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Risk associated with estimated glomerular filtration rate and albuminuria for PAD among patients with type 2 diabetes
  1. Chi-Feng Pan1,2,3,
  2. Shih-Ming Chuang2,3,4,
  3. Kuan-Chia Lin5,6,
  4. Ming-Chieh Tsai3,4,
  5. Wei-Tsen Liao4,
  6. Yi-Hong Zeng3,4,
  7. Chun-Chuan Lee3,4
  1. 1Department of Internal Medicine, Division of Nephrology, Mackay Memorial Hospital, Taipei, Taiwan
  2. 2Mackay Junior College of Medicine, Nursing, and Management, Taipei, Taiwan
  3. 3Department of Medicine, Mackay Medical College, New Taipei City, Taiwan
  4. 4Department of Internal Medicine, Division of Endocrinology and Metabolism, Mackay Memorial Hospital, Taipei, Taiwan
  5. 5Institute of Hospital and Health Care Administration, National Yang-Ming University, Taipei, Taiwan
  6. 6Community Medicine Research Center, Preventive Medicine Research Center, National Yang-Ming University, Taipei, Taiwan
  1. Correspondence to Chun-Chuan Lee, Mackay Memorial Hospital, Number 92, Section 2, Zhongshan North Road, Zhongshan District, Taipei 10449, Taiwan; lee5957.5957{at}mmh.org.tw

Abstract

Chronic kidney disease (CKD) is significantly associated with peripheral arterial disease (PAD) in some studies, but data on the association of the risk of PAD across a broad range of kidney function in patients with type 2 diabetes are limited. Between October 17, 2013 and February 7, 2015, all consecutive outpatients with type 2 diabetes underwent ankle-brachial index (ABI) examination. We investigated the association of estimated glomerular filtration rate (eGFR) and albumin-to-creatinine ratio (ACR) with the risk of PAD. A total of 1254 patients were cross-classified into 12 groups based on ACR category (normoalbuminuria, microalbuminuria and macroalbuminuria) and eGFR stage (≥90, 60–89, 30–59 and <30 mL/min/1.73 m2). Logistic regression analysis was used to investigate the association of eGFR and ACR with PAD. Within each ACR category, a lower eGFR stage was associated with PAD. Similarly, within each eGFR group, a higher ACR category was also associated with PAD. The OR for PAD was highest in patients with eGFR <30 mL/min/1.73 m2 and macroalbuminuria (OR 14.42, 95% CI 4.60 to 45.31) when compared with the reference group of subjects with eGFR ≥90 mL/min/1.73 m2 and normoalbuminuria. Our study found that cross-classification of eGFR with ACR revealed a more comprehensive association with risk of PAD than eGFR or ACR alone.

  • peripheral arterial disease
  • diabetic nephropathies
  • diabetes complications

Data availability statement

The data used to support the findings of this study are available from the corresponding author upon request.

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Data availability statement

The data used to support the findings of this study are available from the corresponding author upon request.

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Footnotes

  • C-FP and S-MC contributed equally.

  • Contributors Conceptualization, C-FP; data curation, M-CT, W-TL and Y-HZ; formal analysis, K-CL; methodology, S-MC; project administration, M-CT; resources, K-CL and M-CT; software, W-TL; supervision, C-CL; validation, Y-HZ; writing—original draft, C-FP and S-MC; Writing—review and editing, C-CL.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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