Diabetic patients with chronic kidney disease: Non-invasive assessment of cardiovascular risk

Abstract

The prevalence and burden of diabetes mellitus and chronic kidney disease on global health and socioeconomic development is already heavy and still rising. Diabetes mellitus by itself is linked to adverse cardiovascular events, and the presence of concomitant chronic kidney disease further amplifies cardiovascular risk. The culmination of traditional (male gender, smoking, advanced age, obesity, arterial hypertension and dyslipidemia) and non-traditional risk factors (anemia, inflammation, proteinuria, volume overload, mineral metabolism abnormalities, oxidative stress, etc. ) contributes to advanced atherosclerosis and increased cardiovascular risk. To decrease the morbidity and mortality of these patients due to cardiovascular causes, timely and efficient cardiovascular risk assessment is of huge importance. Cardiovascular risk assessment can be based on laboratory parameters, imaging techniques, arterial stiffness parameters, ankle-brachial index and 24 h blood pressure measurements. Newer methods include epigenetic markers, soluble adhesion molecules, cytokines and markers of oxidative stress. In this review, the authors present several non-invasive methods of cardiovascular risk assessment in patients with diabetes mellitus and chronic kidney disease.

Blood pressure and vascular determinants of glomerular filtration rate decline in diabetic kidney disease

“…Vascular markers have been linked to eGFR decline and to morbidity but most studies focused on individual markers, without exploring whether their predictive values were equal or additive (9)(10)(11)(12). In this cohort of 135 DT2 patients with different degrees of DKD we show that office, 24 h, and central systolic BP, pulse pressure, pulse wave velocity and renal resistive index all correlated with eGFR decline in univariate models, whereas diastolic BP, intima media thickness did not.…”

“…All these drugs have hemodynamic effects, suggesting that vascular factors have an important role in disease progression. Furthermore, elevated blood pressure, pulse pressure, pulse wave velocity, intima media thickness and renal resistive index have all been associated with eGFR decline (eGFR-d); however, the relative contribution of each factor to eGFR-d in the same individual has not been explored in detail, due to a lack of studies that have measured these vascular markers simultaneously (9)(10)(11)(12).…”

Association of a low ankle brachial index with progression to end-stage kidney disease in patients with advanced-stage diabetic kidney disease

“…Previous studies have suggested that the ABI can be used to evaluate pathological changes in patients with diabetic nephropathy [ 9 ]. Patients with CKD are especially prone to complications of atherosclerosis, PAD, calcification of arterial walls, and increased arterial stiffness [ 22 ]. The ABI is used to detect PAD and is a marker of generalized atherosclerosis.…”

Dietary interventions improve diabetic kidney disease, but not peripheral neuropathy, in a db/db mouse model of type 2 diabetes

“…5 DKD is one of the leading causes of end-stage renal disease and a key risk factor for cardiovascular events. 4,6 DPN affects around 50% of individuals with T2D and is a chronic loss of the peripheral nerves that progresses in a distal-to-proximal fashion. 3,7 Loss of sensation in the extremities increases susceptibility to ulcer development and foot infection and can ultimately lead to lower-limb amputation.…”

“…DKD affects 25%–40% of T2D patients and is characterized by increased albuminuria and a subsequent reduction in glomerular filtration rate 5 . DKD is one of the leading causes of end‐stage renal disease and a key risk factor for cardiovascular events 4,6 . DPN affects around 50% of individuals with T2D and is a chronic loss of the peripheral nerves that progresses in a distal‐to‐proximal fashion 3,7 .…”