Urinary sulphate excretion and progression of diabetic nephropathy in Type 1 diabetes. Issue 5 (7th March 2013)

• Record Type: Journal Article
• Authors: Andrésdóttir, G.; Bakker, S. J. L.; Hansen, H. P.; Parving, H.‐H.; Rossing, P.
• Is Part Of: Diabetic medicine. Volume 30:Issue 5(2013:May)
• Page Start: 563
• Page End: 566
• Publication Date: 2013-03-07
• Subjects: Diabetes -- Periodicals; 616.462
• DOI: 10.1111/dme.12131
• Languages: English
• ISSNs: 0742-3071

Abstract

<abstract abstract-type="main" xml:lang="en" id="dme12131-abs-0001"> <title>Abstract</title> <sec id="dme12131-sec-0001" sec-type="section"> <title>Aims</title> <p>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.</p> </sec> <sec id="dme12131-sec-0002" sec-type="section"> <title>Methods</title> <p>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 <sup>51</sup>Cr‐EDTA plasma clearance (GFR) and less than 1 year of follow‐up (<italic>n</italic> = 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.</p> </sec> <sec id="dme12131-sec-0003" sec-type="section"> <title>Results</title> <p>Sulphate excretion was significantly associated with the slope of GFR (<italic>r</italic><sub>s</sub> = –0.28, <italic>P</italic> = 0.02). In a multivariate regression model, sulphate excretion was a significant determinant of decline in GFR, independent of age, gender, blood pressure, HbA<sub>1c</sub>, smoking, albuminuria, baseline GFR and diet group (<italic>P</italic> < 0.01). In addition, adjusted <italic>r</italic><sup>2</sup> 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, <italic>P</italic> = 0.026) for each natural log unit increase in urinary sulphate excretion.</p> </sec> <sec id="dme12131-sec-0004" sec-type="section"> <title>Conclusion</title> <p>High urinary sulphate excretion was significantly associated with slower decline in <sup>51</sup>Cr‐EDTA‐assessed GFR in diabetic nephropathy, independent of known progression promoters.</p> </sec> </abstract>