title: Hemorheological Approach for Early Detection of Chronic Kidney Disease and Diabetic Nephropathy in Type 2 Diabetes.
abstract: BACKGROUND
  Hemorheologic alterations or changes in blood viscosity have been suggested to play a role in the pathogenesis of microvascular complications in diabetes. We measured various hemorheologic parameters in type 2 diabetes patients at different stages of chronic kidney disease (CKD) and assessed their possible role as early markers of diabetic nephropathy and renal insufficiency.
  
  
  METHODS
  One hundred-five patients with type 2 diabetes were divided into four groups according to glomerular filtration rate (GFR), which represents the kidney function. Hemorheologic parameters, including erythrocyte deformability, fibrinogen/elongation index (EI), and aggregation index (AI) were measured using a microfluidic hemorheometer, and critical shear stress (CSS) was measured using a microfluidic technique. Various metabolic parameters were assessed from fasting blood samples, and the urine albumin-to-creatinine ratio (ACR) was calculated from first morning voided urine.
  
  
  RESULTS
  There were significant differences in red blood cell (RBC) deformability, AI, CSS, fibrinogen/EI, and ACR among patients in different stages of CKD (all P<0.05). RBC deformability and fibrinogen/EI significantly differed between normal (GFR >90 mL/min/1.73 m(2)) and CKD stage 2 (GFR 60-90 mL/min/1.73 m(2)) patients, whereas there was no such difference in ACR. In multiple regression analysis, fibrinogen/EI under a moderate shear stress of 3 Pa was an independent predictor of GFR (β=-0.328, P<0.05). Also, AI, CSS, and fibrinogen/EI were significantly different among patients at different stages of diabetic nephropathy, with a significant difference in fibrinogen/EI between normal and microalbuminuric patients (all P<0.05).
  
  
  CONCLUSIONS
  RBC deformability and fibrinogen/EI are sensitive parameters measured via point-of-care testing for detecting erythrocyte alterations in early CKD and nephropathy in patients with type 2 diabetes. Further studies are warranted to verify their use as screening tools for diabetic nephropathy and renal impairment.
authors.affiliation: 1 Division of Endocrinology and Metabolism, Department of Internal Medicine, Yonsei University College of Medicine , Seoul, Korea.
authors.forename: Seohui
authors.initials: S
authors.lastname: Lee
authors.affiliation: 1 Division of Endocrinology and Metabolism, Department of Internal Medicine, Yonsei University College of Medicine , Seoul, Korea.
authors.forename: Min Young
authors.initials: MY
authors.lastname: Lee
authors.affiliation: 1 Division of Endocrinology and Metabolism, Department of Internal Medicine, Yonsei University College of Medicine , Seoul, Korea.|2 Severance Institute for Vascular and Metabolic Research, Yonsei University College of Medicine , Seoul, Korea.
authors.forename: Ji Sun
authors.initials: JS
authors.lastname: Nam
authors.affiliation: 1 Division of Endocrinology and Metabolism, Department of Internal Medicine, Yonsei University College of Medicine , Seoul, Korea.|2 Severance Institute for Vascular and Metabolic Research, Yonsei University College of Medicine , Seoul, Korea.
authors.forename: Shinae
authors.initials: S
authors.lastname: Kang
authors.affiliation: 1 Division of Endocrinology and Metabolism, Department of Internal Medicine, Yonsei University College of Medicine , Seoul, Korea.|2 Severance Institute for Vascular and Metabolic Research, Yonsei University College of Medicine , Seoul, Korea.
authors.forename: Jong Suk
authors.initials: JS
authors.lastname: Park
authors.affiliation: 3 Department of Engineering, Korea University College of Medicine , Seoul, Korea.
authors.forename: Sehyun
authors.initials: S
authors.lastname: Shin
authors.affiliation: 1 Division of Endocrinology and Metabolism, Department of Internal Medicine, Yonsei University College of Medicine , Seoul, Korea.|2 Severance Institute for Vascular and Metabolic Research, Yonsei University College of Medicine , Seoul, Korea.
authors.forename: Chul Woo
authors.initials: CW
authors.lastname: Ahn
authors.affiliation: 1 Division of Endocrinology and Metabolism, Department of Internal Medicine, Yonsei University College of Medicine , Seoul, Korea.
authors.forename: Kyung Rae
authors.initials: KR
authors.lastname: Kim
mesh_terms: D000419:Albuminuria / Q000652:urine; D015415:Biomarkers / Q000097:blood / Q000652:urine; D003404:Creatinine / Q000652:urine; D003430:Cross-Sectional Studies; D003924:Diabetes Mellitus, Type 2 / Q000097:blood* / Q000150:complications / Q000503:physiopathology; D003928:Diabetic Nephropathies / Q000097:blood* / Q000209:etiology / Q000503:physiopathology; D042241:Early Diagnosis; D004903:Erythrocyte Aggregation; D004907:Erythrocyte Deformability; D005215:Fasting / Q000097:blood; D005260:Female; D005340:Fibrinogen / Q000032:analysis; D005919:Glomerular Filtration Rate; D006801:Humans; D008297:Male; D008875:Middle Aged; D012044:Regression Analysis; D051436:Renal Insufficiency, Chronic / Q000097:blood* / Q000209:etiology / Q000503:physiopathology
chemical_list: D015415:Biomarkers; D005340:Fibrinogen; D003404:Creatinine