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Aims/Introduction  The present retrospective study investigated the impact of renal arteriosclerosis ( AS ) and hypertension ( HT ) on long‐term renal and cardiovascular outcomes in Japanese type 2 diabetes patients with biopsy‐proven diabetic nephropathy.    Materials and Methods  A total of 185 patients were enrolled. Patients were divided into four groups stratified by renal  AS  status and the presence of  HT . The outcomes for this study were the first occurrence of renal events (a need for dialysis or a 30% decline in estimated glomerular filtration rate from baseline) and cardiovascular events (cardiovascular death, non‐fatal myocardial infarction, coronary intervention or non‐fatal stroke).    Results  The proportion of renal  AS  scores ≥1 was 88.3% among patients with normal‐range blood pressure ( BP ) and 95.4% among patients with HT. During a mean follow‐up period of 7.6 years, 129 episodes of renal composite events and 55 episodes of cardiovascular events were observed. Compared with patients with no renal  AS  and normal‐range  BP , a renal  AS  score ≥1 increased the risk of renal composite events with a multivariable‐adjusted hazard ratio of 3.21 (95% confidence interval [95% CI] 1.27–8.14) in patients with normal‐range  BP  and 4.99 (95% CI 1.98–12.54) in patients with  HT , whereas renal  AS  score ≥1 increased the risk of cardiovascular events with a multivariable‐adjusted hazard ratio of 6.06 (95% CI 1.24–29.61) in patients with normal‐range  BP  and 10.02 (95% CI 1.92–52.39) in patients with  HT .    Conclusions  Renal  AS  was associated with increasing risks for renal composite events and cardiovascular events in both normal‐range  BP  and  HT . The risks of renal composite events and cardiovascular events were the highest in both renal  AS  and  HT .

journal of diabetes investigation

Association of renal arteriosclerosis and hypertension with renal and cardiovascular outcomes in Japanese type 2 diabetes patients with diabetic nephropathy