Early marker of renal decline discovered in diabetes patients

Arterial stiffness, as measured by aortic pulse wave velocity (Ao-PWV), was an early marker of renal function decline in patients with type 2 diabetes younger than 60 years, according to the results of a study published recently in The Journal of the American Heart Association.

“Diabetes is a leading cause of end stage renal disease,” study researcher Janaka Karalliedde, MRCP, PhD, clinical senior lecturer in the cardiovascular division, faculty of life science and medicine, at King's College in London, told Medical Economics. “There is a need to identify early risk markers that predict renal function decline in patients with type 2 diabetes. “

Based on the results of this study, measurement of Ao-PWV may help to “identify patients at high risk of renal function decline,” Karalliedde added.

The prospective single-center study was designed to evaluate whether Ao-PWV could predict glomerular filtration rate (eGFR) decline in patients with type 2 diabetes. This study included 211 patients with type 2 diabetes and an eGFR of 45 mL/min or greater. At baseline, patients had a mean age of 60.1 years, with 117 patients older than the mean and 94 patients younger than the mean. The primary endpoint was reaching a final eGFR below the median for the age group and an eGFR fall of 1 mL/min or greater per year.

With a median follow-up of 9 years, about half of patients in each age group achieved the primary endpoint of progression. In older patients, those who progressed had significantly higher body mass index, higher urine albumin to creatinine ratio (ACR), and lower baseline eGFR compared with those who did not progress. In patients aged older than 60, Ao-PWV was similar in those who did or did not achieve the primary endpoint.

“Increased arterial stiffness, an index of vascular aging, predicted renal function decline in younger patients with type 2 diabetes,” Karalliedde said.

Next: Results for patients younger than 60

In patients younger than 60, those who progressed had significantly longer duration of diabetes, higher prevalence of hypertension, higher systolic blood pressure, urine ACR, and lower EGFR at baseline. In addition, in younger patients, those who achieved the primary endpoint had a higher Ao-PWV at baseline compared with those who did not (10.8 m/s vs. 9.5 m/s; P=.007).

Ao-PWV was an independent predictor of the primary endpoint, even after adjustment for traditional risk factors only in younger patients (P=.02). Specifically, in younger patients, each 1 m/s increase in Ao-PWV was associated with a mean decrease in eGFR of 2.1 mL/min per year independent of other risk factors (P=.04)

According to Karalliedde, these results were surprising because arterial stiffness predicted renal function decline only in younger patients with relatively preserved renal function.

“Arterial stiffness may be a marker that predicts renal function decline in type 2 diabetes mellitus and potential treatment target to delay progression of renal disease in type 2 diabetes mellitus,” Karalliedde said.