Relationship between chronic kidney disease and silent cerebral infarction in patients with Type 2 diabetes.
OBJECTIVE
Silent cerebral infarction (SCI) is an independent risk factor for future symptomatic stroke. Although the prevalence of SCI is closely related to kidney function in non-diabetic individuals, evidence is lacking whether albuminuria and/or reduced estimated glomerular filtration rate (eGFR) independently increase the risk of SCI in diabetic patients. We therefore examined the relationships between albuminuria, eGFR and SCI in patients with Type 2 diabetes mellitus (T2DM).


METHODS
We studied 786 T2DM patients with an eGFR > or = 15 ml/min 1.73/m(2), including 337 women and 449 men [mean (+/- sd), age 65 +/- 11 years]. All patients underwent cranial magnetic resonance imaging (MRI) to detect SCI. GFR was estimated using the modified three-variable equation for Japanese subjects. Albuminuria was defined as a first morning urinary albumin-to-creatinine ratio (ACR) > or = 30 mg/g.


RESULTS
SCI was detected in 415 (52.8%) of the subjects. The prevalence of SCI was significantly associated with both elevated ACR and decreased eGFR in univariate analysis. In multivariate logistic regression analysis, urinary ACR remained independently associated with SCI after adjusting for conventional cardiovascular risk factors [odds ratio (OR) of urinary ACR per logarithmical value: 1.89, 95% confidence interval (CI) = 1.41-2.51, P < 0.001]; however, eGFR was no longer significantly associated with SCI (OR per ml/min 1.73/m(2) = 0.99, 95% CI = 0.98-1.00, P = 0.095).


CONCLUSIONS
In conclusion, albuminuria but not decreased eGFR may be an independent predictor of prevalent SCI in patients with T2DM.
Division of Nephrology and Hypertension, Department of Medicine, Diabetes Centre, Tokyo Women's Medical University School of Medicine, Tokyo, Japan.
R
R
Bouchi
T
T
Babazono
N
N
Yoshida
I
I
Nyumura
K
K
Toya
T
T
Hayashi
K
K
Hanai
N
N
Tanaka
A
A
Ishii
Y
Y
Iwamoto
D000368:Aged; D000418:Albumins / Q000032:analysis; D000419:Albuminuria / Q000175:diagnosis; D002544:Cerebral Infarction / Q000150:complications / Q000453:epidemiology* / Q000503:physiopathology; D003404:Creatinine / Q000652:urine; D003924:Diabetes Mellitus, Type 2 / Q000150:complications* / Q000503:physiopathology; D003928:Diabetic Nephropathies / Q000150:complications* / Q000503:physiopathology; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D051436:Renal Insufficiency, Chronic / Q000150:complications* / Q000503:physiopathology
D000418:Albumins; D003404:Creatinine