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

Research output: Contribution to journalArticle

69 Citations (Scopus)

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.

Original languageEnglish
Pages (from-to)613-620
Number of pages8
JournalClinical and Experimental Nephrology
Volume18
Issue number4
DOIs
Publication statusPublished - Aug 2014

Keywords

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

ASJC Scopus subject areas

  • Physiology
  • Nephrology
  • Physiology (medical)

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    Wada, T., Haneda, M., Furuichi, K., Babazono, T., Yokoyama, H., Iseki, K., Araki, S. I., Ninomiya, T., Hara, S., Suzuki, Y., Iwano, M., Kusano, E., Moriya, T., Satoh, H., Nakamura, H., Shimizu, M., Toyama, T., Hara, A., & Makino, H. (2014). Clinical impact of albuminuria and glomerular filtration rate on renal and cardiovascular events, and all-cause mortality in Japanese patients with type 2 diabetes. Clinical and Experimental Nephrology, 18(4), 613-620. https://doi.org/10.1007/s10157-013-0879-4