Kidney and Blood Pressure Research

Original Paper

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Albuminuria Is the Stronger Risk Factor for Peripheral Arterial Disease than eGFR Decline in a Type 2 Diabetic Taiwanese Population

Lee M.Y.a · Lin K.-D.a, b · Chang Y.-H.a, b · Hsiao P.-J.a, b · Shin S.-J.a–c

Author affiliations

aDivision of Endocrinology and Metabolism, Department of Internal Medicine, Kaohsiung Medical University Hospital, bGraduate Institute of Medicine, and cGraduate Institute of Medical Genetics, Kaohsiung Medical University, Kaohsiung, Taiwan, ROC

Corresponding Author

Prof. Shyi-Jang Shin

Division of Endocrinology and Metabolism, Department of Internal Medicine

Kaohsiung Medical University Hospital, 100 Tzyou 1st Road

Kaohsiung 807, Taiwan (ROC)

Tel. +886 7 312 1101, ext. 7377, Fax +886 7 312 2810, E-Mail sjshin@kmu.edu.tw

Keywords: MacroalbuminuriaGlomerular filtration ratePeripheral arterial diseaseAnkle-brachial indexDiabetes

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Kidney Blood Press Res 2010;33:352–359
https://doi.org/10.1159/000317524

Abstract

Background: Several studies have shown the identified risk factors for peripheral arterial disease in individuals with diabetes, but relatively little information has been provided regarding the risk factors for peripheral arterial disease especially in individuals with renal insufficiency and albuminuria. Aims: In our study, we attempted to determine whether peripheral arterial disease is related to the reduction of estimated glomerular filtration rate (eGFR) or albuminuria in type 2 diabetic patients if both were measured. Methods: We included 478 type 2 diabetic patients that were more than 50 years old in this study and determined their urine albumin to creatinine ratio and eGFR. The ankle-brachial index was measured. Results: We found a prevalence of peripheral arterial disease of 12 and 11.7% in the normoalbuminuria and >90 ml/min/1.73 m2 eGFR group. Simple logistic regression analysis showed that both macroalbuminuria and eGFR <60 ml/min/1.73 m2 were significantly associated with peripheral arterial disease individually, but most interestingly in the multiple logistic regression analysis, macroalbuminuria and age are independent factors for peripheral arterial disease with a p value of 0.012 (β = 1.014) and <0.001 (β = 0.107), respectively. Conclusion: In summary, our study indicates that macroalbuminuria is a stronger indicator for peripheral arterial disease than eGFR <60 ml/min/1.73 m2 in a type 2 diabetic population older than 50 years of age.

© 2010 S. Karger AG, Basel

References

  1. Tseng CH: Prevalence and risk factors of peripheral arterial obstructive disease in Taiwanese type 2 diabetic patients. Angiology 2003;54:331–338.
    External Resources
  2. Heart Disease and Stroke Statistics – 2009 Update. A Report from the American Heart Association Statistics Committee and Stroke Statistics Subcommittee.
  3. Sigvant, Wiberg-Hedman K, Bergqvist D, Rolandsson O, Andersson B, Persson E, Wahlberg E: A population-based study of peripheral arterial disease prevalence with special focus on critical limb ischemia and sex differences. J Vasc Surg 2007;45:1185–1191.
    External Resources
  4. Borch-Johnsen K, Kreiner S: Proteinuria: value as predictor of cardiovascular mortality in insulin dependent diabetes mellitus. Br Med J (Clin Res Ed) 1987;294:1651–1654.
    External Resources
  5. Adler AI, Stevens RJ, Maney SE, Bilous RW, Cull CA, Holman RR: Development and progression of nephropathy in type 2 diabetes: the United Kingdom Prospective Diabetes Study (UKPDS 64). Kidney Int 2003;63:225–232.
    External Resources
  6. So WY, Kong AP, Ma RC, Ozaki R, Szeto CC, Chan NN, Ng V, Ho CS, Lam CW, Chow CC, Cockram CS, Chan JC, Tong PC: Glomerular filtration rate, cardiorenal end points, and all cause mortality in type 2 diabetic patients. Diabetes Care 2006;29:2046–2052.
    External Resources
  7. American Diabetes Association: Standards of medical care in diabetes. Diabetes Care 2007;30(suppl 1):S4–S41.
    External Resources
  8. Bruno G, Merletti F, Bargero G, Novelli G, Melis D, Soddu A, Perotto M, Pagano G, Cavallo-Perin P: Estimated glomerular filtration rate, albuminuria and mortality in type 2 diabetes: the Casale Monferrato study. Diabetologia 2007;50:941–948.
    External Resources
  9. Levey AS, Coresh J, Greene T, Marsh J, Stevens LA, Kusek JW, Van Lente F, Chronic Kidney Disease Epidemiology Collaboration: Expressing the Modification of Diet in Renal Disease Study equation for estimating glomerular filtration rate with standardized serum creatinine values. Clin Chem 2007;53:766–772.
    External Resources
  10. American Diabetes Association: Peripheral arterial disease in people with diabetes. Diabetes Care 2003;26:3333–3341.
    External Resources
  11. Kramer H, Molitch ME: Screening for kidney disease in adults with diabetes. Diabetes Care 2005;28:1813–1816.
    External Resources
  12. Tsalamandris C, Allen TJ, Gilbert RE, Sinha A, Panagiotopoulos S, Cooper ME, Jerums G: Progressive decline in renal function in diabetic patients with and without albuminuria. Diabetes 1994;43:649–655.
    External Resources
  13. Retnakaran R, Cull CA, Thorne KI, Adler AI, Holman RR: Risk factors for renal dysfunction in type 2 diabetes: UK Prospective Diabetes Study 74. Diabetes 2006;55:1832–1839.
    External Resources
  14. Ochodnicky P, Henning RH, van Dokkum RP, de Zeeuw D: Microalbuminuria and endothelial dysfunction: emerging targets for primary prevention of end-organ damage. J Cardiovasc Pharmacol 2006;47(suppl 2): S151–S162.
    External Resources
  15. Deckert T, Feldt-Rasmussen B, Borch-Johnsen K, Jensen T, Koefoed-Enevoldsen A: Albuminuria reflects widespread vascular damage. The Steno hypothesis. Diabetologia 1989;32:219–226.
    External Resources
  16. Tseng CH, Chong CK, Tseng CP, Tai TY: The association between urinary albumin excretion and ankle branchial index in elderly Taiwanese patients with type 2 diabetes mellitus. Age Ageing 2008;37:77–82.
    External Resources
  17. Wattanakit K, Folsom AR, Criqui MH, Kramer HJ, Cushman M, Shea S, Hirsch AT: Albuminuria and peripheral arterial disease: results from the multi-ethnic study of atheroscelrosis (MESA). Atherosclerosis 2008;201:212–216.
    External Resources
  18. Wattanakit K, Folsom AR, Selvin E, Coresh J, Hirsch AT, Weatherley BD: Kidney function and risk of peripheral arterial disease: results from the Atherosclerosis Risk in Communities (ARIC) Study. J Am Soc Nephrol 2007;18:629–636.
    External Resources
  19. O’Hare AM, Glidden DV, Fox CS, Hsu CY: High prevalence of peripheral arterial disease in persons with renal insufficiency: results from the National Health and Nutrition Examination Survey 1999–2000. Circulation 2004;109:320–323.
    External Resources
  20. de Vinuesa SG, Ortega M, Martinez P, Goicoechea M, Campdera FG, Luño J: Subclinical peripheral arterial disease in patients with chronic kidney disease: prevalence and related risk factors. Kidney Int Suppl 2005;93:S44–S47.
    External Resources
  21. Shlipak MG, Fried LF, Crump C, Bleyer AJ, Manolio TA, Tracy RP, Furberg CD, Psaty BM: Cardiovascular disease risk status in elderly persons with renal insufficiency. Kidney Int 2002;62:997–1004.
    External Resources
  22. Leskinen Y, Salenius JP, Lehtimäki T, Huhtala H, Saha H: The prevalence of peripheral arterial disease and medial arterial calcification in patients with chronic renal failure: requirements for diagnostics. Am J Kidney Dis 2002;40:472–479.
    External Resources
  23. Selvin E, Erlinger TP: Prevalence of and risk factors for peripheral arterial disease in the United States: results from the National Health and Nutrition Examination Survey, 1999–2000. Circulation 2004;110:738–743.
    External Resources
  24. O’Hare AM, Vittinghoff E, Hsia J, Shlipak MG: Renal insufficiency and the risk of lower extremity peripheral arterial disease: results from the Heart and Estrogen/Progestin Replacement Study (HERS). J Am Soc Nephrol 2004;15:1046–1051.
    External Resources
  25. Weir MR: Albuminuria predicting outcome in diabetes: incidence of microalbuminuria in Asia-Pacific Rim. Kidney Int Suppl 2004;92:S38–S39.
    External Resources
  26. Wu AY, Kong NC, de Leon FA, Pan CY, Tai TY, Yeung VT, Yoo SJ, Rouillon A, Weir MR: An alarmingly high prevalence of diabetic nephropathy in Asian type 2 diabetic patients: the MicroAlbuminuria Prevalence (MAP) Study. Diabetologia 2005;48:17–26.
    External Resources
  27. Bernstein EF, Fronek A: Current status of non-invasive tests in the diagnosis of peripheral arterial disease. Surg Clin North Am 1982;62:473–487.
    External Resources
  28. Strandness DE Jr, Bell JW: Peripheral vascular disease: diagnosis and evaluation using a mercury strain gauge. Ann Surg 1965;161(suppl 4):1–35.

Article / Publication Details

First-Page Preview
Abstract of Original Paper

Received: April 01, 2010
Accepted: June 18, 2010
Published online: August 12, 2010
Issue release date: November 2010

Number of Print Pages: 8
Number of Figures: 0
Number of Tables: 4

ISSN: 1420-4096 (Print)
eISSN: 1423-0143 (Online)

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2010, Vol.33, No. 5

November 2010

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