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      Waist Circumference Is Strongly Associated with Renal Resistive Index in Normoalbuminuric Patients with Type 2 Diabetes

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          Abstract

          Objective: Anthropometric parameters may play a role in modulating the risk of kidney dysfunction. The aim of this study was to evaluate whether anthropometric indices and the metabolic syndrome are associated with alterations of the renal resistive index (RI) in normoalbuminuric type 2 diabetic (T2DM) patients. Methods: A sample of 99 consecutively recruited patients with T2DM (76 male and 23 female) was examined. The RI was assessed by duplex Doppler sonography. Results: In univariate analysis, a significant association between the RI values and age (r = 0.507, p < 0.0001), gender (being higher in women, p = 0.002), systolic blood pressure (r = 0.285, p = 0.011), smoking habit (being lower in current smokers, p = 0.047), estimated glomerular filtration rate (r = –0.435, p < 0.0001), and intima-media thickness of the carotid arteries (r = 0.271, p = 0.020) was observed. As far as anthropometric parameters are concerned, a strong correlation between waist circumference (WC; r = 0.401, p < 0.0001), BMI (r = 0.337, p = 0.003) and RI values was found but only WC maintained a significant correlation after adjusting for several confounders (p = 0.001). Conclusions: In normoalbuminuric T2DM patients, the intrarenal hemodynamic abnormalities seem primarily associated with WC.

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          Most cited references11

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          Treatment of obesity: need to focus on high risk abdominally obese patients.

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            Albuminuria reflects widespread vascular damage

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              Central obesity, incident microalbuminuria, and change in creatinine clearance in the epidemiology of diabetes interventions and complications study.

              Weight gain and central obesity are associated with insulin resistance, hypertension, and dyslipidemia in type 1 diabetes. These metabolic abnormalities are risk factors for kidney disease in the general population, but data addressing the relationship of central obesity with kidney disease in type 1 diabetes are limited. Whether waist circumference is associated with incident microalbuminuria and change in creatinine clearance was examined among 1279 participants who had type 1 diabetes and were enrolled in the Epidemiology of Diabetes Interventions and Complications Study, the observational extension of the Diabetes Control and Complications Trial (DCCT). Ninety-three of 1105 participants with normal albumin excretion rate (AER) at DCCT closeout developed incident microalbuminuria over 5.8 yr of follow-up. The hazard ratio for incident microalbuminuria that was associated with each 10-cm greater waist circumference at DCCT closeout was 1.34 (95% confidence interval 1.07 to 1.68), after adjustment for DCCT closeout age, gender, duration of diabetes, treatment group, smoking status, glycosylated hemoglobin, and AER. This increased risk was modestly attenuated when additional adjustment was made for levels of BP and serum lipids. Creatinine clearance declined by an average of 0.34 ml/min per 1.73 m2 each yr over 8 yr of follow-up. Greater rate of decline in creatinine clearance was associated with greater age, conventional insulin therapy during the DCCT, smoking, and greater glycosylated hemoglobin and AER at DCCT closeout but not with waist circumference. In conclusion, waist circumference predicts the subsequent development of microalbuminuria in type 1 diabetes. In contrast, no association of waist circumference with decline in creatinine clearance was observed.
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                Author and article information

                Journal
                AJN
                Am J Nephrol
                10.1159/issn.0250-8095
                American Journal of Nephrology
                S. Karger AG
                0250-8095
                1421-9670
                2008
                November 2007
                28 September 2007
                : 28
                : 1
                : 54-58
                Affiliations
                aUnit of Endocrinology and Metabolic Diseases, Department of Medical Sciences, and bUnit of Nephrology, Department of Molecular Medicine, University of Foggia, Foggia, Italy
                Article
                109239 Am J Nephrol 2008;28:54–58
                10.1159/000109239
                17901690
                208cf8fa-70e8-46d2-9540-13dbd49dcf36
                © 2007 S. Karger AG, Basel

                Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher. Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug. Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

                History
                : 28 July 2007
                : 14 August 2007
                Page count
                Figures: 1, Tables: 2, References: 21, Pages: 5
                Categories
                Original Report: Patient-Oriented, Translational Research

                Cardiovascular Medicine,Nephrology
                Type 2 diabetes,Metabolic syndrome,Chronic kidney disease,Albuminuria,Resistive index

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