Carotid Intima-Media Thickness and Visit-to-Visit HbA1c Variability Predict Progression of Chronic Kidney Disease in Type 2 Diabetic Patients with Preserved Kidney Function

Abstract

Background/Aims. Subclinical atherosclerosis and long-term glycemic variability have been reported to predict incident chronic kidney disease (CKD) in the general population. However, these associations have not been investigated in patients with type 2 diabetes with preserved kidney function. Methods. We prospectively followed up 162 patients with type 2 diabetes (mean age, 62.3 years; 53.6% men) and assessed whether carotid intima-media thickness (IMT) measured by B-mode ultrasound and visit-to-visit HbA1c variability are associated with deterioration of CKD (incident CKD defined as estimated GFR [eGFR] < 60 mL/min/1.73 m2 and progression of CKD stages) over a median follow-up of 6.0 years. At baseline, 25 patients (15.4%) had CKD. Cox proportional hazards regression models were used for identifying associated factors of CKD deterioration. Results. Estimated GFR decreased from 75.8 ± 16.3 to 67.4 ± 18.2 mL/min/1.73 m2 (p < 0.01). Of 162 patients, 32 developed CKD and 8 made a progression of CKD stages. Multivariate Cox regression analysis revealed that carotid IMT (HR: 4.0, 95% CI: 1.1–14.226.7, and p = 0.03) and coefficient of variation of HbA1c (HR: 1.12, 95%: 1.04–1.21, and p = 0.003) were predictors of deterioration of CKD independently of age, mean HbA1c, urinary albumin/creatinine ratio, baseline eGFR, uric acid, and leucocyte count. Conclusions. Subclinical atherosclerosis and long-term glycemic variability predict deterioration of chronic kidney disease (as defined by incident or worsening CKD) in type 2 diabetic patients with preserved kidney function.

Assessment of Peritoneal Membrane Arteriolar Structure in Conjunction with Traditional Cardiovascular System Evaluation in Chronic Kidney Disease (CKD) Stage 5 Patients

“…Increased c-IMT complex is a well-known parameter which reflects early atherosclerotic lesions and indicate higher cardiovascular risk in patients with hypertension and also predict incident CKD in the general population [22]. There were not any statistically significant differences in c-IMT measurements in both analyzed groups (Table 2).…”

Relationship of chronic kidney disease of the with glycemic status, cardiovascular diseases and laboratory indicators in patients with type 2 diabetes mellitus

“…Несмотря на высокие показатели HbA 1c у пациентов с МАУ, этот показатель не играл значительной роли в формировании МАУ. Согласно [9] (2016), длительную вариабельность HbA 1c в общей популяции можно рассматривать как предиктор ХБП. В обследованной же популяции, снижение СКФ сопровожда- лось относительным улучшением контроля гликемического статуса, однако эта связь была статистически недостоверной.…”

“…По данным [9] (2016), ТКИМ может расцениваться как предиктор ХБП. В представленной популяции самые высокие показатели ТКИМ наблюдались у пациентов с МАУ 100 мг/дл и наиболее выраженные изменения отмечались в правой сонной артерии.…”

“…В представленной популяции самые высокие показатели ТКИМ наблюдались у пациентов с МАУ 100 мг/дл и наиболее выраженные изменения отмечались в правой сонной артерии. Следовательно, признаки субклинического атеросклероза также следует принимать как ФР ХБП [9]. Было доказано, что у больных СД-2 ССЗ ускоряют возникновение поражения почек [20].…”

The Cluster of Abnormalities Related to Metabolic Syndrome Is Associated With Reduced Glomerular Filtration Rate and Raised Albuminuria in Patients With Type 2 Diabetes Mellitus

“…For example, more than 90% of type 2 diabetes patients in a UK hospital had MS and their body mass index (BMI) averaged 33 kg/m 2 [ 12 ]. Therefore, we evaluated association between the two conditions in Japanese patients with type 2 diabetes who had a mean BMI < 25 kg/m 2 [ 7 , 13 ].…”