Renal Insufficiency Without Albuminuria is Associated with Peripheral Artery Atherosclerosis and Lipid Metabolism Disorders in Patients with Type 2 Diabetes

Aims: A high prevalence of a low glomerular filtration rate (GFR) has recently been reported in patients with diabetes without albuminuria. We aimed to clarify the clinical characteristics of such patients, including the associations between these characteristics and atherosclerosis.

Methods: We investigated the correlations between the estimated GFR (eGFR) and lipid profiles, the ankle-brachial index (ABI) and the intima-media thickness (IMT) in 450 patients with type 2 diabetes without macroalbuminuria.

Results: The prevalence of renal insufficiency (RI) (GFR ＜60 mL/min/1.73 m(2)) in the patients without albuminuria was 19.1%. The ABI values of the patients with RI were significantly lower than those of the patients without RI, regardless of the presence of microalbuminuria, while there were no significant differences in IMT between the patients with and without RI. In a multivariate analysis, a low ABI was found to be significantly associated with a low eGFR, independent of age, sex, smoking, history of hypertension and/or dyslipidemia and duration of diabetes (β=0.134, p=0.013), whereas no significant associations were observed between the ABI and the urinary albumin excretion rate (UAER). The ApoB/LDL-C ratios and levels of ApoC3 were significantly higher in the patients with RI than those observed in the patients without RI, regardless of the presence of albuminuria.

Conclusions: RI without albuminuria is closely associated with atherosclerosis of the peripheral arteries in diabetic patients. Furthermore, alterations in lipid metabolism may underlie this association.