title: Toe-brachial index is associated more strongly with albuminuria or glomerular filtration rate than ankle-brachial index in patients with type 2 diabetes.
abstract: The aim of this study was to investigate whether toe-brachial index (TBI) is more strongly associated with albuminuria or estimated glomerular filtration rate (eGFR) than ankle-brachial index (ABI), and thus is a more suitable tool for evaluating the association between peripheral artery disease (PAD) and diabetic nephropathy than ABI in patients with type 2 diabetes. We evaluated the relationships between ABI or TBI and the degree of urinary albumin excretion or eGFR, as well as the major cardiovascular risk factors, in 390 patients with type 2 diabetes. Furthermore, we compared the area under the receiver-operator characteristic curve (AUC) of TBI or ABI for albuminuria or chronic kidney disease (CKD). Low-density lipoprotein cholesterol was negatively associated with ABI. Age and duration of diabetes were negatively associated with TBI, and diastolic blood pressure and high-density lipoprotein cholesterol were positively associated with TBI. Log (urinary albumin excretion) was associated more strongly with TBI (r=-0.265, P<0.0001) than with ABI (r=-0.132, P=0.0111), and eGFR was positively associated with TBI (r=0.195, P=0.0002) but not with ABI (r=0.023, P=0.6571). The AUCs of TBI for albuminuria (P=0.0002) and CKD (P=0.0322) were significantly greater than those of ABI. In conclusion, TBI is associated more strongly with albuminuria and eGFR than ABI in patients with type 2 diabetes. Our study suggests that TBI may be a more suitable tool for evaluating the association between PAD and diabetic nephropathy than ABI in patients with type 2 diabetes.
authors.affiliation: Department of Endocrinology and Metabolism, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, Kamigyo-ku, Kyoto, Japan.
authors.forename: Michiaki
authors.initials: M
authors.lastname: Fukui
authors.forename: Muhei
authors.initials: M
authors.lastname: Tanaka
authors.forename: Masahide
authors.initials: M
authors.lastname: Hamaguchi
authors.forename: Takafumi
authors.initials: T
authors.lastname: Senmaru
authors.forename: Kazumi
authors.initials: K
authors.lastname: Sakabe
authors.forename: Mai
authors.initials: M
authors.lastname: Asano
authors.forename: Masahiro
authors.initials: M
authors.lastname: Yamazaki
authors.forename: Goji
authors.initials: G
authors.lastname: Hasegawa
authors.forename: Saeko
authors.initials: S
authors.lastname: Imai
authors.forename: Naoto
authors.initials: N
authors.lastname: Nakamura
mesh_terms: D000368:Aged; D000419:Albuminuria / Q000503:physiopathology*; D055109:Ankle Brachial Index; D008078:Cholesterol, LDL / Q000097:blood; D003924:Diabetes Mellitus, Type 2 / Q000503:physiopathology*; D003928:Diabetic Nephropathies / Q000503:physiopathology; D005260:Female; D005919:Glomerular Filtration Rate / Q000502:physiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D058729:Peripheral Arterial Disease / Q000503:physiopathology; D012372:ROC Curve
chemical_list: D008078:Cholesterol, LDL