ABSTRACT
AIM: To analyze the relationship between visceral obesity and urinary albumin excretion rate (UAER). METHODS: A cross-sectional study of 73 normoalbuminuric (urinary albumin excretion rate < 20 microg/min) type 2 patients was performed. Patients were divided into two groups according to the median of UAER (7.5 microg/min). Office auscultatory blood pressure was measured in sitting position after a 10-min rest. RESULTS: Waist to hip ratio was higher in the group with UAER > 7.0 microg/min (0.98 +/- 0.08), when compared to the other group (0.93 +/- 0.08, p= 0.01). Waist to hip ratio significantly correlated with UAER (r = 0.28; p= 0.018). In multiple linear regression analysis, only waist to hip ratio was associated with UAER (r = 0.29; p = 0.04). A1c, DM duration and systolic BP levels were excluded from the model. CONCLUSIONS: Type 2 normoalbuminuric diabetic patients with higher levels of UAER could represent a group with an elevated risk for the development of cardiovascular diseases.
Subject(s)
Albumins/metabolism , Albuminuria/urine , Diabetes Mellitus, Type 2/metabolism , Intra-Abdominal Fat , Obesity/metabolism , Cardiovascular Diseases/etiology , Cross-Sectional Studies , Diabetes Mellitus, Type 2/complications , Diabetes Mellitus, Type 2/physiopathology , Diabetic Retinopathy/etiology , Female , Humans , Male , Obesity/complications , Obesity/physiopathology , Statistics, Nonparametric , Waist-Hip RatioABSTRACT
OBJETIVO: Analisar a relação entre obesidade e taxa de excreção urinária de albumina (TEUA). MÉTODOS: Este é um estudo de corte de 73 pacientes com diabetes tipo 2 (DM) normoalbuminúricos (TEUA < 20 µg/min), que foram divididos em dois grupos de acordo com a mediana da TEUA (7,5 µg/min). A pressão sanguínea auscultatória foi medida em consultório com o paciente sentado, após repouso de 10min. RESULTADOS: A relação cintura:quadril (RCQ) foi maior no grupo com TEUA > 7,0 µg/min (0,98 ± 0,08), em comparação com o outro grupo (0,93 ± 0,08, p= 0,01). A RCQ correlacionou-se significantemente com a TEUA (r= 0,28; p= 0,018). Na análise de regressão linear múltipla, somente a RCQ associou-se com a TEUA (r= 0,29; p= 0,04). A HbA1c, a duração do DM e os níveis da PA sistólica foram excluídos do modelo.CONCLUSÕES: Pacientes com DM2 normoalbuminúricos com níveis mais elevados de TEUA podem representar um grupo com risco mais elevado para o desenvolvimento de doenças cardiovasculares.
Subject(s)
Female , Humans , Male , Albumins/metabolism , Albuminuria/urine , /metabolism , Intra-Abdominal Fat , Obesity/metabolism , Cross-Sectional Studies , Cardiovascular Diseases/etiology , /complications , /physiopathology , Diabetic Retinopathy/etiology , Obesity/complications , Obesity/physiopathology , Statistics, Nonparametric , Waist-Hip RatioABSTRACT
Among patients on hemodialysis, the mortality rate is higher in individuals with diabetes than in nondiabetic individuals, especially due to cardiovascular causes. The objective of the present study was to evaluate the role of echocardiographic abnormalities to predict mortality in diabetic patients starting hemodialysis. A 4.25-year prospective study was carried out with 40 diabetic and 28 nondiabetic patients starting hemodialysis in five dialysis centers in the metropolitan area of Porto Alegre, Brazil, between August 1996 and June 1999. Cardiovascular status was evaluated based on World Health Organization criteria, resting electrocardiogram (ECG), myocardial scintigraphy (at rest and after dipyridamole administration), and M-mode and Doppler echocardiography. Left ventricular diastolic function was classified into the following filling patterns: normal, impaired relaxation, pseudonormal, or restrictive. The survival rate was analyzed by Kaplan-Meier curves and predictors of death by Cox's proportional-hazards model. At the end of the study, the overall mortality rate was higher in patients with diabetes [19/40 (47.5%)] than in those without diabetes [2/28 (7.1%), P=.0013, log rank test]. Pseudonormal and restrictive filling patterns (HR: 3.2; 95% CI: 1.2-8.8; P=.02) and presence of diabetes (HR: 4.7; 95% CI: 1.03-21.4; P=.04) were associated with mortality. In conclusion, left ventricular diastolic dysfunction (LVDD) was the main predictor of mortality in this cohort of diabetic and nondiabetic patients starting dialysis. Intensive treatment of cardiovascular risk factors before the start of dialysis and during the treatment might reduce the mortality rate in diabetic patients.
