Diabetic Nephropathy And Noninvasive Indices Of Arterial

Object: Investigate the relationship between the progress of diabetic nephropathy and macrovascular disease to evaluate the significance of different noninvasive vascular examinations in progression of diabetic nephropathy.Methods: 113 patients with type 2 diabetes were divided into 4 groups according to urinary microalbumin and serum creatinine as follow: Group A, 42 diabetic patients without nephropathy (DM); Group B, 48 diabetic patients with microalbumin (Early DN); Group C, 11 patients in clinical stage of diabetic nephropathy (DN); Group D, 13 patients in renal failure stage of diabetic nephropathy (DNF). Serum biochemical parameters and 24h urinary albumin were determined, as well as intimal plus media thickness (IMT) of carotid arterial wall, Ankle/Brachium Index (ABI), brachial ankle pulse wave velocity ((baPWV) and renal artery resisitance index (RI ).Results:(1)Compared to the incidence rate of the lower limb pathological changes in diabetic patients without nephropathy group (DM, Group A, 17.1%), it was increased significantly (χ2 = 7.380, P=0.007) in diabetic nephropathy group (DN, Group B,C,D, 41%).(2)ABI in Group C and D was lower than Group A and B remarkably (P<0.05). With ABI=0.9 as boundary, logistic regression analysis showed that the risk of the lower limb pathological changes in DN (B,C,D) was only correlated with age (P=0.045) and systolic blood pressure(SBP) (P=0.033), while it was not significantly correlated with abuminuria,(3)BaPWV and IMT in DN Groups (B,C,D) were significantly higher than in DM group (A). Logistic regression analysis suggested that stage of the disease, SBP, LDL-c and eGFR are the risk factors of higher IMT, stage, urinary albumin and renal artery resistance index (RI) are the risk factors of higher BaPWV. With urinary ablumin(UALB)=30 mg/24h as boundary,logistic regression analysis on Group A and B showed that stage, age, BaPWV and HbA1c are the relative risk factors of UALB.(4)RI in group B,C, D was higher remarkably than in group A. With RI=0.72 as boundary in DN group (B, C, D), logistic regression analysis revealed that UALB and BaPWV are the risk factors of lower RI.Conclusions:(1)The incidence rate or lower limb pathological changes in DN group (B, C, D) is significantly higher than in DM group (A).(2)Correlated to urinary albumin, renal artery resistance index ( RI) is a good index of judging atherosclerosis, which can be used to identify, evaluate and access the diabetic nephropathy and renal function.(3)ULAB is independently correlated with BaPWV and IMT after calibrating of age, gender, BMI, heart beat, blood pressure, blood glucose, lipid and HbA1c. BaPWV and IMT are ideal tools to evaluate macrovascular disease and cardiovascular risk in DM and different-stage DN.