title: Plasma prekallikrein: a risk marker for hypertension and nephropathy in type 1 diabetes.
abstract: The relevance and significance of the plasma kallikrein/kinin system as a risk factor for the development of vascular complications in diabetic patients was explored in a cross-sectional study. We measured the circulating levels of plasma prekallikrein (PK) activity, factor XII, and high-molecular weight kininogen in the plasma of 636 type 1 diabetic patients from the Diabetes Control and Complications Trial/Epidemiology and Diabetes Intervention and Complications Study cohort. The findings demonstrated that type 1 diabetic patients with blood pressure > or =140/90 mmHg have increased PK levels compared with type 1 diabetic patients with blood pressure <140/90 (1.53 +/- 0.07 vs. 1.27 +/- 0.02 units/ml; P < 0.0001). Regression analysis also determined that plasma PK levels positively and significantly correlated with diastolic (DBP) and systolic blood pressures (SBP) as continuous variables (r = 0.17 and 0.18, respectively; P < 0.0001). In multivariate regression analysis, the semipartial r(2) value for PK was 2.93% for SBP and 2.92% for DBP (P < 0.0001). A positive correlation between plasma PK levels and the urinary albumin excretion rate (AER) was also observed (r = 0.16, P < 0.0001). In categorical analysis, patients with macroalbuminuria had a significantly higher level of plasma PK than normoalbuminuric patients (1.45 +/- 0.08 vs. 1.27 +/- 0.02 units/ml; P < 0.01), whereas microalbuminuric patients had an intermediate PK value (1.38 +/- 0.05 units/ml; P = NS). Among patients in the microalbuminuric subgroup, we observed a positive and independent correlation between PK and AER in univariate and multivariate regression analysis (r = 0.27, P < 0.03; n = 63). We concluded that in type 1 diabetes, 1) PK levels are elevated in association with increased blood pressure; 2) PK levels are independently correlated with AER and are categorically elevated in patients with macroalbuminuria; and 3) although the positive correlation between PK and AER within the subgroups of patients with microalbuminuria suggest that PK could be a marker for progressive nephropathy, longitudinal studies will be necessary to address this issue.
authors.affiliation: Department of Medicine, Endocrinology-Diabetes-Medical Genetics, Medical University of South Carolina, 114 Doughty Street, PO Box 250776, Charleston, SC 29425, USA. jaffaa@musc.edu
authors.forename: Ayad A
authors.initials: AA
authors.lastname: Jaffa
authors.forename: Ramon
authors.initials: R
authors.lastname: Durazo-Arvizu
authors.forename: Deyi
authors.initials: D
authors.lastname: Zheng
authors.forename: Daniel T
authors.initials: DT
authors.lastname: Lackland
authors.forename: Sujata
authors.initials: S
authors.lastname: Srikanth
authors.forename: W Timothy
authors.initials: WT
authors.lastname: Garvey
authors.forename: Alvin H
authors.initials: AH
authors.lastname: Schmaier
mesh_terms: D000419:Albuminuria; D015415:Biomarkers / Q000097:blood*; D001794:Blood Pressure; D015992:Body Mass Index; D001835:Body Weight; D015331:Cohort Studies; D003922:Diabetes Mellitus, Type 1 / Q000097:blood* / Q000503:physiopathology / Q000652:urine; D003925:Diabetic Angiopathies / Q000097:blood / Q000503:physiopathology; D003928:Diabetic Nephropathies / Q000097:blood* / Q000503:physiopathology; D005174:Factor XII / Q000032:analysis; D005260:Female; D006801:Humans; D006973:Hypertension / Q000097:blood*; D007610:Kallikreins / Q000032:analysis; D019679:Kininogen, High-Molecular-Weight / Q000032:analysis; D007705:Kinins / Q000032:analysis; D008297:Male; D011288:Prekallikrein / Q000032:analysis*; D012307:Risk Factors
chemical_list: D015415:Biomarkers; D019679:Kininogen, High-Molecular-Weight; D007705:Kinins; D005174:Factor XII; D011288:Prekallikrein; D007610:Kallikreins