Cardiovascular disease biomarkers are associated with declining renal function in type 2 diabetes

Abstract

Aims/hypothesisWe investigated whether biochemical cardiovascular risk factors and/or markers of subclinical cardiovascular disease were associated with the development of reduced renal function in people with type 2 diabetes.MethodsA cohort of 1066 Scottish men and women aged 60–74 years with type 2 diabetes from the Edinburgh Type 2 Diabetes Study were followed up for a median of 6.7 years. New-onset reduced renal function was defined as two eGFRs <60 ml−1 min−1 (1.73 m)−2 at least 3 months apart with a > 25% decline from baseline eGFR. Ankle brachial pressure index (ABI), N-terminal pro-B-type natriuretic peptide (NT-proBNP) and high-sensitivity troponin T (hsTnT) were measured at baseline. Pulse wave velocity (PWV) and carotid intima media thickness were measured 1 year into follow-up. Data were analysed using Cox proportional hazards models.ResultsA total of 119 participants developed reduced renal function during follow-up. ABI, PWV, NT-proBNP and hsTnT were all associated with onset of decline in renal function following adjustment for age and sex. These associations were attenuated after adjustment for additional diabetes renal disease risk factors (systolic BP, baseline eGFR, albumin:creatinine ratio and smoking pack-years), with the exception of hsTnT which remained independently associated (HR 1.51 [95% CI 1.22, 1.87]). Inclusion of hsTnT in a predictive model improved the continuous net reclassification index by 0.165 (0.008, 0.286).Conclusions/interpretationOur findings demonstrate an association between hsTnT, a marker of subclinical cardiac ischaemia, and subsequent renal function decline. Further research is required to establish the predictive value of hsTnT and response to intervention.

Diabetic kidney disease: New clinical and therapeutic issues. Joint position statement of the Italian Diabetes Society and the Italian Society of Nephrology on “The natural history of diabetic kidney disease and treatment of hyperglycemia in patients with type 2 diabetes and impaired renal function”

“…An association with eGFR decline was described also for CVD biomarkers, especially high-sensitivity troponin T [140] and left ventricular ejection fraction [141], possibly reflecting the contribution of chronic cardiac dysfunction to progressive eGFR impairment in the context of type 2 cardio-renal syndrome [142]. In addition, arterial stiffness, a marker of arteriosclerosis, was found to be negatively associated with eGFR [143] and to independently predict eGFR decline [141,144], possibly reflecting the contribution of highly pulsatile pressure and flow to small vessel disease in the kidney [145].…”

Prognostic impact of carotid intima-media thickness and carotid plaques on the development of micro- and macrovascular complications in individuals with type 2 diabetes: the Rio de Janeiro type 2 diabetes cohort study

“…In longitudinal population-based studies, increased CIMT has been associated with progression of albuminuria [22], incident CKD [23] and incident ESRD [36]. However, longitudinal studies in patients with type 2 diabetes are scarce and with opposing findings [20, 21]. A previous study, with 162 individuals followed-up for 6 years, reported that CCA-IMT was associated with renal function deterioration [20]; whereas another study, with 1066 individuals followed-up for 6.7 years, reported no association between CCA-IMT and declining renal function [21].…”

“…On the other hand, although several previous cross-sectional analyses reported associations between carotid atherosclerosis and prevalent microvascular complications in individuals with diabetes [12–19], longitudinal studies evaluating ultrasonographic carotid parameters as predictors of future development and progression of microvascular complications are scarce, mainly related to renal function deterioration, and with opposing findings [20, 21]. In population-based studies, CIMT has been shown to be associated with albuminuria progression [22] and with incident chronic kidney disease [23].…”

Assessment of the Relationship between Carotid Intima-Media Thickening and Early-Stage Diabetic Kidney Disease Coupled with Helicobacter pylori Infection

“…In addition, the severity of DKD has been reported to be positively correlated with CIMT, and DKD should therefore be considered as another probable independent risk factor that contributes to atherosclerosis development [ 27 ]. However, contradictory results in the current literature suggest that patients with DKD do not have increased CIMT, particularly so in patients with early-stage DKD [ 12 ]. Consistent with these results, no association was found between early-stage DKD and CIMT in our study.…”

“…However, results contradictory to the observations have also been reported. There have been several epidemiological reports suggesting no associations between DKD and CIMT [ 12 , 13 ]. This is particularly true in the relationship between early-stage DKD and CIMT [ 14 ].…”