Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy.
Department of Translational and Precision Medicine, Sapienza University of Rome, Italy.
J Clin Endocrinol Metab. 2022 Aug 18;107(9):e3857-e3865. doi: 10.1210/clinem/dgac291.
To evaluate early, before the onset of cardiovascular events and of chronic renal insufficiency, the association between chronic kidney disease (CKD)-mineral bone disorder (MBD) biomarkers and vascular stiffness [Cardio Ankle Vascular Index (CAVI)] in the course of type 2 diabetes (T2DM).
We evaluated 174 T2DM patients [median age 56 years; male/female (M/F) 100/74] with diabetes duration < 10 years and without decreased estimated glomerular filtration rate (eGFR; ≥60 mL/min/1.73 m2) or macrovascular complications. Thirty-four age-matched healthy subjects [M/F 13/21; age 53.5 (50.0-57.7) years; eGFR 107.5 (97.0-119.7) mL/ min1.73 m2] served as local reference control for CAVI (pathological: ≥8) and the novel CKD-MBD biomarkers.
Albumin-to-creatinine ratio (ACR) averaged 8.5 mg/g (5.6-17.2) with 12.6% of the patients showing pathologic values, indicative of incipient diabetic nephropathy. Serum parathyroid hormone, fibroblast growth factor 23, and sclerostin were higher while 1,25-dihydroxyvitamin D and Klotho were lower than a control group. CAVI was normal (<8) in only 54% and correlated positively with age (P < 0.001), hemoglobin 1A1c (P = 0.036), and systolic (P = 0.021) and diastolic blood pressure (DBP) (P = 0.001) and negatively correlated with 25-hydroxyvitamin D (P = 0.046). In multivariate analysis, age, DBP, ACR, and serum Klotho were independent positive predictors of CAVI.
In the absence of overt cardiovascular disease and of chronic renal insufficiency, CAVI is frequently pathologic in T2DM. DBP and ACR are modifiable risk factors of vascular stiffness in T2DM, thus warranting optimal assessment.
在心血管事件和慢性肾功能不全发生之前，评估 2 型糖尿病（T2DM）患者慢性肾脏病（CKD）-矿物质骨代谢障碍（MBD）生物标志物与血管僵硬[脉波速度（PWV）]之间的关系。
我们评估了 174 名 T2DM 患者[中位年龄 56 岁；男/女（M/F）100/74]，糖尿病病程<10 年，且估算肾小球滤过率（eGFR；≥60 mL/min/1.73 m2）或大血管并发症无降低。34 名年龄匹配的健康受试者[M/F 13/21；年龄 53.5（50.0-57.7）岁；eGFR 107.5（97.0-119.7）mL/min/1.73 m2]作为 PWV（病理：≥8）和新型 CKD-MBD 生物标志物的本地参考对照。
白蛋白/肌酐比值（ACR）平均为 8.5 mg/g（5.6-17.2），12.6%的患者存在病理性值，提示存在早期糖尿病肾病。血清甲状旁腺激素、成纤维细胞生长因子 23 和骨硬化蛋白升高，而 1,25-二羟维生素 D 和 Klotho 降低。仅 54%的患者 PWV 正常（<8），与年龄呈正相关（P<0.001），与血红蛋白 1A1c（P=0.036）、收缩压（P=0.021）和舒张压（DBP）（P=0.001）呈负相关，与 25-羟维生素 D（P=0.046）呈负相关。多元分析显示，年龄、DBP、ACR 和血清 Klotho 是 PWV 的独立正相关预测因子。
在无明显心血管疾病和慢性肾功能不全的情况下，T2DM 患者的 PWV 常呈病理性改变。DBP 和 ACR 是 T2DM 患者血管僵硬的可改变危险因素，因此需要进行最佳评估。
