• Takashi Wada, Masakazu Haneda, Kengo Furuichi, Tetsuya Babazono, Hiroki Yokoyama, Kunitoshi Iseki, Shin-ichi Araki, Toshiharu Ninomiya, Shigeko Hara, Yoshiki Suzuki, Masayuki Iwano, Eiji Kusano, Tatsumi Moriya, Hiroaki Satoh, Hiroyuki Nakamura, Miho Shimizu, Tadashi Toyama, Akinori Hara, Hirofumi Makino, and Research Group of Diabetic Nephropathy, Ministry of Health, Labour, and Welfare of Japan.
• Division of Nephrology, Kanazawa University Hospital, Kanazawa, Japan, twada@m-kanazawa.jp.
• Clin. Exp. Nephrol. 2014 Aug 1; 18 (4): 613-20.

BackgroundThe number of patients suffering from diabetic nephropathy resulting in end-stage kidney disease is increasing worldwide. In clinical settings, there are limited data regarding the impact of the urinary albumin-to-creatinine ratio (UACR) and reduced estimated glomerular filtration rate (eGFR) on renal and cardiovascular outcomes and all-cause mortality.MethodsWe performed a historical cohort study of 4328 Japanese participants with type 2 diabetes from 10 centers. Risks for renal events (requirement for dialysis or transplantation, or half reduction in eGFR), cardiovascular events (cardiovascular death, nonfatal myocardial infarction, or nonfatal stroke), and all-cause mortality were assessed according to UACR and eGFR levels.ResultsDuring follow-up (median 7.0 years, interquartile range 3.0-8.0 years), 419 renal events, 605 cardiovascular events and 236 deaths occurred. The UACR levels increased the risk and the adjusted hazard ratios for these three events. In addition to the effects of UACR levels, eGFR stages significantly increased the adjusted hazard ratios for renal events and all-cause mortality, especially in patients with macroalbuminuria. Diabetic nephropathy score, based on the prognostic factors, well predicted incidence rates per 1000 patient/year for each event.ConclusionsIncreased UACR levels were closely related to the increase in risks for renal, cardiovascular events and all-cause mortality in Japanese patients with type 2 diabetes, whereas the association between high levels of UACR and reduced eGFR was a strong predictor for renal events.

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