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

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 123Clin Exp Nephrol DOI 10.1007/s10157-013-0879-4 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.

The renoprotective effect and safety of a DPP-4 inhibitor, sitagliptin, at a small dose in type 2 diabetic patients with a renal dysfunction when changed from other DPP-4 inhibitors: REAL trial

“…We tried to estimate the medical cost reduction when we changed DPP-4 inhibitors to a small dose of sitagliptin depending on the renal function. It is estimated that 9.5 million individuals in Japan are diabetics, and 2.36 million (24.8%) of them have decreased renal function with eGFR of less than 60 mL/min/1.73 m 2 , requiring a dose adjustment of sitagliptin (excluding patients on dialysis) [46]. By adding 125,000 patients receiving dialysis attributed to diabetic nephropathy, the number of Japanese diabetic patients with decreased renal function has been estimated to be 2.485 million.…”

A new classification of Diabetic Nephropathy 2014: a report from Joint Committee on Diabetic Nephropathy

“…Prior to revising the Classification, as part of a MHLW-subsidized project on kidney disease, entitled 'Diabetic Nephropathy Research, from the Ministry of Health, Labor and Welfare of Japan,' a 'historical cohort study' was conducted by the Research Group of Diabetic Nephropathy, MHLW, involving a total of 4,355 subjects with type 2 diabetes from 10 participating healthcare facilities with the aim of evaluating renal events (i.e., a decrease in eGFR to half the baseline level and/or the need for dialysis), cardiovascular events and all-cause mortality 10,11 . Summarized below are the major findings of that study (for detailed information, please access the MHLW website http://www.…”

A new classification of Diabetic Nephropathy 2014: a report from Joint Committee on Diabetic Nephropathy

“…Prior to revising the Classification, as part of a MHLWsubsidized project on kidney disease, entitled ''Diabetic Nephropathy Research, from the Ministry of Health, Labour and Welfare of Japan'', a ''historical cohort study'' was conducted by the Research Group of Diabetic Nephropathy, MHLW, involving a total of 4,355 subjects with type 2 diabetes from 10 participating healthcare facilities with the aim of evaluating renal events (i.e., a decrease in eGFR to half the baseline level and/or the need for dialysis), cardiovascular events and all-cause mortality [10,11]. Summarized below are the major findings of this study (for detailed information, please access the MHLW website http://www.mhlw.go.jp/ or refer to the literature cited above).…”