Toe–brachial index is associated more strongly with albuminuria or glomerular filtration rate than ankle–brachial index in patients with type 2 diabetes

Abstract

The aim of this study was to investigate whether toe-brachial index (TBI) is more strongly associated with albuminuria or estimated glomerular filtration rate (eGFR) than ankle-brachial index (ABI), and thus is a more suitable tool for evaluating the association between peripheral artery disease (PAD) and diabetic nephropathy than ABI in patients with type 2 diabetes. We evaluated the relationships between ABI or TBI and the degree of urinary albumin excretion or eGFR, as well as the major cardiovascular risk factors, in 390 patients with type 2 diabetes. Furthermore, we compared the area under the receiveroperator characteristic curve (AUC) of TBI or ABI for albuminuria or chronic kidney disease (CKD). Low-density lipoprotein cholesterol was negatively associated with ABI. Age and duration of diabetes were negatively associated with TBI, and diastolic blood pressure and high-density lipoprotein cholesterol were positively associated with TBI. Log (urinary albumin excretion) was associated more strongly with TBI (r¼À0.265, Po0.0001) than with ABI (r¼À0.132, P¼0.0111), and eGFR was positively associated with TBI (r¼0.195, P¼0.0002) but not with ABI (r¼0.023, P¼0.6571). The AUCs of TBI for albuminuria (P¼0.0002) and CKD (P¼0.0322) were significantly greater than those of ABI. In conclusion, TBI is associated more strongly with albuminuria and eGFR than ABI in patients with type 2 diabetes. Our study suggests that TBI may be a more suitable tool for evaluating the association between PAD and diabetic nephropathy than ABI in patients with type 2 diabetes.

Pathologic changes of pancreatic endothelial cells in Diabetic Rat

“…The endothelial cells play an important role in many aspects, because it is an important screen between blood and vascular smooth muscle barrier, and can accomplish the metabolism of exchange between blood and tissue fluid, merger secrete a variety of biological active substances and maintain the body's coagulation in keeping the blood vessels blood fibrinolytic system balance, inhibiting platelet aggregation and reducing the endothelial permeability, the adhesion molecule expression and the proliferation vascular smooth muscle cell. More and more research has been found that vascular cell adhesion molecule-1 (VCAM-1), angiogenin (Ang) and its receptor (Tie) in the development of the disease have promoted the angiogenesis, reshaping, maturity and stability [10]. Diabetes is a common metabolic disease around the world.…”

“…In the early, the vascular lesions was damaged, endothelial cell injury and vascular endothelial loss of diastolic function [9,10]. The endothelial cells play an important role in many aspects, because it is an important screen between blood and vascular smooth muscle barrier, and can accomplish the metabolism of exchange between blood and tissue fluid, merger secrete a variety of biological active substances and maintain the body's coagulation in keeping the blood vessels blood fibrinolytic system balance, inhibiting platelet aggregation and reducing the endothelial permeability, the adhesion molecule expression and the proliferation vascular smooth muscle cell.…”

“…The micro vessel disorders, which could result in vascular homeostasis imbalance and vascular dysfunction, is the main causes of morbidity in the diabetic patients [1,2]. Diabetes mellitus is a vascular systemic disease, which can lead to systemic vascular injury, especially pancreatic vascular injury associated with hyperlipidemia.…”

Brachial‐ankle pulse wave velocity, but not ankle‐brachial index, predicts all‐cause mortality in patients with diabetes after lower extremity amputation

“…ABI is known to be a powerful prognostic predictor in various clinical settings [7][8][9] . However, in patients with diabetes, especially in those who had longer durations of diabetes and kidney complications, ABI values are likely to be unreliable because of false elevations or falsely normal values, caused by medial arterial calcification [10][11][12] . Participants in this cohort had long durations of diabetes (mean 21 years), and many cases had kidney dysfunction (Table 1); therefore, the unreliability of ABI values might explain these present results.…”

Toe-Brachial Index in the Second Toe: Substitutability to Toe-Brachial Index in the Great Toe and Ankle-Brachial Index

“…[1][2][3] These patients often show false elevated ankle systolic pressures despite having the highest risk of PAD. For such patients, toe pressure (TP) and toe-brachial index (TBI) measurements have been recommended as more reliable markers than ABI [4][5][6][7][8] because pedal arteries are very slowly affected by calcification than ankle arteries.…”