Influence of sex on hyperfiltration in patients with uncomplicated type 1 diabetes

• Published in: American journal of physiology. Renal physiology 2017-04, Vol.312 (4), p.F599-F606
• Main Authors: Škrtić, Marko, Lytvyn, Yuliya, Bjornstad, Petter, Reich, Heather N, Scholey, James W, Yip, Paul, Sochett, Etienne B, Perkins, Bruce, Cherney, David Z I
• Format: Article
• Language: English
• Subjects: Adult; Cross-Sectional Studies; Diabetes; Diabetes Mellitus, Type 1 - complications; Diabetes Mellitus, Type 1 - diagnosis; Diabetes Mellitus, Type 1 - physiopathology; Diabetic Nephropathies - diagnosis; Diabetic Nephropathies - etiology; Diabetic Nephropathies - physiopathology; Female; Gender; Glomerular Filtration Rate; Hemodynamics; Humans; Intervention; Kidney Glomerulus - blood supply; Male; Models, Biological; Patients; Renal Plasma Flow, Effective; Retrospective Studies; Risk Factors; Sex Factors; Vascular Resistance; Young Adult
• ISSN: 1931-857X; 1522-1466
• DOI: 10.1152/ajprenal.00357.2016

The aim of this analysis was to examine sex-based differences in renal segmental resistances in healthy controls (HCs) and patients with type 1 diabetes (T1D). We hypothesized that hyperfiltration-an early hemodynamic abnormality associated with diabetic nephropathy-would disproportionately affect women with T1D, thereby attenuating protection against the development of renal complications. Glomerular hemodynamic parameters were evaluated in HC ( = 30) and in normotensive, normoalbuminuric patients with T1D and either baseline normofiltration [ = 36, T1D-N, glomerular filtration rate (GFR) 90-134 ml·min ·1.73 m ] or hyperfiltration ( = 32, T1D-H, GFR ≥ 135 ml·min ·1.73 m ) during euglycemic conditions (4-6 mmol/l). Gomez's equations were used to derive efferent (R ) and afferent (R ) arteriolar resistances, glomerular hydrostatic pressure (P ) from inulin (GFR) and paraaminohippurate [effective renal plasma flow (ERPF)] clearances, plasma protein and estimated ultrafiltration coefficients (K ). Female patients with T1D with hyperfiltration (T1D-H) had higher R (1,985 ± 487 vs. 1,381 ± 296 dyne·sec ·cm , < 0.001) and filtration fraction (FF, 0.20 ± 0.047 vs. 0.16 ± 0.03 < 0.05) and lower ERPF (876 ± 245 vs. 1,111 ± 298 134 ml·min ·1.73 m < 0.05) compared with male T1D-H patients. Overall, T1D-H patients had higher P and lower R vs. HC subjects, although there were no sex-based differences. In conclusion, female T1D-H patients had higher R and FF and lower ERPF than their male counterparts with no associated sex differences in R Prospective intervention studies should consider sex as a modifier of renal hemodynamic responses to renal protective therapies.