Clinical and Experimental Nephrology

, Volume 15, Issue 3, pp 391–397 | Cite as

Risk of macrovascular disease stratified by stage of chronic kidney disease in type 2 diabetic patients: critical level of the estimated glomerular filtration rate and the significance of hyperuricemia

  • Kentaro Tanaka
  • Shigeko Hara
  • Akifumi Kushiyama
  • Yoshifumi Ubara
  • Yoko Yoshida
  • Sonoo Mizuiri
  • Atsushi Aikawa
  • Shouji Kawatzu
Original Article



Although a high prevalence of macrovascular disease (MVD) has been reported in patients with stage 3 chronic kidney disease (CKD), few studies have reported its risk with respect to the underlying cause of kidney disease. This study investigated the prevalence of MVD in type 2 diabetic patients with CKD stratified by CKD stage, as defined by estimated glomerular filtration rate (eGFR), as well as the risk factors for MVD.


1493 patients with diabetic CKD (1273 males, 220 females) were stratified by CKD stage (stage 1: 39, stage 2: 272, stage 3: 1052, stage 4: 101, stage 5: 29) based on eGFR calculated by the Japanese formula and averaged over 8 months. MVD was defined as one of the following: coronary heart disease (CHD), stroke or arteriosclerosis obliterans (ASO).


The prevalence of MVD was 18.6%. A significant increasing trend in MVD prevalence was observed from stage 3 (17.78%) to 4 (52.48%). According to a receiver operating characteristic curve analysis on MVD prevalence in stage 3 patients, an eGFR of 46.4 ml/min/1.73 m2 was determined to be a critical cut-off level. Proteinuria, eGFR <60 ml/min/1.73 m2 and hyperuricemia were independent risk factors for MVD.


In patients with diabetic CKD, a significant increase in MVD prevalence was observed from stage 3 to 4. An eGFR of 46.4 ml/min/1.73 m2 is a critical level that affects MVD prevalence. From the perspective of cardiorenal association, CKD stage 3 should be divided into two substages. As hyperuricemia is related to an increased risk of MVD, uric acid control may be important in reducing MVD risk in diabetic CKD.


Type 2 diabetes Chronic kidney disease Macrovascular disease Hyperuricemia 


Conflict of interest

The authors have no conflict of interest to disclose.


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Copyright information

© Japanese Society of Nephrology 2011

Authors and Affiliations

  • Kentaro Tanaka
    • 1
    • 3
  • Shigeko Hara
    • 1
    • 2
  • Akifumi Kushiyama
    • 1
  • Yoshifumi Ubara
    • 2
  • Yoko Yoshida
    • 1
  • Sonoo Mizuiri
    • 3
  • Atsushi Aikawa
    • 3
  • Shouji Kawatzu
    • 1
  1. 1.Division of Diabetes and MetabolismThe Institute for Adult Diseases, Asahi Life FoundationTokyoJapan
  2. 2.Kidney Center and Okinaka Memorial Institute for Medical ResearchToranomon HospitalTokyoJapan
  3. 3.Department of NephrologyToho University School of MedicineTokyoJapan

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