Microalbuminuria, but not reduced eGFR, is associated with cardiovascular subclinical organ damage in type 2 diabetes

Aim.-This study explored the association between reduced estimated glomerular filtration rate (eGFR) and microalbuminuria vs. subclinical organ damage in patients with type 2 diabetes. Methods. Data from middle-aged patients with type 2 diabetes (n=706) treated in primary care were analyzed for microalbuminura, defined as a urinary albumin/creatinine ratio (uACR) >= 3.0 mmol/mol, and reduced eGFR, defined as <60 mL/min/1.73 m(2), in relation to blood pressure, pulse wave velocity (PWV), left ventricular mass index (LVMI), and carotid intima media thickness (IMT) and lumen diameter (LD). Results. Patients with microalbuminuria had significantly higher 24-h ambulatory systolic blood pressure (ASBP) compared with subjects with uACR <3 mg/mmol: 137 vs. 128 mmHg (P < 0.001). There were no differences in ASBP in patients with eGFR <60 mL/min/1.73 m(2). However, patients with vs. without microalbuminuria had increased PWV (11.4 vs. 10.1 m/s; P<0.001), LVMI (134.4 vs. 118.6 g/m(2); P<0.001), LD (7.01+/-0.93 vs. 6.46+/-0.74 mm; P<0.001) and IMT (0.78 vs. 0.74 mm; P=0.047),respectively. The associations between uACR vs. PWV and LVMI were more robust after adjusting for age, diabetes duration, ASBP, HbA(1c), LDL-cholesterol, and antihypertensive and lipid-lowering therapy compared with uACR vs. IMT. There were no statistically significant differences in PWV, LVMI or IMT between patients with reduced (< 60 mL/min/1.73 m(2)) vs. normal eGFR. Conclusion. Levels of urinary albumin excretion, but not reduced eGFR, were associated with increased arterial stiffness, left ventricular mass and atherosclerosis in patients with type 2 diabetes. (C) 2013 Elsevier Masson SAS. All rights reserved.