Supplementary Material for: The relationship between vascular aging phenotypes and renal damage among individuals with type 2 diabetes

Objective: To investigate the relationship between vascular aging (VA) phenotypes and renal damage in type 2 diabetic population. Methods: In this cross-sectional study, we included 8,141 individuals with type 2 diabetes who participated in the Kailuan Study during 2010 to 2018 and completed the brachial-ankle pulse wave velocity (baPWV) assessment for arterial stiffness, an indicator for VA. The age- and sex-specific 10th and 90th percentiles of baPWV based on a reference cohort were used as cutoffs to define supernormal VA (SUPERNOVA, baPWV90th percentiles). The estimated glomerular filtration rate (eGFR) and proteinuria levels were used to assess renal damage, including isolated proteinuria, isolated kidney function decline (eGFR<60ml/min/1.73m2), and proteinuria combined with kidney function decline. Multivariable logistic regression analysis was used to analyze the relationship between VA phenotypes and diabetic kidney damage. Results: The prevalence of isolated proteinuria, isolated kidney function decline, and proteinuria combined with kidney function decline was 17.0%, 12.2%, and 5.4%, respectively. Compared with NVA, SUPERNOVA was associated with 34% lower odds (95% confidence interval [CI]: 0.46-0.96) of isolated proteinuria after adjusting for age, sex, and other potential confounders. EVA was associated with higher odds of all three types of kidney damage; the adjusted odds ratio (95% CI) was 1.42 (1.20-1.67) for proteinuria, 1.24 (1.01-1.51) for kidney function decline, and 1.56 (1.18-2.06) for proteinuria combined with kidney function decline. Conclusions: Vascular aging phenotypes are associated with renal damage, especially isolated proteinuria. SUPERNOVA was associated with lower odds of isolated proteinuria and EVA was associated with higher odds of proteinuria and kidney function decline.研究目的：探讨2型糖尿病人群中血管衰老（vascular aging, VA）表型与肾损伤的关联。 研究方法：本研究为横断面研究，纳入2010至2018年参与开滦研究（Kailuan Study）、且完成动脉僵硬度检测指标——肱踝脉搏波传导速度（brachial-ankle pulse wave velocity, baPWV）评估的8141名2型糖尿病个体。基于参考队列的baPWV按年龄和性别分层的第10、90百分位数作为截断值，定义超正常血管衰老（SUPERNOVA，即baPWV≥第90百分位数）。采用估算肾小球滤过率（estimated glomerular filtration rate, eGFR）与蛋白尿水平评估肾损伤，涵盖孤立性蛋白尿、孤立性肾功能下降（eGFR<60ml/min/1.73m²）以及蛋白尿合并肾功能下降三种类型。采用多变量logistic回归分析血管衰老表型与糖尿病肾损伤的关联。 研究结果：孤立性蛋白尿、孤立性肾功能下降及蛋白尿合并肾功能下降的患病率分别为17.0%、12.2%与5.4%。校正年龄、性别及其他潜在混杂因素后，与正常血管衰老（normal vascular aging, NVA）组相比，SUPERNOVA组的孤立性蛋白尿发生风险降低34%（95%置信区间[CI]：0.46~0.96）。异常血管衰老（EVA）组与三种肾损伤类型的更高发生风险均存在关联：校正后的比值比（95% CI）分别为：蛋白尿1.42（1.20~1.67）、肾功能下降1.24（1.01~1.51）、蛋白尿合并肾功能下降1.56（1.18~2.06）。 研究结论：血管衰老表型与肾损伤存在显著关联，尤以与孤立性蛋白尿的关联最为突出。SUPERNOVA与孤立性蛋白尿的较低发生风险相关，而EVA则与蛋白尿及肾功能下降的较高发生风险相关。