Kidney Hemodynamic Function in Historic vs. Contemporary Patients with Type 1 Diabetes

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Background: Advances in insulin technology have led to better glycemic control in patients with type 1 diabetes (T1D), but whether renal hemodynamic function has changed over time with advances in insulin technology in T1D is unknown. Methods: We measured renal hemodynamic function in 23 patients with long-standing T1D from an ongoing clinical trial and compared findings to those from older adults with T1D from the Canadian Study of Longevity in Type 1 Diabetes (Lytvyn et al. AJKD 2019). Glomerular filtration rate (GFR) was measured using iohexol clearance, effective renal plasma flow (RPF) measured using para-aminohippurate clearance, while intraglomerular pressure (PGLO), renal vascular resistance (RVR), efferent arteriole resistance (RE), and afferent arteriolar resistance (RA) estimated using the Gomez equations. Results: Participants from the contemporary cohort were slightly younger and more likely to be male than the historic cohort (Table). HbA1c trended towards being lower in the contemporary cohort but it did not reach statistical significance. GFR, RPF, RBF, and PGLO were significantly greater in the contemporary vs. historic cohort. In contrast, FF, RVR, RE, and RA were significantly lower in the contemporary cohort. There were no differences in systolic blood pressure or mean arterial pressure between the groups. Conclusion: T1D patients from the contemporary cohort had significantly less renal vasoconstriction and intraglomerular pressure than patients from the historic cohort. Funding: Private Foundation Support - Parameter Contemporary Cohort (N=23) Historic Cohort (N=66) P-value Demographic and Clinical Characteristics Age, years 60 ± 15 66 ± 8 0.01 Male, N(%) 17 (73.9) 30 (45) <0.0001 BMI, kg/m2 28.1 ± 6.3 26.6 ± 3.9 0.29 HbA1C, % 7.0 ± 0.8 7.4 ± 0.8 0.07 Renal Hemodynamic Function RPF (ml/min) 586 ± 112 447 ± 101 <0.0001 GFR (ml/min) 107 ± 17 103 ± 17 <0.0001 Filtration Fraction 0.19 ± 0.03 0.24 ± 0.04 <0.0001 RBF (L/min) 1025 ± 251 689 ± 166 <0.0001 RVR (mm Hg/L/min) 0.09 ± 0.02 0.14 ± 0.04 <0.0001 Intraglomerular Hemodynamic Parameters PGLO, mm Hg 54.3 ± 4.2 51.4 ± 4.3 0.006 R E, dyne-s-cm-5 2,954 ± 878 4,546 ± 1714 <0.0001 RE, dyne-s-cm-5 1,586 ± 311 2,403 ± 544 <0.0001 Mean (SD) unless otherwise specified

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