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Journal of Diabetes Research
Volume 2016, Article ID 3295747, 6 pages
http://dx.doi.org/10.1155/2016/3295747
Research Article

Carotid Intima-Media Thickness and Visit-to-Visit HbA1c Variability Predict Progression of Chronic Kidney Disease in Type 2 Diabetic Patients with Preserved Kidney Function

1Department of Food Sciences and Nutrition, School of Human Environmental Sciences, Hyogo, Japan
2Research Institute for Nutrition Sciences, Mukogawa Women’s University, Hyogo, Japan
3Department of Nutrition, Osaka City Juso Hospital, Osaka, Japan
4Diabetes Division, Sadamitsu Hospital, Hyogo, Japan

Received 20 August 2016; Revised 25 October 2016; Accepted 28 November 2016

Academic Editor: Daisuke Yabe

Copyright © 2016 Akiko Takenouchi et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background/Aims. Subclinical atherosclerosis and long-term glycemic variability have been reported to predict incident chronic kidney disease (CKD) in the general population. However, these associations have not been investigated in patients with type 2 diabetes with preserved kidney function. Methods. We prospectively followed up 162 patients with type 2 diabetes (mean age, 62.3 years; 53.6% men) and assessed whether carotid intima-media thickness (IMT) measured by B-mode ultrasound and visit-to-visit HbA1c variability are associated with deterioration of CKD (incident CKD defined as estimated GFR [eGFR] < 60 mL/min/1.73 m2 and progression of CKD stages) over a median follow-up of 6.0 years. At baseline, 25 patients (15.4%) had CKD. Cox proportional hazards regression models were used for identifying associated factors of CKD deterioration. Results. Estimated GFR decreased from to  mL/min/1.73 m2 (). Of 162 patients, 32 developed CKD and 8 made a progression of CKD stages. Multivariate Cox regression analysis revealed that carotid IMT (HR: 4.0, 95% CI: 1.1–14.226.7, and ) and coefficient of variation of HbA1c (HR: 1.12, 95%: 1.04–1.21, and ) were predictors of deterioration of CKD independently of age, mean HbA1c, urinary albumin/creatinine ratio, baseline eGFR, uric acid, and leucocyte count. Conclusions. Subclinical atherosclerosis and long-term glycemic variability predict deterioration of chronic kidney disease (as defined by incident or worsening CKD) in type 2 diabetic patients with preserved kidney function.