CHANGES OF HEMORHEOLOGY IN DIABETIC NEPHR OPATHY - A POSSIBLE PACEMAKER OF LATE COMPLICATIONS OF DIABETES

Patients with diabetes mellitus (IDDM and NIDDM) run a great risk for developing renal insufficiency, retinopathy, neuropathy and coronary h eart disease. Both, macroangiopathy and microangiopathy seem to be acc elerated in people who develop signs of nephropathy. Only little atten tion is paid to changes of plasma protein composition and their influe nce on hemorheology in diabetic patients with nephropathy. We therefor e divided 45 diabetic patients (IDDM and NIDDM) according to renal fun ction into four groups (none, beginning, advanced and terminal nephrop athy) and investigated plasma protein composition (fibrinogen, albumin ) and the hemorheology (plasmaviscosity, erythrocyte aggregation), bes ides the frequency of macroangiopathy, retinopathy and neuropathy. Man ifested nephropathy was accompanied by a significant increase of macro angiopathy, retinopathy and neuropathy. Diabetic patients with beginni ng, advanced and terminal renal insufficiency presented higher levels of plasma fibrinogen concentration (p < 0,01), plasma viscosity (p < 0 ,05) and erythrocyte aggregation (p < 0,05) and a lower level of plasm a albumin concentration (p < 0,01) in comparison with diabetic patient s without any signs of nephropathy. Plasma fibrinogen concentration si gnificantly correlated with plasma viscosity (r = 0,55, p < 0,001) and erythrocyte aggregation (r = 0,71, p < 0.001). An inverse correlation was found between plasma albumin concentration and erythrocyte aggreg ation (r = 0,54, p < 0.001). We conclude, that in diabetic patients wi th nephropathy altered plasma protein composition (hyperfibriinogenemi a, hypoalbuminemia) entails deterioration of hemorheology and thus may bei jointly responsible for acceleration of nonrenal diabetic complic ations in diabetic nephropathy.