Arterial Stiffness Is More Associated with Albuminuria than Decreased Glomerular Filtration Rate in Patients with Type 2 Diabetes Mellitus: The REBOUND Study.

Ji Hye Suk,Bo Hyun Kim,Min Jung Kwon,Kwang Jae Lee,Jun Hyeob Ahn,Sang Soo Kim,Sun Hae Shin,Sung Pyo Son,In Joo Kim,Jeong Hyun Park,Min Chul Kim,Soon Hee Lee,Jong Ho Kim,Ja Young Park,Chang Won Lee

doi:10.1155/2017/7047909

Abstract

Aim The aim of this study was to evaluate the association between arterial stiffness and albuminuria and glomerular filtration rate (GFR) in patients with type 2 diabetes mellitus. Methods This multicenter cohort study analyzed 2613 patients with type 2 diabetes. Brachial-ankle pulse wave velocity (baPWV) was used as a noninvasive marker of arterial stiffness. Additionally, the patients were categorized into four groups according to their albumin-to-creatinine ratio (ACR, normoalbuminuria versus albuminuria) and estimated GFR (eGFR, <60 mL/min/1.73 m2 versus ≥60 mL/min/1.73 m2). Results A univariate analysis revealed that maximal baPWV was significantly associated with both the ACR (r = 0.297, P < 0.001) and eGFR (r = −0.220, P < 0.001). A multivariate analysis adjusted for significant clinical variables and eGFR showed that baPWV remained significantly correlated with the ACR (r = 0.150, P < 0.001). Also, baPWV was correlated positively with the ACR in patients with an eGFR ≥ 60 mL/min/1.73 m2 (r = 0.146, P < 0.001). However, baPWV was not correlated with eGFR after adjustment for significant clinical variables. Conclusions The present findings indicate that arterial stiffness is more associated with albuminuria than a decrease in GFR in patients with type 2 diabetes mellitus.

Highlights

Diabetic nephropathy is one of the most serious microvascular complications that influence the mortality of diabetic patients [1]
In the present study, compared with a decline in glomerular filtration rate (GFR), arterial stiffness was more associated with albuminuria in patients with type 2 diabetes mellitus
Arterial stiffness was not associated with GFR in both the normoalbuminuric and albuminuric patients with type 2 diabetes after adjusting for several significant clinical variables

Summary

Introduction

Diabetic nephropathy is one of the most serious microvascular complications that influence the mortality of diabetic patients [1]. It is estimated that 20–40% of diabetic patients are affected by this disorder, which manifests clinically as albuminuria or as a reduced glomerular filtration rate (GFR) [2–4]. Varying degrees of increased arterial stiffness are associated with different stages of chronic kidney disease (CKD) [5] and are an independent risk factor for cardiovascular disease (CVD) and mortality [6]. Most studies have shown that arterial stiffness is independently associated with the two main components of CKD, albuminuria and a reduced GFR [7–10]. Some studies have found that these associations can be identified in patients with type 2 diabetes [11–14], there are conflicting data regarding these relationships [15].

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