Objective Glomerular filtration rate (GFR) decreases without or prior to the development of albuminuria in many patients with diabetes. Therefore, albuminuria and/or a low GFR in patients with diabetes is referred to as diabetic kidney disease (DKD). A certain proportion of patients with diabetes show a rapid progressive decline in renal function in a unidirectional manner and are termed early decliners. This study aimed to elucidate the prevalence of DKD and early decliners and clarify their risk factors.
Research design and methods This combination cross-sectional and cohort study included 2385 patients with diabetes from 15 hospitals. We defined DKD as a urinary albumin to creatinine ratio (ACR) ≥30 mg/gCr and/or estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m². We classified patients into four groups based on the presence or absence of albuminuria and a decrease in eGFR to reveal the risk factors for DKD. We also performed a trajectory analysis and specified the prevalence and risk factors of early decliners with sequential eGFR data of 1955 patients in five facilities.
Results Of our cohort, 52% had DKD. Above all, 12% with a low eGFR but no albuminuria had no traditional risk factors, such as elevated glycated hemoglobin, elevated blood pressure, or diabetic retinopathy in contrast to patients with albuminuria but normal eGFR. Additionally, 14% of our patients were early decliners. Older age, higher basal eGFR, higher ACR, and higher systolic blood pressure were significantly associated with early decliners.
Conclusions The prevalence of DKD in this cohort was larger than ever reported. By testing eGFR yearly and identifying risk factors in the early phase of diabetes, we can identify patients at high risk of developing end-stage renal disease.
- chronic kidney disease
- chronic diabetic complications
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Contributors YY contributed data interpretation, conducted statistical analysis, and wrote the first draft of the manuscript. KK and YM supervised programming for statistical analysis. YH, TT, MN, SN, HI, MO, KU, TW, TM, DK, KM, JW, MS, HW, YI, IN, and NK collected data, reviewed, and revised the manuscript.
Funding This work was supported by Japan Agency for Medical Research and Development under Grant Number JP19ek0210095h001.
Competing interests J-DREAMS is supported by Ministry of Health, Labour and Welfare, Japan Agency for Medical Research and Development, Japan Diabetes Society, Nippon Boehringer Ingelheim, Eli Lilly, Novo Nordisk Pharma, and Abbott Japan. KU reports lecture fees from Eli Lilly, Nippon Boehringer Ingelheim, Novo Nordisk, and Abbott Japan; grants and endowments from Eli Lilly, Nippon Boehringer Ingelheim, and Novo Nordisk.
Patient consent for publication Not required.
Provenance and peer review Not commissioned; externally peer reviewed.
Data availability statement The inspection and usage of the raw data in this study is restricted according to the ethical approval. All data relevant to the study are included in the article or uploaded as supplementary information.
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