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Microvascular endothelial function is an independent predictor for albuminuria progression among Asians with type 2 diabetes—A prospective cohort study
Author(s) -
Zhang Xiao,
Low Serena,
Ang Keven,
Yeoh Lee Ying,
Tavintharan Subramaniam,
Sum Chee Fang,
Lim Su Chi
Publication year - 2018
Publication title -
microcirculation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.793
H-Index - 83
eISSN - 1549-8719
pISSN - 1073-9688
DOI - 10.1111/micc.12453
Subject(s) - albuminuria , microalbuminuria , medicine , urology , endothelial dysfunction , diabetes mellitus , endocrinology , renal function
Objective We aim to investigate whether microvascular endothelial dysfunction is an independent predictor for future albuminuria progression in T2 DM cohort. Methods A total of 1098 patients with T2 DM were clinically assessed at baseline and 3.2‐year follow‐up. Progression was defined as transition from normoalbuminuria ( ACR <30 mg/g) to microalbuminuria ( ACR = 30‐299 mg/g) or macroalbuminuria ( ACR >300 mg/g), or microalbuminuria to macroalbuminuria. Microvascular endothelial vasodilation at baseline was quantified using LDF. The increase in perfusion in response to ACh and NaNP was calculated. Logistic regression model was used to estimate the OR for albuminuria progression. Results Albuminuria progression occurred in 226 (20.6%) patients. Baseline AC h was significantly higher in nonprogression than progression group (80.0 ± 53.2% vs 72.0 ± 49.7%, P = .04). There is no significant difference in Na NP between the two groups (111.1 ± 80.3% vs 121.1 ± 87.4%, P = .12). After multivariable adjustment, 1‐ SD increase in AC h was marginally associated with albuminuria progression ( OR = 0.87, 95% CI , 0.72‐1.02, P = .08) in all patients. When stratified by baseline albuminuria, 1‐ SD increase in AC h was significantly associated with albuminuria progression in normoalbuminuria ( OR = 0.76, 95% CI , 0.59‐0.97, P = .03), but not in microalbuminuria patients ( OR = 1.18, 95% CI , 0.81‐1.70, P = .39). Conclusions Impaired endothelial‐dependent microvascular reactivity predicts the onset of albuminuria progression among T2 DM patients with normoalbuminuria.