Aims:


We aimed to study the effect of diabetes (DM) on endothelial
dysfunction assessed by flow-mediated vasodilatation (FMD), carotid
intima-media thickness (cIMT) and abdominal aortic calcification score
(AAC) in chronic kidney disease (CKD) stage 4-5 patients not on
dialysis.

Methods:


Altogether 199 non-dialysis CKD stage 4-5 patients enrolled in the
Chronic Arterial Disease, quality of life and mortality in chronic
KIDney injury (CADKID) study with plain lumbar radiograph for the
assessment of AAC were included. Data on cIMT and FMD were available for
172 and 161 patients, respectively.

Results:


Median age was 65 (IQR 54-76) years, 88 (44.2%) patients had DM and median eGFR was 12 (IQR 10-14) ml/min/1.73 m²
in the study. FMD [controls: 3.3(2.0-6.7)% vs. DM-patients:
4.3(1.3-6.6)%, p = 0.73] and cIMT [controls: 0.65(0.58-0.87)mm vs.
DM-patients: 0.67(0.59-0.81)mm, p = 0.65], were similar between the
groups. AAC was higher in patients with DM [controls: 5(1-9) vs.
DM-patients: 7(2-13), p = 0.01]. The significant multivariate
determinants for AAC were older age (β = 0.22, p < 0.0001), pulse
pressure (β = 0.05, p < 0.0001), DM (β = 1.33, p = 0.04) and ProBNP
(per µg/l β = 0.18, p = 0.0008). AAC and cIMT were associated with
incident cardiovascular death independent of DM.

Conclusions:


DM is associated with increased AAC but not increased cIMT or attenuated FMD in advanced CKD patients.

Keywords:


Abdominal aortic calcification score; Atherosclerosis; Carotid
intima-media thickness; Chronic kidney disease; Flow-mediated
dilatation.