The ankle brachial index is associated with prognosis in patients with diabetic kidney disease.
OBJECTIVE
Peripheral arterial disease (PAD) could be an additional risk factor for the clinical outcomes in different populations. The purpose of this study was to evaluate the influence of PAD on patients with diabetic kidney disease.


METHODS
362 persons with type 2 diabetes were followed-up for a mean 4.8 years grouped by ankle brachial index (ABI) (<0.9 vs. ≧0.9) and albuminuria (with or without). Primary and secondary outcomes were composite events (all-cause mortality, hospitalization for coronary artery disease, stroke, re-vascularization, amputation, and diabetic foot) and all-cause mortality.


RESULTS
Inter-group differences in duration of diabetes, glycated hemoglobin, creatinine, and estimated glomerular filtration rate were significant. During the follow-up period, 53 composite events were recorded (14.7%) and 13 (3.5%) individuals died. Subjects with albuminuria plus ABI<0.9 had higher risk of composite events than those with albuminuria but normal ABI (p<0.05). The only trend difference between the two groups was in all-cause mortality. Albuminuria plus ABI <0.9 was associated with risk of composite events (hazard ratio [HR] 4.20, 95% confidence interval [CI] 1.77-9.92, p=0.001) and all-cause mortality (HR 17.77, 95% CI 1.93-162.20, p=0.011).


CONCLUSIONS
PAD might be an additional risk factor for adverse outcomes in patients with diabetic kidney disease. Further prospective data are required to validate this conclusion.
Division of Endocrinology and Metabolism, Department of Medicine, Tauyan Branch of Taipei Veterans General Hospital, Tauyuan, Taiwan.
Li-Hsin
LH
Chang
Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan; Division of Otology, Department of Otorhinolaryngology-Head and Neck Surgery, Taipei Veterans General Hospital, Taipei, Taiwan.
Chia-Huei
CH
Chu
Division of Endocrinology and Metabolism, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.
Hong-Da
HD
Lin
Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan; Division of Endocrinology and Metabolism, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.
Ching-Fai
CF
Kwok
Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan; Division of Endocrinology and Metabolism, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.
Justin G S
JG
Won
Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan; Division of Endocrinology and Metabolism, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.
Harn-Shen
HS
Chen
Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan; Division of Endocrinology and Metabolism, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan. Electronic address: linly@vghtpe.gov.tw.
Liang-Yu
LY
Lin
D000368:Aged; D000419:Albuminuria / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology; D055109:Ankle Brachial Index; D003924:Diabetes Mellitus, Type 2 / Q000150:complications* / Q000175:diagnosis* / Q000503:physiopathology; D003928:Diabetic Nephropathies / Q000175:diagnosis* / Q000209:etiology / Q000503:physiopathology; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D058729:Peripheral Arterial Disease / Q000150:complications; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors
Albuminuria; Ankle brachial index; Cardiovascular outcome; Type 2 diabetes mellitus