Carotid Intima-Media Thickness and Visit-to-Visit HbA1c Variability Predict Progression of Chronic Kidney Disease in Type 2 Diabetic Patients with Preserved Kidney Function

Abstract EN

Background/Aims.

Subclinical atherosclerosis and long-term glycemic variability have been reported to predict incident chronic kidney disease (CKD) in the general population.

However, these associations have not been investigated in patients with type 2 diabetes with preserved kidney function.

Methods.

We prospectively followed up 162 patients with type 2 diabetes (mean age, 62.3 years; 53.6% men) and assessed whether carotid intima-media thickness (IMT) measured by B-mode ultrasound and visit-to-visit HbA1c variability are associated with deterioration of CKD (incident CKD defined as estimated GFR [eGFR] < 60 mL/min/1.73 m2 and progression of CKD stages) over a median follow-up of 6.0 years.

At baseline, 25 patients (15.4%) had CKD.

Cox proportional hazards regression models were used for identifying associated factors of CKD deterioration.

Results.

Estimated GFR decreased from 75.8±16.3 to 67.4±18.2 mL/min/1.73 m2 (p<0.01).

Of 162 patients, 32 developed CKD and 8 made a progression of CKD stages.

Multivariate Cox regression analysis revealed that carotid IMT (HR: 4.0, 95% CI: 1.1–14.226.7, and p=0.03) and coefficient of variation of HbA1c (HR: 1.12, 95%: 1.04–1.21, and p=0.003) were predictors of deterioration of CKD independently of age, mean HbA1c, urinary albumin/creatinine ratio, baseline eGFR, uric acid, and leucocyte count.

Conclusions.

Subclinical atherosclerosis and long-term glycemic variability predict deterioration of chronic kidney disease (as defined by incident or worsening CKD) in type 2 diabetic patients with preserved kidney function.