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

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• 作者：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)
  
• 关键词：Diabetic nephropathy ; Chronic kidney disease ; Albuminuria ; Cardiovascular disease ; Mortality ; Glomerular filtration rate
• 刊名：Clinical and Experimental Nephrology
• 出版年：2014
• 出版时间：August 2014
• 年：2014
• 卷：18
• 期：4
• 页码：613-620
• 全文大小：184 KB
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  2. Nakayama M, Sato T, Sato H, Yamaguchi Y, Obara K, Kurihara I, et al. Different clinical outcomes for cardiovascular events and mortality in chronic kidney disease according to underlying renal disease: the Gonryo study. Clin Exp Nephrol. 2010;14:333-. CrossRef
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  7. Drury PL, Ting R, Zannino D, Ehnholm C, Flack J, Whiting M, et al. Estimated glomerular filtration rate and albuminuria are independent predictors of cardiovascular events and death in type 2 diabetes mellitus: the Fenofibrate Intervention and Event Lowering in Diabetes (FIELD) study. Diabetologia. 2011;54:32-3. CrossRef
  8. Levey AS, de Jong PE, Coresh J, El Nahas M, Astor BC, Matsushita K, et al. The definition, classification and prognosis of chronic kidney disease: a KDIGO Controversies Conference report. Kidney Int. 2011;80:17-8. CrossRef
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  10. Matsuo S, Imai E, Horio M, Yasuda Y, Tomita K, Nitta K, et al. Revised equations for estimated GFR from serum creatinine in Japan. Am J Kidney Dis. 2009;53:982-2. CrossRef
  11. Yokoyama H, Matsushima M, Kawai K, Hirao K, Oishi M, Sugimoto H, et al. Low incidence of cardiovascular events in Japanese patients with type 2 diabetes in primary care settings; a prospective cohort study. Diabetic Med. 2011;28:1221-. CrossRef
  12. Bruno G, Merletti F, Bargero G, Novelli G, Melis D, Soddu A, et al. Estimated glomerular filtration rate, albuminuria and mortality in type 2 diabetes: the Casale Monferrato study. Diabetologia. 2007;50:941-. CrossRef
  13. Sone H, Tanaka S, Tanaka S, Iimuro S, Oida K, Yamasaki Y, et al. Serum level of triglycerides is a potent risk factor comparable to LDL cholesterol for coronary heart disease in Japanese patients with type 2 diabetes: subanalysis of the Japan Diabetes Complications Study (JDCS). J Clin Endocrinol Metab. 2011;96:3448-6. CrossRef
  14. Yokoyama H, Araki S, Haneda M, Matsushima M, Kawai K, Hirao K, et al. Chronic kidney disease categories and renal-cardiovascular outcomes in type 2 diabetes without prevalent cardiovascular disease: a prospective cohort study (JDDM 25). Diabetologia. 2012;55:1911-. CrossRef
  15. So WY, Kong AP, Ma RC, Ozaki R, Szeto CC, Chan NN, et al. Glomerular filtration rate, cardiorenal end points, and all-cause mortality in type 2 diabetic patients. Diabetes Care. 2006;29:2046-2. CrossRef
  16. Hallan S, Astor B, Romundstad S, Assar?d K, Kvenild K, Coresh J. Association of kidney function and albuminuria with cardiovascular mortality in older vs. younger individuals: The HUNT II Study. Arch Intern Med. 2007;167:2490-. CrossRef
  17. Yokoyama H, Kawai K, Kobayashi M, Japan Diabetes Clinical Data Management Study Group. Microalbuminuria is common in Japanese type 2 diabetic patients: a nationwide survey from the Japan Diabetes Clinical Data Management Study Group (JDDM 10). Diabetes Care. 2007;30:989-2. CrossRef
  18. Rigalleau V, Lasseur C, Raffaitin C, Beauvieux MC, Barthe N, Chauveau P, et al. Normoalbuminuric renal-insufficient diabetic patients: a lower-risk group. Diabetes Care. 2007;30:2034-. CrossRef
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  20. Vlek AL, van der Graaf Y, Spiering W, Algra A, Visseren FL, SMART study group. Cardiovascular events and all-cause mortality by albuminuria and decreased glomerular filtration rate in patients with vascular disease. J Intern Med. 2008;264:351-0. CrossRef
  21. Couchoud C, Labeeuw M, Moranne O, Allot V, Esnault V, Frimat L, et al. A clinical score to predict 6-month prognosis in elderly patients starting dialysis for end-stage renal disease. Nephrol Dial Transplant. 2009;24:1553-1. CrossRef
  
• 作者单位：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)
  
  1. Division of Nephrology, Kanazawa University Hospital, Kanazawa, Japan
  2. Division of Nephrology, Department of Laboratory Medicine, Institute of Medical, Pharmaceutical and Health Sciences, Faculty of Medicine, Kanazawa University, Kanazawa, 13-1 Takara-machi, Kanazawa, 920-8641, Japan
  4. Department of Medicine, Asahikawa Medical University, Asahikawa, Japan
  3. Department of Disease Control and Homeostasis, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Kanazawa, Japan
  5. Division of Nephrology and Hypertension, Diabetes Center, Tokyo Women’s Medical University School of Medicine, Tokyo, Japan
  6. Jiyugaoka Medical Clinic, Internal Medicine, Obihiro, Japan
  7. Dialysis Unit, University Hospital of the Ryukyus, Nishihara, Okinawa, Japan
  8. Department of Medicine, Shiga University of Medical Science, Otsu, Shiga, Japan
  9. Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
  10. Center of Health Management, Toranomon Hospital, Tokyo, Japan
  11. Health Administration Center, Niigata University, Niigata, Japan
  12. Division of Nephrology, Department of General Medicine, University of Fukui, Fukui, Japan
  13. Division of Nephrology, Department of Internal Medicine, Jichi Medical University, Tochigi, Japan
  14. Health Care Center, Kitasato University, Sagamihara, Japan
  15. Department of Nephrology, Hypertension, Diabetology, and Metabolism, Fukushima Medical University, Fukushima, Japan
  16. Department of Environmental and Preventive Medicine, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Kanazawa, Japan
  17. Department of Medicine and Clinical Science, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
  
• ISSN：1437-7799

文摘

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-.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.