What does this research mean for the field?

Higher aortic stiffness is independently associated with an increased risk of incident albuminuria and a more rapid decline in glomerular filtration rate in patients with type 2 diabetes. Novelty: ClaimNovelty.NOVEL_FINDING. Consensus alignment: ConsensusAlignment.NEUTRAL.

What question did this study set out to answer?

To investigate the association between aortic stiffness, measured by carotid-femoral pulse wave velocity, and incident albuminuria as well as decline in estimated glomerular filtration rate in patients with type 2 diabetes.

October 5, 2011Diabetes CareOpen Access

Arterial Stiffness Is Associated With Incident Albuminuria and Decreased Glomerular Filtration Rate in Type 2 Diabetic Patients

Q: What are the key findings of this study?

Higher aortic stiffness was significantly associated with an increased risk of incident albuminuria (HR 1.23) and a faster decline in glomerular filtration rate in patients with type 2 diabetes.

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Type 2 diabetes with normo- or microalbuminuria (n=461). Intervention: Higher aortic stiffness (cf-PWV ≥9.1 m/s or continuous) vs. Lower aortic stiffness (cf-PWV <9.1 m/s). Primary outcome: Transition from normo- to microalbuminuria or micro- to macroalbuminuria (HR 1.23, 95% CI 1.13-1.33, p=<0.001).

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Key result

Higher aortic stiffness linked to ~23% increased risk of incident albuminuria in type 2 diabetes.

HR 1.23
95% CI 1.13-1.33
P<0.001
n=461

Why the study?

Does higher aortic stiffness predict incident albuminuria and decline in eGFR in patients with type 2 diabetes?

Population

461 Japanese adults with type 2 diabetes and normo- or microalbuminuria, mean age 59, 43.2% female.

Comparison

Higher aortic stiffness vs Lower aortic stiffness

Design

Cohort

Follow-up

median 5.9 years

Authors

RBRyotaro BouchiNational Center for Global Health and Medicine TBTetsuya BabazonoTokyo Women's Medical University MMMichino MugishimaHypertension Institute

Discussion

Member takes

Implication

May flag higher renal risk in type 2 diabetes; leaves open whether stiffness-targeted therapy alters progression.

Key Points

To investigate the association between aortic stiffness, measured by carotid-femoral pulse wave velocity, and incident albuminuria as well as decline in estimated glomerular filtration rate in patients with type 2 diabetes.
Conducted a single-center observational cohort study evaluating 461 Japanese patients with type 2 diabetes (199 women, 262 men; mean age 59 ± 11 years) followed for a median of 5.9 years (range 0.3–8.6).
Assessed aortic stiffness via carotid-femoral pulse wave velocity (cf-PWV; median cutoff 9.1 m/s) and defined the renal endpoint as transition from normo- to microalbuminuria or micro- to macroalbuminuria across consecutive tests.
Used Cox proportional hazards models to calculate hazard ratios for albuminuria progression and multiple linear regression to analyze the annual rate of change in eGFR (evaluated in 567 patients followed for ≥2.0 years).
Progression of albuminuria occurred in 85 patients, with a 5-year cumulative incidence of 8.5% in patients with cf-PWV <9.1 m/s versus 19.4% in those with cf-PWV ≥9.1 m/s (log-rank P = 0.002).
Multivariate Cox regression showed higher cf-PWV was significantly associated with incident albuminuria (HR 1.23, 95% CI 1.13–1.33, P < 0.001; adjusted HR 1.24, 95% CI 1.13–1.37, P < 0.001).
Multiple linear regression demonstrated an independent association between higher cf-PWV and a faster annual decline in eGFR (standardized estimate -0.095, P = 0.031).

Study Design

Type

Cohort (n=461)

Multicenter

Structured PICO

Does higher aortic stiffness predict incident albuminuria and decline in eGFR in patients with type 2 diabetes?

Population

461 Japanese adults with type 2 diabetes and normo- or microalbuminuria, mean age 59, followed for a median of 5.9 years.

Exposure

Higher aortic stiffness (carotid-femoral pulse wave velocity ≥9.1 m/s or evaluated as a continuous variable)

Comparator

Lower aortic stiffness (carotid-femoral pulse wave velocity <9.1 m/s)

Outcome

Transition from normo- to microalbuminuria or micro- to macroalbuminuriasurrogate

Main Result

Hazard Ratio: 1.23 (95% CI 1.13–1.33)

Absolute Event Rate: 19.4% vs 8.5%

p-value: p=<0.001

Aortic stiffness is an independent predictor of albuminuria progression and eGFR decline in patients with type 2 diabetes, suggesting a link between macrovascular hemodynamics and microvascular kidney damage.

Limitations

Ethnically and socially homogeneous hospital-based population
Unable to evaluate longitudinally the association between changes in aortic stiffness and kidney disease
Did not restrict the interval between two consecutive results of testing for albuminuria
Lower muscle mass in elderly patients may have affected GFR levels

Cite This Study

Bouchi et al. (2011) conducted a cohort in Type 2 diabetes with normo- or microalbuminuria (n=461). Higher aortic stiffness (cf-PWV ≥9.1 m/s or continuous) vs. Lower aortic stiffness (cf-PWV <9.1 m/s) was evaluated on Transition from normo- to microalbuminuria or micro- to macroalbuminuria (HR 1.23, 95% CI 1.13-1.33, p=<0.001). Higher aortic stiffness was significantly associated with an increased risk of incident albuminuria (HR 1.23) and a faster decline in glomerular filtration rate in patients with type 2 diabetes.

synapsesocial.com/papers/6a1fc7e9ce3cb5ba46e69a25 https://doi.org/10.2337/dc11-1020

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Arterial Stiffness Is Associated With Incident Albuminuria and Decreased Glomerular Filtration Rate in Type 2 Diabetic Patients

Discussion

Member takes

Implication

Key Points

Study Design

Structured PICO

Main Result

Limitations

Cite This Study

Arterial Stiffness Is Associated With Incident Albuminuria and Decreased Glomerular Filtration Rate in Type 2 Diabetic Patients

Discussion

Member takes

Implication

Key Points

Study Design

Structured PICO

Main Result

Limitations

Cite This Study

Also Consider

Also Consider