title: 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.
abstract: 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.
authors.affiliation: Department of Medicine, Shiga University of Medical Science, Seta Tsukinowa-cho, Otsu, Shiga 520-2192, Japan.
authors.forename: Toru
authors.initials: T
authors.lastname: Yoshimura
authors.forename: Eiji
authors.initials: E
authors.lastname: Suzuki
authors.forename: Isamu
authors.initials: I
authors.lastname: Ito
authors.forename: Masayoshi
authors.initials: M
authors.lastname: Sakaguchi
authors.forename: Takashi
authors.initials: T
authors.lastname: Uzu
authors.forename: Yoshihiko
authors.initials: Y
authors.lastname: Nishio
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Maegawa
authors.forename: Shigehiro
authors.initials: S
authors.lastname: Morikawa
authors.forename: Toshiro
authors.initials: T
authors.lastname: Inubushi
authors.forename: Akitaka
authors.initials: A
authors.lastname: Hisatomi
authors.forename: Kazuma
authors.initials: K
authors.lastname: Fujimoto
authors.forename: Jun
authors.initials: J
authors.lastname: Takeda
authors.forename: Atsunori
authors.initials: A
authors.lastname: Kashiwagi
mesh_terms: 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
chemical_list: D006442:Glycated Hemoglobin