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- Title
Urinary sulphate excretion and progression of diabetic nephropathy in Type 1 diabetes.
- Authors
Andrésdóttir, G.; Bakker, S. J. L.; Hansen, H. P.; Parving, H.‐H.; Rossing, P.
- Abstract
Aims Hydrogen sulphide levels are reduced in many disease states, including diabetes and end-stage renal disease. We aimed to determine whether urinary sulphate excretion, as a proxy for hydrogen sulphide, was associated with progression of diabetic nephropathy. Methods We conducted a post-hoc study of a prospective, randomized, controlled trial on the effect of a low vs. normal protein diet for 4 years, on decline of renal function in patients with Type 1 diabetes and diabetic nephropathy. We excluded patients with less than three measurements of glomerular filtration rate assessed by 51Cr- EDTA plasma clearance ( GFR) and less than 1 year of follow-up ( n = 10), leaving 72 patients eligible for analyses. We studied both association of rate of decline in GFR and association of the combined endpoint of end-stage renal disease and death with baseline 24-h urinary sulphate excretion. Results Sulphate excretion was significantly associated with the slope of GFR ( rs = -0.28, P = 0.02). In a multivariate regression model, sulphate excretion was a significant determinant of decline in GFR, independent of age, gender, blood pressure, HbA1c, smoking, albuminuria, baseline GFR and diet group ( P < 0.01). In addition, adjusted r2 increased from 5% in a model with the aforementioned risk factors to 22% when sulphate excretion was included in the model. Cox regression revealed a hazard ratio of 0.34 (95% CI 0.13-0.88, P = 0.026) for each natural log unit increase in urinary sulphate excretion. Conclusion High urinary sulphate excretion was significantly associated with slower decline in 51Cr- EDTA-assessed GFR in diabetic nephropathy, independent of known progression promoters.
- Subjects
DIABETIC nephropathies; GLOMERULAR filtration rate; TYPE 1 diabetes; LONGITUDINAL method; EVALUATION of medical care; STATISTICS; SULFIDES; SULFUR compounds; URINE; URINALYSIS; DATA analysis; BODY mass index; DIAGNOSIS
- Publication
Diabetic Medicine, 2013, Vol 30, Issue 5, p563
- ISSN
0742-3071
- Publication type
Article
- DOI
10.1111/dme.12131