DOI: http://dx.doi.org/10.18203/2349-3933.ijam20204071

Study of association between urine albumin creatinine ratio and ankle brachial index or peripheral arterial disease in type 2 diabetes mellitus patients

Puneet Saxena, Deepak Chadha, Rishika Goyal, Adarsh Kenchappa Shanbogh

Abstract


Background: To establish association between urine albumin creatinine ratio and ankle brachial index or peripheral arterial disease in type 2 diabetes patients.

Methods: Total 74 patients of type 2 diabetes mellitus of >50 years of age subjected to calculation of urine albumin creatinine ratio and  ankle brachial index was calculated using doppler sonography and estimation of peripheral arterial diseases was done. The data obtained subjected to analysis.

Results: In group with ABI <0.9 suggestive of PAD, mean age of the patient was 62.32±5.8 years, mean BMI was 26.11±2.48kg/m2, mean duration of diabetes was 11.19±41 years, 7 (18.92%) were smokers, 15 (40.54%) were insulin users, 27 (72.97%) were hypertensive, mean SBP was 142.49±13.46mmHg, mean DBP was 84±6.42mmHg, mean serum cholesterol was 221.35±17.10mg/dl, mean serum triglyceride was 242.81 ± 17.10mg/dl, mean serum HDL was 44.03±5.77mg/dl, mean serum LDL was 116.89±28.77mg/dl, mean urine ACR was 294.62±314.90mg/gm, prevalence of normoalbuminuria, microlbuminuria and macroalbuminuria was 12 (32.43%), 21 (56.76%) and 4 (10.81%)  respectively. The statistical significant difference was found in age, duration of diabetes, number of patients on insulin therapy, systolic BP, serum cholesterol, triglyceride, LDL, HDL, urine ACR and distribution of albuminuria.

Conclusions: we conclude that statistical significant relationship exist between urine ACR and PAD. Hence urinary ACR can be considered as surrogate marker for early prediction of PAD in elderly patients with type 2diabetes mellitus eventually leading to aggressive intervention for prevention and management.


Keywords


Urine albumin creatinine ratio, Ankle brachial index, Peripheral arterial disease, Type 2 diabetes mellitus

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References


Borch-Johnsen K, Feldt-Rasmussen B, Strandgaard S, Schroll M, Jensen JS. Urinary albumin excretion, an independent predictor of ischemic heart disease. Arterioscler Thromb Vasc Biol. 1999;19:1992-7.

Valmadrid CT, Klein R, Moss SE, Klein BE. The risk of cardiovascular disease mortality associated with microalbuminuria and gross proteinuria in persons with older-onset diabetes mellitus. Arch Intern Med. 2000;160:1093-100.

Yokoyama H, Kawai K, Kobayashi M. Japan diabetes clinical datamanagement study group. Microalbuminuria is common in Japanese type 2 diabetic patients: a nationwide survey from the Japan diabetes clinical data management study group (JDDM 10). Diabetes Care. 2007;30:989-92.

American diabetes association position statement; standards of medical care in diabetes-207. Diabetes Care. 2007;30:S4-41.

Sasso FC, De Nicola L, Carbonara O. Cardiovascular risk factors and diseasemanagement in type 2 diabetic patients with diabetic nephropathy. Diabetes Care. 2006;29:498-503.

Parving HH, Lewis JB. DEMAND investigators. Prevalence and risk factors for microalbuminuria in a referred cohort of type II diabetic patients: a global perspective. Kidney Int. 2006;69:2057-63.

Wang Z, Hoy WE. Albuminuria and incident coronary heart disease in Australian aboriginal people. Kidney Int. 2005;68:1289-93.

Dinneen SF, Gerstein HC. The association of microalbuminuria and mortality in non-insulin- dependent diabetes mellitus: a systematic overview of the literature. Arch Intern Med. 1997;157:1413-8.

Mathiesen ER, Ronn B, Storm B, Foght H, Deckert T. The natural course of microalbuminuria in insulin-dependent diabetes: a 10- year prospective study. Diabet Med. 1995;12:482-7.

Gerstein HC, Mann JF, Yi Q, Zinman B, Dinneen SF, Hoogwerf B, et al. Albuminuria and risk of cardiovascular events, death, and heart failure in diabetic and nondiabetic individuals. JAMA. 2001;286:421-6.

Wattanakit K, Folsom AR, Selvin E, Coresh J, Hirsch AT, Weatherley BD. Kidney function and risk of peripheral arterial disease: Results from the Atherosclerosis Risk in Communities (ARIC) Study. J Am Soc Nephrol. 2007;18:629-36.

O'Hare AM, Glidden DV, Fox CS, Hsu CY. High prevalence of peripheral arterial disease in persons with renal insufficiency: results from the National health and nutrition examination survey 1999-2000. Circulation. 2004;109:320-3.

Chou CK, Weng SW, Chang HW, Chih-Yin C,Sheng C, Rue-Tsuan L. Analysis of traditional and nontraditional risk factors for peripheral arterial disease in elderly type 2 diabetic patients in Taiwan. Diabetes Res Clin Prac. 2008;81:331-7.

Tseng CH, Chong CK, Tseng CP, Tong-Yuan T. The association between urinary albumin excretion and ankle-brachial index in elderly Taiwanese patients with type 2 diabetes mellitus. Age Agein. 2008;37:77-82.

Currie CJ, Morgan CL, Peters JR. The epidemiology and cost of inpatient care for peripheral vascular disease, infection, neuropathy, and ulceration in diabetes. Diabetes Care. 1998;21:42-8.

Unwin N. The Global Lower Extremity Amputation Study Group. Epidemiology of lower extremity amputation in centers in Europe, North America and East Asia. Br J Surg. 2000;87:328-37.

Tseng CH. Prevalence and risk factors of diabetic foot problems in Taiwan: A cross-sectional survey of non-type 1 diabetic patients from a nationally representative sample. Diabetes Care. 2003;26:3351.

Lavery LA, Armstrong DG, Wunderlich RP. Risk factors for foot infections in individuals with diabetes. Diabetes Care. 2006;29:1288-93.

Centers for Disease Control and Prevention (CDC). Mobility limitation among persons aged ≥40 years with and without diagnosed diabetes and lower extremity disease–United States, 1999–2002. MMWR. 2005;54:1183-6.

Mathiesen ER, Rønn B, Storm B, Foght H, Deckert T. The natural course of microalbuminuria in insulin-dependent diabetes: a 10- year prospective study. Diabet Med. 1995;12:482-7.

Deckert T, Feldt-Rasmussen B, Borch-Johnsen K, Jensen T, Kofoed-Enevoldsen A. Albuminuria reflects widespread vascular damage. The Steno hypothesis. Diabetologia. 1989;32:219-26.

Kario K, Matsuo T, Kobayashi H, Matsuo M, Sakata T, Miyata T. Activation of tissue factor-induced coagulation and endothelial cell dysfunction in non-insulin-dependent diabetic patients with microalbuminuria. Arterioscler Thromb Vasc Biol. 1995;15:1114-20.

O’Rourke MF, Safar ME. Relationship between aortic stiffening and microvascular disease in brain and kidney: cause and logic of therapy. Hypertension. 2005;46:200-4.

Wu CK, Yang CY, Tsai CT, Fu-Chun C, Yin-Tsen H, Jen-Kuang L. Association of low glomerular filtration rate and albuminuria with peripheral arterial disease: the National Health and Nutrition Examination Survey, 1999-2004. Atherosclerosis. 2010;209:230-4.

Melzer D, Gardener E, Guralnik JM. Mobility disability in the middle-aged: cross-sectional associations in the English longitudinal study of ageing. Age Ageing. 2005;34:594-602.

Sigvant M, Wiberg-Hedman K, Bergqvist D, Rolandsson O, Andersson B, Persson E, et al. A population-based study of peripheral arterial disease prevalence with special focus on critical limb ischemia and sex differences. J Vasc Surg. 2007;45:1185-91.

Potier L, Abi Khalil C, Mohammedi K. Use and utility of ankle brachial index in patients with diabetes. Eur J Vasc Endovasc Sur. 2011;41:110-6.

Resnick HE, Lindsay RS, McDermott MM, Devereux RB, Jones KL, Fabsitz RR. Relationship of high and low ankle brachial index to all-cause and cardiovascular disease mortality: the strong heart study. Circulation 2004;109:733-9.