Absent or diminished pedal pulses and estimated GFR decline in patients with diabetic kidney disease

Autor: Michael S. Simonson, Laure Sayyed Kassem, Nivetha Subramanian, Jennifer Xu, Niraj Desai
Jazyk: angličtina
Rok vydání: 2019
Předmět:
Male
renal failure
medicine.medical_treatment
030232 urology & nephrology
Disease
Type 2 diabetes
030204 cardiovascular system & hematology
Critical Care and Intensive Care Medicine
Kidney
0302 clinical medicine
Risk Factors
Medicine
Longitudinal Studies
Prospective Studies
Aged
80 and over
General Medicine
Middle Aged
Nephrology
Cardiology
Disease Progression
Pedal pulses
Female
type 2 diabetes
medicine.symptom
Glomerular Filtration Rate
Adult
medicine.medical_specialty
Renal function
03 medical and health sciences
Peripheral Arterial Disease
Internal medicine
CKD
Humans
In patient
cardiovascular diseases
Renal Insufficiency
Chronic
Vascular Patency
Aged
business.industry
Critical limb ischemia
medicine.disease
Diseases of the genitourinary system. Urology
body regions
Logistic Models
Amputation
Diabetes Mellitus
Type 2
Multivariate Analysis
Clinical Study
RC870-923
business
Complication
Biomarkers
Zdroj: Renal Failure
Renal Failure, Vol 41, Iss 1, Pp 691-697 (2019)
ISSN: 1525-6049
0886-022X
Popis: Background: Peripheral artery disease (PAD) is a complication of type 2 diabetes that leads to critical limb ischemia and amputation. We tested whether absent or diminished pedal pulses (ADPPs) predicts subsequent renal functional decline in patients with diabetic chronic kidney disease (CKD). We also examined the association between urinary biomarkers and ADPP as well as worsening CKD. Methods: Using a prospective longitudinal design, we studied 91 patients with type 2 diabetes and estimated glomerular filtration rate (eGFR) from 7 to 146 mL/min/1.73 m2. Baseline pedal pulses were assessed by standardized history and physical examination. The primary endpoint was decline in eGFR >30%. Potential confounders of the relationship between pedal pulses and eGFR were assessed by multivariable logistic regression. Results: Of 91 participants (median age 58 (range 30–83); median eGFR 72.4 ± 33.4 mL/min/1.73 m2), 43% had at least one ADPP. Baseline ADPP associated with increased risk of greater than 30% decline in eGFR (OR= 3.67, p = .004). This association remained significant (OR = 3.09, p = .029) after adjustment for traditional risk factors of renal function decline in diabetic kidney disease (DKD). In addition, urinary endothelin-1 (ET-1) was higher among patients with ADPP (p =.0006) and associated with eGFR decline greater than 30% (adjusted OR = 1.81, p = .035). Conclusions: ADPP is a strong predictor of decline in renal function in type 2 diabetes. Patients with type 2 diabetes and abnormal pedal pulses should be screened for DKD and monitored closely for progression of CKD.
Databáze: OpenAIRE
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