Relationship Between Estimatedglomerular Filtrationrate And Albuminuria And Atherosclerosis In Elderly Type 2 Diabetic Patients

Objective:Estimated Glomerular filtration rate(eGFR) is a sensitive index to reflect the actual changes in renal hemodynamics, can accurately reflect the renal function.With increasing age and diabetes progresses, eGFR is falling, its decline reflects the degree of glomerular damage. Diabetic nephropathy is the main performance of the diabetic microangiopathy, the development of diabetic nephropathy, The emergence of proteinuria is an important symbol of renal impairment. Atherosclerosis is the most common major vascular complications of patients with T2 DM,carotid intima-media thickness(cIMT) is the ideal indicator of reflect the degree of early atherosclerosis. Thickening of cIMT have independent prediction effect on coronary atherosclerosis, can be a predictors of stroke in patients with diabetes. The study found that eGFR decrease in patients with type 2 diabetes mellitus(T2DM) was associated with the progress of atherosclerosis and cardiovascular disease risk. Also studies have hown that microalbuminuria is an independent risk factors for atherosclerosis and coronary heart disease. How the relationship between the progress of eGFR、proteinuria and carotid artery atherosclerosis? We tested eGFR, UAER and cIMT of 279 cases of elderly patients with T2 DM,and discussed the relationship with the progress of atherosclerosis in elderly patients with T2 DM and its significance. Method:A total of 279 patients whose age is above 60 years were included and the patients’ blood pressure were controlled below 140/90 mmHg.The patients were divided into two groups:cIMT<1.0mm(the no IMT thick group),cIMT≥1.0mm(the thick group).Urinary albumin excretion rates( UAER),Serum creatinine(Cr)、Glycosylated hemoglobin(HbA1c) 、Serum lipid were measured,the clinic medical history were collected. UAER)≥20μg/min was defined as microalbuminuria,eGFR was calculated according to Chinese modified MDRD formula. Results:1. Between 279 patients, the age and the duration of diabetes,the incidence of hypertension, coronary heart disease,cerebrovascular disease of cIMT thickening group were higher than that of cIMT normal group,cIMT thickening group’e GFR significantly decreased compared with cIMT normal group(P<0.05).cIMT thickening group’UAER increased,there was no statistical significance.(P=0.16)2. With the declining of eGFR, cIMT thickness increase gradually(P < 0.05).However, with the increase of UAER, cIMT thickness in stage of normal albuminuria, microalbuminuria, and macroalbuminuria was no significant difference(P>0.05).3. Spearman correlation analysis showed c IMT were positively correlated with age and duration of diabetes(P<0.05); cIMT were negatively Correlated with eGFR(P<0.05). there is no obvious correlation between cIMT and UAER、BMI、FBG、HbA1c、TG、HDL-C、LDL-C.4. Multiple stepwise regression analysis showed, cIMT were positively correlated with age and duration of diabetes and negatively correlated with eGFR. After adjusted for age、diabetes duration,eGFR decline as an independent risk factor for cIMT thickening. Conclusions:The decline of eGFR in elderly patients with type 2 diabetes can be a risk factors of carotid atherosclerosis.