Open AccessSecular changes in clinical manifestations of kidney disease among Japanese adults with type 2 diabetes from 1996 to 2014
Author(s) -
Kume Shinji,
Araki Shinichi,
Ugi Satoshi,
Morino Katsutaro,
Koya Daisuke,
Nishio Yoshihiko,
Haneda Masakazu,
Kashiwagi Atsunori,
Maegawa Hiroshi
Publication year - 2019
Publication title -
journal of diabetes investigation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.089
H-Index - 50
eISSN - 2040-1124
pISSN - 2040-1116
DOI - 10.1111/jdi.12977
Subject(s) - medicine , albuminuria , microalbuminuria , renal function , diabetes mellitus , kidney disease , cohort , type 2 diabetes , endocrinology , urology
Abstract Aims/Introduction Diabetic kidney disease is characterized by increased albuminuria and/or a reduced glomerular filtration rate ( GFR ). We analyzed secular changes in the prevalence of albuminuria and reduced estimated GFR ( eGFR ) in Japanese patients with type 2 diabetes, and identified factors associated with these changes. Materials and Methods Using 1996, 2001, 2006 and 2014 cohort data from the Japanese serial cross‐sectional studies conducted at Shiga University of Medical Science, secular changes in the prevalence of diabetic kidney disease (albuminuria and/or reduced eGFR ), patient characteristics and their associations were analyzed. Results The prevalence of microalbuminuria and macroalbuminuria decreased over time, whereas the prevalence of moderately reduced eGFR (30–60 mL/min/1.73 m 2 ) and severely reduced eGFR (<30 mL/min/1.73 m 2 ) increased. Severely reduced eGFR was observed mainly in the patients with macroalbuminuria, regardless of year. Conversely, the prevalence of moderately reduced eGFR increased in the patients without macroalbuminuria. Both macroalbuminuria and moderately reduced eGFR without macroalbuminuria in the 2014 cohort were refractory to the recently recommended intensive therapy. Finally, we showed that obesity accompanied by vascular dysfunction was a risk factor for the development of albuminuria, and that age‐dependent arterial stiffness was associated with reduced eGFR without macroalbuminuria in the 2014 cohort. Conclusions During the past 20 years in Japan, the prevalence of albuminuria declined, whereas that of reduced eGFR increased. Additionally, obesity‐ and high age‐related vascular damage seems to be associated with macroalbuminuria and reduced eGFR without macroalbuminuria, respectively.