Clinical Impact of Albuminuria and Glomerular Filtration Rate on Renal and Cardiovascular Events, and All-cause Mortality in Japanese Patients with Type 2 Diabetes

Overview

Journal Clin Exp Nephrol

Publisher Springer

Specialty Nephrology

Date 2013 Oct 18

PMID 24132561

Citations 84

Authors

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

Affiliations

Soon will be listed here.

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.

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