Higher pulse pressure predicts initiation of dialysis in Japanese patients with diabetes

Osawa, Taeko; Fujihara, Kazuya; Harada, Mayuko; Yamamoto, Masahiko; Ishizawa, Masahiro; Sano, Hiroshi; Ishiguro, Hajime; Matsubayashi, Yasuhiro; Seida, Hiroyasu; Yamanaka, Nauta; Tanaka, Shiro; Shimano, Hitoshi; Kodama, Satoru

doi:10.1002/dmrr.3120

Cited by 11 publications

(8 citation statements)

References 34 publications

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“…80 In the J-DOIT3 study, intensive therapy with treatment targets of HbA1c <6.2%, blood pressure < 120/75 mmHg, and low-density lipoprotein (LDL) cholesterol <80 mg/dL significantly reduced the onset and progression of nephropathy and retinopathy by 32% and 14%, respectively, showing that comprehensive management is effective in preventing these complications. 81 Studies have shown that high pulse pressure (PP) is an independent risk factor of dialysis 82 and severe retinopathy 83 in patients with diabetes. Since high PP indicates the existence of arteriosclerosis, these results suggest that comprehensive management of hypertension and dyslipidaemia is critical to improve the prognosis of diabetes by preventing the onset and progression of arteriosclerosis.…”

Section: Type 2 Diabetes Mellitus: Recent Treatment Pattern Management Of Complications and Comparative Effectiveness Studiesmentioning

confidence: 99%

Current trends in diabetes mellitus database research in Japan

Kohsaka

Morita

Okami

et al. 2021

Diabetes Obesity Metabolism

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With the widespread use of electronic medical records and administrative claims databases, analytic results from so‐called real‐world data have become increasingly important in healthcare decision‐making. Diabetes mellitus is a heterogeneous condition that involves a broad spectrum of patients. Real‐world database studies have been recognised as a powerful tool to understand the impact of current practices on clinical courses and outcomes, such as long‐term glucose control, development of microvascular or macro‐vascular diseases, and mortality. Diabetes is also a major global health issue and poses a significant social and economic burden worldwide. Therefore, it is critical to understand the epidemiology, clinical course, treatment reality, and long‐term outcomes of diabetes to determine realistic solutions to a variety of disease‐related issues that we are facing. In the present review, we summarise the healthcare system and large‐scale databases currently available in Japan, introduce the results from recent database studies involving Japanese patients with diabetes, and discuss future opportunities and challenges for the use of databases in the management of diabetes.

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Section: Type 2 Diabetes Mellitus: Recent Treatment Pattern Management Of Complications and Comparative Effectiveness Studiesmentioning

confidence: 99%

Current trends in diabetes mellitus database research in Japan

Kohsaka

Morita

Okami

et al. 2021

Diabetes Obesity Metabolism

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“…It is the SBP which is raised; that augments pulse pressure and such pulsatile flow lead to end organ damage to kidney that manifests as DN. [16]…”

Section: Discussionmentioning

confidence: 99%

Association of brachial and central hemodynamic parameters to eGFR and proteinuria in Gujarati diabetics with mild-to-moderate nephropathy

Solanki

Patel

Hadiyel

et al. 2019

J Family Med Prim Care

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Introduction:Diabetes mellitus (DM) is a significant risk factor for nephropathy and cardiovascular morbidity. Pulse wave analysis (PWA) gives direct inference of brachial hemodynamics (BH) and central hemodynamics (CH). We studied relation of them with diabetic nephropathy (DN) among type-2 diabetics (T2D).Methods:We studied oscillometric PWA by a cross-sectional study in 160 T2Ds. Using Mobil-o-Graph (IEM, Germany), we derived BH (blood pressure, pulse pressure index, rate pressure product) and CH (aortic pressure, cardiac index, stroke volume index, stroke work). They were further compared and associated with DN in terms of creatinine, proteinuria, and estimated glomerular filtration rate (eGFR).Results:There were 89 males, mean age 56 years, mean duration 4.8 years, 80% hypertensive predominantly using ACE inhibitors, poor glycemic blood pressure (BP) control, mainly mild-to-moderate DN, mean eGFR 88.2, 34% prevalence of proteinuria. Arterial stiffness was high with female disadvantage. BH and CH parameters were not different with or without DN using proteinuria or eGFR (60 cutoff) criteria. BH, CH correlated insignificantly with creatinine and eGFR. Female disadvantage, correlation with bSBP and aSBP were only significant results.Conclusions:BH and CH are not related to eGFR and proteinuria in predominantly hypertensive, Gujarati diabetics with mild-to-moderate nephropathy suggesting need of other cardiovascular parameters.

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“…8 Details of the claims data and classifications were described elsewhere. [8][9][10] Patients aged 19-72 years who were followed for at least 3 years from 1 April 2008 to 31 March 2013 without a history of dialysis based on dialysis-related procedures performed in the 1 year before follow-up were included in this analysis and continued to be followed until 31 September 2016. For the present study, we examined data on 296 121 individuals.…”

Section: Study Participantsmentioning

confidence: 99%

Severity of Hypertension as a Predictor of Initiation of Dialysis among Study Participants with and without Diabetes Mellitus

Osawa

Fujihara

Yamamoto

et al. 2021

Journal of Investigative Medicine

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To determine associations between severity of hypertension and risk of starting dialysis in the presence or absence of diabetes mellitus (DM). A nationwide database with claims data on 258 874 people with and without DM aged 19–72 years in Japan was used to elucidate the impact of severity of hypertension on starting dialysis. Initiation of dialysis was determined from claims using International Classification of Diseases-10 codes and medical procedures. Using multivariate Cox modeling, we investigated the severity of hypertension to predict the initiation of dialysis with and without DM. Hypertension was significantly associated with the initiation of dialysis regardless of DM. The incidence of starting dialysis in those with systolic blood pressure (SBP) ≤119 mm Hg and DM (DM+) was almost the same as in those with SBP ≥150 mm Hg and absence of DM (DM−). In comparison with SBP ≤119 mm Hg, SBP ≥150 mm Hg significantly increased the risk of the initiation of dialysis about 2.5 times regardless of DM+ or DM−. Compared with DM− and SBP ≤119 mm Hg, the HR for DM+ and SBP ≥150 mm Hg was 6.88 (95% CI 3.66 to 12.9). Although the risks of hypertension differed only slightly regardless of the presence or absence of DM, risks for starting dialysis with DM+ and SBP ≤119 mm Hg were equivalent to DM− and SBP ≥150 mm Hg, indicating more strict blood pressure interventions in DM+ are needed to avoid dialysis. Future studies are required to clarify the cut-off SBP level to avoid initiation of dialysis considering the risks of strict control of blood pressure.

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Higher pulse pressure predicts initiation of dialysis in Japanese patients with diabetes

Cited by 11 publications

References 34 publications

Current trends in diabetes mellitus database research in Japan

Current trends in diabetes mellitus database research in Japan

Association of brachial and central hemodynamic parameters to eGFR and proteinuria in Gujarati diabetics with mild-to-moderate nephropathy

Severity of Hypertension as a Predictor of Initiation of Dialysis among Study Participants with and without Diabetes Mellitus

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