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Risk associated with estimated glomerular filtration rate and albuminuria for PAD among patients with type 2 diabetes

Chi-Feng Pan, Shih-Ming Chuang, Kuan-Chia Lin, Ming-Chieh Tsai, Wei-Tsen Liao, Yi-Hong Zeng, Chun-Chuan Lee
DOI: 10.1136/jim-2021-001786 Published 26 July 2021
Chi-Feng Pan
1Department of Internal Medicine, Division of Nephrology, Mackay Memorial Hospital, Taipei, Taiwan
2Mackay Junior College of Medicine, Nursing, and Management, Taipei, Taiwan
3Department of Medicine, Mackay Medical College, New Taipei City, Taiwan
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Shih-Ming Chuang
2Mackay Junior College of Medicine, Nursing, and Management, Taipei, Taiwan
3Department of Medicine, Mackay Medical College, New Taipei City, Taiwan
4Department of Internal Medicine, Division of Endocrinology and Metabolism, Mackay Memorial Hospital, Taipei, Taiwan
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Kuan-Chia Lin
5Institute of Hospital and Health Care Administration, National Yang-Ming University, Taipei, Taiwan
6Community Medicine Research Center, Preventive Medicine Research Center, National Yang-Ming University, Taipei, Taiwan
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Ming-Chieh Tsai
3Department of Medicine, Mackay Medical College, New Taipei City, Taiwan
4Department of Internal Medicine, Division of Endocrinology and Metabolism, Mackay Memorial Hospital, Taipei, Taiwan
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Wei-Tsen Liao
4Department of Internal Medicine, Division of Endocrinology and Metabolism, Mackay Memorial Hospital, Taipei, Taiwan
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Yi-Hong Zeng
3Department of Medicine, Mackay Medical College, New Taipei City, Taiwan
4Department of Internal Medicine, Division of Endocrinology and Metabolism, Mackay Memorial Hospital, Taipei, Taiwan
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Chun-Chuan Lee
3Department of Medicine, Mackay Medical College, New Taipei City, Taiwan
4Department of Internal Medicine, Division of Endocrinology and Metabolism, Mackay Memorial Hospital, Taipei, Taiwan
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Abstract

Chronic kidney disease (CKD) is significantly associated with peripheral arterial disease (PAD) in some studies, but data on the association of the risk of PAD across a broad range of kidney function in patients with type 2 diabetes are limited. Between October 17, 2013 and February 7, 2015, all consecutive outpatients with type 2 diabetes underwent ankle-brachial index (ABI) examination. We investigated the association of estimated glomerular filtration rate (eGFR) and albumin-to-creatinine ratio (ACR) with the risk of PAD. A total of 1254 patients were cross-classified into 12 groups based on ACR category (normoalbuminuria, microalbuminuria and macroalbuminuria) and eGFR stage (≥90, 60–89, 30–59 and <30 mL/min/1.73 m2). Logistic regression analysis was used to investigate the association of eGFR and ACR with PAD. Within each ACR category, a lower eGFR stage was associated with PAD. Similarly, within each eGFR group, a higher ACR category was also associated with PAD. The OR for PAD was highest in patients with eGFR <30 mL/min/1.73 m2 and macroalbuminuria (OR 14.42, 95% CI 4.60 to 45.31) when compared with the reference group of subjects with eGFR ≥90 mL/min/1.73 m2 and normoalbuminuria. Our study found that cross-classification of eGFR with ACR revealed a more comprehensive association with risk of PAD than eGFR or ACR alone.

Footnotes

  • C-FP and S-MC contributed equally.

  • Contributors Conceptualization, C-FP; data curation, M-CT, W-TL and Y-HZ; formal analysis, K-CL; methodology, S-MC; project administration, M-CT; resources, K-CL and M-CT; software, W-TL; supervision, C-CL; validation, Y-HZ; writing—original draft, C-FP and S-MC; Writing—review and editing, C-CL.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

Data availability statement

The data used to support the findings of this study are available from the corresponding author upon request.

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Vol 69 Issue 6 Table of Contents
Journal of Investigative Medicine: 69 (6)
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Risk associated with estimated glomerular filtration rate and albuminuria for PAD among patients with type 2 diabetes
Chi-Feng Pan, Shih-Ming Chuang, Kuan-Chia Lin, Ming-Chieh Tsai, Wei-Tsen Liao, Yi-Hong Zeng, Chun-Chuan Lee
Journal of Investigative Medicine Aug 2021, 69 (6) 1182-1188; DOI: 10.1136/jim-2021-001786

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Risk associated with estimated glomerular filtration rate and albuminuria for PAD among patients with type 2 diabetes
Chi-Feng Pan, Shih-Ming Chuang, Kuan-Chia Lin, Ming-Chieh Tsai, Wei-Tsen Liao, Yi-Hong Zeng, Chun-Chuan Lee
Journal of Investigative Medicine Aug 2021, 69 (6) 1182-1188; DOI: 10.1136/jim-2021-001786
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Risk associated with estimated glomerular filtration rate and albuminuria for PAD among patients with type 2 diabetes
Chi-Feng Pan, Shih-Ming Chuang, Kuan-Chia Lin, Ming-Chieh Tsai, Wei-Tsen Liao, Yi-Hong Zeng, Chun-Chuan Lee
Journal of Investigative Medicine Aug 2021, 69 (6) 1182-1188; DOI: 10.1136/jim-2021-001786
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