SP437
RENAL ARTERIOLAR HYALINOSIS, NOT INTIMAL THICKENING IN LARGER ARTERIES, IS ASSOCIATED WITH CARDIOVASCULAR EVENTS IN PATIENTS WITH BIOPSY-PROVEN DIABETIC NEPHROPATHY Free

INTRODUCTION AND AIMS: Diabetic nephropathy (DN), a pathologically diagnosed microvascular complication of diabetes mellitus, is a strong risk factor for cardiovascular (CV) events, which mainly involve larger arteries than those affected in DN. Pathological findings in DN consist of hierarchical glomerular lesions with varying degrees of interstitial and vascular involvement. It remains unclear whether pathologic findings in DN are closely associated with the development of CV events.

METHODS: We conducted a retrospective cohort study of 408 patients with type 2 diabetes and biopsy-proven DN, with a mean follow-up period of 8.9 ± 8.0 years. We investigated how CV events were impacted by 2 vascular DN lesions, namely arteriolar hyalinosis and arterial intimal thickening, as well as by glomerular and interstitial lesions.

RESULTS: Of the 408 DN patients, 353 (87%) and 295 (72%) had arteriolar hyalinosis and arterial intimal thickening, respectively. During the entire follow-up period, patients with arteriolar hyalinosis had higher rates of CV events in the crude Kaplan-Meier analysis than those without these lesions (P=0.005 by the log-rank test). When fully adjusted for clinically relevant confounders, arteriolar hyalinosis independently predicted CV events (hazard ratio [HR], 1.91; 95% confidence interval [CI], 1.15 to 3.35), but we did not find any relationship between arterial intimal thickening and CV events (HR, 0.86; 95% CI, 0.61 to 1.25). In addition, neither glomerular nor interstitial lesions were independently associated with CV events in the fully adjusted model.

CONCLUSIONS: Arteriolar hyalinosis but not intimal thickening in large arteries was strongly associated with CV events in patients with DN.