Arterial stiffness and renal impairment in non‐proteinuric type 2 diabetic patients

Aims/Introduction: Although increases in urinary protein excretion generally precede a decline in the glomerular filtration rate, non‐proteinuric renal impairment is common in patients with diabetes. In the present study, we examined the relationship between indices of arterial stiffness and renal function in type 2 diabetic patients without proteinuria. Methods: Blood sampling, 24‐h urine collection, brachial–ankle pulse wave velocity, and 24‐h ambulatory blood pressure monitoring were performed in type 2 diabetic patients without overt proteinuria. The ambulatory arterial stiffness index was calculated as (1 – the regression slope of diastolic/systolic ambulatory blood pressure). Estimated glomerular filtration rate (eGFR)was calculated using the simplified prediction equation proposed by the Japanese Society of Nephrology. Results: Of 213 non‐proteinuric patients with type 2 diabetes, 60 (28.2%) had a reduced eGFR (<60 mL/min per 1.73 m(2)). Although the urinary albumin excretion rate was significantly correlated with the eGFR, 34 of 152 patients with normoalbuminuria (22.4%) had a reduced eGFR. The eGFR was significantly and negatively correlated with the ambulatory arterial stiffness index and brachial–ankle pulse wave velocity, but not with 24‐h pulse pressure. Multivariate analysis revealed that increased age and increased urinary albumin excretion were independently associated with decreased eGFR. In addition, the ambulatory arterial stiffness index, but not brachial–ankle pulse wave velocity, were found to be independently and significantly associated with eGFR. Conclusions: Ambulatory arterial stiffness index is a marker for increased risk of renal failure in non‐proteinuric patients with type 2 diabetes. (J Diabetes Invest, doi: 10.1111/j.2040‐1124.2011.00146.x, 2012)