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Association of low glomerular filtration rate and albuminuria with peripheral arterial disease: The National Health and Nutrition Examination Survey, 1999–2004

  • Author Footnotes
    1 These authors contributed equally to this work.
    Cho-Kai Wu
    Footnotes
    1 These authors contributed equally to this work.
    Affiliations
    Department of Internal Medicine, National Taiwan University College of Medicine and Hospital Yun-Lin Branch, Yun-Lin, Taiwan

    Division of Cardiology, Department of Internal Medicine, National Taiwan University College of Medicine and Hospital, Taipei, Taiwan

    Graduate Institute of Clinical Medicine, National Taiwan University College of Medicine, Taipei, Taiwan
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  • Author Footnotes
    1 These authors contributed equally to this work.
    Chung-Yi Yang
    Footnotes
    1 These authors contributed equally to this work.
    Affiliations
    Department of Medical Imaging, National Taiwan University College of Medicine and Hospital Yun-Lin Branch, Yun-Lin, Taiwan
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  • Chia-Ti Tsai
    Affiliations
    Division of Cardiology, Department of Internal Medicine, National Taiwan University College of Medicine and Hospital, Taipei, Taiwan
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  • Fu-Chun Chiu
    Affiliations
    Department of Internal Medicine, National Taiwan University College of Medicine and Hospital Yun-Lin Branch, Yun-Lin, Taiwan

    Division of Cardiology, Department of Internal Medicine, National Taiwan University College of Medicine and Hospital, Taipei, Taiwan
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  • Yin-Tsen Huang
    Affiliations
    Department of Family Medicine, Mackay Memorial Hospital, Taipei, Taiwan
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  • Jen-Kuang Lee
    Affiliations
    Department of Internal Medicine, National Taiwan University College of Medicine and Hospital Yun-Lin Branch, Yun-Lin, Taiwan

    Department of Laboratory Medicine, National Taiwan University Hospital, Taipei, Taiwan
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  • Chia-Ling Cheng
    Affiliations
    Division of Cardiology, Department of Internal Medicine, National Taiwan University College of Medicine and Hospital, Taipei, Taiwan
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  • Lian-Yu Lin
    Correspondence
    Corresponding author at: Division of Cardiology, Department of Internal Medicine, National Taiwan University College of Medicine and Hospital, No. 7, Chung-Shan South Road, Taipei 100, Taiwan. Tel.: +886 2 23123456x62152; fax: +886 2 23951841.
    Affiliations
    Division of Cardiology, Department of Internal Medicine, National Taiwan University College of Medicine and Hospital, Taipei, Taiwan
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  • Jou-Wei Lin
    Correspondence
    Corresponding author at: Department of Internal Medicine, National Taiwan University College of Medicine and Hospital Yun-Lin Branch, Cardiovascular Center, National Taiwan University Hospital Yun-Lin Branch, 579 Yun-Lin Road, Section 2 Dou-Liou City, Yun-Lin 640, Taiwan. Tel.: +886 922861953; fax: +886 55373257.
    Affiliations
    Department of Internal Medicine, National Taiwan University College of Medicine and Hospital Yun-Lin Branch, Yun-Lin, Taiwan

    Division of Cardiology, Department of Internal Medicine, National Taiwan University College of Medicine and Hospital, Taipei, Taiwan
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  • Juey-Jen Hwang
    Affiliations
    Department of Internal Medicine, National Taiwan University College of Medicine and Hospital Yun-Lin Branch, Yun-Lin, Taiwan

    Division of Cardiology, Department of Internal Medicine, National Taiwan University College of Medicine and Hospital, Taipei, Taiwan
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  • Fu-Tien Chiang
    Affiliations
    Department of Internal Medicine, National Taiwan University College of Medicine and Hospital Yun-Lin Branch, Yun-Lin, Taiwan

    Department of Laboratory Medicine, National Taiwan University Hospital, Taipei, Taiwan
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  • Author Footnotes
    1 These authors contributed equally to this work.

      Abstract

      Microalbuminuria may be an early sign of intra-renal vascular dysfunction and a marker of vascular risk in the general population as well as in high-risk individuals. However, the association between albuminuria and PAD has been demonstrated only in few small studies. The aim of current study is to evaluate the relative impact of albuminuria and glomerular filtration rate on the risk of peripheral artery disease (PAD) in a nationally representative sample population.
      Data (ankle brachial index [ABI], urine albumin, fasting glucose, and glomerular filtration rate [GFR] estimated using the Modification of Diet in Renal Disease [MDRD] Study equation) were collected on 7068 adults from the National Health and Nutrition Examination Survey (NHANES 1999–2004). PAD was defined as ABI <0.9 or >1.4. There was a trend towards an association between the presence of abnormal renal function (GFR < 60 mL/min/1.73 m2) and PAD in the non-diabetic patients (OR of 1.43, 95% CI: 0.98–2.09; P = 0.07) where as the presence of abnormal renal function was strongly associated PAD in the diabetic patients (OR of 2.3, 95% CI: 1.34–3.95; P = 0.046). On the contrary, albuminuria was independently associated with PAD in the non-diabetic (OR, 1.87; 95% CI, 1.38–2.52; P = 0.0003) but not in the diabetic patients (OR: 1.08, 95% CI: 0.68–1.73, P = 0.7411).
      We concluded that albuminuria, independent of renal function, is strongly associated with PAD in non-diabetic subjects. As diabetes develops and HbA1c level increases, the predictive value of albuminuria gradually diminishes after adjustment for renal function.

      Keywords

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