Increased Carotid Intima-Media Thickness is Associated with Progression of Diabetic Nephropathy in Patients with Type 2 Diabetes

Dong-Hyeok Cho; Jin-Ook Chung; Dong-Jin Chung; Min-Young Chung

doi:10.3803/EnM.2011.26.4.310

Journal List > Endocrinol Metab > v.26(4) > 1085907

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Cho, Chung, Chung, and Chung: Increased Carotid Intima-Media Thickness is Associated with Progression of Diabetic Nephropathy in Patients with Type 2 Diabetes

Original Article

Endocrinol Metab 2011;26(4):310-316.

Published online: 5 December 2011

DOI: https://doi.org/10.3803/EnM.2011.26.4.310

Increased Carotid Intima-Media Thickness is Associated with Progression of Diabetic Nephropathy in Patients with Type 2 Diabetes

Dong-Hyeok Cho, Jin-Ook Chung, Dong-Jin Chung, Min-Young Chung

Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea

Corresponding author: Min-Young Chung Department of Internal Medicine, Chonnam National University Hospital, Chonnam National University Medical School, 42 Jebong-ro, Dong-gu, Gwangju 501-757, Korea Tel: +82-62-220-6500, Fax: +82-62-225-8578, E-mail: mychung@jnu.ac.kr

Received 11 August 2011 Accepted 9 November 2011

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

초록

Background

Cardiovascular risk is higher among people with diabetic nephropathy than among those with normal renal function. Carotid intima-media thickness (IMT) is an independent predictor of cardiovascular mortality in type 2 diabetic patients. However, the relationship between carotid IMT and diabetic nephropathy is not well known. The aim of our study was to elucidate whether carotid IMT is associated with progression of diabetic nephropathy in type 2 diabetic patients.

Methods

We recruited a total of 354 type 2 diabetic patients with diabetic nephropathy. Renal function was evaluated by serum creatinine levels, estimated glomerular filtration rate (eGFR), and urinary albumin/creatinine ratio (ACR). Carotid IMT was assessed using B-mode ultrasound by measuring generally used parameters. Baseline-to-study end changes in eGFR were calculated, and the yearly change of eGFR (mL/min/yr) was computed.

Results

Age, diabetes duration, ACR, and eGFR were significantly correlated with mean or maximal carotid IMT; however, lipid profiles, HbA1c, and blood pressure were not correlated. The mean yearly eGFR change was −4.9 ± 5.3 mL/min/yr. The yearly eGFR change was negatively correlated with mean and maximal carotid IMT. After adjusting for age and diabetes duration, the mean IMT is an independent predictor of yearly eGFR change.

Conclusion

Carotid IMT may be a predictor of diabetic nephropathy progression in patients with type 2 diabetes.

Keywords: Carotid artery intima-media thickness, Glomerular filtration rate, Type 2 diabetes mellitus

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Fig. 1.

Relationship between change of estimated glomerular filtration rate (eGFR) and intima-media thickness (IMT). A. Mean IMT. B. Maximal IMT.

Table 1.

Baseline clinical characteristics of the patients

Characteristic	Total (n = 354)
Age (yr)	60.5 ± 11.1
Sex (M/F)	178/176
Duration of diabetes (yr)	12.6 ± 8.2
BMI (kg/m²)	25.4 ± 3.8
SBP (mmHg)	130.2 ± 13.2
DBP (mmHg)	82.5 ± 9.7
Smoking (%)	38.4
Hypertension (%)	83.3
ACE inhibitor or ARB treatment (%)	89.8
HbA1c (%)	8.2 ± 2.2
Total cholesterol (mg/dL)	180.1 ± 36.8
Triglycerides (mg/dL)	149.8 ± 87.4
HDL-C (mg/dL)	40.0 ± 13.2
LDL-C (mg/dL)	104.9 ± 36.7
Serum creatinine (mg/dL)	1.6 ± 1.1
ACR (mg/gCr)	1,327.4 ± 623.1
eGFR (mL/min/1.73 m²)	62.4 ± 28.4
Change of eGFR (mL/min/yr)	-4.9 ± 5.3
Mean IMT (mm)	0.80 ± 0.19
Maximal IMT (mm)	0.94 ± 0.24

Values are expressed as mean ± SD or %.

ACE, angiotensin converting enzyme; ACR, albumin creatinine ratio; ARB, angiotensin receptor blocker; BMI, body mass index; DBP, diastolic blood pressure; eGFR, estimated glomerular filtration rate; HbA1c, hemoglobin A1c; HDL-C, high density lipoprotein cholesterol; IMT, intima-media thickness; LDL-C, low density lipoprotein cholesterol; SBP, systolic blood pressure.

Table 2.

Comparison of clinical characteristics in the groups without and with subclinical atherosclerosis

Characteristic	Mean IMT < 1.0 mm (n = 320)	Mean IMT ≥ 1.0 mm (n = 34)	P value
Age (yr)	59.2 ± 8.6	64.8 ± 13.2	0.032
Sex (M/F)	159/161	19/15	NS
Duration of diabetes (yr)	12.4 ± 7.6	15.2 ± 12.1	0.028
BMI (kg/m²)	25.3 ± 3.2	25.7 ± 5.2	NS
SBP (mmHg)	126.7 ± 10.2	135.7 ± 14.7	NS
DBP (mmHg)	80.6 ± 9.1	87.2 ± 12.8	NS
HbA1c (%)	8.1 ± 2.1	8.3 ± 4.0	NS
Total cholesterol (mg/dL)	178.5 ± 35.7	186.3 ± 46.3	NS
Triglycerides (mg/dL)	151.9 ± 95.2	146.6 ± 89.3	NS
HDL-C (mg/dL)	39.4 ± 12.1	41.9 ± 13.6	NS
LDL-C (mg/dL)	105.3 ± 28.2	104.6 ± 46.9	NS
Serum creatinine (mg/dL)	1.5 ± 0.7	1.9 ± 1.6	NS
ACR (mg/gCr)	1,156.7 ± 406.4	2,457.6 ± 1,087.3	0.040
eGFR (mL/min/1.73 m²)	67.3 ± 20.2	51.2 ± 31.8	0.033
Change of eGFR (mL/min/yr)	-4.4 ± 4.8	-7.1 ± 6.9	0.026

Values are expressed as mean ± SD.

ACR, albumin creatinine ratio; BMI, body mass index; DBP, diastolic blood pre- ssure; eGFR, estimated glomerular filtration rate; HbA1c, hemoglobin A1c; HDL-C, high density lipoprotein cholesterol; IMT, intima-media thickness; LDL-C, low density lipoprotein cholesterol; NS, not significant; SBP, systolic blood pressure.

Table 3.

Simple correlation coefficients of intima-media thickness (IMT) with clinical and biochemical parameters

Parameter	Mean IMT	Maximal IMT
Age	0.394^†	0.369^†
Duration of diabetes	0.360^†	0.401^†
SBP	0.105	0.131
DBP	0.037	0.053
BMI	0.139	0.117
HbA1c	0.204	0.228
Total cholesterol	0.127	0.102
Triglycerides	0.198	0.165
HDL-C	-0.104	-0.156
LDL-C	0.121	0.051
Serum creatinine	0.244∗	0.217
ACR	0.270∗	0.228∗
eGFR	-0.265∗	-0.282∗

^∗ P < 0.05; ^† P < 0.01. ACR, albumin creatinine ratio; BMI, body mass index;

DBP, diastolic blood pressure; eGFR, estimated glomerular filtration rate; HbA1c, hemoglobin A1c; HDL-C, high density lipoprotein cholesterol; LDL-C, low density lipoprotein cholesterol; SBP, systolic blood pressure.

Table 4.

Multiple regression analysis for risk factors associated with change of eGFR

Parameter	β	P value
Age	-0.342	0.025
Duration of diabetes	-0.299	0.020
Use of antihypertensive drugs	0.105	NS
BMI	-0.023	NS
HbA1c	-0.110	NS
ACR	-0.172	NS
Mean IMT	-0.234	0.032

ACR, albumin creatinine ratio; BMI, body mass index; eGFR, estimated glomerular filtration rate; HbA1c, hemoglobin A1c; IMT, intima-media thickness; NS, not significant.

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