Impaired peripheral circulation in lower-leg arteries caused by higher arterial stiffness and greater vascular resistance associates with nephropathy in type 2 diabetic patients with normal ankle-brachial indices.
Diabetic nephropathy is a major cause of lower-limb amputation. We enrolled 250 type 2 diabetic patients without apparent occlusive peripheral arterial disease (ankle-brachial indices >0.9) and 40 age-matched nondiabetic subjects consecutively admitted to our hospital. Flow volume and resistive index (RI), an index of vascular resistance, at the popliteal artery were evaluated using gated two-dimensional cine-mode phase-contrast magnetic resonance imaging. Brachial-ankle pulse wave velocity (baPWV) was measured as an index of arterial distensibility. Flow volume was negatively correlated with both baPWV (p=0.0009) and RI (p<0.0001) among the patients. When the patients were grouped into four subgroups with or without albuminuria and renal insufficiency according to the levels of urinary albumin excretion rate (>or=20 or <20microg/min) and estimated glomerular filtration rate (eGFR) (<60 or >or=60ml/min/1.73m(2)), albuminuric patients with renal insufficiency (n=30) showed the lowest flow volume (p=0.0078) and the highest baPWV (p=0.0006) and RI (p=0.0274) among the groups. Simple linear regression analyses demonstrated that eGFR correlated positively with flow volume (p=0.0020) and negatively with baPWV (p=0.0258) and RI (p=0.0029) in patients with albuminuria (n=92), but not with normoalbuminuria (n=158). Impaired peripheral circulation in lower-leg arteries associates with nephropathy in diabetic patients even though they have normal ankle-brachial indices.
Yoshimura
Toru
T
Department of Medicine, Shiga University of Medical Science, Seta Tsukinowa-cho, Otsu, Shiga 520-2192, Japan.
Suzuki
Eiji
E
Ito
Isamu
I
Sakaguchi
Masayoshi
M
Uzu
Takashi
T
Nishio
Yoshihiko
Y
Maegawa
Hiroshi
H
Morikawa
Shigehiro
S
Inubushi
Toshiro
T
Hisatomi
Akitaka
A
Fujimoto
Kazuma
K
Takeda
Jun
J
Kashiwagi
Atsunori
A
D000368:Aged; D001157:Arterial Occlusive Diseases / Q000503:physiopathology*; D001783:Blood Flow Velocity; D001794:Blood Pressure; D001916:Brachial Artery / Q000503:physiopathology*; D003924:Diabetes Mellitus, Type 2 / Q000503:physiopathology*; D003925:Diabetic Angiopathies / Q000503:physiopathology*; D003928:Diabetic Nephropathies / Q000503:physiopathology*; D003971:Diastole; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D007866:Leg; D008297:Male; D008875:Middle Aged; D016491:Peripheral Vascular Diseases / Q000503:physiopathology*; D014655:Vascular Resistance
D006442:Glycated Hemoglobin