Decline in estimated glomerular filtration rate is associated with risk of end-stage renal disease in type 2 diabetes with macroalbuminuria: an observational study from JDNCS

Shimizu, Miho; Furuichi, Kengo; Toyama, Tadashi; Funamoto, Tomoaki; Kitajima, Shinji; Hara, Akinori; Ogawa, Daisuke; Koya, Daisuke; Ikeda, Kenzo; Koshino, Yoshitaka; Kurokawa, Yukie; Abe, Hideharu; Mori, Kiyoshi; Nakayama, Masaaki; Konishi, Yoshio; Samejima, Ken-ichi; Matsui, Masaru; Gohda, Tomohito; Fukami, Kei; Nagata, Daisuke; Yamazaki, Hidenori; Suzuki, Yuichi; Fujimoto, Shouichi; Maruyama, Shoichi; Kato, Shinichi; Naito, Tateaki; Yoshimura, Kenichi; Yokoyama, Hitoshi; Wada, Takashi

doi:10.1007/s10157-017-1467-9

Cited by 14 publications

(10 citation statements)

References 27 publications

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“…Our report also confirms that severely increased albuminuria is strongly predictive for progression to advanced renal disease or long‐term dialysis. Previous studies in Pima Indians and Japanese patients with type 2 diabetes showed that severely increased albuminuria predicts ESKD 34,35 . With regard to blood pressure this study confirms that high systolic blood pressures in T2DM are associated with a steep decline in kidney function 36 …”

Section: Discussionsupporting

confidence: 81%

Rate of kidney function decline and factors predicting progression of kidney disease in type 2 diabetes mellitus patients with reduced kidney function: A nationwide retrospective cohort study

et al. 2020

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Currently, the data on independent risk factors for the progression of kidney disease in type 2 diabetes mellitus (T2DM) patients with CKD are limited. This study aimed to investigate CKD progression in T2DM patients who have reduced kidney function with baseline estimated glomerular filtration rate (eGFRs) between 15 and 59 mL/min/1.73 m2. This study was composed of a nationwide retrospective cohort of adult T2DM patients from 831 public hospitals in Thailand during the year 2015. T2DM patients with CKD stages 3 and 4 were followed up, until development of CKD stage 5, requirement of chronic dialysis, loss to follow‐up, death, or 31 May 2018, whichever came first. Cox proportional hazard regression was utilized for analysis. A total of 8464 participants were included; 30.4% were male. The mean age was 69 ± 10 years. The mean eGFR was 45 ± 11 mL/min/1.73 m2. The incidence of CKD stage 5 or the need for chronic dialysis was 16.4 per 1000 person‐years. The annual rate of eGFR decline during a mean follow‐up of 29 months was −2.3 mL/min/1.73 m2; 14.4% had a rapid decline in eGFR. The risk factors associated with progression to CKD stage 5 or the need for chronic dialysis were diabetes duration, systolic blood pressure, serum uric acid, albuminuria, and baseline eGFR. Conversely, older age and the use of renin‐angiotensin aldosterone system blockade were associated with decreased risks for rapid CKD progression and incidence CKD stage 5 or dialysis. This study identifies multiple predictive risk factors that support a multifaceted approach to prevent progression of advanced CKD.

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Section: Discussionsupporting

confidence: 81%

Rate of kidney function decline and factors predicting progression of kidney disease in type 2 diabetes mellitus patients with reduced kidney function: A nationwide retrospective cohort study

et al. 2020

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“…The incident nonproliferative diabetic retinopathy and progression from nonproliferative to proliferative diabetic retinopathy assessed by ophthalmologists as well as procedures involving vitrectomy or photocoagulation were counted as diabetic retinopathy outcomes. The outcomes of new or worsening nephropathy were defined as having any of the following: progression of albuminuria based on urinary albumin to creatinine ratio (incident microalbuminuria or progression from microalbuminuria to macroalbuminuria), doubling of serum creatinine, ≥30% decline in eGFR, or development of end-stage kidney disease [ 20 ]. Diabetic peripheral neuropathy was assessed by questionnaire, electromyography, or a nerve conduction study.…”

Section: Methodsmentioning

confidence: 99%

Time to Reach Target Glycosylated Hemoglobin Is Associated with Long-Term Durable Glycemic Control and Risk of Diabetic Complications in Patients with Newly Diagnosed Type 2 Diabetes Mellitus: A 6-Year Observational Study

et al. 2021

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Background: To evaluate the association of time to reach the target glycosylated hemoglobin (HbA1c) level with long-term durable glycemic control and risk of diabetic complications in patients with newly diagnosed type 2 diabetes mellitus (T2DM). Methods: In a longitudinal observational cohort, 194 patients with T2DM newly diagnosed between January 2011 and March 2013 were followed up over 6 years. Patients were classified according to the time needed to reach the target HbA1c (<7.0%): <3, 3 to 6 (early achievement group), and ≥6 months (late achievement group). Risks of microvascular complications including diabetic retinopathy, nephropathy, and neuropathy as well as macrovascular events including ischemic heart disease, ischemic stroke, and peripheral arterial disease were assessed by multivariable Cox proportional hazards analysis. Results: During a median follow-up of 6.53 years, 66 microvascular and 14 macrovascular events occurred. Maintenance of durable glycemic control over 6 years was more likely in the early achievement groups than in the late achievement group (34.5%, 30.0%, and 16.1% in <3, 3 to 6, and ≥6 months, respectively, P=0.039). Early target HbA1c achievement was associated with lower risk of composite diabetic complications (adjusted hazard ratio [HR, 0.47; 95% confidence interval [CI], 0.26 to 0.86 in <3 months group) (adjusted HR, 0.50; 95% CI, 0.23 to 1.10 in 3 to 6 months group, in reference to ≥6 months group). Similar trends were maintained for risks of microvascular and macrovascular complications, although statistical significance was not reached for macrovascular complications. Conclusion: Early target HbA1c achievement was associated with long-term durable glycemic control and reduced risk of diabetic complications in newly diagnosed T2DM.

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“…However, the clinical stage of albuminuria was also a significant risk factor for the occurrence of a CV event irrespective of the occurrence of a renal event. Studies in Japan have found that renal and cardiovascular outcomes were much more frequent in patients with albuminuria, and that those with a reduced eGFR without albuminuria had a relatively benign status 17–20 . Yokoyama et al 21 .…”

Section: Discussionmentioning

confidence: 99%

“…Studies in Japan have found that renal and cardiovascular outcomes were much more frequent in patients with albuminuria, and that those with a reduced eGFR without albuminuria had a relatively benign status [17][18][19][20] . Yokoyama et al 21 reported that non-albuminuric DKD patients did not have a high risk of mortality, CVD events or renal function decline when non-albuminuric DKD was not accompanied by previous macrovascular complication.…”

Section: Discussionmentioning

confidence: 99%

One‐year estimated glomerular filtration rate decline as a risk factor of cardiovascular and renal end‐points in high‐risk Japanese patients

Meguro

Inaishi

Sato

et al. 2020

J of Diabetes Invest

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Aims/Introduction As estimated glomerular filtration rate (eGFR) progression might correlate with cardiovascular prognosis, the correlation between 1‐year decline in eGFR and cardiovascular incidences and renal outcome was investigated. Materials and Methods The 1‐year percentage decline in eGFR at the first observation year was calculated in a cohort of the standard versus intEnsive statin therapy for hypercholesteroleMic Patients with diAbetic retinopaTHY (EMPATHY) trial participants. The primary end‐point was the composite cardiovascular end‐point including the renal end‐point. The associations between the incidence of each end‐point and clinical markers were analyzed using the Cox proportional hazards regression model. Results A total of 4,461 patients were analyzed. The mean observation period was 765.3 ± 363.1 days. The best cut‐off value of 1‐year eGFR decline was 0.099 in the first year for renal end‐point prediction by receiver operating characteristic curve analysis. The area under the curve of the model including the 1‐year eGFR decline of the first year was significantly larger than the model without it (0.943, 95% confidence interval 0.915–0.971 to 0.967, 95% confidence interval 0.950–0.983, P = 0.019). Primary end‐point incidences and the renal end‐point were much higher in rapid eGFR decliners compared with non‐decliners (P < 0.0001). The cardiovascular end‐point incidence, except for the renal end‐point, was not different between the groups. According to Cox regression analysis, 1‐year eGFR decline during the first year was a significant risk factor for the end‐points, including the renal end‐point, independent of albuminuria and eGFR at baseline. Conclusions The 1‐year eGFR decline rate provided useful information for cardiovascular end‐point predictions, including the renal end‐point, in addition to the conventional risk factors.

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Decline in estimated glomerular filtration rate is associated with risk of end-stage renal disease in type 2 diabetes with macroalbuminuria: an observational study from JDNCS

Cited by 14 publications

References 27 publications

Rate of kidney function decline and factors predicting progression of kidney disease in type 2 diabetes mellitus patients with reduced kidney function: A nationwide retrospective cohort study

Rate of kidney function decline and factors predicting progression of kidney disease in type 2 diabetes mellitus patients with reduced kidney function: A nationwide retrospective cohort study

Time to Reach Target Glycosylated Hemoglobin Is Associated with Long-Term Durable Glycemic Control and Risk of Diabetic Complications in Patients with Newly Diagnosed Type 2 Diabetes Mellitus: A 6-Year Observational Study

One‐year estimated glomerular filtration rate decline as a risk factor of cardiovascular and renal end‐points in high‐risk Japanese patients

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