Two-year longitudinal trajectory patterns of albuminuria and subsequent rates of end-stage kidney disease and all-cause death: a nationwide cohort study of biopsy-proven diabetic kidney disease

Yamanouchi, Masayuki; Furuichi, Kengo; Hoshino, Junichi; Toyama, Tadashi; Shimizu, Miho; Yamamura, Yuta; Oda, Megumi; Kitajima, Shinji; Hara, Akinori; Iwata, Yasunori; Sakai, Norihiko; Oba, Yuki; Matsuoka, Shusaku; Ikuma, Daisuke; Mizuno, Hiroki; Suwabe, Tatsuya; Sawa, Naoki; Kitamura, Hiroshi; Suzuki, Yuichi; Sato, Hiroshi; Uesugi, Noriko; Ueda, Yoshihiko; Nishi, Shinichi; Yokoyama, Hitoshi; Nishino, Tomoya; Samejima, Ken-ichi; Kohagura, Kentaro; Shibagaki, Yugo; Makino, Hírofumi; Matsuo, Seiichi; Ubara, Yoshifumi; Wada, Takashi

doi:10.1136/bmjdrc-2021-002241

Cited by 4 publications

(10 citation statements)

References 42 publications

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“…16,21 Lower blood pressure levels have been shown to be associated with regression from moderate albuminuria to normal UACR, especially in patients with type-2 DM. 36 Optimizing hypertension management by lowering blood pressure levels reduce risk of progression from moderate albuminuria to severe albuminuria, and ESKD. 20 Hyperlipidemia has been implicated in the pathogenesis of DKD, however experimental models show that elevated levels of total cholesterol and triglycerides were not sufficient to drive overt changes in renal structure and function.…”

Section: Discussionmentioning

confidence: 99%

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Risk Factors and Comorbidities Associated with Diabetic Kidney Disease

Roy

Schweiker-Kahn

Jafry

et al. 2021

J Prim Care Community Health

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Introduction/objectives: Diabetic Kidney Disease (DKD) is the leading cause of end-stage kidney disease. Despite optimal glycemic control and blood pressure management, progression to DKD cannot be halted in some patients. We aimed to find the association of modifiable and non-modifiable risk factors and comorbid conditions in patients with DKD. Methods: Retrospective medical record review of adult patients with diabetes mellitus (DM) was performed who visited our internal medicine office between January 1, 2020 and December 31, 2020. Results: Among 728 patients with DM, 471 (64.7%) patients had DKD, and 257 (35.3%) patients were without DKD. Among the group of patients with DKD, the majority were in CKD stage G1A2 (34.6%), followed equally by G2A2 and G3aA1 (16.8% each). Mean age of the patients with DKD was significantly greater than the patients without DKD (69.4 years vs 62.2 years; P < .001). For each unit increase in age, there was a 7.8% increase in the odds of DKD (95% CI 5.3-10.4; P < .001). Women had 2.32 times greater odds of DKD (95% CI, 1.41-3.81; P = .001). We found decreased odds of DKD for those who consumed alcohol moderately (OR 0.612, 95% CI 0.377-0.994; P < .05). Significantly higher frequencies of associations of several comorbid medical conditions were seen in patients with DKD compared to the patients without DKD, such as hypertension (91.9% vs 75.6%), hyperlipidemia (86.6% vs 78.2%), coronary artery disease (39.3% vs 16.8%), cerebrovascular accidents (13.4% vs 7.4%), congestive heart failure (12.9% vs 4.1%), carotid artery stenosis (11.3% vs 2.6%), aortic aneurysm (5.4% vs 2.0%), peripheral artery disease (10.8% vs 3.5%), gout (12.4% vs 5.5%), and osteoarthritis (41.4% vs 31.2%). Conclusions: In patients with diabetes, increasing age, female sex, and lack of moderate alcohol consumption were associated with increased odds of DKD. Higher frequencies of association of hypertension, hyperlipidemia, coronary artery disease, cerebrovascular accidents, congestive heart failure, carotid artery stenosis, aortic aneurysm, peripheral artery disease, gout, and osteoarthritis were also seen in patients with DKD.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Risk Factors and Comorbidities Associated with Diabetic Kidney Disease

Roy

Schweiker-Kahn

Jafry

et al. 2021

J Prim Care Community Health

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“…Recently, five different classes of DKD have been described based on cluster analysis of 6 variables [31]. These divergent phenotypes may have divergent pathogenesis and lncRNA trajectories [5]. Sixth, studies are largely based on glomerulocentric view of DKD pathogenesis, with glomerular hyperfiltration and protein leak viewed as the initial inciting event.…”

Section: Discussionmentioning

confidence: 99%

“…A broadening array of established and novel risk markers may be utilized for DKD diagnosis and staging; but clinical practice relies mainly on measurement of albuminuria, mainly urinary albumin/creatinine ratio (UACR), and estimated glomerular filtration rate (eGFR) [4]. However, the classical model of DKD starting with glomerular hyperfiltration and increased UACR, followed by declining eGFR has been greatly challenged; and many other different trajectories of albuminuria and renal function alteration were described in biopsy-proven DKD patients [5]. Moreover, DKD categorization by UACR is hampered by generally low sensitivity/specificity and significant intraindividual variability [6]; whereas creatinine-based eGFR formulas are perplexed by methodological limitations, nonrenal confounders, and inaccuracies at the near-normal range [4].…”

Section: Introductionmentioning

confidence: 99%

Serum Long Non-Coding RNAs in Diabetic Kidney Disease

Abdel-Aty

Mowafy

El-Attar

et al. 2022

Clinical Diabetology

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“…It is generally believed that microalbuminuria is not only an indicator of glomerular endothelial damage representing microvascular injuries but also reflects widespread vascular damage 11 . It is well established that microalbuminuria and macroalbuminuria were significant risk factors of CV and all‐cause mortality in diabetic patients 12–15 . The research of Hoorn Diabetes Care System cohort showed increased UACR (>3.0 mg/mmol) was prospectively associated with a higher risk of CV mortality in type 2 DM patients 16 .…”

Section: Introductionmentioning

confidence: 99%

Lower urinary albumin‐to‐creatinine ratio predicted all‐cause and cardiovascular mortality in Chinese population with diabetes and prediabetes—The Shanghai Changfeng cohort study

Chen,

Wu,

et al. 2023

Journal of Diabetes

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IntroductionElevated urinary albumin‐to‐creatinine ratio (UACR) was associated with increased mortality in general population and diabetic patients. However, whether the association remains similar in the subjects with different status of glucose metabolism was unclear. The optimal level of UACR in predicting mortality also remained unknown. This study aims to investigate the relationship between UACR with all‐cause and cardiovascular mortality in population with different status of glucose metabolism and explore the predictive cutoff point of UACR.MethodsSix thousand three hundred and eighty‐six community‐dwelling individuals aged ≥45 years were enrolled and followed for an average of 5.3 years. Cox proportional hazards model was performed to analysis the association of baseline UACR and all‐cause as well as cardiovascular mortality according to the status of glucose metabolism. Receiver operating characteristic curve was plotted to explore the optimal predictive cutoff point of UACR.ResultsWith UACR increasing, both the prevalence of all‐cause and cardiovascular death increased. Cox analyses showed baseline UACR independently predicted the risk of all‐cause and cardiovascular mortality in the patients with prediabetes mellitus (pre‐DM) and diabetes mellitus (DM) but not in subjects with normal glucose tolerance (NGT). When divided by quartiles of UACR, the cumulative survival rate decreased acrossing the quartiles. Compared to the subjects with lowest quartile of UACR, participants with UACR ≥7.40 mg/gCr had a higher risk of all‐cause mortality, and participants with UACR ≥16.60 mg/gCr had an increased risk of cardiovascular mortality in all hyperglycemia subjects. The optimal predictive cutoff point of UACR was about 17 mg/gCr.ConclusionUACR was an independent predictor of all‐cause and cardiovascular mortality in population with pre‐DM and DM but not in the subjects with NGT. The optimal predictive cutoff point of UACR is about 17 mg/gCr, which was far below the diagnostic cutoff point of microalbuminuria. Earlier interventions of albuminuria should be initiated from very early stage of hyperglycemia to reduce the burden of death in all patients whose glucose metabolism are impaired.

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Two-year longitudinal trajectory patterns of albuminuria and subsequent rates of end-stage kidney disease and all-cause death: a nationwide cohort study of biopsy-proven diabetic kidney disease

Cited by 4 publications

References 42 publications

Risk Factors and Comorbidities Associated with Diabetic Kidney Disease

Risk Factors and Comorbidities Associated with Diabetic Kidney Disease

Serum Long Non-Coding RNAs in Diabetic Kidney Disease

Lower urinary albumin‐to‐creatinine ratio predicted all‐cause and cardiovascular mortality in Chinese population with diabetes and prediabetes—The Shanghai Changfeng cohort study

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