Low Ankle‐Brachial Index Is Associated With Albuminuria and Diabetic Kidney Disease in Type 2 Diabetes; A Cross Sectional Study

TL;DR

A low ankle-brachial index is linked to kidney disease in type 2 diabetes patients, suggesting it could be a useful screening tool.

Contribution

This is the first study from the Middle East to show a strong link between PAD and DKD in type 2 diabetes.

Findings

ABI ≤ 0.9 is associated with a 2.32-fold higher risk of albuminuria in type 2 diabetes patients.

ABI ≤ 0.9 increases the odds of diabetic kidney disease by 2.7 times in type 2 diabetes patients.

ABI < 0.8 is linked to a 7.5-fold higher risk of diabetic kidney disease after adjustment for confounders.

Abstract

Micro‐ and macrovascular complications of type 2 diabetes, including diabetic kidney disease (DKD) and peripheral artery disease (PAD), impose a significant burden on patients and healthcare systems. Diabetes is associated with a twofold higher risk of PAD. No studies from the Middle East have examined the relationship between PAD and DKD. Given the shared vascular pathology of DKD and PAD, this study investigated the association between a low ankle‐brachial index (ABI) and albuminuria/DKD.

This analytical cross‐sectional study included patients diagnosed with diabetes per ADA criteria. ABI was measured using a four‐channel automated oscillometric sphygmomanometer after 30 min of rest. DKD was defined as albuminuria [urinary albumin > 30 mg/g cr] and/or eGFR < 60 mL/min/1.73 m2. Binary logistic regression assessed the association between ABI and both albuminuria and DKD, adjusting for confounders.

Among 151 patients, 48% had PAD in at least one limb defined by ABI ≤ 0.9. ABI ≤ 0.9 was associated with albuminuria (OR = 2.32, 95% CI: 1.15–4.7, p = 0.01), which remained significant after adjustment for age, sex, hypertension, and coronary artery disease (CAD) (OR = 2.97, 95% CI: 1.28–6.8, p = 0.02). Similarly, ABI ≤ 0.9 increased the odds of DKD (OR = 2.7, 95% CI: 1.39–5.2, p = 0.003), and after adjustment, the association remained significant (OR = 2.99, 95% CI: 1.05–8.4, p = 0.04). ABI < 0.8 further increased the risk of DKD (OR = 7.5, 95% CI: 1.9–29, p = 0.003).

A reduced ABI (< 0.9) is independently associated with both albuminuria and DKD in type 2 diabetes, with a stronger association at ABI < 0.8. These findings highlight the potential role of ABI as a simple, non‐invasive, and accessible screening tool for identifying patients at increased risk of DKD.

Low ankle brachial index (< 0.9) in patients with type 2 diabetes is associated with 3‐fold higher odds of both albuminuria and diabetic kidney disease.

Figures