Abstract: FR-PO0348
Stage-Dependent Endothelial Dysfunction in Diabetic Nephropathy: A Cross-Sectional TM Flow-Based Study
Session Information
- Diabetic Kidney Disease: Progression, Predictive Tools, Therapeutics, and Outcomes
November 07, 2025 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Diabetic Kidney Disease
- 702 Diabetic Kidney Disease: Clinical
Authors
- Sajjad, Ahsan, Ibn Sina Community Clinic, Houston, Texas, United States
- Sajjad, Mobeen, Saad Hospital and Cardiac Care Center, Sialkot, Punjab, Pakistan
- Amer, Rida, Prolato Clinical Research Center, Houston, Texas, United States
- Masood, Attique Ur Rehman, Xenon Health, Jersey City, New Jersey, United States
- Butt, Muhammad Daoud, Universiti Malaya, Federal Territory of Kuala Lumpur, Federal Territory of Kuala Lumpur, Malaysia
- Patel, Ranjan, Ibn Sina Community Clinic, Houston, Texas, United States
- Mandayam, Sreedhar A., The University of Texas MD Anderson Cancer Center Division of Radiation Oncology, Houston, Texas, United States
- Abbasi, Shehroz, Services Institute of Medical Sciences, Lahore, Punjab, Pakistan
Background
Endothelial dysfunction is an early marker of cardiovascular disease and is prevalent in type 2 diabetes. In diabetic nephropathy, worsening kidney function may accelerate vascular damage, increasing cardiovascular risk. However, its stage-dependent progression remains underexplored. This study evaluated endothelial function across CKD stages in diabetic patients using TM Flow, a non-invasive tool for vascular and autonomic assessment.
Methods
This cross-sectional study included 63 adults with type 2 diabetes and CKD from a U.S. community clinic. Patients were grouped into Stage 2 (n = 33; eGFR 60–89) and Stage 3 CKD (n = 30; eGFR 30–59) per KDIGO criteria. TM Flow testing measured Endothelial Reactivity Index, Sympathetic/Vagal Balance, Sudomotor Score, and Pulse Wave Velocity. Data were analyzed using SPSS-25. Normality was tested with Shapiro-Wilk; group comparisons used t-tests or Mann–Whitney U tests. Significance was set at p < 0.05.
Results
The mean age of the study population was 63.1 ± 9.4 years, with 55% male participants. ERI was significantly reduced in Stage 3 CKD patients (1.18 ± 0.32) compared to Stage 2 (1.47 ± 0.29), indicating impaired endothelial-dependent vasodilation (p = 0.003). Sympathetic/Vagal Balance Ratio was higher in Stage 3 patients (2.91 ± 1.08) than in Stage 2 (2.13 ± 0.87), suggesting heightened sympathetic activity (p = 0.009). Sudomotor Function Score was lower in Stage 3 (1.3 ± 0.6) versus Stage 2 (2.0 ± 0.7), indicative of early peripheral autonomic neuropathy (p = 0.012). PWV was significantly elevated in Stage 3 (11.6 ± 1.9 m/s) compared to Stage 2 (9.8 ± 1.7 m/s), reflecting increased arterial stiffness (p = 0.001).Multivariate regression analysis adjusting for age, sex, HbA1c, BMI, and antihypertensive use confirmed Stage 3 CKD as an independent predictor of impaired ERI (β = -0.27; p = 0.004) and reduced sudomotor function (β = -0.23; p = 0.015).
Conclusion
Diabetic patients with Stage 3 CKD exhibit significantly more pronounced endothelial dysfunction, sympathetic dominance, and arterial stiffness compared to those with Stage 2 CKD. TM Flow testing offers valuable insight into early vascular and autonomic impairments and may aid in cardiovascular risk stratification and proactive management of high-risk diabetic CKD populations.