Diabetes Metab J.  2019 Dec;43(6):840-853. 10.4093/dmj.2018.0186.

Presence of Carotid Plaque Is Associated with Rapid Renal Function Decline in Patients with Type 2 Diabetes Mellitus and Normal Renal Function

Affiliations
  • 1Department of Endocrinology and Metabolism, Inha University School of Medicine, Incheon, Korea. namms@inha.ac.kr
  • 2Department of Nephrology and Hypertension, Inha University School of Medicine, Incheon, Korea.
  • 3Department of Biomedical Sciences, Inha University School of Medicine, Incheon, Korea.
  • 4Department of Endocrinology and Metabolism, Kyung Hee University School of Medicine, Seoul, Korea.
  • 5Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea.
  • 6Department of Molecular and Integrative Physiology, University of Illinois at Urbana-Champaign, IL, USA.
  • 7Department of Endocrinology and Metabolism, Ajou University School of Medicine, Suwon, Korea.

Abstract

BACKGROUND
Recent evidences indicate that early rapid renal function decline is closely associated with the development and progression of diabetic kidney disease. We have investigated the association between carotid atherosclerosis and rapid renal function decline in patients with type 2 diabetes mellitus and preserved renal function.
METHODS
In a prospective, multicenter cohort, a total of 967 patients with type 2 diabetes mellitus and preserved renal function were followed for 6 years with serial estimated glomerular filtration rate (eGFR) measurements. Common carotid intima-media thickness (CIMT) and presence of carotid plaque were assessed at baseline. Rapid renal function decline was defined as an eGFR decline >3.3% per year.
RESULTS
Over a median follow-up of 6 years, 158 participants (16.3%) developed rapid renal function decline. While there was no difference in CIMT, the presence of carotid plaque in rapid decliners was significantly higher than in non-decliners (23.2% vs. 12.2%, P<0.001). In multivariable logistic regression analysis, presence of carotid plaque was an independent predictor of rapid renal function decline (odds ratio, 2.33; 95% confidence interval, 1.48 to 3.68; P<0.0001) after adjustment for established risk factors. The model including the carotid plaque had better performance for discrimination of rapid renal function decline than the model without carotid plaque (area under the receiver operating characteristic curve 0.772 vs. 0.744, P=0.016).
CONCLUSION
Close monitoring of renal function and early intensive management may be beneficial in patients with type 2 diabetes mellitus and carotid plaques.

Keyword

Carotid stenosis; Diabetes mellitus, type 2; Diabetic nephropathies
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