Relationship Between Diabetic Kidney Disease And Peripheral Artery Disease In The Patients With T2DM

ObjectiveDiabetic kidney disease (DKD) and peripheral artery disease(PAD) are the common chronic diabetic complications and related to the morbidity and mortality of diabetes. The urine albumin excretion and ankle brachial index (ABI) are used widely to diagnosis of DKD and PAD, we evaluate the relationship between ABI and urine albumin/creatinine (Alb/Cr) and analysize related risk factors of these two diabetic complications .MethodsAll the data from the diabetic complications assessment database from the diabetes center of 306 hospital , which was set up since 1993 and includes more than 12000 patients so far. In this study, 4031 patients with type 2 diabetes finished the diabetic complication assessment were divided into different groups based on the ankle-brachial index (ABI) and albuminuria. The prevalence and related risk factors of PAD and DKD were investigated . ResultsIn all 4031 patients (male:female , 2176:1855), the age range from 13-88 yrs(x±s, 56.0±11.2),median 56 yrs. The diabetic duration range from 1-480 months( x±s ,62.2±64.9),median 36.1.We divided all patients into three subgroups: normal albuminuria (Alb/Cr<30mg/g, n=2969),micro-albuminuria (30≤Alb/Cr <300mg/g, n=967), clinical albuminuria(Alb/Cr≥300 mg/g, n=95). The prevalence of DKD was 26.35%.Compared to abnormal albuminuria groups, the normal albuminuria group was younger with less duration, lower PBG and HbA1c, lower TC and TG, lower BUN, Cr, UA and higher A/G (P<0.05or 0.01). The micro-albuminuria group with less duration, lower HbA1c, lower TG and TC, lower BUN, Cr, UA and higher A/G than clinical albuminuria group. Prevalence of abnormal ABI was 14.55%, 21.92% and 28.42% in the normal, micro- and clinical albuminuria. There were significantly differences in the abnormality rates of ABI, lying-systolic and diastolic blood pressure(P<0.05 or 0.01) among these three groups2. In all 4031 patients(ABI≤0.9 :ABI>1.3: 0.9<ABI≤1.3,251: 464: 3316), prevalence of abnormal ABI (≤0.9 or > 1.3)was 17.73%. Abnormal ABI groups are older with longer duration, higher BMI, HbA1C, BUN and UA,lower ALT and A/G. The calcified sclerosis rate of lower extremity artery (ABI>1.3) is higher for male than female. Prevalence of DKD were 23.79%, 41.43% and 30.60% in the patients with normal ABI, ABI≤0.9 and ABI>1.3. The abnormal ABI groups are different from normal ABI group in urine Alb/Cr, serum albumin, creatinine, incidence of DKD,L-SBP, S-DBP,LS-DBP ,and so on. ABI>1.3 group is similar to 0.6<ABI<=0.9 group in urine Alb/Cr, serum albumin, creatinine and prevalence of DKD.3.Multiple variables analysis showed that age, duration of diabetes, abnormal ABI ,BMI, supine systolic blood pressure and diastolic blood pressure, postprandial blood glucose,HbA1C, albumin, A/G, triglyceride, HDL-C, creatinine and urea nitrogen were risk factors with DKD. Age, sex, abnormal albuminuria,BMI, orthostatic systolic blood pressure and diastolic blood pressure, fasting blood glucose, total protein, albumin, total cholesterol, LDL-C and serum creatinine were independent risk factors associated with peripheral artery disease. ConclusionThere are common risk factors for the PAD and DKD such as hyperglycemia, hypertension, hyperlipemia. PAD prevalence increases with higher albuminuria, DKD prevalence increases with the severity of ABI abnormity,the more severe DKD, the more severe PAD. Both of DKD and PAD should be screened and treated as earlier as possible for decreasing the morbidity and mortality of DM.