The Prevalence of the Risk Factors for Atherosclerosis among Type 2 Diabetic Patients Is Greater in the Progressive Stages of Chronic Kidney Disease

Abstract

Background/Aims: The prevalence of the risk factors for atherosclerosis, other than diabetes mellitus, among type 2 diabetic patients with different stages of chronic kidney disease (CKD) determined by glomerular filtration rate (GFR) was investigated. Methods: The prevalence of ten risk factors (age ≥65 years, history of smoking, male gender, obesity, albuminuria, hypertension, hypercholesterolemia, hypo-HDL-cholesterolemia, hyperuricemia and anemia) was determined in 2,107 Japanese type 2 diabetic patients with different stages of CKD (six stages according to GFR). Results: The risk factors for age ≥65 years and male gender were found in 49 and 62% of the study subjects, respectively. The percentages of subjects with a current history of smoking, obesity, albuminuria, hypertension, hypercholesterolemia, hypo-HDL-cholesterolemia, hyperuricemia and anemia were 35, 44, 47, 70, 61, 13, 21 and 26%, respectively. The prevalence of age ≥65 years, male gender, albuminuria, hypertension, hypo-HDL-cholesterolemia, hyperuricemia and anemia was greater in the later stages of GFR, whereas the prevalence of hypercholesterolemia and obesity did not differ between stages. The prevalence of a current history of smoking was lower in the later stages of GFR. The cumulative number of risk factors increased from 3.1 to 6.8 in the later stages of GFR. Conclusion: Among type 2 diabetic patients with CKD, the total number of risk factors increases with the progression of renal dysfunction. It is important to pay attention to newly recognized risk factors for hyperuricemia and anemia, in addition to hypertension, albuminuria and hypo-HDL-cholesterolemia, in monitoring diabetic patients with later stages of CKD.

Anaemia among primary care patients with type 2 diabetes mellitus (T2DM) and chronic kidney disease (CKD): a multicentred cross-sectional study

“…This European study used the same definition of anaemia as our study 8. Two other studies done among patients with diabetic nephropathy in the UK6 and Japan10 demonstrated even lower prevalence of anaemia compared with others in which both studies showed a prevalence of 26.0%.…”

<p>Comparison of the changes in the factors associated with the renal prognosis of non-elderly and elderly subjects treated with empagliflozin- a retrospective observation study in Japanese patients with type 2 diabetes</p>

“…The number of elderly patients with type 2 diabetes continues to increase in Japan 12. The aging of patients is closely related to frequent renal impairment in individuals with type 2 diabetic13,14 and such patients are considered to be at high risk for cardiovascular events 15,16. Thus, dipeptidyl peptidase-4 (DPP-4) inhibitors are commonly used in real-world clinical practice for the treatment of Japanese patients with type 2 diabetes9,10 because of safety and reliability from the viewpoint of AEs and glycemic control in elderly patients with renal impairment 17,18.…”

Flow Mediated Dilatation Is Reduced with the Progressive Stages of Glomerular Filtration Rate and Albuminuria in Type 2 Diabetic Patients without Coronary Heart Disease

“…Recently, it has been clarified that CKD plays an important role in the development of cardiovascular diseases [ 27 , 28 ]. We have also reported that the presence of CKD in the patients with type 2 diabetes mellitus is associated with an increased number of risk factors for atherosclerosis [ 29 ], hypertension resistant to medication [ 30 ], surrogate markers for atherosclerosis such as the cIMT [ 3 ], lower levels of serum eicosapentaenoic acid/arachidonic acid (which is considered to be a new risk factor for CHD) [ 31 ], and high frequencies of diabetic macroangiopathies [ 32 , 33 ]. The reduction in the FMD with the progressive stages of GFR or albuminuria in the diabetic subjects without CHD may reflect that the presence of CKD is associated with the early stage of atherosclerosis.…”