Abstract 19720: Exercise Training Reduces Angiotensin II and Advanced Glycation Endproducts in Patients with Diabetic Kidney Disease
Introduction: We have previously reported a significant improvement in endothelial function assessed by flow-mediated vasodilation (FMD) and arterial stiffness measured by pulse wave velocity (PWV) following 12-wks of exercise training in patients with stage 2-4 type 2 diabetic kidney disease (DKD). The mechanisms for these changes are unknown. Angiotensin II (Ang-II) and advanced glycation endproducs (AGEs) have been shown to be intricately involved in mediating endothelial dysfunction and arterial stiffness in patients with DKD. The efficacy of exercise training to reduce Ang-II and AGEs in patients with DKD is unknown.
Hypothesis: We hypothesized that exercise training would reduce levels of Ang-II and AGEs, and that this reduction would be associated with an improvement in endothelial function and arterial stiffness.
Method: In a randomized controlled trial involving 91 participants (68 % male, age 64.1+9.2 yrs) with stage 2-4 DKD completing either 12-weeks of moderate-intensity walking exercise training, 4x/wk for 45 minutes (n=46) or a usual medical care control group (n=45) a blood sample was taken at baseline and at 12 weeks for Ang-II and AGEs. There were no differences between groups in baseline demographic, or medical variables.
Results: At 12-wk follow-up, group comparisons were analyzed by ANCOVA using baseline as a covariate. Ang-II and AGEs were significantly reduced in the intervention group by -15.9 ±7.4 pg/mL (p=.026) and -0.07 ± 0.04 ng/mL (p=.029) respectively, with a mean difference between groups -21.7 ±9.5 pg/mL (p=.026) and -0.12 ±0.06 ng/mL (p=.029) respectively. There was a significant correlation between change in AGEs and change in PWV (r=0.22, p=0.05). Change in Ang-II was inversely correlated with change in FMD (-0.21, p=0.05), and aerobic capacity (r=-0.26, p=0.02). There was a non-significant trend for correlation between Ang-II and PWV (r=0.20, p=0.08). Levels of AGEs were correlated with F2-isoprostane (oxidative stress) levels (r=0.32, p=0.04).
Conclusion: Exercise training reduces Ang-II and AGEs in patients with DKD, suggesting that the exercise-induced improvement observed in vascular endothelial function and arterial stiffness is partially mediated by a reduction in Ang-2 and AGEs in this population.
Author Disclosures: U.G. Bronas: Research Grant; Significant; NIH-NIDDK Grant Support. D. Duprez: None. D. Treat-Jacobson: None. M. Rosenberg: None.
- © 2014 by American Heart Association, Inc.