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Contribution of chronic kidney failure to subclinical peripheral arterial disease in patients with diabetes mellitus
Abstracts / Atherosclerosis 235 (2014) e192–e301
Methods: We compared 227 randomly sampled Indian Gujaratis in Sandwell, Britain (49.8 (14.4) years, 50% men) with 277 contemporaries living in villages of origin in Gujarat (47.6 (11.8) years, 41 % men). Both groups underwent a 75g oral-glucose-tolerance test. Dietary intake and physical activity, were evaluated with standardised questionnaires. Laboratory measurements including glucose, haematology, insulin, CRP, vitamin B12, serum folate and ferritin were conducted. Results: Across sites, the age-adjusted prevalence of diabetes was 9.8%. Anaemia was significantly less common in Britain (P<0.01), and greater amongst women compared to men. Rates of vitamin B12 or folate related anaemia were similar between sites. Iron deficiency anaemia was more common amongst those in India. There was no influence of aneamia on diabetes status save iron deficiency anaemia (P ¼ 0.01), which was protective. Serum ferritin was higher amongst diabetics (P ¼ 0.005), irrespective of site, gender, and central obesity (P 0.02), and were associated with fasting and post-challenge glucose, anthropometry, blood pressure, triglycerides and non-esterified fatty acids (P<0.001). Diabetes was less in those with low ferritin (<20mg/ml), p<0.008, risk estimate ¼ 0.35 (95%CI 0.15-0.81), as were blood pressure and metabolic risk factors. On multivariate analysis, diabetes was independently associated with ferritin (P¼0.001) and age (P<0.001). Conclusion: Ferritin levels are positively associated with glucose intolerance in our population of rural and migrant Indians. This relationship is independent of gender and Indian or UK lifestyle factors. 60 - Chronic kidney disease and nephropathies EAS-0117. CONTRIBUTION OF CHRONIC KIDNEY FAILURE TO SUBCLINICAL PERIPHERAL ARTERIAL DISEASE IN PATIENTS WITH DIABETES MELLITUS J. Enaa, C.R. Argenteb, T. Lozanoc, C.E. Alvareza Internal Medicine, Hospital Marina Baixa, Villajoyosa, Spain; b Clinical Endocrinology, Hospital Marina Baixa, Villajoyosa, Spain; c Cardiology, Hospital Marina Baixa, Villajoyosa, Spain a
Objectives: Atherosclerotic disease is a common condition in patients with chronic kidney disease and diabetes. We investigated the independent contribution of chronic kidney failure to the presence of subclinical peripheral arterial disease in patients with diabetes. Methods: Cross-sectional study in 360 patients with diabetes mellitus, older than 50 years old, able to walk and who were treated in the Department of Medicine of our hospital. We excluded patients with extreme edema or swelling in the lower limbs, amputation or revascularization, those hemodynamically unstable or previously diagnosed with peripheral arterial disease, as well as patients on dialysis, renal transplants, or with an arteriovenous fistula. Chronic kidney failure was defined as a glomerular filtration rate [GFR] estimated by MDRD4 less than 60 mL/min per 1.73 m2. As confounder variables we considered age, sex, smoking status, presence of hypertension and dyslipidemia. The presence of peripheral arterial disease was defined as an ankle-brachial index measured by Doppler less than 0.90. Results: Patients’ mean age was 67 years (range 50-90), 68% were males, 23% were smokers, 81% had hypertension and 79% had dyslipidemia. Chronic kidney failure was present in 26% of subjects. The overall prevalence of peripheral arterial disease in our series was 27.2% (95% confidence interval [CI]: 22-32%). Patients with chronic kidney failure had greater prevalence of peripheral arterial disease than patients with GFR equal or above 60 mL/min per 1.73 m2 (41.8% vs. 23.7%; Odds Ratio [OR]: 2.31 (95% CI: 1.35-3.93; p ¼ 0.002). After controlling for confounders the adjusted association between chronic kidney failure and peripheral arterial disease had a OR: 2.0 (95% CI: 1.11-3.59; p ¼ 0.020). Conclusion: Chronic kidney failure increases by a factor of 2 the presence of subclinical peripheral arterial disease in patients with diabetes mellitus. This very high risk population should be target for preventive measures and foot care.
e241
60 - Chronic kidney disease and nephropathies EAS-0871. ARTERIAL STIFFNESS AND CHRONIC KIDNEY DISEASE IN MIDDLE-AGED PATIENTS WITH TYPE 2 DIABETES MELLITUS O. Georgescua, S. Craciunb, C. Nicab, L. Banub, C. Ion Toaderb, S. Ficaa a
Endocrinology Diabetes and Nutrition, Elias Emergency University Hospital University of Medicine and Pharmacy Carol Davila, Bucharest, Romania; b Endocrinology Diabetes and Nutrition, Elias Emergency University Hospital, Bucharest, Romania Objectives: Cardio-Ankle Vascular Index (CAVI) was developed as index of arterial stiffness and early marker of atherosclerosis, independent by blood pressure.The aim of our study was to evaluate the correlation between CAVI and kidney function in patients with type 2 diabetes mellitus (T2DM) compared with normoglycemic subjects. Methods: 133 patients with type T2DM and 77 subjects representing the control group, mean age 53.04 5.94 years were biochemical and vascular through CAVI evaluated. The glomerular rate filtration was estimated by MDRD (Modified Diet in Renal Disease) according to K/DOQI Clinical Practice Guidelines. Results: Duration of diabetes mellitus was 6.74 3.45 years. The prevalence of arterial stiffness in whole study group was 37.45%, 56.39% from T2DM and 18.52% from control group having pathological arterial stiffness (CAVI > 8 m/s). The mean value of CAVI was higher in T2DM patients compared with control group (8.35 2.32 m/s vs. 6.25 1.70 m/s, p¼ 0.04) positive correlated with age and negative with MDRD, without statistically significant differences between these two groups. Among pacients with pathological vascular stiffness (CAVI > 8m/s), the prevalence of chronic kidney disease (CKD) was 3.84 times higher in T2DM patients than in control (64% vs. 16.66%). Splitting whole study group in 4 subgroups according to the presence of T2DM and CKD we found the following mean CAVI values: without T2DM without CKD ¼ 1.04 m/s, without T2DM with CKD ¼ 7.24 m/s, T2DM without CKD ¼ 6.8 m/s, T2DM with CKD ¼ 10.04 m/ s, the difference between first and last group being statistically significant (p ¼ 0.003). Conclusion: The atherosclerosis relevated through CAVI is early developed in middle-age patients with type 2 diabetes mellitus and the arterial stiffness has a negative influence on renal damage. 60 - Chronic kidney disease and nephropathies EAS-0892. INVOLVEMENT OF DDAH-ADMA AXIS IN AKI N. Obaraa, S. Uedaa, S. Yamagishib, Y. Nakayamaa, K. Taguchia, M. Yokoroa, K. Fukamia, S. Okudaa a Division of Nephrology Department of Medicine, Kurume University, Fukuoka, Japan; b Department of Physiology and Therapeutics of Diabetic vascular Complications, Kurume University, Fukuoka, Japan
Objectives: Injury to the renal vasculature plays important roles in the pathogenesis of acute kidney injury (AKI). However, roles of asymmetric dimethylarginine (ADMA), an endogenous inhibitor of nitric oxide synthease, in AKI remain unclear. So, we investigated the kinetics and the roles of ADMA in ischemia/ reperfusion (IR)-injured mice and patients undergoing elective coronary angiography (CAG). Methods: We first examined the kinetics of ADMA, and DDAH-1, a key enzyme for ADMA degradation, levels in the kidney of IR-injured mice. Further, we examined the effects of continuous infusion of ADMA on renal IR injury, and studied whether the IR injury could be attenuated in DDAH-1 transgenic (Tg) mice. Furthermore, we collected blood and urine samples of 52 patients before and after elective CAG at our institution.
Methods: We compared 227 randomly sampled Indian Gujaratis in Sandwell, Britain (49.8 (14.4) years, 50% men) with 277 contemporaries living in villages of origin in Gujarat (47.6 (11.8) years, 41 % men). Both groups underwent a 75g oral-glucose-tolerance test. Dietary intake and physical activity, were evaluated with standardised questionnaires. Laboratory measurements including glucose, haematology, insulin, CRP, vitamin B12, serum folate and ferritin were conducted. Results: Across sites, the age-adjusted prevalence of diabetes was 9.8%. Anaemia was significantly less common in Britain (P<0.01), and greater amongst women compared to men. Rates of vitamin B12 or folate related anaemia were similar between sites. Iron deficiency anaemia was more common amongst those in India. There was no influence of aneamia on diabetes status save iron deficiency anaemia (P ¼ 0.01), which was protective. Serum ferritin was higher amongst diabetics (P ¼ 0.005), irrespective of site, gender, and central obesity (P 0.02), and were associated with fasting and post-challenge glucose, anthropometry, blood pressure, triglycerides and non-esterified fatty acids (P<0.001). Diabetes was less in those with low ferritin (<20mg/ml), p<0.008, risk estimate ¼ 0.35 (95%CI 0.15-0.81), as were blood pressure and metabolic risk factors. On multivariate analysis, diabetes was independently associated with ferritin (P¼0.001) and age (P<0.001). Conclusion: Ferritin levels are positively associated with glucose intolerance in our population of rural and migrant Indians. This relationship is independent of gender and Indian or UK lifestyle factors. 60 - Chronic kidney disease and nephropathies EAS-0117. CONTRIBUTION OF CHRONIC KIDNEY FAILURE TO SUBCLINICAL PERIPHERAL ARTERIAL DISEASE IN PATIENTS WITH DIABETES MELLITUS J. Enaa, C.R. Argenteb, T. Lozanoc, C.E. Alvareza Internal Medicine, Hospital Marina Baixa, Villajoyosa, Spain; b Clinical Endocrinology, Hospital Marina Baixa, Villajoyosa, Spain; c Cardiology, Hospital Marina Baixa, Villajoyosa, Spain a
Objectives: Atherosclerotic disease is a common condition in patients with chronic kidney disease and diabetes. We investigated the independent contribution of chronic kidney failure to the presence of subclinical peripheral arterial disease in patients with diabetes. Methods: Cross-sectional study in 360 patients with diabetes mellitus, older than 50 years old, able to walk and who were treated in the Department of Medicine of our hospital. We excluded patients with extreme edema or swelling in the lower limbs, amputation or revascularization, those hemodynamically unstable or previously diagnosed with peripheral arterial disease, as well as patients on dialysis, renal transplants, or with an arteriovenous fistula. Chronic kidney failure was defined as a glomerular filtration rate [GFR] estimated by MDRD4 less than 60 mL/min per 1.73 m2. As confounder variables we considered age, sex, smoking status, presence of hypertension and dyslipidemia. The presence of peripheral arterial disease was defined as an ankle-brachial index measured by Doppler less than 0.90. Results: Patients’ mean age was 67 years (range 50-90), 68% were males, 23% were smokers, 81% had hypertension and 79% had dyslipidemia. Chronic kidney failure was present in 26% of subjects. The overall prevalence of peripheral arterial disease in our series was 27.2% (95% confidence interval [CI]: 22-32%). Patients with chronic kidney failure had greater prevalence of peripheral arterial disease than patients with GFR equal or above 60 mL/min per 1.73 m2 (41.8% vs. 23.7%; Odds Ratio [OR]: 2.31 (95% CI: 1.35-3.93; p ¼ 0.002). After controlling for confounders the adjusted association between chronic kidney failure and peripheral arterial disease had a OR: 2.0 (95% CI: 1.11-3.59; p ¼ 0.020). Conclusion: Chronic kidney failure increases by a factor of 2 the presence of subclinical peripheral arterial disease in patients with diabetes mellitus. This very high risk population should be target for preventive measures and foot care.
e241
60 - Chronic kidney disease and nephropathies EAS-0871. ARTERIAL STIFFNESS AND CHRONIC KIDNEY DISEASE IN MIDDLE-AGED PATIENTS WITH TYPE 2 DIABETES MELLITUS O. Georgescua, S. Craciunb, C. Nicab, L. Banub, C. Ion Toaderb, S. Ficaa a
Endocrinology Diabetes and Nutrition, Elias Emergency University Hospital University of Medicine and Pharmacy Carol Davila, Bucharest, Romania; b Endocrinology Diabetes and Nutrition, Elias Emergency University Hospital, Bucharest, Romania Objectives: Cardio-Ankle Vascular Index (CAVI) was developed as index of arterial stiffness and early marker of atherosclerosis, independent by blood pressure.The aim of our study was to evaluate the correlation between CAVI and kidney function in patients with type 2 diabetes mellitus (T2DM) compared with normoglycemic subjects. Methods: 133 patients with type T2DM and 77 subjects representing the control group, mean age 53.04 5.94 years were biochemical and vascular through CAVI evaluated. The glomerular rate filtration was estimated by MDRD (Modified Diet in Renal Disease) according to K/DOQI Clinical Practice Guidelines. Results: Duration of diabetes mellitus was 6.74 3.45 years. The prevalence of arterial stiffness in whole study group was 37.45%, 56.39% from T2DM and 18.52% from control group having pathological arterial stiffness (CAVI > 8 m/s). The mean value of CAVI was higher in T2DM patients compared with control group (8.35 2.32 m/s vs. 6.25 1.70 m/s, p¼ 0.04) positive correlated with age and negative with MDRD, without statistically significant differences between these two groups. Among pacients with pathological vascular stiffness (CAVI > 8m/s), the prevalence of chronic kidney disease (CKD) was 3.84 times higher in T2DM patients than in control (64% vs. 16.66%). Splitting whole study group in 4 subgroups according to the presence of T2DM and CKD we found the following mean CAVI values: without T2DM without CKD ¼ 1.04 m/s, without T2DM with CKD ¼ 7.24 m/s, T2DM without CKD ¼ 6.8 m/s, T2DM with CKD ¼ 10.04 m/ s, the difference between first and last group being statistically significant (p ¼ 0.003). Conclusion: The atherosclerosis relevated through CAVI is early developed in middle-age patients with type 2 diabetes mellitus and the arterial stiffness has a negative influence on renal damage. 60 - Chronic kidney disease and nephropathies EAS-0892. INVOLVEMENT OF DDAH-ADMA AXIS IN AKI N. Obaraa, S. Uedaa, S. Yamagishib, Y. Nakayamaa, K. Taguchia, M. Yokoroa, K. Fukamia, S. Okudaa a Division of Nephrology Department of Medicine, Kurume University, Fukuoka, Japan; b Department of Physiology and Therapeutics of Diabetic vascular Complications, Kurume University, Fukuoka, Japan
Objectives: Injury to the renal vasculature plays important roles in the pathogenesis of acute kidney injury (AKI). However, roles of asymmetric dimethylarginine (ADMA), an endogenous inhibitor of nitric oxide synthease, in AKI remain unclear. So, we investigated the kinetics and the roles of ADMA in ischemia/ reperfusion (IR)-injured mice and patients undergoing elective coronary angiography (CAG). Methods: We first examined the kinetics of ADMA, and DDAH-1, a key enzyme for ADMA degradation, levels in the kidney of IR-injured mice. Further, we examined the effects of continuous infusion of ADMA on renal IR injury, and studied whether the IR injury could be attenuated in DDAH-1 transgenic (Tg) mice. Furthermore, we collected blood and urine samples of 52 patients before and after elective CAG at our institution.