A11592 Ankle-brachial index as a marker of renal impairment in patients with arterial hypertension and type 2 diabetes mellitus

Abstract

Objectives: Diabetic nephropathy is a strong risk factor for cardiovascular disease (CVD) and early mortality. Ankle-brachial index (ABI) is a marker of generalized atherosclerosis associated with an increased risk of CVD. Aim of the study was to evaluate associations between kidney function and ABI in patients with AH and T2DM. Methods: 90 patients with AH and T2DM without known CVD were included (39% males, mean age 63,8 ± 11,6 years,44% smokers, 80%with dyslipidemia). Mean office BP was 146 ± 23/86 ± 10 mmHg. Target BP < 140/85 mm Hg was achieved in 52,7% patients. Median duration of DM was 8,5 years. Mean creatinine was 96 ± 21 μmol/l, mean eGFRCKD EPI-64 ± 19 ml/min/1,73m2. eGFR decrease < 60 ml/min/1,73m2 (renal impairment (RI) group) was observed in 43,3% of patients. BP was measured with a validated oscillometric device. ABI was measured by VaSera 1500. ABI < 0,9 was considered as a marker of subclinical atherosclerosis. Results were considered significant in p < 0,05. Results: Mean R-ABI was 1,02 ± 0,17,ABI decrease < 0,9 was observed in 20,2% patients in the whole group and in 30,7% patients in the RI group. Patients from RI group had higher age (69,7 ± 10vs59,2 ± 10,8 years), median duration of DM (10vs6,8, years) and lower right ABI (0,97 ± 0,21vs1,06 ± 0,12),p < 0,05 for trend. Patients with ABI decrease < 0,9 had significantly lower eGFR (53 ± 19vs68 ± 17 ml/min/1,73m2 respectively, p < 0,05).Spearmen analysis revealed significant correlations between eGFR and duration of DM (r = −0,3),R-ABI (r = 0,26), p < 0,05 for trend. Multiple regression analysis showed that eGFR was a significant predictor of ABI decrease (β = 0,35, p = 0,007). Conclusion: Renal impairment is a significant predictor of subclinical atherosclerosis in patients with AH and T2DM. This highlights the importance of clinical screening of PAD in this patient category