 5. Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, Ontario, Canada. 6. Research Division, Joslin Diabetes Center, Boston, MA. 7. Department of Ophthalmology and Vision Sciences and Department of Medicine, University of Toronto, Toronto, Ontario, Canada. 8. Division of Cardiothoracic Radiology, Joint Department of Medical Imaging, University Health Network, Toronto, Ontario, Canada. 9. The Ellen and Martin Prosserman Centre for Neuromuscular Diseases, Krembil Neuroscience Centre, Division of Neurology, Department of Medicine, University Health Network, University of Toronto, Toronto, Ontario, Canada. 10. Department of Physiology, University of Toronto, Toronto, Ontario, Canada.
Abstract
OBJECTIVE: Central adiposity is considered to be an important cardiorenal risk factor in the general population and in type 1 diabetes. We sought to determine the relationship between central adiposity and intrarenal hemodynamic function in adults with long-standing type 1 diabetes with and without diabetic nephropathy (DN). RESEARCH DESIGN AND METHODS: Patients with type 1 diabetes (n = 66, duration ≥50 years) and age-/sex-matched control subjects (n = 73) were studied. The cohort was stratified into 44 DN Resistors (estimated glomerular filtration rate [eGFR] >60 mL/min/1.73 m2 and <30 mg/day urine albumin) and 22 patients with DN (eGFR ≤60 mL/min/1.73 m2 or ≥30 mg/day urine albumin). Intrarenal hemodynamic function (glomerular filtration rate for inulin [GFRINULIN], effective renal plasma flow for p-aminohippuric acid [ERPFPAH]) was measured. Afferent arteriolar resistance, efferent arteriolar resistance, renal blood flow, renal vascular resistance [RVR], filtration fraction, and glomerular pressure were derived from the Gomez equations. Fat and lean mass were quantified by DXA. RESULTS: Whereas measures of adiposity did not associate with GFRINULIN or ERPFPAH in healthy control subjects, trunk fat mass inversely correlated with GFRINULIN (r = -0.46, P < 0.0001) and ERPFPAH (r = -0.31, P = 0.01) and positively correlated with RVR (r = 0.53, P = 0.0003) in type 1 diabetes. In analyses stratified by DN status, greater central adiposity related to lower GFRINULIN values in DN and DN Resistors, but the relationships between central adiposity and ERPFPAH and RVR were attenuated and/or reversed in patients with DN compared with DN Resistors. CONCLUSIONS: The adiposity-intrarenal hemodynamic function relationship may be modified by the presence of type 1 diabetes and DN, requiring further study of the mechanisms by which adiposity influences renal hemodynamic function.
OBJECTIVE: Central adiposity is considered to be an important cardiorenal risk factor in the general population and in type 1 diabetes. We sought to determine the relationship between central adiposity and intrarenal hemodynamic function in adults with long-standing type 1 diabetes with and without diabetic nephropathy (DN). RESEARCH DESIGN AND METHODS: Patients with type 1 diabetes (n = 66, duration ≥50 years) and age-/sex-matched control subjects (n = 73) were studied. The cohort was stratified into 44 DN Resistors (estimated glomerular filtration rate [eGFR] >60 mL/min/1.73 m2 and <30 mg/day urine albumin) and 22 patients with DN (eGFR ≤60 mL/min/1.73 m2 or ≥30 mg/day urine albumin). Intrarenal hemodynamic function (glomerular filtration rate for inulin [GFRINULIN], effective renal plasma flow for p-aminohippuric acid [ERPFPAH]) was measured. Afferent arteriolar resistance, efferent arteriolar resistance, renal blood flow, renal vascular resistance [RVR], filtration fraction, and glomerular pressure were derived from the Gomez equations. Fat and lean mass were quantified by DXA. RESULTS: Whereas measures of adiposity did not associate with GFRINULIN or ERPFPAH in healthy control subjects, trunk fat mass inversely correlated with GFRINULIN (r = -0.46, P < 0.0001) and ERPFPAH (r = -0.31, P = 0.01) and positively correlated with RVR (r = 0.53, P = 0.0003) in type 1 diabetes. In analyses stratified by DN status, greater central adiposity related to lower GFRINULIN values in DN and DN Resistors, but the relationships between central adiposity and ERPFPAH and RVR were attenuated and/or reversed in patients with DN compared with DN Resistors. CONCLUSIONS: The adiposity-intrarenal hemodynamic function relationship may be modified by the presence of type 1 diabetes and DN, requiring further study of the mechanisms by which adiposity influences renal hemodynamic function.
Authors: Mala Chidambaram; John A Duncan; Vesta S Lai; Daniel C Cattran; John S Floras; James W Scholey; Judith A Miller Journal: J Am Soc Nephrol Date: 2002-02 Impact factor: 10.121
Authors: Julie A Lovshin; Yuliya Lytvyn; Leif E Lovblom; Alexandra Katz; Geneviève Boulet; Petter Bjornstad; Vesta Lai; Leslie Cham; Josephine Tse; Andrej Orszag; Hillary A Keenan; Narinder Paul; Vera Bril; David T Wong; Kylen D McReelis; Michael H Brent; Bruce A Perkins; David Z I Cherney Journal: Diabetes Care Date: 2018-12-06 Impact factor: 19.112
Authors: Carissa Vinovskis; Lu-Ping Li; Pottumarthi Prasad; Kalie Tommerdahl; Laura Pyle; Robert G Nelson; Meda E Pavkov; Daniel van Raalte; Marian Rewers; Marlon Pragnell; Farid H Mahmud; David Z Cherney; Richard J Johnson; Kristen J Nadeau; Petter Bjornstad Journal: Diabetes Date: 2020-07-31 Impact factor: 9.461
Authors: Bruce A Perkins; Leif Erik Lovblom; Sebastien O Lanctôt; Krista Lamb; David Z I Cherney Journal: Diabetologia Date: 2021-03-04 Impact factor: 10.122
Authors: Kalie L Tommerdahl; Karl Baumgartner; Michal Schäfer; Petter Bjornstad; Isabella Melena; Shannon Hegemann; Amy D Baumgartner; Laura Pyle; Melanie Cree-Green; Uyen Truong; Lorna Browne; Judith G Regensteiner; Jane E B Reusch; Kristen J Nadeau Journal: Diabetes Care Date: 2021-01-05 Impact factor: 19.112