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

• Published in: Journal of diabetes and its complications Vol. 34; no. 12; p. 107702
• Main Authors: Kakutani, Yoshinori, Morioka, Tomoaki, Mori, Katsuhito, Yamazaki, Yuko, Ochi, Akinobu, Kurajoh, Masafumi, Fukumoto, Shinya, Shioi, Atsushi, Shoji, Tetsuo, Inaba, Masaaki, Emoto, Masanori
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.12.2020; Elsevier Limited
• Subjects: Age; Albuminuria; Blood pressure; Body mass index; Cardiovascular disease; Cholesterol; Coronary vessels; Creatinine; Diabetes; Endothelial function; Flow-mediated dilatation; Glomerular filtration rate; Insulin; Kidney diseases; Laboratories; Mortality; Population; Regression analysis; Type 2 diabetes; Ultrasonic imaging; Japan; Type 2 diabetes; Albuminuria; Endothelial function; Flow-mediated dilatation; Glomerular filtration rate
• ISSN: 1056-8727; 1873-460X; 1873-460X
• DOI: 10.1016/j.jdiacomp.2020.107702

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. 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). 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. 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. •The association between ACR or eGFR and FMD was investigated in type 2 diabetes.•FMD was impaired in advanced stages of CKD based on eGFR and ACR categories.•ACR, but not eGFR, was independently associated with FMD.•Albuminuria would be a surrogate for endothelial dysfunction in type 2 diabetes.