Severely increased albuminuria in patients with type 2 diabetes mellitus is associated with increased subclinical atherosclerosis in femoral arteries with Na [ ¹⁸ F]F activity as a proxy - The DETERMINE study.

Publisher: Elsevier Country of Publication: Ireland NLM ID: 0242543 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1879-1484 (Electronic) Linking ISSN: 00219150 NLM ISO Abbreviation: Atherosclerosis Subsets: MEDLINE

Publication: Limerick : Elsevier
Original Publication: Amsterdam, Elsevier.

Diabetes Mellitus, Type 2*/complications ; Albuminuria*/physiopathology ; Femoral Artery*/diagnostic imaging ; Femoral Artery*/physiopathology ; Glomerular Filtration Rate*; Humans ; Female ; Male ; Middle Aged ; Aged ; Atherosclerosis/diagnostic imaging ; Atherosclerosis/complications ; Vascular Stiffness ; Fluorine Radioisotopes ; Radiopharmaceuticals ; Vascular Calcification/diagnostic imaging ; Vascular Calcification/physiopathology ; Diabetic Nephropathies/physiopathology ; Diabetic Nephropathies/diagnostic imaging ; Asymptomatic Diseases ; Severity of Illness Index ; Positron Emission Tomography Computed Tomography ; Case-Control Studies ; Predictive Value of Tests ; Positron-Emission Tomography

Background and Aims: Sodium [ ¹⁸ F]fluoride (Na [ ¹⁸ F]F) positron emission tomography imaging allows detailed visualization of early arterial micro-calcifications. This study aims to investigate atherosclerosis manifested by micro-calcification, macro-calcification, and aortic stiffness in patients with type 2 diabetes mellitus (T2DM) with and without albuminuria and severely decreased kidney function.
Methods: A cohort was stratified in four groups (N = 10 per group), based on KDIGO categories (G1-5 A1-3). G1-2A1 non-diabetic controls (median [IQR] estimated glomerular filtration rate (eGFR) in mL/min/1.73 m ² 91 [81-104]), G1-2A1 with T2DM (eGFR 87 [84-93], and albumin-creatinin-ratio (ACR) in mg/mmol 0.35 [0.25-0.75]), G1-2A3 with T2DM (eGFR 85 [60-103], and ACR 74 [62-122], and G4A3 with T2DM (eGFR 19 [13-27] and ACR 131 [59-304]).
Results: Na [ ¹⁸ F]F femoral artery grading score differed significantly in the groups with the highest Na [ ¹⁸ F]F activity in A3 groups with T2DM (G1-2A3 with T2DM 228 [100-446] and G4A3 with T2DM 198 [113-578]) from the lowest groups of the G1-2A1 with T2DM (33 [0-93]) and in G1-2A1 non-diabetic controls (75 [0-200], p = 0.001). Aortic Na [ ¹⁸ F]F activity and femoral artery computed tomography (CT)-assessed macro-calcification was increased in G4A3 with T2DM compared with G1-2A1 with T2DM (47.5 [33.8-73.8] vs. 17.5 [8.8-27.5] (p = 0.006) and 291 [170-511] vs. 12.2 [1.41-44.3] mg (p = 0.032), respectively). Carotid-femoral pulse wave velocity (PWV)-assessed aortic stiffness was significantly higher in both A3 groups with T2DM compared with G1-2A1 with T2DM (11.15 and 12.35 vs. 8.86 m/s, respectively (p = 0.009)).
Conclusions: This study indicates that the presence of severely increased albuminuria in patients with T2DM is cross-sectionally associated with subclinical arterial disease in terms of micro-calcification and aortic stiffness. Additional decrease in kidney function was associated with advanced macro-calcifications.
Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.
(Copyright © 2023 The Authors. Published by Elsevier B.V. All rights reserved.)

Keywords: Albuminuria; Atherosclerosis; Calcification; Computed tomography; Na [(18)F]F positron emission tomography; Type 2 diabetes mellitus

0 (Fluorine Radioisotopes)
0 (Radiopharmaceuticals)

Date Created: 20230807 Date Completed: 20240614 Latest Revision: 20240614

20240615

10.1016/j.atherosclerosis.2023.117199

37550141