Decline in estimated glomerular filtration rate is associated with risk of end-stage renal disease in type 2 diabetes with macroalbuminuria: An observational study from JDNCS

Research Group of Diabetic Nephropathy the Ministry of Health, Labour Welfare of Japan and Japan Agency for Medical Research and Development

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Abstract

Background There is increased interest in surrogate endpoints for clinical trials of chronic kidney disease. Methods In this nationwide observational study of 456 patients with type 2 diabetes and clinically suspected diabetic nephropathy followed for a median of 4.2 years, we evaluated the association between estimated glomerular filtration rate (eGFR) and albuminuria at baseline or during follow-up and risk of ESRD. Results Low eGFR (\60 mL/min/1.73 m2) and macroalbuminuria at enrollment were independently associated with risk of ESRD. In patients with macroalbuminuria, both B-50% change and -50 to -30% change in eGFR over 1 and 2 years were predictive of ESRD. The higher cut point (C50% decline in eGFR) was more strongly predictive but less common. Remission of macroalbuminuria to normo-/microalbuminuria at 1 and 2 years was associated with a lower incidence of ESRD than no remission; however, it was not a determinant for ESRD independently of initial eGFR and initial protein-to-crea-tinine ratio. Conclusion These results suggest that a C30% decline in eGFR over 1 or 2 years adds prognostic information about risk for ESRD in patients with type 2 diabetes and macroalbuminuria, supporting the consideration of percentage decline in eGFR as a surrogate endpoint among macroalbuminuric cases in type 2 diabetes. On the other hand, our study suggests that additional analyses on the relationship between remission of macroalbuminuria and risk of ESRD are needed in type 2 diabetes.

Original languageEnglish
Pages (from-to)377-387
Number of pages11
JournalClinical and Experimental Nephrology
Volume22
Issue number2
DOIs
Publication statusPublished - 01-01-2018

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All Science Journal Classification (ASJC) codes

  • Physiology
  • Nephrology
  • Physiology (medical)

Cite this

Research Group of Diabetic Nephropathy the Ministry of Health, Labour Welfare of Japan and Japan Agency for Medical Research and Development (2018). Decline in estimated glomerular filtration rate is associated with risk of end-stage renal disease in type 2 diabetes with macroalbuminuria: An observational study from JDNCS. Clinical and Experimental Nephrology, 22(2), 377-387. https://doi.org/10.1007/s10157-017-1467-9