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Clinical and Experimental Nephrology

, Volume 18, Issue 4, pp 613–620 | Cite as

Clinical impact of albuminuria and glomerular filtration rate on renal and cardiovascular events, and all-cause mortality in Japanese patients with type 2 diabetes

  • Takashi Wada
  • Masakazu Haneda
  • Kengo Furuichi
  • Tetsuya Babazono
  • Hiroki Yokoyama
  • Kunitoshi Iseki
  • Shin-ichi Araki
  • Toshiharu Ninomiya
  • Shigeko Hara
  • Yoshiki Suzuki
  • Masayuki Iwano
  • Eiji Kusano
  • Tatsumi Moriya
  • Hiroaki Satoh
  • Hiroyuki Nakamura
  • Miho Shimizu
  • Tadashi Toyama
  • Akinori Hara
  • Hirofumi Makino
  • The Research Group of Diabetic Nephropathy, Ministry of Health, Labour, and Welfare of Japan
Original Article

Abstract

Background

The number of patients suffering from diabetic nephropathy resulting in end-stage kidney disease is increasing worldwide. In clinical settings, there are limited data regarding the impact of the urinary albumin-to-creatinine ratio (UACR) and reduced estimated glomerular filtration rate (eGFR) on renal and cardiovascular outcomes and all-cause mortality.

Methods

We performed a historical cohort study of 4328 Japanese participants with type 2 diabetes from 10 centers. Risks for renal events (requirement for dialysis or transplantation, or half reduction in eGFR), cardiovascular events (cardiovascular death, nonfatal myocardial infarction, or nonfatal stroke), and all-cause mortality were assessed according to UACR and eGFR levels.

Results

During follow-up (median 7.0 years, interquartile range 3.0–8.0 years), 419 renal events, 605 cardiovascular events and 236 deaths occurred. The UACR levels increased the risk and the adjusted hazard ratios for these three events. In addition to the effects of UACR levels, eGFR stages significantly increased the adjusted hazard ratios for renal events and all-cause mortality, especially in patients with macroalbuminuria. Diabetic nephropathy score, based on the prognostic factors, well predicted incidence rates per 1000 patient/year for each event.

Conclusions

Increased UACR levels were closely related to the increase in risks for renal, cardiovascular events and all-cause mortality in Japanese patients with type 2 diabetes, whereas the association between high levels of UACR and reduced eGFR was a strong predictor for renal events.

Keywords

Diabetic nephropathy Chronic kidney disease Albuminuria Cardiovascular disease Mortality Glomerular filtration rate 

Notes

Acknowledgments

The authors thank Dr. Yukinari Yamaguchi (Nara Medical University), Dr. Mitsuhiro Yoshimura (Noto General Hospital), and Miyuki Murakami (Kanazawa University) for supporting this study. This study was supported by Grant-in-Aids for Diabetic Nephropathy Research and for Diabetic Nephropathy and Nephrosclerosis Research, from the Ministry of Health, Labour and Welfare of Japan and by the Ministry of Education, Science, Sports and Culture, Japan.

Conflict of interest

H. Makino is a consultant for AbbVie, Astellas and Teijin, receives speaker honoraria from Astellas, MSD, Takeda, and Tanabe Mitsubishi, and receives grant support from Astellas, Daiichi Sankyo, Dainippon Sumitomo, MSD, Novo Nodisk and Takeda.

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Copyright information

© Japanese Society of Nephrology 2013

Authors and Affiliations

  • Takashi Wada
    • 1
    • 2
  • Masakazu Haneda
    • 4
  • Kengo Furuichi
    • 1
    • 3
  • Tetsuya Babazono
    • 5
  • Hiroki Yokoyama
    • 6
  • Kunitoshi Iseki
    • 7
  • Shin-ichi Araki
    • 8
  • Toshiharu Ninomiya
    • 9
  • Shigeko Hara
    • 10
  • Yoshiki Suzuki
    • 11
  • Masayuki Iwano
    • 12
  • Eiji Kusano
    • 13
  • Tatsumi Moriya
    • 14
  • Hiroaki Satoh
    • 15
  • Hiroyuki Nakamura
    • 16
  • Miho Shimizu
    • 1
    • 3
  • Tadashi Toyama
    • 1
    • 3
  • Akinori Hara
    • 1
    • 3
  • Hirofumi Makino
    • 17
  • The Research Group of Diabetic Nephropathy, Ministry of Health, Labour, and Welfare of Japan
  1. 1.Division of NephrologyKanazawa University HospitalKanazawaJapan
  2. 2.Division of Nephrology, Department of Laboratory Medicine, Institute of Medical, Pharmaceutical and Health Sciences, Faculty of MedicineKanazawa UniversityKanazawaJapan
  3. 3.Department of Disease Control and Homeostasis, Institute of Medical, Pharmaceutical and Health SciencesKanazawa UniversityKanazawaJapan
  4. 4.Department of MedicineAsahikawa Medical UniversityAsahikawaJapan
  5. 5.Division of Nephrology and Hypertension, Diabetes CenterTokyo Women’s Medical University School of MedicineTokyoJapan
  6. 6.Jiyugaoka Medical Clinic, Internal MedicineObihiroJapan
  7. 7.Dialysis UnitUniversity Hospital of the RyukyusNishiharaJapan
  8. 8.Department of MedicineShiga University of Medical ScienceOtsuJapan
  9. 9.Department of Medicine and Clinical Science, Graduate School of Medical SciencesKyushu UniversityFukuokaJapan
  10. 10.Center of Health ManagementToranomon HospitalTokyoJapan
  11. 11.Health Administration CenterNiigata UniversityNiigataJapan
  12. 12.Division of Nephrology, Department of General MedicineUniversity of FukuiFukuiJapan
  13. 13.Division of Nephrology, Department of Internal MedicineJichi Medical UniversityTochigiJapan
  14. 14.Health Care CenterKitasato UniversitySagamiharaJapan
  15. 15.Department of Nephrology, Hypertension, Diabetology, and MetabolismFukushima Medical UniversityFukushimaJapan
  16. 16.Department of Environmental and Preventive Medicine, Institute of Medical, Pharmaceutical and Health SciencesKanazawa UniversityKanazawaJapan
  17. 17.Department of Medicine and Clinical ScienceOkayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesOkayamaJapan

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