title: Carotid Intima-Media Thickness and Visit-to-Visit HbA1c Variability Predict Progression of Chronic Kidney Disease in Type 2 Diabetic Patients with Preserved Kidney Function.
abstract: Background/Aims. Subclinical atherosclerosis and long-term glycemic variability have been reported to predict incident chronic kidney disease (CKD) in the general population. However, these associations have not been investigated in patients with type 2 diabetes with preserved kidney function.Methods. We prospectively followed up 162 patients with type 2 diabetes (mean age, 62.3 years; 53.6% men) and assessed whether carotid intima-media thickness (IMT) measured by B-mode ultrasound and visit-to-visit HbA1c variability are associated with deterioration of CKD (incident CKD defined as estimated GFR [eGFR] < 60 mL/min/1.73 m2and progression of CKD stages) over a median follow-up of 6.0 years. At baseline, 25 patients (15.4%) had CKD. Cox proportional hazards regression models were used for identifying associated factors of CKD deterioration.Results.Estimated GFR decreased from 75.8 ± 16.3 to 67.4 ± 18.2 mL/min/1.73 m2(p< 0.01). Of 162 patients, 32 developed CKD and 8 made a progression of CKD stages. Multivariate Cox regression analysis revealed that carotid IMT (HR: 4.0, 95% CI: 1.1-14.226.7, andp= 0.03) and coefficient of variation of HbA1c (HR: 1.12, 95%: 1.04-1.21, andp= 0.003) were predictors of deterioration of CKD independently of age, mean HbA1c, urinary albumin/creatinine ratio, baseline eGFR, uric acid, and leucocyte count.Conclusions.Subclinical atherosclerosis and long-term glycemic variability predict deterioration of chronic kidney disease (as defined by incident or worsening CKD) in type 2 diabetic patients with preserved kidney function.
authors.affiliation: Department of Food Sciences and Nutrition, School of Human Environmental Sciences, Hyogo, Japan.
authors.forename: Akiko
authors.initials: A
authors.lastname: Takenouchi
authors.affiliation: Research Institute for Nutrition Sciences, Mukogawa Women's University, Hyogo, Japan; Department of Nutrition, Osaka City Juso Hospital, Osaka, Japan.
authors.forename: Ayaka
authors.initials: A
authors.lastname: Tsuboi
authors.affiliation: Department of Food Sciences and Nutrition, School of Human Environmental Sciences, Hyogo, Japan; Research Institute for Nutrition Sciences, Mukogawa Women's University, Hyogo, Japan.
authors.forename: Miki
authors.initials: M
authors.lastname: Kurata
authors.affiliation: Department of Food Sciences and Nutrition, School of Human Environmental Sciences, Hyogo, Japan; Research Institute for Nutrition Sciences, Mukogawa Women's University, Hyogo, Japan.
authors.forename: Keisuke
authors.initials: K
authors.lastname: Fukuo
authors.affiliation: Research Institute for Nutrition Sciences, Mukogawa Women's University, Hyogo, Japan; Diabetes Division, Sadamitsu Hospital, Hyogo, Japan.
authors.forename: Tsutomu
authors.identifier: 0000-0002-8855-9268
authors.initials: T
authors.lastname: Kazumi
mesh_terms: D000368:Aged; D050197:Atherosclerosis / Q000097:blood / Q000150:complications* / Q000503:physiopathology; D001786:Blood Glucose / Q000032:analysis; D059168:Carotid Intima-Media Thickness; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000150:complications* / Q000503:physiopathology; D003928:Diabetic Nephropathies / Q000097:blood / Q000209:etiology / Q000503:physiopathology*; D018450:Disease Progression; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis*; D006801:Humans; D008297:Male; D008875:Middle Aged; D051436:Renal Insufficiency, Chronic / Q000097:blood / Q000209:etiology / Q000503:physiopathology*; D012307:Risk Factors
chemical_list: D001786:Blood Glucose; D006442:Glycated Hemoglobin; C517652:hemoglobin A1c protein, human