The Relationship Between Ankle-Brachial Index And Chronic Kidney Disease In Type 2 Diabetic Patients

Objective To discuss the prevalence of abnormal ankle-brachial index(ABI)in patients who have type 2 diabetes and diabetic chronic kidney diseases,and the correlation between ABI and early-stage chronic kidney disease in type 2 diabetic patients independent of albuminuria.Methods A retrospective analysis of the clinical data collected from 708 type 2diabetic patients in the Department of Endocrinology,Anhui Provincial Hospital,during the period June 2015 through June 2016.According to the e GFR(estimated glomeruar filtration rate calculated by the Ruijin Formula as a reference),we divided the total amount of patients into three groups – normal renal function group(Group A)containing 295 cases of patients;mild renal impairment group(Group B)containing304 cases of patients and moderate to severe renal impairment group(Group C)containing 109 cases of patients.Within the whole group,395 patients who had normal urinary albumin creatinine ratio with e GFR ≥ 60 ml/(min*1.73m2)were also divided into two groups: Group D e GFR ≥90 ml/(min*1.73m2)containing 235 cases of patients and Group E e GFR ≥ 60 and<90 ml/(min*1.73m2)containing 160 cases of patients.To observe and analyze prevalence of abnormal ankle-brachial index(ABI)among the groups and the correlation between ABI and early-stage chronic kidney disease without albuminuria.Results(1)Comparison of clinical data between three groups of diabetic patients:(1)Data on gender,body mass index(BMI),glycosylated hemoglobin(Hb A1c),low density lipoprotein cholesterol(LDL-C),total cholesterol(TC),triglyceride(TG)had no statistical significance(P value > 0.05).(2)Compared with Group A,Group B and Group C contains patients with older ages,longer disease duration,significantly higher level of urinary albumin to creatinine ratio(UACR),serum creatinine(Scr),blood urea nitrogen(BUN),serum uric acid(UA)and higher prevalence of hypertension(HBP),coronary heart disease(CHD),cerebral infarction(CI)and diabetic retinopathy(DR)(P value<0.05),except for a significantly lower level of fasting blood glucose(FBG)(P value<0.05).Group B had significantly lower proportion of smoking(P value<0.05).Group C had significantly higher prevalence of diabetic peripheral neuropathy(DPN)(P value < 0.05).The data on DPN had no statistically significant difference between Group A and Group B(P value > 0.05).The data on smoking had no statistically significant difference between Group A and Group C(P value>0.05)(3)Compared with Group B,Group C contain patients with older ages,longer disease duration,significantly higher UACR,Scr,BUN,UA,smoking and prevalence of HBP,CHD,DPN,and DR(P value<0.05).There was no statistical significance in comparing data on FBG and CI(P value>0.05).(2)The prevalence of abnormal ABI in patients with type 2 diabetes and diabetic chronic kidney diseases: The prevalence of abnormal ABI was 24.3 percent of 708 cases.Compared with Group A(11.5%).Group B and Group C had significantly higher prevalence of abnormal ABI(26.0%,54.1% respectively P<0.05);And compared with Group B,Group C had a significantly higher prevalence of abnormal ABI(P<0.05).(3)The relationship between ABI and early-stage chronic kidney disease in type 2diabetic patients with normoalbuminuria:The prevalence of abnormal ABI in type 2 diabetic patients who also had early-stage chronic kidney disease without albuminuria was 15.4%.Compared with Group D,Group E had significantly higher prevalence of abnormal ABI(P < 0.05.Logistic regression analysis showed that abnormal ABI was an independent risk factor that resulted in e GFR decline.Before adjusting e GFR related factors,abnormal ABI was associated with a 2.6 fold risk of early-stage chronic kidney disease compared with normal ABI(P=0.001,OR=2.645),and also kept associated with an approximate 2.1fold risk of early-stage chronic kidney disease after adjusting e GFR related factors(P=0.027,OR=2.074).ConclusionsWith the declining of glomerular filtration rate,type 2 diabetic patients’ age,disease duration,level of UACR,Scr,BUN,UA and the prevalence of HBP,CHD and DR significantly increased.At the same time,the incidence of ABI abnormalities with renal dysfunction increased gradually;therefore,abnormal ABI is closely associated with renal function decrease.The tendency also exist in type 2 diabetic patients with early-stage chronic kidney disease independent on albuminuria.Abnormal ABI is an independent risk factor of early renal function decline.