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Severely increased albuminuria in patients with type 2 diabetes mellitus is associated with increased subclinical arterial disease, including micro-calcification and aortic stiffness, while an additional decrease in kidney function is associated with advanced macro-calcifications. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

July 29, 2023Open Access

Severely increased albuminuria in patients with type 2 diabetes mellitus is associated with increased subclinical atherosclerosis in femoral arteries with Na 18FF activity as a proxy - The DETERMINE study

MRMelanie ReijrinkUniversity Medical Center Groningen JSJ. K. SluiterUniversity Medical Center Groningen CVCharlotte A. te Velde‐KeyzerUniversity Medical Center Groningen

Structured PICO

Population

40 patients stratified into four groups (N=10 per group) based on KDIGO categories: G1-2A1 non-diabetic controls, G1-2A1 with T2DM, G1-2A3 with T2DM, and G4A3 with T2DM.

Outcome

Atherosclerosis manifested by micro-calcification (Na [18F]F activity), macro-calcification, and aortic stiffnesssurrogate

Severely increased albuminuria in patients with T2DM is cross-sectionally associated with subclinical arterial disease, including micro-calcification and aortic stiffness.

Abstract

Background and aims Sodium 18Ffluoride (Na 18FF) positron emission tomography imaging allows detailed visualization of early arterial micro-calcifications. This study aims to investigate atherosclerosis manifested by micro-calcification, macro-calcification, and aortic stiffness in patients with type 2 diabetes mellitus (T2DM) with and without albuminuria and severely decreased kidney function. Methods A cohort was stratified in four groups (N = 10 per group), based on KDIGO categories (G1-5 A1-3). G1-2A1 non-diabetic controls (median IQR estimated glomerular filtration rate (eGFR) in mL/min/1.73 m2 91 81–104), G1-2A1 with T2DM (eGFR 87 84–93, and albumin-creatinin-ratio (ACR) in mg/mmol 0.35 0.25–0.75), G1-2A3 with T2DM (eGFR 85 60–103, and ACR 74 62–122, and G4A3 with T2DM (eGFR 19 13-27 and ACR 131 59–304). Results Na 18FF femoral artery grading score differed significantly in the groups with the highest Na 18FF activity in A3 groups with T2DM (G1-2A3 with T2DM 228 100–446 and G4A3 with T2DM 198 113–578) from the lowest groups of the G1-2A1 with T2DM (33 0–93) and in G1-2A1 non-diabetic controls (75 0–200, p = 0.001). Aortic Na 18FF activity and femoral artery computed tomography (CT)-assessed macro-calcification was increased in G4A3 with T2DM compared with G1-2A1 with T2DM (47.5 33.8–73.8 vs. 17.5 8.8–27.5 (p = 0.006) and 291 170–511 vs. 12.2 1.41–44.3 mg (p = 0.032), respectively). Carotid-femoral pulse wave velocity (PWV)-assessed aortic stiffness was significantly higher in both A3 groups with T2DM compared with G1-2A1 with T2DM (11.15 and 12.35 vs. 8.86 m/s, respectively (p = 0.009)). Conclusions This study indicates that the presence of severely increased albuminuria in patients with T2DM is cross-sectionally associated with subclinical arterial disease in terms of micro-calcification and aortic stiffness. Additional decrease in kidney function was associated with advanced macro-calcifications.

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