Department of Pediatric Nephrology, Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa, 34098, Istanbul, Turkey.
Department of Pediatric Endocrinology, Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey.
Pediatr Nephrol. 2020 Jul;35(7):1267-1276. doi: 10.1007/s00467-020-04526-2. Epub 2020 Mar 24.
The aim of the study is to identify the effect of salt intake and diabetes itself on blood pressure (BP) profile and microalbuminuria in children with type one diabetes mellitus (T1DM). Our hypothesis is that higher amount of salt consumption and/or hyperglycemia may impair blood pressure pattern in children with T1DM.
This cross-sectional study included 84 children and adolescents with T1DM (62% females, age 13.9 ± 3.2 years, disease duration 7.3 ± 3.1 years, 43% poorly controlled diabetes) and 54 aged- and sex-matched healthy children with an adequately collected 24-h urine samples. Urine sodium, creatinine, and microalbumin were measured and salt intake was assessed on the basis of sodium excretion in 24-h urine. Blood pressure profile of the children with T1DM was evaluated with 24-h ambulatory blood pressure monitoring.
Compared to the children with well-controlled diabetes, children with poorly controlled diabetes had significantly higher standard deviation scores (SDS) of nighttime systolic BP (0.22 ± 1.28 vs - 0.87 ± 0.76, p = 0.003) and lower dipping in diastole (13.4 ± 5.9 vs 18.4 ± 8.1, p = 0.046). Among T1DM group, children with the highest quartile of salt intake had higher nighttime systolic and diastolic BP-SDS (0.53 ± 1.25 vs - 0.55 ± 0.73, p = 0.002 and 0.89 ± 1.19 vs 0.25 ± 0.63, p = 0.038, respectively) and lower dipping in systole compared to their counterparts (7.7 ± 5.0 vs 11.5 ± 6.1, p = 0.040). High averaged HbA1c was independently associated with higher both daytime and nighttime systolic BP-SDS (p = 0.010, p < 0.001) and nighttime diastolic BP-SDS (p = 0.001), and lower diastolic dipping (p = 0.001). High salt intake was independently associated with higher nighttime systolic BP-SDS (p = 0.002) and lower systolic dipping (p = 0.019). A 24-h MAP-SDS was the only independent risk factor for microalbuminuria (p = 0.035).
Beside poor diabetic control, high salt consumption appears to be an important modifiable risk factor for impaired BP pattern, which contributes to the development of diabetic kidney disease in children with T1DM.
本研究旨在探讨盐摄入量和糖尿病本身对 1 型糖尿病（T1DM）患儿血压（BP）谱和微量白蛋白尿的影响。我们的假设是，较高的盐摄入量和/或高血糖可能会损害 T1DM 患儿的血压模式。
本横断面研究纳入了 84 名 T1DM 患儿（女性占 62%，年龄 13.9±3.2 岁，病程 7.3±3.1 年，43%血糖控制不佳）和 54 名年龄和性别匹配的健康儿童，他们均有充分收集的 24 小时尿液样本。测量尿钠、肌酐和微量白蛋白，并根据 24 小时尿钠排泄量评估盐摄入量。使用 24 小时动态血压监测评估 T1DM 患儿的血压谱。
与血糖控制良好的患儿相比，血糖控制不佳的患儿夜间收缩压标准差（SDS）明显更高（0.22±1.28 对-0.87±0.76，p=0.003），夜间舒张压下降幅度更低（13.4±5.9 对 18.4±8.1，p=0.046）。在 T1DM 组中，盐摄入量最高四分位数的患儿夜间收缩压和舒张压 SDS 更高（0.53±1.25 对-0.55±0.73，p=0.002 和 0.89±1.19 对 0.25±0.63，p=0.038），且夜间收缩压下降幅度更低（7.7±5.0 对 11.5±6.1，p=0.040）。高平均糖化血红蛋白（HbA1c）与日间和夜间收缩压 SDS 升高（p=0.010，p<0.001）以及夜间舒张压 SDS 降低（p=0.001）独立相关，且与舒张压下降幅度降低（p=0.001）独立相关。高盐摄入量与夜间收缩压 SDS 升高（p=0.002）和收缩压下降幅度降低（p=0.019）独立相关。24 小时平均 MAP-SDS 是微量白蛋白尿的唯一独立危险因素（p=0.035）。
除了糖尿病控制不佳外，高盐摄入似乎也是血压模式受损的一个重要可改变危险因素，这可能导致 T1DM 患儿发生糖尿病肾病。
