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Diabetes increases renovascular impedance in patients with liver cirrhosis

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Abstract

Renal failure is a common complication of cirrhosis and is associated with poor prognosis. Several reports have demonstrated the clinical utility of renal resistive indices in the assessment of renal function in cirrhosis patients. It is unknown whether the occurrence of diabetes affects renal haemodynamic indices in patients with cirrhosis. Therefore, the aim of our study was to compare renal Doppler indices in cirrhotic patients with and without type 2 diabetes mellitus (T2DM) and in diabetics without cirrhosis, and to relate the Doppler parameters to albuminuria. We evaluated 89 consecutive patients with normal renal functioning, including 37 with cirrhosis and T2DM (CD-Group), 41 with cirrhosis without diabetes (C-Group) and 11 with diabetes without cirrhosis (D-Group). The kidney pulsatility index (PI) and resistance index (RI) were measured by Doppler ultrasound. Renal function was expressed as the estimated glomerular filtration rate (eGFR) using the modification of diet in renal disease (MDRD) formula. Microalbuminuria (µAlb) was also evaluated. No significant differences were observed with respect to age, the Child–Pugh class or the serum creatinine level. The eGFR was mildly reduced in the CD-Group compared with the C-Group and D-Group, and µAlb was present in 24.4 % of the patients in the CD-Group and in 9 % of those in the D-Group. The PI and RI were significantly increased in the CD-Group and D-Group compared with the C-Group. Both the PI and RI were significantly associated with µAlb independent of age and Child–Pugh class. The novel finding of this study was that T2DM potentially impairs renal haemodynamics in patients with cirrhosis.

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Statement of human and animal rights

All procedures performed in human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. This article does not contain any studies with animals performed by any of the author.

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Authors and Affiliations

  1. Department of Experimental and Clinical Medicine, Garibaldi Hospital Catania, University of Catania, Via Palermo, 636, 95122, Catania, Italy

    Luisa Spadaro, Graziella Privitera, Giuseppe Fede, Orazio Magliocco, Maurizio Russello, Salvatore Piro, Agata Maria Rabuazzo & Francesco Purrello

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  1. Luisa Spadaro
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  2. Graziella Privitera
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  3. Giuseppe Fede
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  4. Orazio Magliocco
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  5. Maurizio Russello
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  6. Salvatore Piro
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  7. Agata Maria Rabuazzo
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  8. Francesco Purrello
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Correspondence to Francesco Purrello.

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Spadaro, L., Privitera, G., Fede, G. et al. Diabetes increases renovascular impedance in patients with liver cirrhosis. Intern Emerg Med 10, 703–709 (2015). https://doi.org/10.1007/s11739-015-1235-3

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  • DOI: https://doi.org/10.1007/s11739-015-1235-3

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