title: The estimated glomerular filtration rate is associated with subclinical atherosclerosis, independently of albuminuria, in patients with type 2 diabetes.
abstract: OBJECTIVE
  The aim of this paper was to study the relationship between the intima-media thickness (IMT) of the carotid artery and the estimated glomerular filtration rate (eGFR) and albuminuria in the Chinese patients with type 2 diabetes mellitus.
  
  
  METHODS
  As a cross-sectional study, common carotid artery (CCA) IMT as a surrogate marker of cardiovascular disease is adopted. Data were obtained from a study undertaken to evaluate the prevalence of diabetic complications. Body mass measurements, fasting blood measures, urinary albuminuria creatinine ratio and carotid atherosclerotic measurements were investigated. Association of the carotid IMT with albuminuria stage and eGFR was determined by stepwise multivariate regression analysis adjusting for the possible confounders.
  
  
  RESULTS
  1) The mean age of all 721 patients was 65.33±11.32 years and the duration of diabetes was 7.72±6.93 years. 2) The percentage of impaired eGFR (<60 mL/min/1.73 m2) and albuminuria was 4.9% and 41.3% respectively, 37.0% with microalbuminuria and 4.3% with macroalbuminuria. 3) Compared to subjects with normoalbuminuria (28.8%), the percentage of CCA-IMT thickening in subjects with macroalbuminuria (41.9%) and microalbuminuria (43.1%) was higher (P<0.01). Moreover, compared to patients with eGFR ≥90 mL/min/1.73 m2 (28.8%), patients with eGFR ranged from 60 to 89 mL/min/1.73 m2 (43.2%) and eGFR< 60 mL/min/1.73 m2 (51.4%) tended to have greater percentage of CCA-IMT thickening (P<0.01). 4) In a stepwise regression model, age, fasting blood glucose, total cholesterol, reduced HDL-cholesterol and eGFR were independent predictors of CCA-IMT, after adjusting for potential confounders including gender, current smoker, duration of diabetes, waist circumference, hypertension, systolic blood pressure, diastolic blood pressure, triglyceride, LDL-cholesterol, postprandial glucose, HbA1c and albuminuria stage.
  
  
  CONCLUSIONS
  Reduced eGFR associated with IMT thickening independently of albuminuria is found in the patients with type 2 diabetes mellitus, and further studies investigating the clinical outcomes are needed because this study is based on a cross-sectional design.
authors.affiliation: Department of Endocrinology and Metabolism, Huashan Hospital, Institute of Endocrinology and Diabetology at Fudan University, Shanghai 200040, China. binlu@fudan.edu.cn
authors.forename: B
authors.initials: B
authors.lastname: Lu
authors.forename: J
authors.initials: J
authors.lastname: Wan
authors.forename: Y
authors.initials: Y
authors.lastname: Yang
authors.forename: Y
authors.initials: Y
authors.lastname: Li
authors.forename: R
authors.initials: R
authors.lastname: Hu
mesh_terms: D000368:Aged; D000419:Albuminuria / Q000175:diagnosis* / Q000453:epidemiology / Q000503:physiopathology; D058070:Asymptomatic Diseases; D015415:Biomarkers / Q000097:blood; D001786:Blood Glucose / Q000378:metabolism; D002339:Carotid Arteries / Q000000981:diagnostic imaging; D002340:Carotid Artery Diseases / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000453:epidemiology; D059168:Carotid Intima-Media Thickness; D016009:Chi-Square Distribution; D002681:China / Q000453:epidemiology; D003430:Cross-Sectional Studies; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000175:diagnosis* / Q000453:epidemiology; D003928:Diabetic Nephropathies / Q000175:diagnosis* / Q000453:epidemiology / Q000503:physiopathology; D005260:Female; D005919:Glomerular Filtration Rate; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D007668:Kidney / Q000503:physiopathology*; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011237:Predictive Value of Tests; D015995:Prevalence; D012307:Risk Factors
chemical_list: D015415:Biomarkers; D001786:Blood Glucose; D006442:Glycated Hemoglobin; C517652:hemoglobin A1c protein, human