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Albuminuria and reduced glomerular filtration rate for predicting the renal outcomes in type 2 diabetic patients
Author(s) -
Tanaka Nobue,
Babazono Tetsuya,
Takagi Michino,
Yoshida Naoshi,
Toya Kiwako,
Nyumura Izumi,
Hanai Ko,
Uchigata Yasuko
Publication year - 2015
Publication title -
nephrology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.752
H-Index - 61
eISSN - 1440-1797
pISSN - 1320-5358
DOI - 10.1111/nep.12446
Subject(s) - medicine , albuminuria , microalbuminuria , renal function , urology , confidence interval , kidney disease , diabetic nephropathy , diabetes mellitus , kidney , endocrinology
Aim The first clinical manifestation of diabetic kidney disease is usually the development of microalbuminuria. However, recent studies have focused on diabetic patients with reduced glomerular filtration rate ( GFR ) without albuminuria. To evaluate the association of albuminuria and GFR with renal outcomes, we performed an observational study. Methods A total of 3231 type 2 diabetic patients were included in this study between 2003 and 2005. There were 1249 women and the mean age was 59 ± 12 years. The renal endpoints were defined as the initiation of renal replacement therapy ( RRT ) or 50% reduction from the baseline of estimated GFR (eGFR). Results At baseline, 669 (20.7%) patients had eGFR <60 mL/min per 1.73 m 2 and 1134 (35.1%) had albuminuria. During the mean follow‐up period of 5.9 ± 1.6 years, 107 patients initiated RRT . A 50% reduction of eGFR from the baseline value was found in 279 patients. None of the normoalbuminuric subjects with or without reduced eGFR required RRT during the observational period ( P < 0.01). Compared to normoalbuminuria patients with eGFR ≥60 mL/min per 1.73 m 2 at baseline, the group of normoalbuminuria patients with reduced eGFR had a 2.5‐fold risk of developing the renal endpoints, (95% confidence interval ( CI ): 1.0–6.3, P = 0.053). Patients with microalbuminuria with eGFR ≥60 mL/min per 1.73 m 2 at baseline had a 5.0‐fold risk of developing the evaluated renal endpoints (95% CI : 2.8–8.8, P < 0.001). Conclusion Albuminuria was a significant predictor for the evaluated renal endpoints, but the impact of eGFR is likely to be less than that of albuminuria.