1. The Prognosis of Patients With Type 2 Diabetes and Nonalbuminuric Diabetic Kidney Disease Is Not Always Poor: Implication of the Effects of Coexisting Macrovascular Complications (JDDM 54)
- Author
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Hiroki Yokoyama, Shin-ichiro Shirabe, Hidekatsu Sugimoto, Shin-ichi Araki, Masae Minami, Itsuko Miyazawa, Hiroshi Maegawa, Katsuya Yamazaki, and Koichi Kawai
- Subjects
Male ,medicine.medical_specialty ,Endocrinology, Diabetes and Metabolism ,Renal function ,030209 endocrinology & metabolism ,Comorbidity ,Type 2 diabetes ,Kidney ,Cohort Studies ,03 medical and health sciences ,chemistry.chemical_compound ,0302 clinical medicine ,Japan ,Diabetes mellitus ,Internal medicine ,Internal Medicine ,medicine ,Albuminuria ,Humans ,Diabetic Nephropathies ,030212 general & internal medicine ,Mortality ,Aged ,Advanced and Specialized Nursing ,Creatinine ,business.industry ,Hazard ratio ,Middle Aged ,Prognosis ,medicine.disease ,Diabetes Mellitus, Type 2 ,chemistry ,Cardiovascular Diseases ,Female ,medicine.symptom ,business ,Diabetic Angiopathies ,Follow-Up Studies ,Glomerular Filtration Rate ,Cohort study - Abstract
OBJECTIVE Nonalbuminuric diabetic kidney disease (DKD) has become the prevailing phenotype in patients with type 2 diabetes. However, it remains unclear whether its prognosis is poorer than that of other DKD phenotypes. RESEARCH DESIGN AND METHODS A total of 2,953 Japanese patients with type 2 diabetes and estimated glomerular filtration rate (eGFR) ≥30 mL/min/1.73 m2, enrolled in an observational cohort study in 2004, were followed until 2015. On the basis of albuminuria (>30 mg/g creatinine) and reduced eGFR ( RESULTS During the mean follow-up of 9.7 years, 113 patients died and 263 developed CVD. In nonalbuminuric DKD, the risks of death or CVD were not higher than those in no-DKD (adjusted hazard ratio 1.02 [95% CI 0.66, 1.60]) and the annual decline in eGFR was slower than in other DKD phenotypes. The risks of death or CVD in nonalbuminuric DKD without prior CVD were similar to those in no-DKD without prior CVD, whereas the risks in nonalbuminuric DKD with prior CVD as well as other DKD phenotypes were higher. CONCLUSIONS Nonalbuminuric DKD did not have a higher risk of mortality, CVD events, or renal function decline than the other DKD phenotypes. In nonalbuminuric DKD, the presence of macrovascular complications may be a main determinant of prognosis rather than the renal phenotype.
- Published
- 2020