Liu Mengyi, Zhang Yanjun, Zhang Yuanyuan, He Panpan, Zhou Chun, Ye Ziliang, Yang Sisi, Gan Xiaoqin, Hou Fan Fan, Qin Xianhui
Division of Nephrology, Nanfang Hospital, Southern Medical University; National Clinical Research Center for Kidney Disease; State Key Laboratory of Organ Failure Research; Guangdong Provincial Institute of Nephrology, Guangdong Provincial Key Laboratory of Renal Failure Research, Guangzhou, China.
Division of Nephrology, Nanfang Hospital, Southern Medical University; National Clinical Research Center for Kidney Disease; State Key Laboratory of Organ Failure Research; Guangdong Provincial Institute of Nephrology, Guangdong Provincial Key Laboratory of Renal Failure Research, Guangzhou, China.
Am J Kidney Dis. 2025 Jan;85(1):36-44.e1. doi: 10.1053/j.ajkd.2024.06.024. Epub 2024 Sep 30.
RATIONALE & OBJECTIVE: Ankle-brachial index (ABI) is used to screen for vascular complications in the setting of diabetes. This study sought to examine the relationship of longitudinal ABI data and chronic kidney disease (CKD) progression in patients with type 2 diabetes mellitus (T2DM) and increased body mass index.
A post hoc analysis of the Look AHEAD (Action for Health in Diabetes) trial.
SETTING & PARTICIPANTS: This study included 3,631 participants in the Look AHEAD trial with a baseline estimated glomerular filtration rate>60mL/min/1.73m.
Average ABI and average annual change in ABI were calculated based on annual ABI measurements during the first 4 years of the study.
CKD progression, defined as kidney failure requiring maintenance dialysis or the occurrence of an estimated glomerular filtration rate<60mL/min/1.73m with a decrease of≥30% versus baseline at a follow-up visit.
Restricted cubic spline and Cox proportional hazards models were fit to estimate associations and to explore nonlinearity.
During a median follow-up of 10.1 years, CKD progression developed in 1,051 participants. There was a reversed J-shaped relationship of CKD progression with average ABI (ABI<1.17: HR per 1-SD decrement, 1.23; 95% CI, 1.06-1.42; ABI≥1.17: HR per 1-SD increment, 1.10; 95% CI, 1.00-1.22) and average annual change in ABI (change in ABI less than-0.007: HR per 1-SD decrement, 1.37; 95% CI, 1.12-1.66; change in ABI of at least-0.007: HR per 1-SD increment, 1.13; 95% CI, 1.03-1.24).
Observational study, potential unmeasured confounding.
Low and high-average ABI, even at clinically normal values, as well as decreasing and increasing average annual ABI, were associated with a higher risk of CKD progression in patients with T2DM and increased body mass index. Monitoring ABI and its changes over time may facilitate CKD risk stratification in patients with T2DM.
PLAIN-LANGUAGE SUMMARY: The ankle-brachial index (ABI) has recently become a routine screening parameter for vascular complications in patients with diabetes. In this post hoc analysis of the Look AHEAD (Action for Health in Diabetes) trial including 3,631 participants with type 2 diabetes mellitus and increased body mass index, we examined the longitudinal relationship of average ABI and annual change in ABI with chronic kidney disease progression. We observed that low and high-average ABI, even at clinically normal values, as well as decreases and increases in average annual ABI, were associated with a higher risk of chronic kidney disease progression in patients with type 2 diabetes mellitus and increased body mass index.
踝臂指数（ABI）用于筛查糖尿病患者的血管并发症。本研究旨在探讨2型糖尿病（T2DM）且体重指数增加患者的纵向ABI数据与慢性肾脏病（CKD）进展之间的关系。
对糖尿病健康行动（Look AHEAD）试验进行事后分析。
本研究纳入了糖尿病健康行动试验中的3631名参与者，其基线估计肾小球滤过率>60mL/min/1.73m²。
根据研究前4年的年度ABI测量值计算平均ABI和ABI的平均年变化。
CKD进展，定义为需要维持性透析的肾衰竭，或随访时估计肾小球滤过率<60mL/min/1.73m²且较基线下降≥30%。
采用受限立方样条和Cox比例风险模型来估计关联并探索非线性关系。
在中位随访10.1年期间，1051名参与者出现了CKD进展。CKD进展与平均ABI呈倒J形关系（ABI<1.17：每降低1个标准差的风险比，1.23；95%置信区间，1.06 - 1.42；ABI≥1.17：每增加1个标准差的风险比，1.10；95%置信区间，1.00 - 1.22），与ABI的平均年变化也呈倒J形关系（ABI变化小于 - 0.007：每降低1个标准差的风险比，1.37；95%置信区间，1.12 - 1.66；ABI变化至少为 - 0.007：每增加1个标准差的风险比，1.13；95%置信区间，1.03 - 1.24）。
观察性研究，可能存在未测量的混杂因素。
平均ABI较低和较高，即使在临床正常范围内，以及ABI的平均年变化降低和增加情况，均与T2DM且体重指数增加患者的CKD进展风险较高相关。监测ABI及其随时间的变化可能有助于T2DM患者的CKD风险分层。
踝臂指数（ABI）最近已成为糖尿病患者血管并发症的常规筛查参数。在这项对糖尿病健康行动（Look AHEAD）试验的事后分析中，纳入了3631名2型糖尿病且体重指数增加的参与者，我们研究了平均ABI和ABI年变化与慢性肾脏病进展的纵向关系。我们观察到，平均ABI较低和较高，即使在临床正常范围内，以及ABI平均年变化的降低和增加，均与2型糖尿病且体重指数增加患者的慢性肾脏病进展风险较高相关。
