ArticleJCI insight2018
Renin-angiotensin-aldosterone system activation in long-standing type 1 diabetes.
Article in JCI insight, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 31 papers, 1 of them a synthesis that pooled it.
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Who cites it
31 citing papers in PubMed, 1 synthesis or guideline pooled it, 53 citations in OpenAlex.
- Prediabetes and the risk of incident chronic kidney disease in adults: A systematic review and meta-analysis.Biomolecules & biomedicine · 2026Pooled it
- Salt and chronic kidney disease.Nature reviews. Nephrology · 2026Review
- Type 1 diabetes, ageing and frailty: an underexplored intersection.Diabetologia · 2026Review
- Hypertension and Diabetes as Determinants of Patient-Reported Quality of Life in Permanent Atrial Fibrillation.Diagnostics (Basel, Switzerland) · 2025Article
- Metabolic and vascular insulin resistance: partners in the pathogenesis of cardiovascular disease in diabetes.American journal of physiology. Heart and circulatory physiology · 2025Review
- Renal microcirculation and mechanisms in diabetic kidney disease.Frontiers in endocrinology · 2025Review
- Rediscovery of the implication of albuminuria in heart failure: emerging classic index for cardiorenal interaction.ESC heart failure · 2024Review
- Circulating Protein and Metabolite Correlates of Histologically Confirmed Diabetic Kidney Disease.Kidney medicine · 2024Article
- Diabetes and Renal Complications: An Overview on Pathophysiology, Biomarkers and Therapeutic Interventions.Biomedicines · 2024Review
- A new perspective on proteinuria and drug therapy for diabetic kidney disease.Frontiers in pharmacology · 2024Review
- Oxidative Stress Induced by Lipotoxicity and Renal Hypoxia in Diabetic Kidney Disease and Possible Therapeutic Interventions: Targeting the Lipid Metabolism and Hypoxia.Antioxidants (Basel, Switzerland) · 2023Review
- Alterations to Kidney Physiology during Cardiopulmonary Bypass-A Narrative Review of the Literature and Practical Remarks.Journal of clinical medicine · 2023Review
- Pharmacological management of youth with type 2 diabetes and diabetic kidney disease: a comprehensive review of current treatments and future directions.Expert opinion on pharmacotherapy · 2023Review
- Identification of necroptosis-related features in diabetic nephropathy and analysis of their immune microenvironent and inflammatory response.Frontiers in cell and developmental biology · 2023Article
- Urinary Angiotensinogen in Patients With Type 1 Diabetes With Microalbuminuria: Gender Differences and Effect of Intensive Insulin Therapy.Kidney international reports · 2022Article
- Youth versus adult-onset type 2 diabetic kidney disease: Insights into currently known structural differences and the potential underlying mechanisms.Clinical science (London, England : 1979) · 2022Article
- Renal hemodynamic dysfunction and neuropathy in longstanding type 1 diabetes: Results from the Canadian study of longevity in type 1 diabetes.Journal of diabetes and its complications · 2022Article
- Glomerular hyperfiltration.Nature reviews. Nephrology · 2022Review
- Cellular Senescence and Regulated Cell Death of Tubular Epithelial Cells in Diabetic Kidney Disease.Frontiers in endocrinology · 2022Review
- Update on Pathogenesis of Glomerular Hyperfiltration in Early Diabetic Kidney Disease.Frontiers in endocrinology · 2022Review
Corrections and comments
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Authors and funding
18 authors at 4 institutions in 2 countries.
Funding
Abstract
backgroundIn type 1 diabetes (T1D), adjuvant treatment with inhibitors of the renin-angiotensin-aldosterone system (RAAS), which dilate the efferent arteriole, is associated with prevention of progressive albuminuria and renal dysfunction. Uncertainty still exists as to why some individuals with long-standing T1D develop diabetic kidney disease (DKD) while others do not (DKD resistors). We hypothesized that those with DKD would be distinguished from DKD resistors by the presence of RAAS activation.
methodsRenal and systemic hemodynamic function was measured before and after exogenous RAAS stimulation by intravenous infusion of angiotensin II (ANGII) in 75 patients with prolonged T1D durations and in equal numbers of nondiabetic controls. The primary outcome was change in renal vascular resistance (RVR) in response to RAAS stimulation, a measure of endogenous RAAS activation.
resultsThose with DKD had less change in RVR following exogenous RAAS stimulation compared with DKD resistors or controls (19%, 29%, 31%, P = 0.008, DKD vs. DKD resistors), reflecting exaggerated endogenous renal RAAS activation. All T1D participants had similar changes in renal efferent arteroilar resistance (9% vs. 13%, P = 0.37) irrespective of DKD status, which reflected less change versus controls (20%, P = 0.03). In contrast, those with DKD exhibited comparatively less change in afferent arteriolar vascular resistance compared with DKD resistors or controls (33%, 48%, 48%, P = 0.031, DKD vs. DKD resistors), indicating higher endogenous RAAS activity.
conclusionIn long-standing T1D, the intrarenal RAAS is exaggerated in DKD, which unexpectedly predominates at the afferent rather than the efferent arteriole, stimulating vasoconstriction.
fundingJDRF operating grant 17-2013-312.
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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.