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Decline in the estimated glomerular filtration rate (eGFR) following metabolic control and its relationship with baseline eGFR in type 2 diabetes with microalbuminuria or macroalbuminuria

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Abstract

Aims

Relationship between baseline eGFR and the rate of decline in eGFR was investigated in diabetic kidney disease.

Materials and methods

Patients with type 2 diabetes with microalbuminuria (MI) (n = 124) or macroalbuminuria (MA) (n = 81) received team-based medical care to prevent the development of diabetic kidney disease. The decline in eGFR over 4 years, divided into the first year and subsequent 3 years, was estimated by linear-mixed modeling.

Results

The eGFR showed a rapid decline during the first year, followed by a slower decline. On multiple regression analysis, the baseline eGFR was positively correlated with HbA1c in MI and negatively correlated with carotid plaque in MI and in MA. Subsequent eGFR decline following 1-year intervention was negatively correlated with the baseline eGFR and HbA1c level at 1 year in MI, whereas it was positively correlated with baseline eGFR and negatively correlated with the amount of proteinuria at 1 year in MA. Even in maintained baseline eGFR(≧ 60 ml/min/1.73 m2) at the first year, when HbA1c ≧ 7.5%, eGFR reduction rate and years to ESKD were much faster and shorter, compared to the group of HbA1c < 7.5% [− 3.44 (SE 1.137) vs. − 1.695 (SE 0.431) ml/min/1.73 m2/year, and 19.4 vs. 35.7 years, respectively]. In MA, lower eGFR (< 60 ml/min/1.73 m2) and higher proteinuria (≧ 2.25 g/gCre) had a much faster eGFR decline and shorter time to ESKD, compared to the group of maintained eGFR and lower proteinuria (< 2.25 g/gCre) [− 5.240 (SE 1.537) vs. − 2.67 (SE 0.997) ml/min/1.73 m2/year, and 4.41 vs. 22.8 years, respectively].

Conclusions

In MI, even in maintained eGFR, the continued increase in eGFR in response to hyperglycemia (HbA1c ≧ 7.5%) led to a faster decline in renal function and in MA, lower eGFR, with an increase in proteinuria, contributed to rapid decline of renal function.

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Abbreviations

DDP:

Diabetes dialysis prevention

ESKD:

End-stage kidney disease

LMM:

Linear mixed model

MI:

Microalbuminuria

MA:

Macroalbuminuria

MBP:

Mean blood pressure

UAC:

Urinary albumine-to-creatinine ratio

UPC:

Urinary protein-to-creatinine excretion rate

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Acknowledgements

We would like to express our deep gratitude to Dr Eiji Kawasaki, Dr Yuko Nakano, Dr Yoko Sagara, Dr Aira Uchida, Dr Takahiro Fukuyama, Dr Masayuki Tojikubo, and Dr Hidekazu Tamai who involved in the treatment in prevention of diabetes dialysis at the Diabetes Center of Shin-koga Hospital. We thank Mr. Daiki Setoguchi and Mr. Hiroaki Tagawa for his involvement in data organization.

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Authors and Affiliations

  1. Center of Diabetes, Koseikai Hospital, Hayama 1-3-2, Nagasaki, Japan

    Shoichi Akazawa & Yasunori Sera

  2. Life Science Institute, Saga-Ken Medical Center Koseikan, Saga, Japan

    Eiji Sadashima

  3. Shin-Koga Hospital, Kurume, Japan

    Nobuhiko Koga

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  1. Shoichi Akazawa
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  2. Eiji Sadashima
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  4. Nobuhiko Koga
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Contributions

ES performed statistical analysis and wrote the manuscript. YS and NK contributed to the discussion and reviewed and edited the manuscript.

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Correspondence to Shoichi Akazawa.

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The authors have no conflicts of interest to declare.

Ethical approval

This study was approved by the Ethical committee at Koseikai Hospital (2020-12, 2020/12/3) and Shin-Koga Hospital (2019/11/13, 2018/11/12).

Informed consent

All informed consent was given before management of Diabetes Dialysis Prevention was initiated. All patients were fully informed about DDP, understood how to do it, and agreed to receive not only treatment by a doctor, but also dietary guidance by a registered dietitian and lifestyle guidance by a nurse.

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Akazawa, S., Sadashima, E., Sera, Y. et al. Decline in the estimated glomerular filtration rate (eGFR) following metabolic control and its relationship with baseline eGFR in type 2 diabetes with microalbuminuria or macroalbuminuria. Diabetol Int 13, 148–159 (2022). https://doi.org/10.1007/s13340-021-00517-2

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