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Barzilay JI, Farag YMK, Durthaler J. Albuminuria: An Underappreciated Risk Factor for Cardiovascular Disease. J Am Heart Assoc 2024; 13:e030131. [PMID: 38214258 PMCID: PMC10926810 DOI: 10.1161/jaha.123.030131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2024]
Abstract
Albuminuria, an established biomarker of the progression of chronic kidney disease, is also recognized as a biomarker for the risk of cardiovascular disease. Elevated urinary albumin excretion indicates kidney damage and systemic vascular disease, including myocardial capillary disease and arterial stiffness. Albuminuria is associated with an increased risk of coronary artery disease, stroke, heart failure, arrhythmias, and microvascular disease. There are now several therapeutic agents that can lead to albuminuria lowering and a reduction in cardiovascular risk. However, screening for albuminuria is still low. Considering the importance of multidisciplinary management of patients with cardiovascular disease, it is crucial that health care professionals managing such patients are aware of the benefits of albuminuria surveillance and management.
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Li J, Gao J, Zhang X, Cui L, Hou J, Gao B, Wu S, Lu C. The Relationship between Vascular Aging Phenotypes and Renal Damage among Individuals with Type 2 Diabetes. Cardiorenal Med 2023; 13:91-100. [PMID: 36843125 DOI: 10.1159/000526345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 07/15/2022] [Indexed: 02/26/2023] Open
Abstract
OBJECTIVE The aim of this study was to investigate the relationship between vascular aging (VA) phenotypes and renal damage in type 2 diabetic population. METHODS In this cross-sectional study, we included 8,141 individuals with type 2 diabetes who participated in the Kailuan Study during 2010-2018 and completed the brachial-ankle pulse wave velocity (baPWV) assessment for arterial stiffness, an indicator for VA. The age- and sex-specific 10th and 90th percentiles of baPWV based on a reference cohort were used as cutoffs to define supernormal VA (SUPERNOVA, baPWV<10th percentiles), normal VA (NVA, baPWV 10th to 90th percentiles), and early VA (EVA, baPWV>90th percentiles). The estimated glomerular filtration rate (eGFR) and proteinuria levels were used to assess renal damage, including isolated proteinuria, isolated kidney function decline (eGFR<60 mL/min/1.73 m2), and proteinuria combined with kidney function decline. Multivariable logistic regression analysis was used to analyze the relationship between VA phenotypes and diabetic kidney damage. RESULTS The prevalences of isolated proteinuria, isolated kidney function decline, and proteinuria combined with kidney function decline were 17.0%, 12.2%, and 5.4%, respectively. Compared with NVA, SUPERNOVA was associated with 34% lower odds (95% confidence interval [CI]: 0.46-0.96) of isolated proteinuria after adjusting for age, sex, and other potential confounders. EVA was associated with higher odds of all three types of kidney damage; the adjusted odds ratio (95% CI) was 1.42 (1.20-1.67) for proteinuria, 1.24 (1.01-1.51) for kidney function decline, and 1.56 (1.18-2.06) for proteinuria combined with kidney function decline. CONCLUSIONS VA phenotypes are associated with renal damage, especially isolated proteinuria. SUPERNOVA was associated with lower odds of isolated proteinuria and EVA was associated with higher odds of proteinuria and kidney function decline.
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Affiliation(s)
- Junjuan Li
- First Central Clinical College of Tianjin Medical University, Tianjin, China
- Department of Cardiology, Tianjin First Central Hospital, Tianjin, China
- Department of Nephrology, Kailuan General Hospital, Tangshan, China
| | - Jingli Gao
- Department of Intensive medicine, Kailuan General Hospital, Tangshan, China
| | - Xinyuan Zhang
- Department of Nutritional Sciences, Pennsylvania State University, State College, Philadelphia, Pennsylvania, USA
| | - Liufu Cui
- Department of Rheumatology and Immunology, Kailuan General Hospital, Tangshan, China
| | - Jinhong Hou
- Department of Nephrology, Kailuan General Hospital, Tangshan, China
| | - Bixia Gao
- Renal Division, Department of Medicine, Peking University Institute of Nephrology, Key Laboratory of Renal Disease, Ministry of health of China, and Key Laboratory of Chronic Kidney disease Prevention and Treatment (Peking University), Ministry of Education, Beijing, China
| | - Shouling Wu
- Department of Cardiology, Kailuan General Hospital, Tangshan, China
| | - Chengzhi Lu
- First Central Clinical College of Tianjin Medical University, Tianjin, China
- Department of Cardiology, Tianjin First Central Hospital, Tianjin, China
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Wang T, Fan F, Gong Y, Gao L, Liu Z, Jia J, Liu M, Jiang Y, Zhang Y, Li J. Comparison of brachial-ankle pulse wave velocity and carotid-femoral pulse wave velocity in association with albuminuria in a community of Beijing: a cross-sectional study. J Hum Hypertens 2022; 37:412-418. [PMID: 35474137 DOI: 10.1038/s41371-022-00697-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2021] [Revised: 03/15/2022] [Accepted: 04/12/2022] [Indexed: 11/09/2022]
Abstract
This study was performed to investigate and compare the association of albuminuria with the brachial-ankle pulse wave velocity (baPWV) and carotid-femoral pulse wave velocity (cfPWV) in a community-based population in Beijing. Subjects were enrolled from a follow-up survey conducted in 2018 from an atherosclerosis cohort in Shijingshan district, Beijing, China. The baPWV and cfPWV were measured using a BP-203 RPE III arteriosclerosis detection device and PulsePen, respectively. Albuminuria was defined as a urinary albumin-creatinine ratio of ≥30 mg/g. A multivariate logistic regression model was used to evaluate the impacts of different PWV measurements on the prevalence of albuminuria. In total, 5605 subjects were included in the analyses. Their mean age was 62.22 ± 7.55 years, and the prevalence of albuminuria was 8.22%. In the multivariate logistic regression model adjusted for potential covariates, both baPWV (odds ratio [OR], 1.06; 95% confidence interval [CI], 1.03-1.10; P < 0.001) and cfPWV (OR, 1.07; 95% CI, 1.01-1.14; P = 0.018) were significantly associated with albuminuria. Furthermore, when baPWV and cfPWV were entered into the logistic regression model simultaneously, only baPWV was significantly associated with albuminuria using either continuous value (OR, 1.05; 95% CI, 1.01-1.10; P = 0.007) or classified into quartiles (highest vs. lowest value group: OR, 1.55; 95% CI, 1.01-2.37; P for trend = 0.019). Both cfPWV and baPWV were positively associated with albuminuria, while baPWV had a stronger relationship than cfPWV. Thus, baPWV measurement could be considered for the purpose of community health screening.
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Affiliation(s)
- Ting Wang
- Department of Cardiology, Peking University First Hospital, Beijing, People's Republic of China.,Institute of Cardiovascular Disease, Peking University First Hospital, Beijing, People's Republic of China
| | - Fangfang Fan
- Department of Cardiology, Peking University First Hospital, Beijing, People's Republic of China.,Institute of Cardiovascular Disease, Peking University First Hospital, Beijing, People's Republic of China
| | - Yanjun Gong
- Department of Cardiology, Peking University First Hospital, Beijing, People's Republic of China.,Institute of Cardiovascular Disease, Peking University First Hospital, Beijing, People's Republic of China
| | - Lan Gao
- Department of Cardiology, Peking University First Hospital, Beijing, People's Republic of China.,Institute of Cardiovascular Disease, Peking University First Hospital, Beijing, People's Republic of China
| | - Zhihao Liu
- Department of Cardiology, Peking University First Hospital, Beijing, People's Republic of China.,Institute of Cardiovascular Disease, Peking University First Hospital, Beijing, People's Republic of China
| | - Jia Jia
- Department of Cardiology, Peking University First Hospital, Beijing, People's Republic of China.,Institute of Cardiovascular Disease, Peking University First Hospital, Beijing, People's Republic of China
| | - Mengyuan Liu
- Department of Cardiology, Peking University First Hospital, Beijing, People's Republic of China.,Institute of Cardiovascular Disease, Peking University First Hospital, Beijing, People's Republic of China
| | - Yimeng Jiang
- Department of Cardiology, Peking University First Hospital, Beijing, People's Republic of China.,Institute of Cardiovascular Disease, Peking University First Hospital, Beijing, People's Republic of China
| | - Yan Zhang
- Department of Cardiology, Peking University First Hospital, Beijing, People's Republic of China. .,Institute of Cardiovascular Disease, Peking University First Hospital, Beijing, People's Republic of China.
| | - Jianping Li
- Department of Cardiology, Peking University First Hospital, Beijing, People's Republic of China. .,Institute of Cardiovascular Disease, Peking University First Hospital, Beijing, People's Republic of China.
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Shi S, Ni L, Gao L, Wu X. Comparison of Nonalbuminuric and Albuminuric Diabetic Kidney Disease Among Patients With Type 2 Diabetes: A Systematic Review and Meta-Analysis. Front Endocrinol (Lausanne) 2022; 13:871272. [PMID: 35721745 PMCID: PMC9203723 DOI: 10.3389/fendo.2022.871272] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 04/29/2022] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Diabetic kidney disease (DKD) is one of most common complications of diabetes. Recently, the classical phenotype of DKD, which is characterized by albuminuria preceding renal insufficiency, has been challenged since a subset of diabetic patients with renal insufficiency but without albuminuria has been increasingly reported. However, the available evidence is inconsistent. Thus, the present systematic review will assess and summarize the available data regarding nonalbuminuric diabetic kidney disease (NADKD). METHODS PubMed, Embase, and Cochrane were searched for clinical trials related to NADKD. The results were limited to full-text articles published in English, without restrictions on the publication time. The quality of clinical trials was appraised, and the data were extracted. Meta-analysis was conducted using a random-effects model. Descriptive analysis was performed if the data were insufficient. RESULTS A final total of 31 articles were included in this review. The meta-analysis of 18 studies showed that compared with albuminuric DKD, patients with NADKD were older (MD = 1.04 years old, 95% CI [0.52, 1.57], p < 0.05); were more often women (Male RR = 0.74, 95% CI [0.68, 0.81], p < 0.05); had shorter diabetes duration (MD = -2.9 years, 95% CI [-3.63, -2.18], p < 0.05), lower HbA1c levels (MD = -0.34%, 95% CI [-0.42, -0.25], p < 0.05), and lower blood pressure (systolic blood pressure MD = -6.21 mmHg, 95% CI [-9.41, -3.0], p < 0.05; diastolic blood pressure MD = -1.27 mmHg, 95% CI [-2.15, 4.0], p < 0.05); less frequently experienced diabetic retinopathy (RR = 0.58, 95% CI [0.51, 0.67], p < 0.05); and less frequently used renin-angiotensin-aldosterone system (RAAS) inhibitors. The underlying pathology of NADKD might be different from that of the classic phenotype of DKD, which is associated with more advanced tubulointerstitial and vascular lesions but mild typical glomerular lesions. The annual estimated glomerular filtration rate decline tended to be lower in patients with NADKD than in those with albuminuric DKD. The risk for cardiovascular disease, end-stage renal disease, and all-cause death was lower for patients with NADKD than patients with albuminuric DKD. CONCLUSIONS The prevalence of NADKD has increased in recent decades, and its characteristics, pathology, and prognosis are different from those of albuminuric DKD; thus, diagnosis and treatment strategies should be different. More attention should be given to this phenotype.
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Affiliation(s)
- Shaomin Shi
- Department of Nephrology, Zhongnan Hospital of Wuhan University, Wuhan, China
- Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, China
| | - Lihua Ni
- Department of Nephrology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Ling Gao
- Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, China
- *Correspondence: Xiaoyan Wu, ; Ling Gao,
| | - Xiaoyan Wu
- Department of Nephrology, Zhongnan Hospital of Wuhan University, Wuhan, China
- *Correspondence: Xiaoyan Wu, ; Ling Gao,
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Santiago-Hernandez A, Martin-Lorenzo M, Martínez PJ, Gómez-Serrano M, Lopez JA, Cannata P, Esteban V, Heredero A, Aldamiz-Echevarria G, Vázquez J, Ruiz-Hurtado G, Barderas MG, Segura J, Ruilope LM, Alvarez-Llamas G. Early renal and vascular damage within the normoalbuminuria condition. J Hypertens 2021; 39:2220-2231. [PMID: 34261953 DOI: 10.1097/hjh.0000000000002936] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE A continuous association between albuminuria and cardiorenal risk exists further below moderately increased albuminuria ranges. If only based in albumin to creatinine ratio (ACR) higher than 30 mg/g, a significant percentage of individuals may be out of the scope for therapeutic management. Despite epidemiological outcomes, the identification of biochemical changes linked to early albuminuria is underexplored, and normoalbuminuric individuals are usually considered at no risk in clinical practice. Here, we aimed to identify early molecular alterations behind albuminuria development. METHODS Hypertensive patients under renin-angiotensin system (RAS) suppression were classified as control, (ACR < 10 mg/g) or high-normal (ACR = 10-30 mg/g). Urinary protein alterations were quantified and confirmed by untargeted and targeted mass spectrometry. Coordinated protein responses with biological significance in albuminuria development were investigated. Immunohistochemistry assays were performed in human kidney and arterial tissue to in situ evaluate the associated damage. RESULTS A total of 2663 identified proteins reflect inflammation, immune response, ion transport and lipids metabolism (P value ≤ 0.01). A1AT, VTDB and KNG1 varied in high-normal individuals (P value < 0.05), correlated with ACR and associated with the high-normal condition (odds ratio of 20.76, 6.00 and 7.04 were found, respectively (P value < 0.001)). After 12 months, protein variations persist and aggravate in progressors to moderately increased albuminuria. At tissue level, differential protein expression was found in kidney from individuals with moderately increased albuminuria and atherosclerotic aortas for the three proteins, confirming their capacity to reflect subclinical organ damage. CONCLUSION Early renal and vascular damage is molecularly evidenced within the normoalbuminuria condition.
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Affiliation(s)
| | - Marta Martin-Lorenzo
- Immunoallergy and Proteomics Laboratory, Department of Immunology, IIS-Fundación Jiménez Díaz, UAM
| | - Paula J Martínez
- Immunoallergy and Proteomics Laboratory, Department of Immunology, IIS-Fundación Jiménez Díaz, UAM
| | - María Gómez-Serrano
- Laboratory of Cardiovascular Proteomics, CNIC
- Institute for Tumor Immunology, Philipps University of Marburg, Marburg, Germany
| | - Juan Antonio Lopez
- Laboratory of Cardiovascular Proteomics, CNIC
- CIBER de Enfermedades Cardiovasculares (CIBERCV)
| | | | - Vanesa Esteban
- Department of Allergy and Immunology, IIS-Fundación Jiménez Díaz, UAM
- Red de asma, reacciones adversas y alérgicas (ARADyAL)
- Faculty of Medicine and Biomedicine, Alfonso X El Sabio University
| | | | | | - Jesús Vázquez
- Laboratory of Cardiovascular Proteomics, CNIC
- CIBER de Enfermedades Cardiovasculares (CIBERCV)
| | - Gema Ruiz-Hurtado
- CIBER de Enfermedades Cardiovasculares (CIBERCV)
- Cardiorenal Translational Laboratory, Hospital Universitario 12 de Octubre, Madrid
| | - Maria G Barderas
- Department of Vascular Physiopathology, Hospital Nacional de Parapléjicos SESCAM, Toledo
| | - Julian Segura
- Hypertension Unit, Hospital Universitario 12 de Octubre
| | - Luis M Ruilope
- Cardiorenal Translational Laboratory, Hospital Universitario 12 de Octubre, Madrid
| | - Gloria Alvarez-Llamas
- Immunoallergy and Proteomics Laboratory, Department of Immunology, IIS-Fundación Jiménez Díaz, UAM
- Red de Investigación Renal (REDINREN), Madrid, Spain
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Associations between macrovascular and renal microvascular dysfunction in type 2 diabetes and non-diabetes: the HELIUS study. Microvasc Res 2021; 136:104162. [PMID: 33705823 DOI: 10.1016/j.mvr.2021.104162] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Revised: 02/26/2021] [Accepted: 03/05/2021] [Indexed: 12/16/2022]
Abstract
BACKGROUND Although the associations between measures of macrovascular and microvascular dysfunctions are well characterized in diabetes, there is limited data on these associations in individuals without diabetes. We compared the associations between macrovascular dysfunction and renal microvascular dysfunction in individuals with type 2 diabetes (T2D) and without diabetes. METHODS Cross-sectional analyses of baseline data from the multiethnic Healthy Life in an Urban Setting (HELIUS) study (Amsterdam, the Netherlands), including 986 participants with T2D and 7680 participants without diabetes were done. Logistic regression analyses were used to examine the associations between macrovascular dysfunction [aortic stiffness, coronary artery disease (CAD), peripheral artery disease (PAD), and stroke] and renal microvascular dysfunction [albuminuria] with adjustments for age, sex, ethnicity, waist-to-hip ratio, systolic blood pressure, LDL-cholesterol, and smoking (and HbA1c and diabetes duration for the T2D group). RESULTS In the fully adjusted models, aortic stiffness was associated with albuminuria in individuals with T2D [OR 2.55; 95% CI,1.30-4.98], but not without diabetes [0.96; 0.63-1.45]; stroke was associated with albuminuria in T2D [2.40;1.10-5.25], but not in non-diabetes [1.39;0.83-2.33]. In age-sex adjusted models, CAD was associated with albuminuria in T2D [1.65;1.09-2.50] and in non-diabetes [1.56;1.13-2.15]; the associations were no longer significant in the fully adjusted model. There were no associations between PAD and albuminuria in T2D and non-diabetes. CONCLUSIONS Our study shows important differences in the associations between measures of macrovascular and renal microvascular dysfunction in T2D and non-diabetes. These findings provide opportunities for future research aimed at prevention and treatment strategies for individuals with vascular dysfunction.
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Kim JM, Kim SS, Kim IJ, Kim JH, Kim BH, Kim MK, Lee SH, Lee CW, Kim MC, Ahn JH, Kim J. Arterial stiffness is an independent predictor for risk of mortality in patients with type 2 diabetes mellitus: the REBOUND study. Cardiovasc Diabetol 2020; 19:143. [PMID: 32962704 PMCID: PMC7510263 DOI: 10.1186/s12933-020-01120-6] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 09/12/2020] [Indexed: 12/21/2022] Open
Abstract
Background This study aimed to evaluate the benefit of brachial-ankle pulse wave velocity (baPWV) as a noninvasive marker of arterial stiffness for the prediction of all-cause and cause-specific mortality in patients with type 2 diabetes. Methods This multicenter prospective observational study analyzed 2308 patients with type 2 diabetes between 2008 and 2018. The patients were categorized according to the quartiles of baPWV. Cause of mortality was determined using death certificates and patient clinical records. We estimated proportional mortality rates from all causes, cardiovascular, cancer, and other causes among adults with diabetic status according to their baPWV. Cox regression models were used to estimate hazard ratios (HRs). Results There were 199 deaths (8.6%) in the study population during a median follow-up duration of 8.6 years. When baPWV was assessed as quartiles, a significantly higher risk of all-cause mortality (HR = 5.39, P < 0.001), cardiovascular-mortality (HR = 14.89, P < 0.001), cancer-mortality (HR = 5.42, P < 0.001), and other-cause mortality (HR = 4.12, P < 0.001) was found in quartile 4 (Q4, ≥ 1830 cm/s) than in quartiles 1–3 (Q1–3). Adding baPWV to baseline model containing conventional risk factors such as age, sex, diabetes duration, body mass index, glycated hemoglobin, systolic blood pressure, glomerular filtration rate, smoking, and insulin improved the risk prediction for all-cause (net reclassification index (NRI) = 49%, P < 0.001) and cause-specific (cardiovascular NRI = 28%, P = 0.030; cancer NRI = 55%, P < 0.001; other-cause NRI 51%, P < 0.001) mortality. Conclusion This long-term, large-scale, multicenter prospective observational cohort study provide evidence that increased arterial stiffness, as measured by baPWV, predicts the risk of all-cause and cause-specific mortality in type 2 diabetes, supporting the prognostic utility of baPWV. Trial registration Clinical Research Information Service (CRIS), KCT 0005010. Retrospectively Registered May 12, 2020. https://cris.nih.go.kr/cris/search/search_result_st01.jsp?seq=16677
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Affiliation(s)
- Jeong Mi Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Biomedical Research Institute, Pusan National University Hospital, 179, Gudeok-ro, Seo-gu, Busan, 49241, South Korea
| | - Sang Soo Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Biomedical Research Institute, Pusan National University Hospital, 179, Gudeok-ro, Seo-gu, Busan, 49241, South Korea.
| | - In Joo Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Biomedical Research Institute, Pusan National University Hospital, 179, Gudeok-ro, Seo-gu, Busan, 49241, South Korea.
| | - Jong Ho Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Biomedical Research Institute, Pusan National University Hospital, 179, Gudeok-ro, Seo-gu, Busan, 49241, South Korea.,Department of Internal Medicine, Isam Hospital, Busan, South Korea
| | - Bo Hyun Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Biomedical Research Institute, Pusan National University Hospital, 179, Gudeok-ro, Seo-gu, Busan, 49241, South Korea
| | - Mi Kyung Kim
- Department of Internal Medicine, Inje University Haeundae Paik Hospital, Inje University College of Medicine, Busan, South Korea
| | - Soon Hee Lee
- Department of Internal Medicine, Inje University Busan Paik Hospital, Inje University College of Medicine, Busan, South Korea
| | - Chang Won Lee
- Department of Internal Medicine, Busan St. Mary's Hospital, Catholic University of Pusan, Busan, South Korea
| | - Min Chul Kim
- Department of Internal Medicine, Ilsin Christian Hospital, Busan, South Korea
| | - Jun Hyeob Ahn
- Department of Internal Medicine, Good Moonhwa Hospital, Busan, South Korea
| | - Jinmi Kim
- Department of Biostatistics, Clinical Trial Center, Biomedical Research Institute, Pusan National University Hospital, Busan, South Korea
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Rosa LCGFD, Zajdenverg L, Souto DL, Dantas JR, Pinto MVR, Salles GFDCMD, Rodacki M. HbA1c variability and long-term glycemic control are linked to diabetic retinopathy and glomerular filtration rate in patients with type 1 diabetes and multiethnic background. J Diabetes Complications 2019; 33:610-615. [PMID: 31227288 DOI: 10.1016/j.jdiacomp.2019.05.022] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Revised: 05/07/2019] [Accepted: 05/26/2019] [Indexed: 11/30/2022]
Abstract
AIM To evaluate the associations between HbA1c variability and long-term glycemic control with microvascular complications in type 1 diabetes (T1D) patients and multiethnic background. METHODS T1D adults with ≥10 years of follow-up and ≥ 2 HbA1c measurements were included. Glycemic variability was evaluated by the standard deviation (HbA1c-SD), and coefficient of variation (HbA1c-CV), and glycemic control by mean HbA1c over 10 years. Diabetic retinopathy (DR), increased urinary albumin excretion rate (UAER) and reduced glomerular filtration rate (eGFR) were diagnosed. Cardiac autonomic neuropathy (CAN) was diagnosed by cardiac reflex tests. Associations between glycemic parameters with complications were assessed by multivariate logistic regressions. RESULTS 220 patients were included. Simultaneously adjusted for each other, mean HbA1c was independently associated with DR (OR: 2.82; 95%CI: 1.45-5.50), increased UAER (OR: 1.97; 95%CI: 1.14-3.09) and CAN (OR: 4.42; 95%CI: 1.45-13.51); whereas HbA1c-CV was independently associated with DR (OR: 8.93; 95%CI: 1.86-42.87) and reduced eGFR (OR: 7.02; 95%CI: 1.47-35.55). CONCLUSIONS Long-term glycemic control was associated with DR, increased UAER and CAN, while glycemic variability was additionally associated with DR and impaired renal function; suggesting that both good and stable glycemic status might be important to prevent microvascular complications in T1D patients and multiethnic background.
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Affiliation(s)
| | - Lenita Zajdenverg
- Federal University of Rio de Janeiro, Brazil; Federal University of Rio de Janeiro, Department of Internal Medicine, Brazil
| | - Débora Lopes Souto
- Federal University of Rio de Janeiro, Brazil; Federal University of Rio de Janeiro, Department of Internal Medicine, Brazil.
| | - Joana Rodrigues Dantas
- Federal University of Rio de Janeiro, Brazil; Federal University of Rio de Janeiro, Department of Internal Medicine, Brazil
| | - Marcus Vinícius Rocha Pinto
- Federal University of Rio de Janeiro, Brazil; Federal University of Rio de Janeiro, Department of Internal Medicine, Brazil
| | | | - Melanie Rodacki
- Federal University of Rio de Janeiro, Brazil; Federal University of Rio de Janeiro, Department of Internal Medicine, Brazil
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Kume S, Araki S, Ugi S, Morino K, Koya D, Nishio Y, Haneda M, Kashiwagi A, Maegawa H. Secular changes in clinical manifestations of kidney disease among Japanese adults with type 2 diabetes from 1996 to 2014. J Diabetes Investig 2019; 10:1032-1040. [PMID: 30451386 PMCID: PMC6626952 DOI: 10.1111/jdi.12977] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Revised: 10/01/2018] [Accepted: 11/14/2018] [Indexed: 01/10/2023] Open
Abstract
AIMS/INTRODUCTION Diabetic kidney disease is characterized by increased albuminuria and/or a reduced glomerular filtration rate (GFR). We analyzed secular changes in the prevalence of albuminuria and reduced estimated GFR (eGFR) in Japanese patients with type 2 diabetes, and identified factors associated with these changes. MATERIALS AND METHODS Using 1996, 2001, 2006 and 2014 cohort data from the Japanese serial cross-sectional studies conducted at Shiga University of Medical Science, secular changes in the prevalence of diabetic kidney disease (albuminuria and/or reduced eGFR), patient characteristics and their associations were analyzed. RESULTS The prevalence of microalbuminuria and macroalbuminuria decreased over time, whereas the prevalence of moderately reduced eGFR (30-60 mL/min/1.73 m2 ) and severely reduced eGFR (<30 mL/min/1.73 m2 ) increased. Severely reduced eGFR was observed mainly in the patients with macroalbuminuria, regardless of year. Conversely, the prevalence of moderately reduced eGFR increased in the patients without macroalbuminuria. Both macroalbuminuria and moderately reduced eGFR without macroalbuminuria in the 2014 cohort were refractory to the recently recommended intensive therapy. Finally, we showed that obesity accompanied by vascular dysfunction was a risk factor for the development of albuminuria, and that age-dependent arterial stiffness was associated with reduced eGFR without macroalbuminuria in the 2014 cohort. CONCLUSIONS During the past 20 years in Japan, the prevalence of albuminuria declined, whereas that of reduced eGFR increased. Additionally, obesity- and high age-related vascular damage seems to be associated with macroalbuminuria and reduced eGFR without macroalbuminuria, respectively.
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Affiliation(s)
- Shinji Kume
- Department of MedicineShiga University of Medical ScienceOtsuJapan
| | - Shin‐ichi Araki
- Department of MedicineShiga University of Medical ScienceOtsuJapan
| | - Satoshi Ugi
- Department of MedicineShiga University of Medical ScienceOtsuJapan
| | - Katsutaro Morino
- Department of MedicineShiga University of Medical ScienceOtsuJapan
| | - Daisuke Koya
- Department of Diabetology & EndocrinologyKanazawa Medical UniversityIshikawaJapan
| | - Yoshihiko Nishio
- Department of Diabetes and Endocrine MedicineKagoshima University Graduate School of Medical and Dental SciencesKagoshimaJapan
| | - Masakazu Haneda
- Department of MedicineAsahikawa Medical UniversityHokkaidoJapan
- Medical Corporation KyousoukaiOsakaJapan
| | - Atsunori Kashiwagi
- Department of MedicineShiga University of Medical ScienceOtsuJapan
- Kusatsu General HospitalKusatsuJapan
| | - Hiroshi Maegawa
- Department of MedicineShiga University of Medical ScienceOtsuJapan
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