Key result
In patients with type 2 diabetes mellitus, reduced estimated GFR and increased brachial-ankle pulse wave velocity were independently associated with greater carotid intima-media thickness, while urinary albumin excretion stage was not.
Cross-Sectional (n=338)
No
p-value: p=0.02
In patients with type 2 diabetes mellitus, reduced eGFR, but not the stage of diabetic nephropathy based on urinary albumin excretion, is independently associated with increased carotid intima-media thickness.
eGFR and baPWV may better inform subclinical atherosclerosis assessment than albuminuria stage in T2DM; leaves open prospective validation.
BACKGROUND: To study the relationship between the intima-media thickness (IMT) of the carotid artery and the stage of chronic kidney disease (CKD) based on the estimated glomerular filtration rate (eGFR) and diabetic nephropathy graded by the urinary albumin excretion (UAE) in the patients with type 2 diabetes mellitus. METHODS: A cross-sectional study was performed in 338 patients with type 2 diabetes mellitus. The carotid IMT was measured using an ultrasonographic examination. RESULTS: The mean carotid IMT was 1.06 +/- 0.27 mm, and 42% of the subjects showed IMT thickening (>or= 1.1 mm). Cerebrovascular disease and coronary heart disease were frequent in the patients with IMT thickening. The carotid IMT elevated significantly with the stage progression of CKD (0.87 +/- 0.19 mm in stage 1, 1.02 +/- 0.26 mm in stage 2, 1.11 +/- 0.26 mm in stage 3, and 1.11 +/- 0.27 mm in stage 4+5). However, the IMT was not significantly different among the various stages of diabetic nephropathy. The IMT was significantly greater in the diabetic patients with hypertension compared to those without hypertension. The IMT positively correlated with the age, the duration of diabetes mellitus, and the brachial-ankle pulse wave velocities (baPWV), and negatively correlated with the eGFR. In a stepwise multivariate regression analysis, the eGFR and the baPWV were independently associated with the carotid IMT. CONCLUSIONS: Our study is the first report showing a relationship between the carotid IMT and the renal parameters including eGFR and the stages of diabetic nephropathy with a confirmed association between the IMT and diabetic macroangiopathy. Our study further confirms the importance of intensive examinations for the early detection of atherosclerosis and positive treatments for hypertension, dyslipidaemia, obesity, as well as hyperglycaemia are necessary when a reduced eGFR is found in diabetic patients.
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Komatsu et al. (2010) conducted a cross-sectional in Type 2 diabetes mellitus (n=338). Estimated glomerular filtration rate (eGFR) and urinary albumin excretion (UAE) was evaluated on Carotid intima-media thickness (IMT) (p=0.02). In patients with type 2 diabetes mellitus, reduced estimated GFR and increased brachial-ankle pulse wave velocity were independently associated with greater carotid intima-media thickness, while urinary albumin excretion stage was not.
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