Hypertension and Sodium/Lithium

Kidney International (1992) 41, 877–882; doi:10.1038/ki.1992.134

Prevalence of raised sodium-lithium countertransport activity in type 1 diabetic patients

José B Lopes de Faria1, Rogério Friedman1, Taimur Tariq1 and GianCarlo Viberti1

1Unit for Metabolic Medicine, United Medical and Dental Schools, Guy's Hospital, London, England, United Kingdom

Correspondence: Prof G C Viberti, Unit for Metabolic Medicine, 4th Floor, Hunt's House, Guy's Hospital, London, SEI 9RT, England, United Kingdom.

Top

Abstract

Prevalence of raised sodium-lithium countertransport activity in type 1 diabetic patients. The prevalence of raised Na+/Li+ countertransport (CT) activity (>0.41 mmol/liter RBC/hr) was assessed in 185 consecutive insulin-dependent diabetic patients attending an outpatient diabetic clinic. Normoalbuminuria was defined as an overnight albumin excretion rate (AER) of <20 microg/min (N = 121), microalbuminuria as AER between 20 and 150 microg/min (N = 35) and macroalbuminuria as AER greater than or equal to 150 microg/min (N = 29). The prevalence of elevated Na+/Li+CT (>0.41 mmol/liter RBC/hr) was 21.5, 42.8 and 51.7% (P = 0.0005), in patients with normo-, micro- and macroalbuminuria, respectively. In the whole group, Na+/Li+CT was significantly related to mean blood pressure (MBP; rs = 0.37, P < 0.001) and AER (rs = 0.38, P < 0.001). In a multiple regression analysis the significant correlates AER, as a continuous variable, or of proteinuria (micro + macroalbuminuria), as a categorical variable, were Na+/Li+CT, MBP, duration of diabetes and glycosylated hemoglobin (HbAl). The frequency of normoalbuminuric patients with high Na+/Li+CT activity fell with duration of diabetes. The risk of proteinuria was significantly greater in patients with raised Na+/Li+CT compared to those with Na+/Li+CT within the normal range (odds ratio 3.8, 95% CI, 1.9 and 7.8). A relative excess of patients with proteinuria (micro + macroalbuminuria) was found in the group with elevated Na+/Li+CT and HbAl above the median value (8.05%) of the whole population (chi2 = 9.7, P < 0.002). Elevated Na+/Li+CT activity is more prevalent in IDDM patients with proteinuria and is rare in long-standing normoalbuminuric patients; the risk of proteinuria increases with increasing Na+/Li+CT rates; blood glucose control and Na+/Li+CT appear to interact in determining proteinuria.

Top

References

  1. Canessa M, Adragna N, Solomon HS, Connolly TM, Tosteson DC: Increased sodium-lithium countertransport in red cells of patients with essential hypertension. N Engl J Med 302:772–776, 1980 | PubMed | ISI | ChemPort |
  2. Walker JD, Tariq T, Viberti GC: Sodium-lithium countertransport activity in red cells of patients with insulin-dependent diabetes and nephropathy and their parents. Br Med J 301:635–1638, 1990
  3. Mangili R, Bending JJ, Scott G, Li LK, Gupta A, Viberti GC: Increased sodium-lithium countertransport activity in red cells of patients with insulin-dependent diabetes and nephropathy. Engl J Med 318:146–150, 1988
  4. Krolewski AS, Canessa M, Warram JH, Laffer LMB, Christlieb R, Knowler WC, Rand LI: Predisposition to hypertension and susceptibility to renal disease in insulin-dependent diabetes mellitus. Engl J Med 318:140–145, 1988
  5. Jones SL, Trevisan R, Tariq T, Semplicini A, Mattock M, Walker JD, Nosadini R, Viberti GC: Sodium-lithium counter-transport in microalbuminuric insulin-dependent diabetic patients. Hypertension 15:570–575, 1990
  6. Trevisan R, Nosadini R, Fioretto P, Semplicini A, Mozzato MG, Giorato C, Viberti GC: Arterial hypertension, cation countertransport and renal function in insulin-dependent diabetic patients. (abstract) Diabetes 38:31A, 1989
  7. Viberti GC: Mechanisms of diabetic renal and cardiovascular disease. Acta Diabetol Lat 27:267–276, 1990
  8. Viberti GC, Hill, RD, Argyropoulos A, Mahmud U, Keen H: Microalbuminuria as a predictor of clinical nephropathy in insulin-dependent diabetes mellitus. Lancet i:1430–1432, 1982
  9. Veall N, Gibbs GP: The accurate determination of tracer clearance rates and equilibrium distribution volumes from single injection plasma measurements using numerical analysis, in Radionuclides in Nephrology, edited by Joekes AM, London, Academic Press, 1982, pp. 125–130
  10. Kahn HA, Sempos CT: Statistical Methods in Epidemiology. New York, Oxford University Press, 1989
  11. Parving HH, Hommel E, Mathiesen E, SkØtt P, Edsberg B, Lauritzen M, Lauritzen M: Prevalence of microalbuminuria, arterial hypertension, retinopathy and neuropathy in patients with insulin dependent diabetes. Br Med J 296:156–160, 1988 | ISI | ChemPort |
  12. Gatling W, Knight C, Mullee MA, Hill RD: Microalbuminuria in diabetes: A population study of the prevalence and as assessment of three screening tests. Diab Med 5:343–347, 1988
  13. Marshall S, Alberti KGMM: Comparison of the prevalence and associated features of abnormal albumin excretion in insulin-dependent and non-insulin-dependent. Quart J Nephrol 261:61–71, 1989
  14. Mogensen CE, Christensen CK: Predicting diabetic nephropathy in insulin-dependent diabetic patients. N Engl J Med 311:89–93, 1984 | PubMed | ISI | ChemPort |
  15. Woorley RJ, Hentshell WH, Cormier C, Nutting S, Pead G, Zelenkov K, Smith JB, Ash KO, Williams RR: Increased sodium-lithium countertransport in erythrocytes of pregnant women. N Engl J Med 307:412–416, 1982
  16. Brent GA, Canessa M, Dluhy RG: Reversible alteration of red cell lithium sodium countertransport in patients with thyroid disease. J Clin Endocrinol Metab 68:1–7, 1989
  17. Hilton PJ: Cellular sodium transport in essential hypertension. N Engl J Med 314:222–229, 1986
  18. McDonald AM, Dyer AR, Liu K, Stamler R, Gosch FC, Grimm R, Berman R, Stamler J: Sodium-lithium countertransport and blood pressure control by nutritional intervention in "mild" hypertension. J Hypertens 6:283–291, 1988
  19. Trevisan M, Ostrow D, Cooper R, Liu K, Sparks S, Okonek A, Stevens E, Marguardt J, Stamler J: Abnormal red blood cell ion transport and hypertension. The People's Gas Company Study. Hypertension 5:363–367, 1983 | PubMed |
  20. Jones SL, Close CE, Mattock MB, Jarrett RJ, Keen H, Viberti GC: Plasma lipid and coagulation factor concentrations in insulin-dependent diabetics with microalbuminuria. Br Med J 289:487–490, 1989
  21. Jensen R, Stender S, Deckert T: Abnormalities in plasma concentrations of lipoprotein and fibrinogen in type 1 (insulin-dependent) diabetic patients with increased urinary albumin excretion. Diabetologia 31:142–145, 1988
  22. Carr S, Mbanya JC, Thomas T, Keavey P, Taylor R, Alberti KGMM, Wilkinson R: Increase in glomerular filtration rate in patients with insulin-dependent diabetes and elevated erythrocyte sodium-lithium countertransport. N Engl J Med 322:500–505, 1990 | PubMed | ISI | ChemPort |
  23. Turner ST, Michels VV: Sodium-lithium countertransport and hypertension in Rochester, Minnesota. Hypertension 18:183–190, 1991 | PubMed |
  24. Williams RR, Hunt SC, Kuida H, Smith JB, Ash KO: Sodium-lithium countertransport in erythrocytes from hypertensive prone families in Utah. Am J Epidemiol 118:338–344, 1983
  25. Hunt SC, Stephenson SH, Hopkins PN, Hasstedt SJ, Williams RR: A prospective study of sodium-lithium counter-transport and hypertension in Utah. Hypertension 17:1–7, 1991
  26. Nosadini R, Viberti, GC, Doria A, Fioretto P, Trevisan R, Avogaro A, Semplicini A, Donadon V, Zanetta G, Luisiani G: Increased Na+/Li+ countertransport activity is associated with cardiac hypertrophy and insulin resistance in hypertensive Type I (insulin-dependent) diabetics. (abstract) Diabetologia 32:523A, 1989
  27. Lopes de Faria JB, Jones SL, McDonald F, Chambers J, Mattock MB, Viberti GC: Insulin resistance and sodium-lithium countertransport activity in normoalbuminuric insulin-dependent diabetic patients. Diabetes (in press)
  28. Ducimitiére P, Eschwége E, Papòz L, Richard JL, Claude JR, Rosselin GE: Relationship of plasma insulin levels to the incidence of myocardial infarction and coronary heart disease mortality in a middle-aged population. Diabetologia 19:205–210, 1980
  29. Martin FIR, Hopper JL: The relationship of acute insulin sensitivity to the progression of vascular disease in long-term type1 (insulin-dependent) diabetes mellitus. (abstract) Diabetologia 30:149, 1987 | Article | PubMed | ISI | ChemPort |
  30. Pyörala K, Uusitupa M, Laakso M, Siitonen O, Niskanen L, Rönnemaa: Macrovascular complications in relation to hyper-insulinaemia in non-insulinrdependent diabetes mellitus. Diab Métab (Paris) 13:345–349, 1987
  31. Catalano C, Winocur PH, Thomas TH, Rodham D, Wilkinson R: Erythrocyte sodium-lithium countertransport, exchangeable sodium and TmPO4 in normoalbuminuric type 1 diabetes. Diabetologia 34 (suppl. 2):A68, 1991
  32. Carr SJ, Thomas TH, Wilkinson R: Erythrocyte sodium lithium countertransport in primary and renal hypertension: Relation to family history. Eur J Clin Invest 19:101–106, 1989 | PubMed | ISI | ChemPort |
  33. Morgan DB, Stewart AD, Davidson C: Relations between erythrocyte lithium efflux, blood pressure and family histories of hypertension and cardiovascular disease. Studies in a factory workforce and a hypertension clinic. J Hypertens 4:609–615, 1986
  34. Yap L, Arazola A, Soria F, Diez J: Is there increased cardiovascular risk in essential hypertensive patients with abnormal kinetic of red blood cell sodium-lithium countertransport? Hypertens 7:667–673, 1989
  35. Borch-Johnsen K, Kreiner S: Proteinuria: Value as predictor of cardiovascular mortality in insulin-dependent diabetes mellitus. Br Med J 294:1651–1654, 1987 | ChemPort |
  36. Jensen T, Borch-Johnsen K, Kofoed-Enevoldsen , Deckert T: Coronary heart disease in young type 1 (insulin-dependent) diabetic patients with and without diabetic nephropathy: Incidence and risk factors. Diabetologia 30:144–148, 1987 | Article | PubMed | ISI | ChemPort |
  37. Nosadini R, Semplicini A, Fioretto P, Lusiani L, Trevisan R, Donadoni V, Zanette G, Nicolosi GL, Dall'Aglio V, Zanuttini D, Viberti GC: Sodium-lithium countertransport and cardio-renal abnormalities in essential hypertension. Hypertension 18:191–198, 1991 | PubMed | ISI | ChemPort |

Extra navigation

.
ADVERTISEMENT