title: Arterial stiffness is an independent predictor for albuminuria progression among Asians with type 2 diabetes-A prospective cohort study.
abstract: OBJECTIVE
  Albuminuria progression has been associated with renal deterioration in type 2 diabetes (T2DM). Central arterial stiffness can aggravate systemic vasculopathy by propagating elevated systolic and pulse pressures forward, thereby accentuating global vascular injury. We aim to investigate whether central arterial stiffness is an independent predictor for albuminuria progression in a multi-ethnic T2DM Asian cohort in Singapore.
  
  
  METHODS
  In a prospective cohort, 1012 T2DM patients were assessed at baseline and after a median follow-up of 3.1years. 880 patients with baseline normo- (urinary albumin-to-creatinine ratio (ACR)<30mg/g, n=579) and microalbuminuria (ACR=30-299mg/g, n=301) were divided into progression and non-progression groups according to ACR changes. Progression was defined as transition from normo- to microalbuminuria, micro- to macroalbuminuria, or normo- to macroalbuminuria. Central arterial stiffness was estimated by carotid-femoral pulse wave velocity (PWV) using applanation tonometry method. Stepwise multiple regression analysis was used to determine the predictor(s) for albuminuria progression.
  
  
  RESULTS
  Albuminuria progression occurred in 178 patients (20.2%). Baseline PWV was higher in progression (10.1±2.9m/s) than non-progression group (9.2±2.4m/s, p<0.001). 1-SD increase in baseline PWV was associated with albuminuria progression (OR=1.457, 95% CI, 1.236-1.718, p<0.001). Stepwise regression analysis identified that baseline PWV (OR=1.241, 95% CI, 1.033-1.490, p=0.021), BMI (OR=1.046, 95% CI, 1.012-1.080, p=0.008), nature log-transformed estimated glomerular filtration rate (LneGFR) (OR=0.320, 95% CI, 0.192-0.530, p=0.010) and LnACR (OR=1.344, 95% CI, 1.187-1.522, p=0.008) are predictors for albuminuria progression.
  
  
  CONCLUSIONS
  Increased central arterial stiffness at baseline predicted future progression of albuminuria. Our results suggest the potential benefit of ameliorating central arterial stiffness to retard albuminuria progression in T2DM.
authors.affiliation: Clinical Research Unit, Khoo Teck Puat Hospital, Singapore 768828, Republic of Singapore.
authors.forename: Xiao
authors.initials: X
authors.lastname: Zhang
authors.affiliation: Clinical Research Unit, Khoo Teck Puat Hospital, Singapore 768828, Republic of Singapore.
authors.forename: Serena
authors.initials: S
authors.lastname: Low
authors.affiliation: Diabetes Centre, Khoo Teck Puat Hospital, Singapore 768828, Republic of Singapore; Department of Medicine, Khoo Teck Puat Hospital, Singapore 768828, Republic of Singapore.
authors.forename: Chee Fang
authors.initials: CF
authors.lastname: Sum
authors.affiliation: Diabetes Centre, Khoo Teck Puat Hospital, Singapore 768828, Republic of Singapore; Department of Medicine, Khoo Teck Puat Hospital, Singapore 768828, Republic of Singapore.
authors.forename: Subramaniam
authors.initials: S
authors.lastname: Tavintharan
authors.affiliation: Department of Medicine, Khoo Teck Puat Hospital, Singapore 768828, Republic of Singapore.
authors.forename: Lee Ying
authors.initials: LY
authors.lastname: Yeoh
authors.affiliation: Clinical Research Unit, Khoo Teck Puat Hospital, Singapore 768828, Republic of Singapore.
authors.forename: Jianjun
authors.initials: J
authors.lastname: Liu
authors.affiliation: Clinical Research Unit, Khoo Teck Puat Hospital, Singapore 768828, Republic of Singapore.
authors.forename: Na
authors.initials: N
authors.lastname: Li
authors.affiliation: Clinical Research Unit, Khoo Teck Puat Hospital, Singapore 768828, Republic of Singapore.
authors.forename: Keven
authors.initials: K
authors.lastname: Ang
authors.affiliation: National Healthcare Group Polyclinics, Singapore 138543, Singapore.
authors.forename: Simon Bm
authors.initials: SB
authors.lastname: Lee
authors.affiliation: National Healthcare Group Polyclinics, Singapore 138543, Singapore.
authors.forename: Wern Ee
authors.initials: WE
authors.lastname: Tang
authors.affiliation: Diabetes Centre, Khoo Teck Puat Hospital, Singapore 768828, Republic of Singapore; Department of Medicine, Khoo Teck Puat Hospital, Singapore 768828, Republic of Singapore. Electronic address: lim.su.chi@alexandrahealth.com.sg.
authors.forename: Su Chi
authors.initials: SC
authors.lastname: Lim
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000419:Albuminuria / Q000175:diagnosis* / Q000208:ethnology / Q000209:etiology / Q000473:pathology; D044466:Asian People; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D003924:Diabetes Mellitus, Type 2 / Q000150:complications* / Q000175:diagnosis* / Q000208:ethnology / Q000473:pathology; D003928:Diabetic Nephropathies / Q000175:diagnosis* / Q000208:ethnology / Q000473:pathology; D018450:Disease Progression; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011379:Prognosis; D051436:Renal Insufficiency, Chronic / Q000175:diagnosis / Q000208:ethnology / Q000209:etiology; D012307:Risk Factors; D012846:Singapore / Q000453:epidemiology; D059289:Vascular Stiffness / Q000502:physiology*; D055815:Young Adult
keywords: Albuminuria progression; Central arterial stiffness; Chronic kidney disease; Pulse wave velocity; Type 2 diabetes