title: Microalbuminuria, but not reduced eGFR, is associated with cardiovascular subclinical organ damage in type 2 diabetes.
abstract: OBJECTIVE
  This study explored the association between reduced estimated glomerular filtration rate (eGFR) and microalbuminuria vs. subclinical organ damage in patients with type 2 diabetes.
  
  
  METHODS
  Data from middle-aged patients with type 2 diabetes (n=706) treated in primary care were analyzed for microalbuminura, defined as a urinary albumin/creatinine ratio (uACR)≥3.0mmol/mol, and reduced eGFR, defined as<60mL/min/1.73m(2), in relation to blood pressure, pulse wave velocity (PWV), left ventricular mass index (LVMI), and carotid intima-media thickness (IMT) and lumen diameter (LD).
  
  
  RESULTS
  Patients with microalbuminuria had significantly higher 24-h ambulatory systolic blood pressure (ASBP) compared with subjects with uACR<3mg/mmol: 137 vs. 128mmHg (P<0.001). There were no differences in ASBP in patients with eGFR<60mL/min/1.73m(2). However, patients with vs. without microalbuminuria had increased PWV (11.4 vs. 10.1m/s; P<0.001), LVMI (134.4 vs. 118.6g/m(2); P<0.001), LD (7.01±0.93 vs. 6.46±0.74mm; P<0.001) and IMT (0.78 vs. 0.74mm; P=0.047), respectively. The associations between uACR vs. PWV and LVMI were more robust after adjusting for age, diabetes duration, ASBP, HbA1c, LDL-cholesterol, and antihypertensive and lipid-lowering therapy compared with uACR vs. IMT. There were no statistically significant differences in PWV, LVMI or IMT between patients with reduced (<60mL/min/1.73m(2)) vs. normal eGFR.
  
  
  CONCLUSIONS
  Levels of urinary albumin excretion, but not reduced eGFR, were associated with increased arterial stiffness, left ventricular mass and atherosclerosis in patients with type 2 diabetes.
authors.affiliation: Skärblacka Primary Health Care Centre, Stationsvägen 2, 61732 Skärblacka, Sweden; Department of Local Care Finspång, County Council of Östergötland, Linköping, Sweden; Department of Medical and Health Sciences, Linköping University, Linköping, Sweden. Electronic address: peter.sjoblom@lio.se.
authors.forename: P
authors.initials: P
authors.lastname: Sjöblom
authors.affiliation: Department of Medical and Health Sciences, Linköping University, Linköping, Sweden; Department of Endocrinology and Metabolism, Linköping University Hospital, Linköping, Sweden.
authors.forename: F H
authors.initials: FH
authors.lastname: Nystrom
authors.affiliation: Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.
authors.forename: T
authors.initials: T
authors.lastname: Länne
authors.affiliation: Department of Medical and Health Sciences, Linköping University, Linköping, Sweden; Department of Clinical Physiology, County Council of Östergötland, Linköping, Sweden.
authors.forename: J
authors.initials: J
authors.lastname: Engvall
authors.affiliation: Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.
authors.forename: C J
authors.initials: CJ
authors.lastname: Östgren
mesh_terms: D000419:Albuminuria / Q000378:metabolism*; D050197:Atherosclerosis / Q000209:etiology / Q000378:metabolism* / Q000503:physiopathology; D015415:Biomarkers / Q000378:metabolism; D001783:Blood Flow Velocity; D001794:Blood Pressure; D059168:Carotid Intima-Media Thickness; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000378:metabolism* / Q000503:physiopathology; D003925:Diabetic Angiopathies / Q000209:etiology / Q000378:metabolism* / Q000503:physiopathology; D003928:Diabetic Nephropathies / Q000209:etiology / Q000378:metabolism* / Q000503:physiopathology; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D007668:Kidney / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D011795:Surveys and Questionnaires; D018487:Ventricular Dysfunction, Left / Q000503:physiopathology
chemical_list: D015415:Biomarkers
keywords: Albuminuria; Atherosclerosis; Cardiovascular disease markers; GFR; Type 2 diabetes