Abstract
Diabetic kidney disease (DKD) is one of the leading causes of end stage renal disease. Despite recent therapies, mortality due to DKD and resources spent on healthcare are important problems. Thus, appropriate markers are needed to predict renal outcomes. Therefore, we investigated the role of peripheral perfusion as an indicator for renal events in patients with type 2 diabetes mellitus. This retrospective cohort study included 566 patients who were admitted to Matsushita Memorial Hospital in Osaka, Japan for type 2 diabetes mellitus. Peripheral perfusion was assessed using perfusion index (PI), which represents the level of circulation through peripheral tissues and was measured on each toe using a Masimo SET Radical-7 (Masimo Corporation, Irvine, CA, USA) instrument. The duration of follow up was 3.0 years. The median age of patients was 70 years (IQR range: 61–77 years) and median PI value was 2.9% (IQR range: 1.8–4.8%). Multiple logistic regression analyses showed that PI (per 1% increase) was associated with an odds ratio of composite of end-stage renal disease (ESRD) and/or doubling of serum creatinine level; n = 40 (odds ratio 0.823 [95% CI: 0.680–0.970]), and composite of ESRD, doubling of serum creatinine level, and renal death and/or cardiovascular death; n = 44 (odds ratio 0.803 [95% CI: 0.665–0.944]). The factors which were statistically significant in univariate analysis and those known to be related factors for renal event were considered simultaneously as independent variables for multiple logistic regression analysis. PI can be a novel indicator for renal events in patients with type 2 diabetes mellitus.
Highlights
Diabetic kidney disease (DKD) is one of the leading causes of end stage renal disease
We have recently demonstrated that a low perfusion index (PI) value indicates atherosclerosis in clinical care setting[14] and diabetic kidney disease in the patients with type 2 disease in the cross sectional
Multiple logistic regression analyses showed that PI was associated with an odds ratio of composite of end-stage renal disease (ESRD) and/or doubling of serum creatinine level in all patients as well as in patients with estimated glomerular filtration rate (eGFR) ≥ 60 ml/min/1.73 m2, and composite of ESRD, doubling of serum creatinine level, and renal death and/or cardiovascular death
Summary
Diabetic kidney disease (DKD) is one of the leading causes of end stage renal disease. We have recently demonstrated that a low PI value indicates atherosclerosis in clinical care setting[14] and diabetic kidney disease in the patients with type 2 disease in the cross sectional www.nature.com/scientificreports n (male/female) Age (years) Duration of diabetes (years) Body mass index (kg/m2) Systolic blood pressure (mmHg) Diastolic blood pressure (mmHg) Heart rate (beat/min) Perfusion index (%) Hemoglobin A1c (%) Total cholesterol (mg/dl) Triglycerides (mg/dl) Uric acid (mg/dl) Creatinine (mg/dl) eGFR (ml/min/1.73 m2) UACR (mg/g Cr) Hypertension (−/+) Smoking status (never/past/recent) History of cardiovascular disease (−/+) RAS inhibitor (−/+) Incretin related therapies (−/+) SGLT-2 inhibitor (−/+) Statin (−/+). We aimed to clarify whether PI might be an indicator for renal events including decline in eGFR, cardiovascular death, and progression of albuminuria, in patients with type 2 diabetes mellitus
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