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

• Seo DH
• Kim SH
• Song JH
• Hong S
• Suh YJ
• Ahn SH
• Woo JT
• Baik SH
• Park Y
• Lee KW
• Kim YS
• Nam M
• on Behalf of the KNDP Study Group

• KMID: 2466505
• DOI: http://doi.org/10.4093/dmj.2018.0186

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

MeSH Terms

Carotid Artery Diseases
Carotid Intima-Media Thickness
Carotid Stenosis
Cohort Studies
Diabetes Mellitus, Type 2*
Diabetic Nephropathies
Discrimination (Psychology)
Follow-Up Studies
Glomerular Filtration Rate
Humans
Logistic Models
Prospective Studies
Risk Factors
ROC Curve

Figure

• 

  Fig. 1 Receiver operating characteristic curve analysis of the models with or without carotid plaque. AUC, area under the curve; CI, confidence interval.

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