Estimated Glomerular Filtration Rate < 60 mL/min/1.73 m^2 is Associated With Abnormal Ankle- and Toe-Brachial Index in Type 2 Diabetes Mellitus

10.6221/AN.202409_38(3).0004

Bi-Ju Su；Pei-Yu Wu；Jiun-Chi Huang；Mei-Yueh Lee；Szu-Chia Chen；Jer-Ming Chang

diabetes mellitus ； peripheral arterial occlusive disease ； ankle-brachial index ； toe-brachial index ； estimated glomerular filtration rate

Acta Nephrologica

38卷3期（2024 / 09 / 01）

167 - 180

英文

BACKGROUND: Diabetes mellitus (DM) is associated with many complications including cardiovascular disease, nephropathy, neuropathy, retinopathy and peripheral arterial occlusive disease (PAOD). Ankle-brachial index (ABI) and toe-brachial index (TBI) are used to detect PAOD, which were cost-effective and non-invasive. The patients with chronic kidney disease have higher prevalence of developing PAOD. The aim of our study is to understand the correlation between estimated glomerular filtration rate (eGFR) < 60 mL/min/1.73 m^2 with ABI < 0.9, and TBI < 0.65 and further survey the risk factors for ABI < 0.9 and TBI < 0.65 in different subgroup (eGFR ≥ 60 and < 60 mL/min/1.73 m^2) in type 2 DM patients. METHODS: Patients with type 2 DM who visited the Endocrinology and Metabolism outpatient department of the Southern Taiwan medical center between February 2022 and May 2022 were included in the study. The ABI and TBI measurements were done once for each patient. PAOD was defined as ABI < 0.9 or TBI below 0.65 in either leg. RESULTS: The mean age of 374 type 2 DM patients was 67.3 ± 11.0 years. The prevalence of ABI < 0.9 and TBI < 0.65 were 10.2% and 28.3%, respectively. After multivariable adjustment, eGFR < 60 mL/min/1.73 m^2 (odds ratio [OR] = 2.560; 95% confidence interval [CI] = 1.028-6.375; P = 0.043) was significantly associated with ABI < 0.9 in all study patients. Besides, eGFR < 60 mL/min/1.73 m^2 (OR = 2.158; 95% CI = 1.263-3.688; P = 0.005) was significantly associated with TBI < 0.65 in all study patients. Furthermore, microalbuminuria (OR = 2.910; 95% CI = 1.226-6.907; P = 0.015) was significantly associated with TBI < 0.65 in inpatients with eGFR ≥ 60 mL/min/1.73 m^2. CONCLUSIONS: Our study disclosed that eGFR < 60 mL/min/1.73 m^2 was associated with ABI < 0.9 and TBI < 0.65 in type 2 DM patients. Further, in the group of eGFR ≥ 60 mL/min/1.73 m^2, microalbuminuria is associated with TBI < 0.65. The results may help to shed light on the importance of eGFR and albuminuria on PAOD in this population.