Brachial-Ankle Pulse Wave Velocity as a Novel Modality for Detecting Early Diabetic Nephropathy in Type 2 Diabetes Patients

Abstract

Brachial-ankle pulse wave velocity (baPWV) has been shown to correlate with a host of disorders associated with arterial stiffness. Type 2 diabetes is associated with the involvement of both small vessels and large vessels. Studies on the relevance of baPWV to early diabetic nephropathy are scarce. This retrospective observational case-control study enrolled 120 patients with type 2 diabetes from our medical records. We classified patients into two groups depending on the magnitude of albuminuria: 60 patients with microalbuminuria were classified as the early diabetic nephropathy group (EDN group) and 60 patients without albuminuria were classified as the diabetes without nephropathy group (DWN group). An additional 30 nondiabetic age- and sex-matched controls were also enrolled. Data regarding the lipid profile, blood pressure, baPWV, high-sensitivity C reactive protein (hs-CRP) level, anthropometric measurements, urine albumin/creatinine ratio (UACR), serum creatinine level, and glycemic control indices (i.e., fasting plasma glucose (FPG), postprandial glucose (PPG), and glycosylated hemoglobin (hemoglobin A1c, HbA1c)) were recorded for all enrolled participants. baPWV was significantly higher in the EDN group than in the DWN group. Moreover, baPWV was positively correlated with age, duration of diabetes, obesity, poor glycemic control, and high serum levels of triglycerides (TG), hs-CRP, creatinine, and uric acid as well as a high UACR (all P < 0.01). A significant negative correlation was found between baPWV and high-density lipoprotein levels (P < 0.05). Multivariate regression analysis showed that the hs-CRP level and duration of diabetes most strongly influenced baPWV. baPWV may be a convenient, noninvasive, and reproducible method for detecting early diabetic nephropathy.

Figure 1

Box plot of baPWV measurements in the three groups. baPWV was significantly higher in patients with diabetes (with or without DN) than in the control group. Patients with DN had a significantly higher baPWV than diabetes patients without nephropathy. ^∗∗∗P < 0.001.

Figure 2

ROC curve for the ability of baPWV to detect DN. The area under the ROC curve was 0.946, with a 95% CI of 0.908–0.983, indicating that baPWV measurement is an effective method for the detection of EDN. The optimal cut-off value of baPWV was 1716 cm/s, with a sensitivity of 91.7% and a specificity of 81.7%.