Increased arterial stiffness is an independent predictor of renal function decline in patients with type 2 diabetes mellitus younger than 60 years

Background--the objective of this study was to evaluate whether aortic pulse wave velocity (ao-pwv) predicts estimated glomerular filtration rate (egfr) decline in patients with type 2 diabetes mellitus. methods and results--this prospective single-center cohort study investigated 211 type 2 diabetes mellitus patients with egfr ≥45 ml/min with a baseline mean age of 60.1 years (range,30-82 years). the mean±sd baseline egfr was 85±26.1 ml/min. we divided the cohort into 2 groups above (n=117,older) and below (n=94,younger) the mean age to evaluate whether ao-pwv predicted progression of kidney disease differentially in older and younger patients. the primary end point was reaching a final egfr below the median for the age group and an egfr fall ≥1 ml/min per year. median follow-up was 9 years (range,3-11 years) and ≈50% of patients in both groups reached the primary end point. in older patients,ao-pwv was similar in those who did and did not reach the primary end point. by contrast,younger patients who reached the primary end point had a higher ao-pwv at baseline compared with those who did not (10.8 m/s versus 9.5 m/s,respectively; mean difference of 1.36 m/s [95% ci,0.38-2.33],p=0.007). ao-pwv was an independent predictor of the primary end point (incident risk ratio,1.09; 95% ci,1.02-1.18) after adjustment for traditional risk factors only in younger patients (p=0.02). a 1m/s increase in ao-pwv was associated with a mean fall in egfr of 2.1 ml/min per year (95% ci,0.09-4.1) independent of other risk factors in younger patients (p=0.04). conclusions--ao-pwv predicts egfr decline,before the onset of advanced renal dysfunction,and is a potential target for renoprotection in younger patients with type 2 diabetes mellitus. © 2017 the authors.