[Cardiovascular risk factors in diabetic nephropathy].
BACKGROUND
Diabetic nephropathy is associated with increased cardiovascular mortality. This may be contributed to by changes in plasma lipids, fibrinogen and hemorheology. Cardiovascular autonomic dysfunction, which is related to an increased incidence of arrhythmic death, may also play a role.


METHODS
Therefore, we investigated in 58 IDDM-patients with none (n = 28), incipient (albuminuria 30 to 300 mg/day, n = 11) and overt clinical nephropathy (albuminuria > 300 mg/day, n = 19) plasma concentrations of lipoproteins and fibrinogen, plasma viscosity, erythrocyte aggregation and erythrocyte rigidity. Assessments of neuropathy included tibial nerve motor conduction velocity, perception of vibration, beat-to-beat variation during rest and during forced respiration, heart-rate response to Valsalva maneuver and heart-rate response to standing (30:15).


RESULTS
Patients with clinical overt nephropathy had, compared to those without nephropathy, significantly higher concentrations of LDL-cholesterol, triglycerides and fibrinogen, significantly lower concentrations of HDL-cholesterol and significantly higher plasma viscosity, erythrocyte aggregability and erythrocyte rigidity. Regarding the assessments of neuropathy we found in patients with nephropathy, compared to those without nephropathy, significantly reduced tibial nerve motor conduction velocity, reduced perception of vibration thresholds and reduced heart rate variability during rest, during forced respiration, in response to Valsalva maneuver and in response to standing. In diabetic patients with microalbuminuria erythrocyte aggregability and erythrocyte rigidity were significantly higher and heart rate variability during rest was significantly lower than in patients without nephropathy.


CONCLUSIONS
In clinical overt nephropathy there is an aggregation of different cardiovascular risk factors, namely, disturbances in lipoprotein concentrations, increased fibrinogen concentration and disturbances in hemorheology. Furthermore marked deterioration in peripheral and autonomic cardial nerve function in these patients is evident accounting for a part of the greatly increased cardiovascular mortality of these patients.
Zimmermann
J
J
Medizinische Klinik, Abteilung Nephrologie, Universität Würzburg.
Schramm
L
L
Mulzer
E
E
Heidbreder
E
E
Henrich
H A
HA
Wanner
C
C
D000328:Adult; D001809:Blood Viscosity / Q000502:physiology; D016757:Death, Sudden, Cardiac / Q000209:etiology*; D003922:Diabetes Mellitus, Type 1 / Q000150:complications* / Q000503:physiopathology; D003928:Diabetic Nephropathies / Q000150:complications* / Q000503:physiopathology; D003929:Diabetic Neuropathies / Q000150:complications / Q000503:physiopathology; D005260:Female; D006339:Heart Rate / Q000502:physiology; D006801:Humans; D008055:Lipids / Q000097:blood; D008297:Male; D012307:Risk Factors
D008055:Lipids
Kardiovaskuläre Risikofaktoren bei diabetischer Nephropathie.