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Positive association between urinary albumin-creatinine ratio and lower extremity peripheral arterial disease in Chinese diabetes patients: A cross-section study with propensity score matching analysis

  • Author Footnotes
    1 Co-first authors Ze Wang and Jian Yuan contributed equally to this paper.
    Ze Wang
    Footnotes
    1 Co-first authors Ze Wang and Jian Yuan contributed equally to this paper.
    Affiliations
    Department of Neurology, Baoshan Branch, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200444, China

    Department of Neurology, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China
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  • Author Footnotes
    1 Co-first authors Ze Wang and Jian Yuan contributed equally to this paper.
    Jian Yuan
    Footnotes
    1 Co-first authors Ze Wang and Jian Yuan contributed equally to this paper.
    Affiliations
    Department of Neurology, Baoshan Branch, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200444, China
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  • Jie Ding
    Affiliations
    Department of Neurology, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China
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  • Lu Han
    Affiliations
    Department of Neurology, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China
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  • Pei Zhao
    Affiliations
    Department of Neurology, Baoshan Branch, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200444, China
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  • Kai Guo
    Affiliations
    Department of Endocrinology, Yangpu Hospital, School of Medicine, Tongji University, Shanghai 200090, China
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  • Li Gao
    Affiliations
    Department of Neurology, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China
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  • Xia-Jun Zhou
    Affiliations
    Department of Neurology, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China
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  • De-Sheng Zhu
    Correspondence
    Corresponding author. Department of Neurology, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, No. 160, Pujian Road, Shanghai 200127, China. . Tel.: +86 13386271865; fax: +86 21-68383482.
    Affiliations
    Department of Neurology, Baoshan Branch, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200444, China

    Department of Neurology, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China
    Search for articles by this author
  • Yang-Tai Guan
    Correspondence
    Corresponding author. Department of Neurology, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, No.160, Pujian Road, Shanghai 200127, China. Tel.: +86 13564719779.
    Affiliations
    Department of Neurology, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China
    Search for articles by this author
  • Author Footnotes
    1 Co-first authors Ze Wang and Jian Yuan contributed equally to this paper.
Open AccessPublished:November 11, 2022DOI:https://doi.org/10.1016/j.numecd.2022.11.013
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      Highlights

      • The mean ABI levels decreased with the increase of ACR levels in total patients before and after propensity score matching.
      • Positive linear relationships between log2-transformed ACR and incidence of low ABI.
      • Curvilinear relationships between log2-transformed ACR and incidence of high ABI.
      • Positive association between urinary ACR and lower extremity peripheral arterial disease in diabetes patients.

      Abstract

      Background and Aims

      Elevated urinary albumin-creatinine ratio (ACR) is an established risk factor for lower extremity peripheral arterial disease (PAD) in non-diabetes individual. This study aimed to determine the relationship between urinary ACR level and PAD in diabetes population.

      Methods and Results

      A cross-section study with 1396 hospitalized diabetes participants from department of endocrinology and neurology were performed and the propensity score matching method was applied to reduce the effects of confounding factors between the matched PAD and Non-PAD groups. The relationship between urinary ACR and ankle–brachial index (ABI) was analyzed by linear curve fitting analyses and multiple logistic regression models. Our study showed that the prevalence of PAD (low ABI, ABI<0.9) was 7.09% in our diabetes patients. The ABI level was significantly lower in high ACR group compared with those in normal urinary ACR group (1.11±0.17 vs 1.13±0.15, p=0.010). The prevalence of PAD was increased with the increased tertile’s of log2-transformed ACR in total patients before and after propensity score matching (p<0.001 and p=0.007, respectively). The OR (95% CI) between log2-transformed ACR and PAD was 1.0 and 1.70 (1.08-2.69, p=0.022) respectively in normal and high ACR levels in diabetes patients after adjusting for potential confounders. After propensity score matching, the OR (95% CI) between log2-transformed ACR and PAD was 1.0 and 1.85 (1.05-3.23, p= 0.031) respectively in normal and high ACR levels in diabetes patients after adjusting for potential confounders.

      Conclusion

      The elevated urinary ACR level was associated with PAD in Chinese diabetes patients.

      Keywords