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

Research output: Contribution to journalArticle

3 Citations (Scopus)

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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Glomerular Filtration Rate
Type 2 Diabetes Mellitus
Chronic Kidney Failure
Observational Studies
Biomarkers
Albuminuria
Diabetic Nephropathies
Chronic Renal Insufficiency
Clinical Trials
Incidence
Proteins

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
Research Group of Diabetic Nephropathy the Ministry of Health, Labour Welfare of Japan and Japan Agency for Medical Research and Development. / 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. In: Clinical and Experimental Nephrology. 2018 ; Vol. 22, No. 2. pp. 377-387.
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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.",
author = "{Research Group of Diabetic Nephropathy the Ministry of Health, Labour Welfare of Japan and Japan Agency for Medical Research and Development} and Miho Shimizu and Kengo Furuichi and Tadashi Toyama and Tomoaki Funamoto and Shinji Kitajima and Akinori Hara and Daisuke Ogawa and Daisuke Koya and Kenzo Ikeda and Yoshitaka Koshino and Yukie Kurokawa and Hideharu Abe and Kiyoshi Mori and Masaaki Nakayama and Yoshio Konishi and Samejima, {Ken Ichi} and Masaru Matsui and Hiroyuki Yamauchi and Tomohito Gohda and Kei Fukami and Daisuke Nagata and Hidenori Yamazaki and Yukio Yuzawa and Yoshiki Suzuki and Shouichi Fujimoto and Shoichi Maruyama and Sawako Kato and Takero Naito and Kenichi Yoshimura and Hitoshi Yokoyama and Takashi Wada",
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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, vol. 22, no. 2, pp. 377-387. https://doi.org/10.1007/s10157-017-1467-9

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.

In: Clinical and Experimental Nephrology, Vol. 22, No. 2, 01.01.2018, p. 377-387.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Decline in estimated glomerular filtration rate is associated with risk of end-stage renal disease in type 2 diabetes with macroalbuminuria

T2 - An observational study from JDNCS

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

AU - Shimizu, Miho

AU - Furuichi, Kengo

AU - Toyama, Tadashi

AU - Funamoto, Tomoaki

AU - Kitajima, Shinji

AU - Hara, Akinori

AU - Ogawa, Daisuke

AU - Koya, Daisuke

AU - Ikeda, Kenzo

AU - Koshino, Yoshitaka

AU - Kurokawa, Yukie

AU - Abe, Hideharu

AU - Mori, Kiyoshi

AU - Nakayama, Masaaki

AU - Konishi, Yoshio

AU - Samejima, Ken Ichi

AU - Matsui, Masaru

AU - Yamauchi, Hiroyuki

AU - Gohda, Tomohito

AU - Fukami, Kei

AU - Nagata, Daisuke

AU - Yamazaki, Hidenori

AU - Yuzawa, Yukio

AU - Suzuki, Yoshiki

AU - Fujimoto, Shouichi

AU - Maruyama, Shoichi

AU - Kato, Sawako

AU - Naito, Takero

AU - Yoshimura, Kenichi

AU - Yokoyama, Hitoshi

AU - Wada, Takashi

PY - 2018/1/1

Y1 - 2018/1/1

N2 - 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.

AB - 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.

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DO - 10.1007/s10157-017-1467-9

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JO - Clinical and Experimental Nephrology

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Research Group of Diabetic Nephropathy the Ministry of Health, Labour Welfare of Japan and Japan Agency for Medical Research and Development. 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. 2018 Jan 1;22(2):377-387. https://doi.org/10.1007/s10157-017-1467-9