title: The estimated GFR, but not the stage of diabetic nephropathy graded by the urinary albumin excretion, is associated with the carotid intima-media thickness in patients with type 2 diabetes mellitus: a cross-sectional study.
abstract: BACKGROUND
  To study the relationship between the intima-media thickness (IMT) of the carotid artery and the stage of chronic kidney disease (CKD) based on the estimated glomerular filtration rate (eGFR) and diabetic nephropathy graded by the urinary albumin excretion (UAE) in the patients with type 2 diabetes mellitus.
  
  
  METHODS
  A cross-sectional study was performed in 338 patients with type 2 diabetes mellitus. The carotid IMT was measured using an ultrasonographic examination.
  
  
  RESULTS
  The mean carotid IMT was 1.06 +/- 0.27 mm, and 42% of the subjects showed IMT thickening (>or= 1.1 mm). Cerebrovascular disease and coronary heart disease were frequent in the patients with IMT thickening. The carotid IMT elevated significantly with the stage progression of CKD (0.87 +/- 0.19 mm in stage 1, 1.02 +/- 0.26 mm in stage 2, 1.11 +/- 0.26 mm in stage 3, and 1.11 +/- 0.27 mm in stage 4+5). However, the IMT was not significantly different among the various stages of diabetic nephropathy. The IMT was significantly greater in the diabetic patients with hypertension compared to those without hypertension. The IMT positively correlated with the age, the duration of diabetes mellitus, and the brachial-ankle pulse wave velocities (baPWV), and negatively correlated with the eGFR. In a stepwise multivariate regression analysis, the eGFR and the baPWV were independently associated with the carotid IMT.
  
  
  CONCLUSIONS
  Our study is the first report showing a relationship between the carotid IMT and the renal parameters including eGFR and the stages of diabetic nephropathy with a confirmed association between the IMT and diabetic macroangiopathy. Our study further confirms the importance of intensive examinations for the early detection of atherosclerosis and positive treatments for hypertension, dyslipidaemia, obesity, as well as hyperglycaemia are necessary when a reduced eGFR is found in diabetic patients.
authors.affiliation: Department of Diabetes, Metabolism and Kidney Disease, Edogawa Hospital, Tokyo, Japan. ito@edogawa.or.jp
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Ito
authors.forename: Yuko
authors.initials: Y
authors.lastname: Komatsu
authors.forename: Mizuo
authors.initials: M
authors.lastname: Mifune
authors.forename: Shinichi
authors.initials: S
authors.lastname: Antoku
authors.forename: Hidenori
authors.initials: H
authors.lastname: Ishida
authors.forename: Yuichiro
authors.initials: Y
authors.lastname: Takeuchi
authors.forename: Michiko
authors.initials: M
authors.lastname: Togane
mesh_terms: D000368:Aged; D000419:Albuminuria / Q000000981:diagnostic imaging / Q000209:etiology* / Q000503:physiopathology; D002339:Carotid Arteries / Q000000981:diagnostic imaging*; D002340:Carotid Artery Diseases / Q000000981:diagnostic imaging / Q000209:etiology* / Q000503:physiopathology; D016022:Case-Control Studies; D002561:Cerebrovascular Disorders / Q000000981:diagnostic imaging / Q000209:etiology / Q000503:physiopathology; D003327:Coronary Disease / Q000000981:diagnostic imaging / Q000209:etiology / Q000503:physiopathology; D003430:Cross-Sectional Studies; D003924:Diabetes Mellitus, Type 2 / Q000150:complications* / Q000000981:diagnostic imaging / Q000503:physiopathology; D003925:Diabetic Angiopathies / Q000000981:diagnostic imaging / Q000209:etiology* / Q000503:physiopathology; D003928:Diabetic Nephropathies / Q000000981:diagnostic imaging / Q000209:etiology* / Q000503:physiopathology; D018450:Disease Progression; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D006973:Hypertension / Q000000981:diagnostic imaging / Q000209:etiology / Q000503:physiopathology; D007668:Kidney / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D012720:Severity of Illness Index; D017539:Tunica Intima / Q000000981:diagnostic imaging*; D017540:Tunica Media / Q000000981:diagnostic imaging*; D014463:Ultrasonography
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