Kidney oxygenation, perfusion and blood flow in people with and without type 1 diabetes

Jens Christian Laursen; Niels Søndergaard-Heinrich; Bryan Haddock; Ida Kirstine Bull Rasmussen; Christian Stevns Hansen; Henrik Bo Wiberg Larsson; Per-Henrik Groop; Petter Bjornstad; Marie Frimodt-Møller; Ulrik Bjørn Andersen; Peter Rossing

doi:10.1093/ckj/sfac145

Kidney oxygenation, perfusion and blood flow in people with and without type 1 diabetes

Clin Kidney J. 2022 May 20;15(11):2072-2080. doi: 10.1093/ckj/sfac145. eCollection 2022 Nov.

Authors

Jens Christian Laursen^{1

2}, Niels Søndergaard-Heinrich^{1

2}, Bryan Haddock³, Ida Kirstine Bull Rasmussen^{1

2}, Christian Stevns Hansen¹, Henrik Bo Wiberg Larsson^{2

3}, Per-Henrik Groop^{4

5

6

7}, Petter Bjornstad⁸, Marie Frimodt-Møller¹, Ulrik Bjørn Andersen¹, Peter Rossing^{1

2}

Affiliations

¹ Complications Research, Steno Diabetes Center Copenhagen, Copenhagen, Denmark.
² Department of Clinical Medicine, the Faculty of Health and Medical Science, University of Copenhagen, Copenhagen, Denmark.
³ Department of Clinical Physiology, Nuclear Medicine and PET, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.
⁴ FinnDiane Study Group, Folkhälsan Research Center, Helsinki, Finland.
⁵ Department of Nephrology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
⁶ Research Program for Clinical and Molecular Metabolism, Faculty of Medicine, University of Helsinki, Helsinki, Finland.
⁷ Department of Medicine, Central Clinical School, Monash University, Melbourne, Australia.
⁸ Department of Medicine, Division of Renal Diseases and Hypertension, Department of Paediatrics, Section of Endocrinology, University of Colorado School of Medicine, CO, USA.

Abstract

Background: We used magnetic resonance imaging (MRI) to study kidney energetics in persons with and without type 1 diabetes (T1D).

Methods: In a cross-sectional study, 15 persons with T1D and albuminuria and 15 non-diabetic controls (CONs) underwent multiparametric MRI (3 Tesla Philips Scanner) to quantify renal cortical and medullary oxygenation (R₂*, higher values correspond to higher deoxyhaemoglobin concentration), renal perfusion (arterial spin labelling) and renal artery blood flow (phase contrast). Analyses were adjusted for age, sex, systolic blood pressure, plasma haemoglobin, body mass index and estimated glomerular filtration rate (eGFR).

Results: Participants with T1D had a higher median (Q1; Q3) urine albumin creatinine ratio (UACR) than CONs [46 (21; 58) versus 4 (3; 6) mg/g; P < .0001] and a lower mean ± SD eGFR (73 ± 32 mL/min/1.73 m² versus 88 ± 15 mL/min/1.73 m²; P = .12), although not significantly. Mean medullary R₂* was lower in T1D (34 ± 6/s versus 38 ± 5/s; P < .01) corresponding to a higher oxygenation. R₂* was not different in the cortex. Cortical perfusion was lower in T1D (163 ± 40 versus 224 ± 49 mL/100 g/min; P < .001). Renal artery blood flow was lower in T1D than in CONs (360 ± 130 versus 430 ± 113 mL/min; P = .05). In T1D, lower cortical oxygenation and renal artery blood flow were both associated with higher UACR and lower eGFR (P < .05).

Conclusions: Participants with T1D and albuminuria exhibited higher medullary oxygenation than CONs, despite lower cortical perfusion and renal artery blood flow. This might reflect perturbed kidney energetics leading to a higher setpoint of medullary oxygenation in T1D. Lower cortical oxygenation and renal artery blood flow were associated with higher UACR and lower eGFR in T1D.

Keywords: diabetic kidney disease; hypoxia inflammation; magnetic resonance imaging; renal haemodynamics; type 1 diabetes.