Increased Arterial Stiffness is an Independent Predictor of Renal Function Decline in Patients With Type 2 Diabetes Mellitus Younger Than 60 Years

BACKGROUND: The objective of this study was to evaluate whether aortic pulse wave velocity (Ao-PWV) predicts estimated glomerular filtration rate (eGFR) decline in patients with type 2 diabetes mellitus.

METHODS AND RESULTS: This prospective single-center cohort study investigated 211 type 2 diabetes mellitus patients with eGFR ≥45 mL/min with a baseline mean age of 60.1 years (range, 30-82 years). The mean±SD baseline eGFR was 85±26.1 mL/min. We divided the cohort into 2 groups above (n=117, "older") and below (n=94, "younger") the mean age to evaluate whether Ao-PWV predicted progression of kidney disease differentially in older and younger patients. The primary end point was reaching a final eGFR below the median for the age group and an eGFR fall ≥1 mL/min per year. Median follow-up was 9 years (range, 3-11 years) and ≈50% of patients in both groups reached the primary end point. In older patients, Ao-PWV was similar in those who did and did not reach the primary end point. By contrast, younger patients who reached the primary end point had a higher Ao-PWV at baseline compared with those who did not (10.8 m/s versus 9.5 m/s, respectively; mean difference of 1.36 m/s [95% CI, 0.38-2.33], P=0.007). Ao-PWV was an independent predictor of the primary end point (incident risk ratio, 1.09; 95% CI, 1.02-1.18) after adjustment for traditional risk factors only in younger patients (P=0.02). A 1m/s increase in Ao-PWV was associated with a mean fall in eGFR of 2.1 mL/min per year (95% CI, 0.09-4.1) independent of other risk factors in younger patients (P=0.04).

CONCLUSIONS: Ao-PWV predicts eGFR decline, before the onset of advanced renal dysfunction, and is a potential target for renoprotection in younger patients with type 2 diabetes mellitus.