Nitric Oxide Gene Polymorphism is a Risk Factor for Diabetic Nephropathy and Atherosclerosis in Type 1 Diabetic Patients.

AIM: To assess the risk factor for diabetic atherosclerosis nephropathy and diabetic nephropathy in type 1 diabetic patients. PATIENTS AND METHODS: Thirty healthy volunteers age and sex-matched and Sixty-five type 1 diabetic patient were in rolled in the study. The mean age of patients was 17.99 ± 2.59 years, mean age of onset of diabetes was 7.00 ± 3.28 years, mean duration of diabetes was 10.91 ± 3.54 years. Glycosylated sex-matched (HbA1c) was assessed in blood samples, serum lipid profile was determined, and serum level of oxidised low-density lipoprotein (OxLDL), and nitric oxide was evaluated by enzyme-linked immunosorbent assay (ELISA) technique. Nitric oxide 894G > T genotype was analysed by (PCR-RFLP) method and confirmed by Sequencing. Assessment of the albumin / creatinine ratio was done in urine samples. Renal Doppler and Carotid intima-media thickness (cIMT) via ultrasound was also performed. RESULTS: OxLDL, lipid profile, albumin/creatinine ratio, cIMT and resistivity index were significantly higher in diabetic patients while nitric oxide was significantly lower. Nitric oxide genotype shows no significant difference between diabetic's patients and controls. Diabetic patients with homozygous NO had a significantly lower serum level of Nitric oxide, a significantly higher OxLDL, albumin / creatinine ratio and lipid profile. CONCLUSION: diabetic patients are liable for the occurrence of early diabetic nephropathy and atherosclerosis as a result of the presence of low level of nitric oxide. Nitric oxide gene polymorphism 894G > T in diabetic patients is a risk factor for diabetic nephropathy and atherosclerosis.

Copeptin as a Biomarker of Atherosclerosis in Type 1 Diabetic Patients.

AIM: To evaluate copeptin as an early marker of atherosclerosis in adolescent type 1 diabetics. METHODS: Sixty-two type 1 diabetic patients and 50 healthy volunteers were enrolled in the study. Serum copeptin, glycosylated haemoglobin (HbA1c), lipid profile, oxidised low-density lipoprotein (OxLDL), urinary albumin/creatinine ratio, carotid intimal medial thickness (cIMT), aortic intimal medial thickness (aIMT) and resistivity index were assessed for all participants in the study. RESULTS: HbA1c, albumin/creatinine ratio, lipid profile, OxlDL, copeptin, cIMT and aIMT were significantly higher in diabetic patients. Copeptin was higher in patients with positive cIMT and aIMT. Copeptin correlated with cIMT and aIMT. Stepwise multiple regression analysis found that copeptin correlated with aIMT. ROC curve showed that copeptin had 100 % specificity with aIMT and cIMT and 95.2 and 60,7 sensitivity with aIMT and cIMT respectively. CONCLUSION: Copeptin can be used as a marker for early detection of atherosclerosis of type 1 diabetic patients.

Osteopontin for Early Detection of Microvascular and Macrovascular Type 1 Diabetic Complication.

AIM: To evaluate the relationship between osteopontin and diabetes complication in type 1 diabetic patient. PATIENTS AND METHODS: Seventy types 1 diabetic and 60 healthy volunteers were studied. Full history, examination, laboratory tests of glycosylated haemoglobin (HbA1c), serum lipids {cholesterol, triglyceride (Tg), high-density lipoprotein-cholesterol (HDL-c), low-density lipoprotein - cholesterol (LDL-c)}, oxidised low-density lipoprotein (OxLDL), Osteopontin and urinary microalbuminuria (albumin/creatinine ratio) were done. Image study in the form of a carotid intimal medial thickness (cIMT) and aortic intimal medial thickness (aIMT), renal doppler for resistivity index was also done for all participant included in the study. RESULTS: Urinary albumin/creatinine ratio, lipid profile, osteopontin, cIMT and aIMT were higher in people with diabetes. Osteopontin was higher in people with diabetes with positive microalbuminuria and cIMT. Systolic blood pressure, microalbuminuria and cIMT had a positive correlation with osteopontin in people with diabetes. Stepwise multiple regression analysis showed that osteopontin had a significant correlation with cIMT. Receiver operating characteristic (ROC) curve showed that the cut off value of Osteopontin for detection of cIMT was > 60 with a specificity of 100% and sensitivity 80.5%, while that of albumin/creatinine ratio was > 64 with a specificity of 66.7 and sensitivity of 92.3. CONCLUSION: Osteopontin is higher in type 1 diabetics and is useful for early detection of diabetic microvascular and macrovascular complication.

Sclerodactyly and Diabetic Complications among Egyptian Adolescent Type 1 Diabetic Patient.

BACKGROUND: One of the common complications of diabetic patients is sclerodactyly which is considered as a part of limited joint mobility. AIM: To assess sclerodactyly in adolescent type 1 diabetics and to detect its relation to other diabetic complications. METHODS: Sixty-three diabetics and 60 controls were studied. Clinical, laboratory assessment, ultrasonography of the skin, carotid artery intima-media thickness (cIMT) & renal colour duplex were done for all participants. RESULTS: Sclerodactyly was positive in 12 (19%) of diabetics. Patients with sclerodactyly had a significantly thickened skin compared to patients without sclerodactyly and controls, P = 0.0001. Male diabetics had significantly thickened skin (p = 0.0001). Diabetic patients with sclerodactyly had significant higher systolic blood pressure (p = 0.03), cholesterol (p = 0.05) and triglyceride (p = 0.004) and lower HDL-c (p = 0.04). Skin thickness had a significant positive correlation with age of diabetic patients (p = 0.02), waist/height ratio (p = 0.04), glycosylated hemoglobin (p = 0.03), albumin/creatinine ratio (p = 0.03), and cIMT (p = 0.03). CONCLUSION: Ultrasound easily diagnoses sclerodactyly. Diabetic patients had a high prevalence of sclerodactyly with increased macrovascular and microvascular complications. Sclerodactyly may be a marker for diabetic vascular complications. Frequent follow up of diabetic patients for early detection of sclerodactyly in uncontrolled diabetic patients is recommended. It could be an alarming sign for microalbuminuria, hypertension, hyperlipidaemia and atherosclerosis.

Apelin, Nitric Oxide and Vascular Affection in Adolescent Type 1 Diabetic Patients.

AIM: To evaluate the relationship of apelin and nitric oxide (NO) to endothelial dysfunction in type 1 diabetics. PATIENTS AND METHODS: Sixty two type 1 diabetics and 30 healthy age and sex matched controls were included. Blood samples for apelin, NO, glycosylated hemoglobin (HbA1c), and lipid profile were collected. Albumin/creatinine ratio was assessed in urine. Flow mediated dilatation (FMD) via ultrasound was done. RESULTS: The mean age of diabetics were 16.3 ± 1.5 yrs (14.0 - 19.0 yrs), and duration of disease, were 9.4 ± 2.9 yrs (5.0 - 16.5 yrs). FMD and FMD/nitrate mediated dilatation (NMD) ratio were lower in diabetics. NO was decreased, while apelin and albumin/creatinine ratio were increased significantly in diabetics. There was a positive correlation between apelin and HbA1c. On the contrary, NO had a negative correlation with HbA1c, albumin/creatinine ratio, LDL-c and OxLDL. CONCLUSION: Diabetic patients had endothelial dysfunction and high apelin level, with no related to each other. High level of apelin is associated with bad glycemic control. Obesity had no role to increase in apelin level. NO is related to diabetic nephropathy and atherosclerosis. We recommend a further large study to evaluate the relationship of apelin with endothelial dysfunction.

Assessment of Increase in Aortic and Carotid Intimal Medial Thickness in Type 1 Diabetic Patients.

AIM: To assess aortic and carotid intima-media thickness (aIMT and cIMT) in diabetic patients. PATIENTS AND METHODS: The study included 75 type 1 diabetic patients and 30 age and sex matched healthy volunteer. A blood sample was taken for analysis of HbA1 and lipid profile and the urine sample was taken for analysis of albumin/creatinine ratio. aIMT and cIMT via ultrasound were also done. RESULTS: cIMT & aIMT were significantly higher in diabetics. aIMT was found to be significantly higher than cIMT in diabetic patients (0.72 ± 0.11 vs. 0.52 ± 0.06, P = 0.0001). Ten of our patients (14%) with normal cIMT revealed significantly increased aIMT. aIMT had a significant positive correlation with age of patients, waist/hip ratio & cIMT. CONCLUSION: Diabetic patients had increased aIMT and cIMT with a relatively greater increase in the aIMT than in the cIMT. Because atherosclerosis begins first in the intima of the aorta, these data suggest that the aIMT might provide the best currently available noninvasive marker of preclinical atherosclerosis in children. We recommend frequent follow up of diabetic patients for early detection of diabetic complication.

Carotid intimal medial thickness and its relation to endothelial dysfunction and echocardiographic changes in adolescents with type 1 diabetes.

AIM: To assess carotid intimal medial thickness (cIMT) in adolescent type 1 diabetic patients and to detect its relation with echocardiographic changes and flow mediated dilatation (FMD) in the brachial artery. METHODS: The study included 62 type 1 diabetic patients and 30 healthy volunteer of the same age and sex. A blood sample was taken for analysis of glycosylated hemoglobin and lipid profile and a urine sample was taken for analysis of albumin/creatinine ratio. cIMT, echocardiography, and FMD via ultrasound were also done; t-test or Mann-Whitney U-test (for non-symmetrically distributed data) for independent variables and Pearson's or Spearman correlation were used. RESULTS: The mean age of patients was 16.3 ± 1.5 years and mean duration of diabetes was 9.4 ± 2.9 years. cIMT (Rt, Lt, and both Rt and Lt) were significantly higher, while FMD and FMD/nitrate mediated dilatation (NMD) ratio was significantly lower in diabetics. Rt cIMT had a significant negative correlation with FMD and FMD/NMD. cIMT had a significant positive correlation with left ventricular end diastolic dimension, inter ventricular septum thickness, peak mitral flow velocity during early diastole/peak mitral flow velocity during late diastole, left ventricular mass, and left ventricular mass index (p<0.05). In addition, cIMT had a significant correlation with waist circumference, waist/height ratio, albumin/ creatinine ratio, total cholesterol, and triglyceride. CONCLUSION: We conclude that alteration in myocardial function and vascular endothelial dysfunction induced by diabetes mellitus may begin early with the association of early atherosclerotic changes.

Assessment of human cartilage glycoprotein 39 (YKL-40), preptin, and nitric oxide in adolescent patients with type 1 diabetes and its relation to cardiorenal affection.

AIM: To evaluate new biomarkers such as YKL-40, preptin, and nitric oxide (NO) in patients with diabetes and to assess its relation to cardiorenal injury. PATIENTS AND METHODS: The study included 62 patients with type 1 diabetes and 30 healthy volunteers. Blood sample was taken for assessment of glycosylated hemoglobin, lipid profile, YKL-40, preptin, and NO. Also, urine sample was taken for analysis of albumin/creatinine ratio. Echocardiography was also done. RESULTS: NO was lower, whereas YKL-40, preptin, and albumin/creatinine ratio were significantly higher in patients with diabetes. NO had a significant negative correlation with LVEDD, LVESD, PWT, LV mass, YKL-40, preptin, and albumin/creatinine ratio. YKL-40 had a significant positive correlation with waist/height ratio, preptin and negative correlation with E/A ratio. Stepwise multiple regression revealed that E/A ratio is the only parameter related to YKL-40. On the contrary, NO and systolic blood pressure are related to preptin. CONCLUSION: A significant reduction of NO and elevation of YKL-40 and preptin was found in patients with diabetes. A decrease in NO is associated with diastolic dysfunction, LV hypertrophy, and renal impairment, whereas YKL-40 is associated with diastolic dysfunction. An increase in preptin level was associated with hypertension.

Evaluation of fetuin-A and carotid intima-media thickness in adolescent type 1 diabetic patients.

OBJECTIVE: To evaluate fetuin-A level and carotid intima-media thickness (CIMT) in adolescent type 1 diabetics. PATIENTS AND METHODS: The study included 62 type 1 diabetic patients and 30 healthy volunteers of the same age and sex. Blood sample was taken for assessment of glycosylated hemoglobin (HbA1), lipid profile, and fetuin-A. Urine sample was also taken for assessment of albumin/creatinine ratio. Anthropometric measurements were taken, including weight, height, and waist and hip circumference. CIMT was assessed for all patients and controls. RESULTS: Serum fetuin-A, Rt., Lt. and both CIMT were significantly higher in diabetics. Fetuin-A had a significant positive correlation with duration of disease, waist and hip circumference, BMI, BMI SDS, waist/height ratio, Rt., Lt. and both CIMT. Stepwise multiple regression analysis revealed that the duration of disease, waist/height ratio, and HDL-c were the factors related to fetuin-A. CONCLUSION: Adolescent type 1 diabetic patients have high fetuin-A levels and increased CIMT, with the latter representing the development of early atherosclerosis. In this light, adolescents with type 1 diabetes require frequent follow up for early detection of atherosclerosis.

Cardiovascular Autonomic Neuropathy and Early Atherosclerosis in Adolescent Type 1 Diabetic Patient.

AIM: To evaluate cardiovascular autonomic neuropathy (CAN) in type 1 Diabetics and to detect its relation to coronary artery calcification. PATIENTS AND METHODS: It is a cross sectional study included 62 diabetics and 30 controls. Clinical, laboratory assessment and 24 Hr holter were done for all patients and controls and coronary artery calcium (CAC) scoring by multisclice CT was done for all patients only. T-test, Mann Whitney U test, and stepwise multiple regression were used for statistical analyses. RESULTS: CAC score was positive in 8.1 % of patients. Heart rate variability (HRV) was significantly lower in diabetics. All parameters of HRV were insignificantly lower in diabetics with positive CAC score. Patients with microalbuminuria had a significantly lower HRV. HRV had a significant correlation with age of patients, duration of disease, HbA1, and Qtc in diabetics. CONCLUSION: Percentage of arrhythmia and early atherosclerosis is high in adolescent type 1 diabetic patients. CAN is associated with early atherosclerosis. Cardiac autonomic neuropathy is associated with older age, longer duration, and poor glycemic control and microalbuminuria.

Cardiac Affection in Type 1 Diabetic Patients in Relation to Omentin.

AIM: To evaluate cardiac affection in type 1 diabetes in relation to Omentin. PATIENTS AND METHODS: Sixty two diabetics and 30 volunteer of the same age and sex were included as a control group. Blood sample was taken for assessment of omentin and oxidized low density lipoprotein (OxLDL), glycosylated hemoglobin (HbA1) and lipid profile. Urine sample was taken for assessment of albumin/creatinine ratio. 24 hour holter was also done. T-test, simple correlation followed by stepwise multiple regression analysis was used for analysis of data. RESULTS: Parameters of 24 hour holter were significantly lower in diabetics. Omentin was significantly lower, while OxLDL were significantly higher than controls. RMSSD, ST deviation and OxLDL were the parameters related to omentin by stepwise multiple regression analysis in diabetics. CONCLUSION: Diabetic patients had a cardiac autonomic neuropathy. A significant reduction of omentin and elevation OxLDL imply that they influence glucose metabolism in type 1 diabetes. Omentin had a significant relation to 24 hr holter which may reflect its role in cardiac affection. Omentin and OxLDL had a role in renal affection.

Relationship of plasma level of chemerin and vaspin to early atherosclerotic changes and cardiac autonomic neuropathy in adolescent type 1 diabetic patients.

OBJECTIVE: Our objective was to evaluate the relationship of plasma level of chemerin and vaspin to early atherosclerotic changes and cardiac autonomic neuropathy (CAN) in adolescent type 1 diabetic patients. PATIENTS AND METHODS: The study included 62 type 1 diabetic patients and 30 healthy volunteers of the same age and sex. Blood samples were taken for assessment of chemerin, vaspin, asymmetric dimenthylarginine (ADMA), and oxidized low-density lipoprotein (OxLDL) by enzyme-linked immunosorbent assay (ELISA) technique. Also, blood samples were taken for analysis of glycosylated hemoglobin; lipid profiles and urine samples were taken for assessment of albumin/creatinine ratio. Twenty-four-hour holter [for assessment of time domain heart rate variability (HRV)] and carotid intima-media thickness (CIMT) were also done. The t-test or Mann-Whitney U-test for independent variables, Pearson's or Spearman's correlation, and stepwise multiple regression analysis were used. RESULTS: The mean age of diabetic patients was 16.3±1.5 years, and mean duration of diabetes was 9.4±2.9 years. Chemerin, vaspin, OxLDL, and albumin/creatinine ratio were significantly higher, whereas ADMA was significantly lower than the controls. By stepwise multiple regression analysis, vaspin had a relation with a standard deviation difference RR (SDARR) and waist/height ratio. Conversely, chemerin had a relation with OxLDL. Albumin/creatinine ratio had a significant positive correlation with chemerin and OxLDL, and a negative correlation with ADMA. CONCLUSIONS: Type 1 diabetic patients had impaired time domain HRV associated with increased CIMT. Vaspin had a significant relation to CAN, whereas chemerin, ADMA, and OxLDL had a significant correlation with albumin/creatinine ratio that reflects their role in renal affection.

Asymmetric dimethyl L-arginine, nitric oxide and cardiovascular disease in adolescent type 1 diabetics.

OBJECTIVE: To evaluate asymmetric dimethyl L-arginine (ADMA), nitric oxide (NO) and cardiovascular disease in adolescent type 1 diabetics. METHODS: The study included 62 type 1 diabetic patients and 30 healthy volunteers of the same age and sex. Blood samples were taken for assessment of ADMA, NO, oxidized low density lipoprotein (OxLDL), glycosylated hemoglobin, and lipid profile. Urine samples were taken for assessment of albumin/creatinine ratio. M mode echocardiography and flow mediated dilatation (FMD) via ultrasound were completed; t-test for independent variables, Pearson's correlation, and stepwise multiple regression analysis were used. RESULTS: The mean age of patients was 16.3±1.5 years and mean duration of diabetes was 9.4±2.9 years. Nitric oxide, ADMA and FMD were significantly lower, while OxLDL and the albumin/creatinine ratio were significantly higher in diabetics. Nitric oxide had a significant negative correlation with left ventricular end-diastolic dimension, left ventricular end-systolic dimension, posterior wall thickness, left ventricular mass, albumin/creatinine ratio, and OxLDL, as well as a positive correlation with ADMA. Albumin/creatinine ratio had a significant positive correlation with OxLDL and negative correlation with ADMA. Stepwise multiple regression analysis revealed that ADMA is the only parameter related to NO, however, albumin/creatinine ratio and OxLDL are related to ADMA. CONCLUSIONS: Type 1 diabetic patients had endothelial and diastolic dysfunction. The reduction in NO, ADMA, and elevation of OxLDL, and its relation to echocardiographic data and albumin/creatinine ratio, may reflect their role in cardiac and renal affection.

Relationship of BsmI polymorphism of vitamin D receptor gene with left ventricular hypertrophy and atherosclerosis in hemodialysis patients.

BACKGROUND: Left ventricular hypertrophy (LVH) is a common manifestation of cardiovascular disease and has an important prognostic value in patients with end-stage renal disease (ESRD). Vitamin D receptor (VDR) has been intensively investigated, and one of these (BsmI) already has been associated with survival in the dialysis population. OBJECTIVE: The aim of this study was to investigate the role of VDR polymorphism (BsmI) on the development of ventricular hypertrophy and atherosclerosis in hemodialysis patients. Subject and methods. The subjects were 80 patients with end-stage renal disease on maintenance hemodialysis, and 40 healthy controls. Clinical and laboratory parameters, including genetic variation in VDR gene (BsmI), were assessed. In addition, echocardiography and intima-media thickness were performed for all subjects. RESULTS: There was no significant difference in the distribution of BsmI genotypes either in patients or in the control group. The frequency of the B allele of BsmI polymorphism (41.6%) in dialysis patients was similar to that of healthy control subjects (39.2%). Patients with BB genotype had significantly lower serum concentrations of 25-hydroxy vitamin D compared to both Bb and bb genotypes. The number of B alleles was positively correlated with left ventricular mass index (LVMI), but not with intima-media thickness. CONCLUSION: These results suggest that the B alleles of the BsmI polymorphism could be considered as novel markers of altered vitamin D signaling in ESRD patients, and this alteration in BB genotype produces an increase in left ventricle mass.

Effect of glycemic control on the progress of left ventricular hypertrophy and diastolic dysfunction in children with type I diabetes mellitus.

OBJECTIVE: To evaluate progression of left ventricular (LV) structural and functional changes in patients with type 1 diabetes and effect of glycemic control on these changes. METHODS: A prospective, longitudinal study consisted of 48 patients who were originally studied. At two years follow-up, 44 patients were reevaluated, 35 patients from the original study were reevaluated after another 2 years for the 3rd time using the same protocol. The control group comprised 30 age-and sex-matched healthy volunteers. All studied patients were subjected to full history taking, clinical and cardiac examination. M-mode echocardiography was done, blood samples were taken and examined for HbA1c and urine samples were tested for the presence of albuminuria. ANOVA for repeated measurements, t-test for dependent and independent variables, and Mann-Whitney U test were used for statistical analyses. RESULTS: Seven (14.6%) of our patients had LV hypertrophy, 23 (47.9%) patients had diastolic dysfunction and ten patients only achieve improvement in glycemic control. Duration of diabetes was significantly higher in patients with LV hypertrophy (LVH) (p<0.05). Patients with no improvement in glycemic control had a significant increase in interventricular septum (IVS) and left ventricular posterior wall (LVPW) in the third examination (p<0.05 for both). CONCLUSION: Prevalence of LVH and diastolic dysfunction among diabetic patients is high. Glycemic control in diabetic patients could not improve LVH or diastolic dysfunction. On the other hand, failure to achieve glycemic control leads to deterioration in structural parameters.

Hypertension in type 1 diabetic patients-the influence of body composition and body mass index: an observational study.

OBJECTIVE: To estimate the influence of body composition and body mass index on blood pressure in type 1 diabetic patients. METHODS: This cross-sectional, observational study included 45 type 1 diabetic patients and 30 age and sex matched healthy volunteers. Blood pressure, anthropometric measurements, and body composition by dual X-ray absorptiometry (DXA) were done for all patients and controls. T-test, one way ANOVA and multiple regressions were used for statistical analyses. RESULTS: Twenty diabetic patients (44.4%) had hypertension. Hypertensive diabetic patients had the highest total fat mass %, soft tissue fat mass %, abdomen fat % and fat/lean ratio followed by non hypertensives and the least was the controls (p=0.0001). Abdominal fat % was the only parameter significantly associated with mean arterial blood pressure (ß-5.8, 95% CI: 3.7-8.0, p=0.0001) and systolic blood pressure (ß-8.6, 95% CI: 5.4-11.9, p=0.0001) by stepwise multiple regression analysis in the diabetic patients. In the contrary, abdominal fat % (ß-2.7, 95% CI: 0.9-4.5, p=0.006), duration of diabetes (ß-2.5, 95% CI: 1.4-3.5, p=0.0001) and fat/ lean ratio (ß-11.7, 95% CI: 1.5-21.9, p=0.03) were related to diastolic blood pressure. CONCLUSION: Diabetes is associated with an increase in body fat especially abdominal, which leads to an increase in insulin resistance and decrease in lean mass. In type 1 diabetic patients, blood pressure depends on body mass index SDS and fat mass. Abdominal fat is the only factor related to mean arterial blood pressure and systolic blood pressure.

Natural progression of cardiac autonomic neuropathy in patients with type 1 diabetes: a four-year follow-up study.

OBJECTIVE: To determine the prevalence and clinical characteristics of cardiac autonomic neuropathy in type 1 diabetic patients who were followed up for 4 years to shed further light on the natural progression of cardiac autonomic neuropathy. METHODS: It is a prospective cohort observational study, consisted of 57 patients who were originally studied using the standard tests proposed by Ewing and Clarke (1985). At two years follow up, 46 patients were reevaluated, 55 patients from the original study were reevaluated after another 2 years for the 3rd time using the same protocol. The control group comprised 30 age and sex matched healthy volunteers. McNemar test, ANOVA for repeated measurements, paired t test and unpaired t test were used for statistical analyses. RESULTS: The prevalence of established cardiac autonomic neuropathy (CAN) at the beginning was 14%. Q-Tc intervals were found to be significantly higher in patients with abnormal cardiovascular reflex (CVRs) in the 2nd examination (0.4±0.04 vs 0.5±0.05 sec, p=0.006). Eighteen patients showed deterioration of their CVRs test between 1st and 3rd examination. There was deterioration of their glycemic control guided by glycosylated hemoglobin (8.5±1.4 vs 9.9±1.5%, p=0.05*) and albumin/creatinine ratio (4.4±4.0 vs 28.2±28.0 mg/g creatinine, p=0.04). On the other hand, 12 patients showed regression of their CVRs test. Only their insulin dose showed significant decrease (1.8±1.3 vs 1.1±0.3 dose/kg, p=0.02). CONCLUSION: The prevalence of established CAN in diabetic patients is high at the beginning of the study. Glycosylated hemoglobin, systolic and diastolic blood pressure were significantly increased in diabetics with deterioration of their CAN. However, the dose of insulin was significantly decreased in diabetics with regression of their CAN.

Relationship of increased circulating adrenomedullin with cardiac dysfunction, inflammation, oxidative stress and volume overload in hemodialysis patients.

Adrenomedullin (AM) is a peptide involved in cardiovascular homeostasis. The aim of our study was to investigate whether circulating AM might be related to cardiac function, volume overload, oxidative stress and inflammation in hemodialysis patients. Plasma adrenomedullin, C-reactive protein (CRP), oxidized LDL (ox-LDL), lipoprotein (a), systolic and diastolic cardiac functions were assessed before hemodialysis in 80 patients as well as in 40 healthy control subjects. Plasma adrenomedullin levels were significantly higher in the hemodialysis group compared to the control group. Plasma adrenomedullin levels were negatively correlated with systolic and diastolic blood pressure, S/D ratio, deceleration time, left ventricular ejection fraction, ox-LDL and lipoprotein (a). However, it was positively correlated with CRP, delta body weight, mitral E/A wave, and inferior vena cava diameter. Higher plasma adrenomedullin levels may provide a possible index of cardiac dysfunction, systemic inflammation, and volume overload conditions in haemodialysis patients with concomitant cardiovascular disease. In addition, the negative correlation between ox-LDL, lipoprotein (a) and adrenomedullin may suggest that endogenous AM is an important protective factor in anti-atherosclerosis and might be useful as a new target for prevention and therapy for the disease.

Apelin: a potential link between inflammation and cardiovascular disease in end stage renal disease patients.

BACKGROUND AND OBJECTIVES: Cardiovascular disease is the leading cause of morbidity and mortality in hemodialysis patients. Increasing evidence suggests a role for apelin in the pathology of the cardiovascular system. In the present study, the plasma level of apelin was studied in patients with hemodialysis to assess the effect of renal transplantation and dialysis session on plasma apelin and whether circulating apelin levels reflect cardiovascular homeostasis and inflammation in these patients. PATIENTS AND METHODS: Plasma apelin, high sensitive CRP (hsCRP) and IL-6 levels were investigated in 30 end stage renal disease (ESRD) patients on maintenance hemodialysis (HD), a group of 15 HD patients scheduled for renal transplantation and a group of 15 HD patients on maintenance HD, as well as ten healthy volunteer subjects who served as controls. An echocardiography was performed for all subjects. RESULTS: Plasma apelin levels were significantly lower in hemodialyzed patients compared to controls. Plasma apelin was also found to be positively correlated with left ventricular end systolic dimension (LVESD), left ventricular end diastolic dimension (LVEDD), interventricular septum (IVS), right ventricle (RV), left atrium (LA), Aorta (Ao), while, it was negatively correlated with hsCRP and IL-6 in ESRD patients. Regarding the effect of hemodialysis on plasma apelin levels, no significant effect was found after a single hemodialysis session, while levels increased significantly in the early post-transplant period. CONCLUSIONS: Apelin is related to echocardiographic features and inflammatory markers in hemodialyzed patients. Apelin may provide a mechanism for systemic inflammatory monitoring and adaptive regulation of cardiovascular function.