Endocrine Abstracts

Objective: Hemorheologic alterations or changes in blood viscosity have been suggested to play a role in the pathogenesis of diabetic microvascular complications. We measured various hemorheologic parameters in type 2 diabetes patients and assessed their possible role as a diagnostic tool for diabetic nephropathy.

Methods: Four hundred-seventy patients with type 2 diabetes were included in this study. Hemorheologic parameters, including erythrocyte deformability, elongation index (EI), critical shear stress (CSS), and aggregation index (AI) were measured using microfluidic hemorheometer. Various metabolic parameters were assessed from fasting blood samples and urinary albumin to creatinine ratio was used to assess diabetic nephropathy.

Results: There were significant differences in Elongation index at 3 Pascal (EI at 3Pa), Fibrinogen/EI, and shear stress among patients in different stages of chronic kidney disease (all P<0.05), EI at 3 Pa, Fibrinogen/EI, and shear stress significantly differed among the groups. Fibrinogen/EI differed between normal or CKD 1 and CKD 2 patients. In multiple regression analysis, Fibrinogen/EI at 3Pa was an independent predictor of albumin to creatinine ratio independent of age, ESR, hematocrit, HbA1c, and body mass index (ß=0.101, P<0.05). Also, critical time, critical stress, fibrinogen/EI at 3Pa, CSS/EI et 3Pa, ad fibrinogen/CSS at 3Pa were significantly different among patients at different stages of diabetic nephropathy (all P< 0.05). Among the variables, Fibrinogen/EI at 3Pa showed area under the ROC curve of 0.721, suggesting 860 mg/dl% as a cut off point for diabetic nephropathy with the sensitivity of 74% and specificity of 62%.

Conclusion: Fibrinogen/EI is a sensitive parameter measured via point-of-care testing for screening diabetic nephropathy in patients with type 2 diabetes.