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The prognosis of subjects showing a reduced estimated glomerular filtration rate without albuminuria in Japanese patients with type 2 diabetes: a cohort study for diabetic kidney disease

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Abstract

Background

To determine the renal and cardiovascular prognosis and all-cause mortality of Japanese patients with type 2 diabetes showing a reduced estimated glomerular filtration rate (eGFR) without albuminuria.

Methods

A population of 675 patients with type 2 diabetes was prospectively observed for 4 years to determine the renal and cardiovascular outcomes and mortality. The subjects were divided into the four groups: those with a preserved eGFR and no albuminuria (n = 306), a preserved eGFR and albuminuria (n = 151), a reduced eGFR and no albuminuria (n = 96), and a reduced eGFR and albuminuria (n = 122). The Cox proportional hazard model and Fine and Gray method were used to assess between-group differences in the risk of mortality and cardiovascular events.

Results

In the group with a reduced eGFR, the eGFR value did not significantly change in the subjects without albuminuria (0 ± 8 mL/min/1.73 m2), whereas it decreased continuously in those with albuminuria (-6 ± 12 mL/min/1.73 m2). The incidence of cardiovascular events was significantly (P = 0.03) higher in the subjects with albuminuria (17%) than those without albuminuria (7%) in the group with a reduced eGFR. Cardiovascular events were significantly (P < 0.01) more frequent in the group with a reduced eGFR than in those with a preserved eGFR in both subjects with and without albuminuria.

Conclusions

The risk of end-stage kidney disease in non-albuminuric subjects with a reduced eGFR is considered to be low. We should focus on cardiovascular prognosis, because these patients are still at high risk of cardiovascular events, even though the prognosis is better in comparison to albuminuric patients.

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Acknowledgements

The authors thank Tomoko Koyanagi in the secretarial section of Edogawa Hospital for her valuable help with data collection.

Funding

No funds were received in support of this work.

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Authors and Affiliations

  1. Department of Diabetes, Metabolism and Kidney Disease, Edogawa Hospital, 2-24-18, Higashikoiwa, Edogawa-ku, Tokyo, 133-0052, Japan

    Hiroyuki Ito, Shinichi Antoku, Takuma Izutsu, Eiji Kusano, Suzuko Matsumoto, Tomoko Yamasaki, Toshiko Mori & Michiko Togane

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  1. Hiroyuki Ito
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  2. Shinichi Antoku
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  3. Takuma Izutsu
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  4. Eiji Kusano
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  7. Toshiko Mori
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Contributions

HI contributed to conception, design, analysis, interpretation, writing first draft, editing, and final approval. SA contributed to reviewing drafts, editing, and final approval. TI, EK, SM, TY, TM and MT contributed to data collection and final approval.

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Correspondence to Hiroyuki Ito.

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Conflict of interest

Hiroyuki Ito has received lecture fees from Eli Lilly Japan KK and Nippon Boehringer Ingelheim Co., Ltd.

Human and animal rights

The study was conducted in accordance with the principles expressed in the 2008 Declaration of Helsinki. The Ethics Committee of Edogawa Hospital approved the study protocol (approved number: 2015-18). The trial is registered on UMIN-CTR, identifier UMIN000038835.

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The Ethics Committee of Edogawa Hospital waived the need for written informed consent because the data were analyzed anonymously for this analysis based on information stored in the hospital.

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Ito, H., Antoku, S., Izutsu, T. et al. The prognosis of subjects showing a reduced estimated glomerular filtration rate without albuminuria in Japanese patients with type 2 diabetes: a cohort study for diabetic kidney disease. Clin Exp Nephrol 24, 1033–1043 (2020). https://doi.org/10.1007/s10157-020-01935-3

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