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Abstract: TH-PO209

Large Artery Stiffness and New-Onset Diabetes in the Chronic Renal Insufficiency Cohort

Session Information

Category: Hypertension and CVD

  • 1602 Hypertension and CVD: Clinical

Authors

  • Sarathy, Harini, University of California San Francisco School of Medicine, San Francisco, California, United States
  • Townsend, Raymond R., University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, United States
  • Rahman, Mahboob, UH Cleveland Medical Center, Cleveland, Ohio, United States
  • Chirinos, Julio Alonso, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, United States
  • Cohen, Jordana B., University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, United States
Background

Chronic kidney disease (CKD) accelerates large artery stiffness (LASt), which can cause damage to low-resistance high-flow microvascular beds in the liver, skeletal muscle, and pancreas, and which may affect insulin sensitivity. Our goal was to explore the relationship of LASt with new-onset diabetes in adults with CKD.

Methods

Carotid femoral pulse wave velocity (CFPWV) was performed in 1,512 participants of the Chronic Renal Insufficiency Cohort (CRIC) Study without diabetes. We used Cox regression and generalized estimating equations to evaluate baseline and time-updated CFPWV and incident diabetes, adjusting for age, sex, race, BMI, MAP, heart rate, eGFR, UPCR, smoking, total cholesterol, HDL, antihypertensives, and family history of diabetes. We assessed for effect modification by age, sex, prediabetes, and proteinuria.

Results

Participants in the highest tertile of CFPWV (median 10.8 m/s) were older (66 vs 53 years), had higher MAP (90 vs 84 mmHg) and lower eGFR (41 vs 50 mL/min/1.73m2) compared to the lowest tertile (median 6.5 m/s). Over a median of 9 years, CFPWV was associated with new-onset diabetes (unadjusted HR 1.25, 95% CI 1.07-1.46 per standard deviation increase in CFPWV [sHR]; Figure), which dissipated after multivariable adjustment (sHR 1.15, 95% CI 0.95-1.38) but persisted in multivariable-adjusted models incorporating time-updated CFPWV (sOR 1.18, 95% CI 1.04-1.33). There was significant effect modification by proteinuria. Higher CFPWV was associated with new-onset diabetes among participants with UPCR <1g/g (sHR 1.27, 95% CI 1.03-1.56) but not ≥1 g/g.

Conclusion

Among adults with CKD, LASt was associated with new-onset diabetes, particularly in those without significant proteinuria. LASt may have a key mechanistic role in abnormal glucose metabolism and could be a helpful marker of diabetes risk among patients with non-proteinuric CKD.

Association of CF-PWV and new-onset diabetes

Funding

  • NIDDK Support