Albuminuria rather than glomerular filtration rate is associated with vascular endothelial function in patients with type 2 diabetes

Yoshinori Kakutani; Tomoaki Morioka; Katsuhito Mori; Yuko Yamazaki; Akinobu Ochi; Masafumi Kurajoh; Shinya Fukumoto; Atsushi Shioi; Tetsuo Shoji; Masaaki Inaba; Masanori Emoto

doi:10.1016/j.jdiacomp.2020.107702

Albuminuria rather than glomerular filtration rate is associated with vascular endothelial function in patients with type 2 diabetes

J Diabetes Complications. 2020 Dec;34(12):107702. doi: 10.1016/j.jdiacomp.2020.107702. Epub 2020 Jul 31.

Authors

Affiliations

¹ Department of Metabolism, Endocrinology and Molecular Medicine, Osaka City University Graduate School of Medicine. 1-4-3, Asahi-machi, Abeno-ku, Osaka 545-8585, Japan.
² Department of Metabolism, Endocrinology and Molecular Medicine, Osaka City University Graduate School of Medicine. 1-4-3, Asahi-machi, Abeno-ku, Osaka 545-8585, Japan. Electronic address: m-tomo@med.osaka-cu.ac.jp.
³ Department of Nephrology, Osaka City University Graduate School of Medicine, 1-4-3, Asahi-machi, Abeno-ku, Osaka 545-8585, Japan.
⁴ Department of Premier Preventive Medicine, Osaka City University Graduate School of Medicine, 1-4-3, Asahi-machi, Abeno-ku, Osaka 545-8585, Japan.
⁵ Department of Vascular Medicine, Osaka City University Graduate School of Medicine, 1-4-3, Asahi-machi, Abeno-ku, Osaka 545-8585, Japan; Vascular Science Center for Translational Research, Osaka City University Graduate School of Medicine, 1-4-3, Asahi-machi, Abeno-ku, Osaka 545-8585, Japan.
⁶ Department of Metabolism, Endocrinology and Molecular Medicine, Osaka City University Graduate School of Medicine. 1-4-3, Asahi-machi, Abeno-ku, Osaka 545-8585, Japan; Vascular Science Center for Translational Research, Osaka City University Graduate School of Medicine, 1-4-3, Asahi-machi, Abeno-ku, Osaka 545-8585, Japan.

PMID: 32888790
DOI: 10.1016/j.jdiacomp.2020.107702

Abstract

Aims: Albuminuria and reduced glomerular filtration rate (GFR) are manifestations of diabetic kidney disease and are both shown to be associated with cardiovascular outcomes. However, the differential association of albuminuria and reduced GFR with endothelial dysfunction, an early feature of atherosclerotic vascular damage, remains unclear. In this study, we investigated the association between albuminuria or estimated GFR (eGFR) and flow-mediated dilatation (FMD), a marker of endothelial function, in patients with type 2 diabetes.

Methods: This study included 633 patients with type 2 diabetes. The FMD of the brachial artery was measured by ultrasonography. Albuminuria was evaluated by urinary albumin-to-creatinine ratio (ACR).

Results: The mean FMD and eGFR, and the median value of ACR were 6.7%, 66.5 mL/min/1.73m² and 12.5 mg/g creatinine, respectively. Impaired FMD was found in patients with advanced stages of chronic kidney disease based on both GFR and albuminuria categories. Multivariate analysis after adjusting for potential confounders revealed that ACR, but not eGFR, was significantly and inversely associated with FMD.

Conclusions: Albuminuria is associated with FMD, independently of traditional cardiovascular risk factors in patients with type 2 diabetes. This study suggests a close relationship between albuminuria, rather than reduced GFR, and endothelial dysfunction in type 2 diabetes.

Keywords: Albuminuria; Endothelial function; Flow-mediated dilatation; Glomerular filtration rate; Type 2 diabetes.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Albuminuria / complications
Albuminuria / diagnosis*
Creatinine / urine
Diabetes Mellitus, Type 2* / complications
Endothelium, Vascular / physiopathology*
Glomerular Filtration Rate
Humans
Renal Insufficiency* / complications
Renal Insufficiency* / diagnosis

Substances

Creatinine