Plasma Prekallikrein: A Risk Marker for Hypertension and Nephropathy in Type 1 Diabetes

A. A. Jaffa, R. Durazo-Arvizu, D. Zheng, D. T. Lackland, S. Srikanth, W. T. Garvey, A. H. Schmaier
2003 Diabetes  
and the DCCT/EDIC Study Group 5 The relevance and significance of the plasma kallikrein/ kinin system as a risk factor for the development of vascular complications in diabetic patients was explored in a cross-sectional study. We measured the circulating levels of plasma prekallikrein (PK) activity, factor XII, and high؊molecular weight kininogen in the plasma of 636 type 1 diabetic patients from the Diabetes Control and Complications Trial/Epidemiology and Diabetes Intervention and
more » ... s Study cohort. The findings demonstrated that type 1 diabetic patients with blood pressure >140/90 mmHg have increased PK levels compared with type 1 diabetic patients with blood pressure <140/90 (1.53 ؎ 0.07 vs. 1.27 ؎ 0.02 units/ml; P < 0.0001). Regression analysis also determined that plasma PK levels positively and significantly correlated with diastolic (DBP) and systolic blood pressures (SBP) as continuous variables (r ‫؍‬ 0.17 and 0.18, respectively; P < 0.0001). In multivariate regression analysis, the semipartial r 2 value for PK was 2.93% for SBP and 2.92% for DBP (P < 0.0001). A positive correlation between plasma PK levels and the urinary albumin excretion rate (AER) was also observed (r ‫؍‬ 0.16, P < 0.0001). In categorical analysis, patients with macroalbuminuria had a significantly higher level of plasma PK than normoalbuminuric patients (1.45 ؎ 0.08 vs. 1.27 ؎ 0.02 units/ml; P < 0.01), whereas microalbuminuric patients had an intermediate PK value (1.38 ؎ 0.05 units/ml; P ‫؍‬ NS). Among patients in the microalbuminuric subgroup, we observed a positive and independent correlation between PK and AER in univariate and multivariate regression analysis (r ‫؍‬ 0.27, P < 0.03; n ‫؍‬ 63). We concluded that in type 1 diabetes, 1) PK levels are elevated in association with increased blood pressure; 2) PK levels are independently correlated with AER and are categorically elevated in patients with macroalbuminuria; and 3) although the positive correlation between PK and AER within the subgroups of patients with microalbuminuria suggest that PK could be a marker for progressive nephropathy, longitudinal studies will be necessary to address this issue.
doi:10.2337/diabetes.52.5.1215 pmid:12716755 fatcat:gpuvxu2wybaazin3jlbp7enlvu