The Relationship Between Low Ankle Brachial Index And Chronic Kidney Disease In2Diabetic Patients

Part One:The prevalence of low ankle brachial index at different stages of chronic kidney disease with type2diabetesAbstractObjectiveTo investigate the prevalence of low ankle brachial index (ABI) in type2diabetic patients staying at different stages of chronic kidney disease.MethodsThe cross-sectional study enrolled1017type2diabetic patients. The patients were stratified into five groups according to the CKD-EPI eGFR level(mL/min/1.73m2):stagel CKD with eGFR level>90, stage2CKD with eGFR level of60-89, stage3CKD with eGFR level of30-59, stage4CKD with eGFR level of15-29, stage2CKD with eGFR level<15. We investigated the prevalence of low ABI (defined as ABI<0.9) at the different stages of CKD in type2diabetic patients. Patients with normoalbuminuria were defined as urinary albumin excretion rate (UAER)<30mg/24h. The prevalence of low ABI in type2diabetic patients with normoalbuminuria was also observed. ResultsThe prevalence of chronic renal insufficiency(eGFR<60mL/min/1.73m2) in the whole type2diabetic patients was7.3%, and the prevalence of low ABI was24.3%.Compared with type2diabetic patients staying at stag1CKD(19.8%) with or without albuminuria, the prevalence of low ABI in the patients staying at stage2-3CKD was higher (30.5%,42.9%,54.5%respectively, P<0.01). This tendency also existed in the type2diabetic patients with normoalbuminuria. The prevalence of low ABI in the type2diabetic patients with normoalbuminuria staying at stag1-3CKD were respectively20%,28.1%,44.4%.ConclusionsWith the declining of renal function, the prevalence of the low ABI was higher in type2diabetic patients with or without albuminuria. The prevalence of low ABI reached up to28%in type2diabetic patients staying at stage2CKD without albuminuria. This suggested the importance to further explore the role of low ABI in type2diabetic patients with early-stage CKD independent of albuminuria. Part Two:Low ankle brachial index is associated with early-stage chronic kidney disease in type2diabetic patients independent of albuminuriaAbstractObjectiveThe role of low ankle-brachial index (ABI) in early-stage chronic kidney disease (CKD) is not fully known. This study is designed to investigate the prevalence of low ABI in early-stage CKD defined as an estimated glomerular filtration rate (eGFR) between60-89ml/min/1.73m2of type2diabetic patients without albuminuria and to determine the association between the low ABI and mildly decreased eGFR.MethodsThe cross-sectional study enrolled448type2diabetic patients with normoalbuminuria. The patients were stratified into two groups according to the CKD-EPI eGFR level:the normal group with eGFR level>90mL/min/1.73m2and the lower group with eGFR of60-89. ABI was categorized as normal (1.0-1.39), low-normal (0.9-0.99), and low (<0.9). Both stepwise forward multiple linear regression and binary logistic regression analyses were performed to examine the association between ABI categories and eGFR level and to assess the relation of low ABI and early-stage CKD.ResultsThe prevalence of low ABI at early-stage CKD of type2diabetic patients without albuminuria was39.5%. Low ABI was associated with an approximate3-fold greater risk of early-stage CKD in bivariate logistic regression analysis, and remained significantly associated with a2.2fold risk (95%confidence interval:1.188-4.077; P=0.012) after adjusting traditional chronic kidney disease risk factors.ConclusionsThere was a high prevalence of low ABI in early-stage CKD patients of type2diabetes who have normoalbuminuria and a close relation between low ABI and early-stage CKD, suggesting that we should pay much more attention to the patients who have only mildly decreased eGFR and normoalbuminuria but have already had a low ABI in clinic work and consider the preventive therapy at early stage.