Risk Factors Associated with Arterial Stiffness in Diabetic Nephropathy in an Asian Population Cohort

Authors

  • Lim Su Chi Department of Medicine, Khoo Teck Puat Hospital, Singapore
  • Phua E Joo Department of Medicine, Khoo Teck Puat Hospital, Singapore
  • Sharon F Nne Diabetes Clinic, Khoo Teck Puat Hospital, Singapore
  • Amizah B Asrap Clinical Research Unit, Khoo Teck Puat Hospital, Singapore
  • Wong DS Melvin Clinical Research Unit, Khoo Teck Puat Hospital, Singapore
  • Tan SH Clara Clinical Research Unit, Khoo Teck Puat Hospital, Singapore
  • Liu J Jun Clinical Research Unit, Khoo Teck Puat Hospital, Singapore
  • Toy W Ching Clinical Research Unit, Khoo Teck Puat Hospital, Singapore
  • Ng X Wei Clinical Research Unit, Khoo Teck Puat Hospital, Singapore
  • Lau PX Dawn Clinical Research Unit, Khoo Teck Puat Hospital, Singapore
  • Pek LT Sharon Clinical Research Unit, Khoo Teck Puat Hospital, Singapore
  • Woon Kaing Clinical Research Unit, Khoo Teck Puat Hospital, Singapore
  • Lin LF Bernice Clinical Research Unit, Khoo Teck Puat Hospital, Singapore
  • S Tavintharan Department of Medicine, Khoo Teck Puat Hospital, Singapore
  • Sum C Fang Department of Medicine, Khoo Teck Puat Hospital, Singapore

Abstract

Introduction. Individuals with diabetic nephropathy (DN) are at risk for cardiovascular disease. Arterial stiffness summarizes an individual’s global cardiovascular risk burden. We investigated the relationship between major modifiable metabolic risk factors (excluding blood pressure) and arterial stiffness DN. Methods. Cross sectional study of 353 Diabetic Asians with Modified Diet to retard Renal Disease (MDRD) formula estimated glomerular filtration rate (eGFR) <90 mls/min/1.73m2. Central Aortic Systolic Pressure (CASP), a surrogate measurement of arterial stiffness, was estimated using validated BPro A-PulseTM tonometry. Visceral fat area (VFA) was estimated by tetrapolar multi-frequency bio-impedence. Results. Study population: 61% male, 9% current smoker, 84% receiving lipid lowering therapy and 45% taking insulin. Mean age(SD) was 61(9) year, CASP 130.0(21.4) mmHg, HBA1c 8.1(1.7)%, eGFR 50.1(26.8) mls/min/1.73m2, urinary albumin-creatinine ratio (ACR) 662(1339) mg/g, LDL 2.67(0.92) mM, VFA 130.0(31.9) cm2.  After adjusting for age, gender, ethnicity and smoking status, eGFR (β coefficient=-0.13) and HBA1c (1.66) remained as significant independent predictors of CASP (P<0.05). However, all the tested modifiable risk factors collectively explained only ~10% of variation in CASP. Conclusion. GFR and HBA1c are modifiable predictive factors for arterial stiffness in DN. However, our results suggested the presence of undiscovered novel risk factors.

Downloads

Download data is not yet available.

References

. Ethnic disparities in diabetic complications in an insured population. JAMA. 2002;287:2519-2527.

. FC Sasso. Cardiovascular risk factors and disease management in type 2 diabetic patients with diabetic nephropathy. Diabetes Care. 2006;29:498–503.

. P Cravedi and G Remuzzi. Treating the kidney to cure the heart. Kidney International. 2008;74(111):S2–S3.

. T Nakagawa, K Tanabe, BP Croker, et al. Endothelial dysfunction as a potential contributor in diabetic nephropathy. Nat. Rev. Nephrol. 2011;7:36–44.

. S Laurent, J Cockcroft, LV Bortel, et al. Non-invasive investigation of large arteries expert consensus document on arterial stiffness: methodological issues and clinical applications. European Heart Journal. 2006;27:2588–2605.

. X Wang, J C Keith Jr., AD Struthers, GZ Feuerstein. Assessment of arterial stiffness, a translational medicine biomarker system for evaluation of vascular risk. Cardiovascular Therapeutics. 2008;26:214–223.

. B Williams, PS Lacy, P Yan, CN Hwee, C Liang, CM Ting. Development and validation of a novel method to derive central aortic systolic pressure from the radial pressure waveform using an N-point moving average method. J. Am. Coll. Cardiol. 2011;57:951–961.

. CDA Stehouwer, RMA Henry, I Ferreira. Arterial stiffness in diabetes and the metabolic syndrome: a pathway to cardiovascular disease. Diabetologia. 2008;51:527–539.

. SS DeLoach and RR Townsend. Vascular stiffness: Its measurement and significance for epidemiologic and outcome studies. Clin. J. Am. Soc. Nephrol. 2008;3:184–192.

. RA Chudleigh. How reliable is estimation of glomerular filtration rate at diagnosis of type 2 diabetes? Diabetes Care. 2007;30:300–305.

. N Rognant. Performance of the chronic kidney disease epidemiology collaboration equation to estimate glomerular filtration rate in diabetic patients. Diabetes Care. 2011;34:1320–1322.

. LA Stevens. Assessing kidney function — measured and estimated glomerular filtration rate. N. Engl. J. Med. 2006;354:2473-2483.

. B Williams, PS Lacy, P Yan, CN Hwee, C Liang, CM Ting. Development and validation of a novel method to derive central aortic systolic pressure from the radial pressure waveform using an N-point moving average method. J. Am. Coll. Cardiol. 2011;57:951–961.

. M Nagai, H Komiya, Y Mori, T Ohta, Y Kasahara, YIkeda. Estimating visceral fat area by multifrequency bioelectrical impedance. Diabetes Care. 2010;33:1077–1079.

. SM Moe, NX Chen. Mechanisms of vascular calcification in chronic kidney disease. J. Am. Soc. Nephrol. 2008;19: 213–216.

. JF Navarro-González, C Mora-Fernández, MM de Fuentes, J García-Pérez. Inflammatory molecules and pathways in the pathogenesis of diabetic nephropathy. Nat. Rev. Nephrol. 2011;7:327–340.

. G Remuzzi, N Perico, M Macia, P Ruggenenti. The role of renin-angiotensin-aldosterone system in the progression of chronic kidney disease. Kidney International. 2005;68(99):S57–S65.

. J Schnermann and JP Briggs. Tubuloglomerular feedback: mechanistic insights from gene-manipulated mice. Kidney International. 2008;74:418–426.

. ND Toussaint and PG Kerr. Vascular calcification and arterial stiffness in chronic kidney disease: Implications and management. Nephrology. 2007;12:500–509.

. SVD Zee, U Baber, S Elmariah, J Winston, V Fuster. Cardiovascular risk factors in patients with chronic kidney disease. Nat. Rev. Cardiol. 2009;6:580–589.

. ME Nahas. Cardio-Kidney-Damage: A unifying concept. Kidney International. 2010;78:14–18.

. AOY Luk. Metabolic syndrome predicts new onset of chronic kidney disease in 5,829 patients with type 2 diabetes: A 5-year prospective analysis of the Hong Kong diabetes registry. Diabetes Care. 2008;31:2357–2361.

. G Bakris. National kidney foundation consensus conference on cardiovascular and kidney diseases and diabetes risk: an integrated therapeutic approach to reduce events. Kidney International. 2010;78:726–736.

. BF Schrijvers, AS De Vriese, A Flyvbjerg. From Hyperglycemia to diabetic kidney disease: the role of metabolic, hemodynamic, intracellular factors and growth factors/cytokines. Endocr. Rev. 2004;25(6):971–1010.

. M Brownlee. Biochemistry and molecular cell biology of diabetic complications. Nature. 2001; 414(6865):813-820.

. SW Zarich. Antidiabetic agents and cardiovascular risk in type 2 diabetes. Nat. Rev. Endocrinol. 2009;5:500–506.

. KK Ray, SRK Seshasai, S Wijesuriya, et al. Effect of intensive control of glucose on cardiovascular outcomes and death in patients with diabetes mellitus: a meta-analysis of randomised controlled trials. Lancet. 2009; 373: 1765–1772.

. BCF Rosuvastatin. Cardiovascular events in patients undergoing hemodialysis. N. Engl. J. Med. 2009;360:1395-1407.

. Baigent C, Landray MJ, Reith C et al. SHARP Investigators. The effects of lowering LDL cholesterol with simvastatin plus ezetimibe in patients with chronic kidney disease (Study of Heart and Renal Protection): a randomised placebo-controlled trial. Lancet. 2011 ;377:2181-92.

. BC Astor, K Matsushita, RT Gansevoort, et al. The chronic kidney disease prognosis consortium lower estimated glomerular filtration rate and higher albuminuria are associated with mortality and end-stage renal disease: A collaborative meta-analysis of kidney disease population cohorts. Kidney International. 2011;79:1331–1340.

. H Haller. Olmesartan for the delay or prevention of microalbuminuria in type 2 diabetes. N. Engl. J. Med. 2001;364:907-917.

. Asselbergs FW, Diercks GF, Hillege HL et al. Effects of fosinopril and pravastatin on cardiovascular events in subjects with microalbuminuria. Circulation. 110:2809–2816, 2004

. A Chudyk. Effects of exercise on cardiovascular risk factors in type 2 diabetes: a meta-analysis. Diabetes Care. 2011;34:1228-1237.

. F Kronenberg. Emerging risk factors and markers of chronic kidney disease progression. Nat. Rev. Nephrol. 2009;5: 677–689.

Downloads

Published

2014-05-28

How to Cite

Su Chi, L., Joo, P. E., F Nne, S., Asrap, A. B., Melvin, W. D., Clara, T. S., … Fang, S. C. (2014). Risk Factors Associated with Arterial Stiffness in Diabetic Nephropathy in an Asian Population Cohort. Journal of the ASEAN Federation of Endocrine Societies, 26(2), 163. Retrieved from https://asean-endocrinejournal.org/index.php/JAFES/article/view/89

Issue

Vol. 26 No. 2 (2011): November Issue

Section

Original Articles

License

Journal of the ASEAN Federation of Endocrine Societies is licensed under a Creative Commons Attribution-NonCommercial 4.0 International. (full license at this link: http://creativecommons.org/licenses/by-nc/3.0/legalcode).

To obtain permission to translate/reproduce or download articles or use images FOR COMMERCIAL REUSE/BUSINESS PURPOSES from the Journal of the ASEAN Federation of Endocrine Societies, kindly fill in the Permission Request for Use of Copyrighted Material and return as PDF file to jafes@asia.com or jafes.editor@gmail.com.

A written agreement shall be emailed to the requester should permission be granted.