Nonproteinuric versus proteinuricphenotypesindiabetic kidney disease: A propensity score–matched analysis of a nationwide, biopsy-based cohort study

Masayuki Yamanouchi, Kengo Furuichi, Junichi Hoshino, Tadashi Toyama, Akinori Hara, Miho Shimizu, Keiichi Kinowaki, Takeshi Fujii, Kenichi Ohashi, Yukio Yuzawa, Hiroshi Kitamura, Yoshiki Suzuki, Hiroshi Sato, Noriko Uesugi, Satoshi Hisano, Yoshihiko Ueda, Shinichi Nishi, Hitoshi Yokoyama, Tomoya Nishino, Kenichi SamejimaKentaro Kohagura, Yugo Shibagaki, Koki Mise, Hirofumi Makino, Seiichi Matsuo, Yoshifumi Ubara, Takashi Wada

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

OBJECTIVE Clinicopathological characteristics, renal prognosis, and mortality in patients with type 2 diabetes and reduced renal function without overt proteinuria are scarce. RESEARCH DESIGN AND METHODS We retrospectively assessed 526 patients with type 2 diabetes and reduced renal function (estimated glomerular filtration rate [eGFR] <60 mL/min/1.73 m2), who underwent clinical renal biopsy and had follow-up data, from Japan’s nationwide multicenter renal biopsy registry. For comparative analyses, we derived one-to-two cohorts of those without proteinuria versus those with proteinuria using propensity score–matching methods addressing the imbalances of age, sex, diabetes duration, and baseline eGFR. The primary end point was progression of chronic kidney disease (CKD) defined as new-onset end-stage renal disease, decrease of eGFR by ‡50%, or doubling of serum creatinine. The secondary end point was all-cause mortality. RESULTS Eighty-two patients with nonproteinuria (urine albumin-to-creatinine ratio [UACR] <300 mg/g) had lower systolic blood pressure and less severe pathological lesions compared with 164 propensity score–matched patients with proteinuria (UACR ‡300 mg/g). After a median follow-up of 1.9 years (interquartile range 0.9–5.0 years) from the date of renal biopsy, the 5-year CKD progression-free survival was 86.6% (95% CI 72.5–93.8) for the nonproteinuric group and 30.3% (95% CI 22.4–38.6) for the proteinuric group (log-rank test P < 0.001). The lower renal risk was consistent across all subgroup analyses. The all-cause mortality was also lower in the nonproteinuric group (log-rank test P 5 0.005). CONCLUSIONS Patients with nonproteinuric diabetic kidney disease had better-controlled blood pressure and fewer typical morphological changes and were at lower risk of CKD progression and all-cause mortality.

Original languageEnglish
Pages (from-to)891-902
Number of pages12
JournalDiabetes care
Volume42
Issue number5
DOIs
Publication statusPublished - 01-05-2019

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Kidney Diseases
Cohort Studies
Kidney
Biopsy
Proteinuria
Glomerular Filtration Rate
Chronic Renal Insufficiency
Creatinine
Mortality
Blood Pressure
Type 2 Diabetes Mellitus
Disease-Free Survival
Disease Progression
Albumins
Urine
Diabetic Nephropathies
Chronic Kidney Failure
Registries
Japan
Serum

All Science Journal Classification (ASJC) codes

  • Internal Medicine
  • Endocrinology, Diabetes and Metabolism
  • Advanced and Specialised Nursing

Cite this

Yamanouchi, Masayuki ; Furuichi, Kengo ; Hoshino, Junichi ; Toyama, Tadashi ; Hara, Akinori ; Shimizu, Miho ; Kinowaki, Keiichi ; Fujii, Takeshi ; Ohashi, Kenichi ; Yuzawa, Yukio ; Kitamura, Hiroshi ; Suzuki, Yoshiki ; Sato, Hiroshi ; Uesugi, Noriko ; Hisano, Satoshi ; Ueda, Yoshihiko ; Nishi, Shinichi ; Yokoyama, Hitoshi ; Nishino, Tomoya ; Samejima, Kenichi ; Kohagura, Kentaro ; Shibagaki, Yugo ; Mise, Koki ; Makino, Hirofumi ; Matsuo, Seiichi ; Ubara, Yoshifumi ; Wada, Takashi. / Nonproteinuric versus proteinuricphenotypesindiabetic kidney disease : A propensity score–matched analysis of a nationwide, biopsy-based cohort study. In: Diabetes care. 2019 ; Vol. 42, No. 5. pp. 891-902.
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abstract = "OBJECTIVE Clinicopathological characteristics, renal prognosis, and mortality in patients with type 2 diabetes and reduced renal function without overt proteinuria are scarce. RESEARCH DESIGN AND METHODS We retrospectively assessed 526 patients with type 2 diabetes and reduced renal function (estimated glomerular filtration rate [eGFR] <60 mL/min/1.73 m2), who underwent clinical renal biopsy and had follow-up data, from Japan’s nationwide multicenter renal biopsy registry. For comparative analyses, we derived one-to-two cohorts of those without proteinuria versus those with proteinuria using propensity score–matching methods addressing the imbalances of age, sex, diabetes duration, and baseline eGFR. The primary end point was progression of chronic kidney disease (CKD) defined as new-onset end-stage renal disease, decrease of eGFR by ‡50{\%}, or doubling of serum creatinine. The secondary end point was all-cause mortality. RESULTS Eighty-two patients with nonproteinuria (urine albumin-to-creatinine ratio [UACR] <300 mg/g) had lower systolic blood pressure and less severe pathological lesions compared with 164 propensity score–matched patients with proteinuria (UACR ‡300 mg/g). After a median follow-up of 1.9 years (interquartile range 0.9–5.0 years) from the date of renal biopsy, the 5-year CKD progression-free survival was 86.6{\%} (95{\%} CI 72.5–93.8) for the nonproteinuric group and 30.3{\%} (95{\%} CI 22.4–38.6) for the proteinuric group (log-rank test P < 0.001). The lower renal risk was consistent across all subgroup analyses. The all-cause mortality was also lower in the nonproteinuric group (log-rank test P 5 0.005). CONCLUSIONS Patients with nonproteinuric diabetic kidney disease had better-controlled blood pressure and fewer typical morphological changes and were at lower risk of CKD progression and all-cause mortality.",
author = "Masayuki Yamanouchi and Kengo Furuichi and Junichi Hoshino and Tadashi Toyama and Akinori Hara and Miho Shimizu and Keiichi Kinowaki and Takeshi Fujii and Kenichi Ohashi and Yukio Yuzawa and Hiroshi Kitamura and Yoshiki Suzuki and Hiroshi Sato and Noriko Uesugi and Satoshi Hisano and Yoshihiko Ueda and Shinichi Nishi and Hitoshi Yokoyama and Tomoya Nishino and Kenichi Samejima and Kentaro Kohagura and Yugo Shibagaki and Koki Mise and Hirofumi Makino and Seiichi Matsuo and Yoshifumi Ubara and Takashi Wada",
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Yamanouchi, M, Furuichi, K, Hoshino, J, Toyama, T, Hara, A, Shimizu, M, Kinowaki, K, Fujii, T, Ohashi, K, Yuzawa, Y, Kitamura, H, Suzuki, Y, Sato, H, Uesugi, N, Hisano, S, Ueda, Y, Nishi, S, Yokoyama, H, Nishino, T, Samejima, K, Kohagura, K, Shibagaki, Y, Mise, K, Makino, H, Matsuo, S, Ubara, Y & Wada, T 2019, 'Nonproteinuric versus proteinuricphenotypesindiabetic kidney disease: A propensity score–matched analysis of a nationwide, biopsy-based cohort study', Diabetes care, vol. 42, no. 5, pp. 891-902. https://doi.org/10.2337/dc18-1320

Nonproteinuric versus proteinuricphenotypesindiabetic kidney disease : A propensity score–matched analysis of a nationwide, biopsy-based cohort study. / Yamanouchi, Masayuki; Furuichi, Kengo; Hoshino, Junichi; Toyama, Tadashi; Hara, Akinori; Shimizu, Miho; Kinowaki, Keiichi; Fujii, Takeshi; Ohashi, Kenichi; Yuzawa, Yukio; Kitamura, Hiroshi; Suzuki, Yoshiki; Sato, Hiroshi; Uesugi, Noriko; Hisano, Satoshi; Ueda, Yoshihiko; Nishi, Shinichi; Yokoyama, Hitoshi; Nishino, Tomoya; Samejima, Kenichi; Kohagura, Kentaro; Shibagaki, Yugo; Mise, Koki; Makino, Hirofumi; Matsuo, Seiichi; Ubara, Yoshifumi; Wada, Takashi.

In: Diabetes care, Vol. 42, No. 5, 01.05.2019, p. 891-902.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Nonproteinuric versus proteinuricphenotypesindiabetic kidney disease

T2 - A propensity score–matched analysis of a nationwide, biopsy-based cohort study

AU - Yamanouchi, Masayuki

AU - Furuichi, Kengo

AU - Hoshino, Junichi

AU - Toyama, Tadashi

AU - Hara, Akinori

AU - Shimizu, Miho

AU - Kinowaki, Keiichi

AU - Fujii, Takeshi

AU - Ohashi, Kenichi

AU - Yuzawa, Yukio

AU - Kitamura, Hiroshi

AU - Suzuki, Yoshiki

AU - Sato, Hiroshi

AU - Uesugi, Noriko

AU - Hisano, Satoshi

AU - Ueda, Yoshihiko

AU - Nishi, Shinichi

AU - Yokoyama, Hitoshi

AU - Nishino, Tomoya

AU - Samejima, Kenichi

AU - Kohagura, Kentaro

AU - Shibagaki, Yugo

AU - Mise, Koki

AU - Makino, Hirofumi

AU - Matsuo, Seiichi

AU - Ubara, Yoshifumi

AU - Wada, Takashi

PY - 2019/5/1

Y1 - 2019/5/1

N2 - OBJECTIVE Clinicopathological characteristics, renal prognosis, and mortality in patients with type 2 diabetes and reduced renal function without overt proteinuria are scarce. RESEARCH DESIGN AND METHODS We retrospectively assessed 526 patients with type 2 diabetes and reduced renal function (estimated glomerular filtration rate [eGFR] <60 mL/min/1.73 m2), who underwent clinical renal biopsy and had follow-up data, from Japan’s nationwide multicenter renal biopsy registry. For comparative analyses, we derived one-to-two cohorts of those without proteinuria versus those with proteinuria using propensity score–matching methods addressing the imbalances of age, sex, diabetes duration, and baseline eGFR. The primary end point was progression of chronic kidney disease (CKD) defined as new-onset end-stage renal disease, decrease of eGFR by ‡50%, or doubling of serum creatinine. The secondary end point was all-cause mortality. RESULTS Eighty-two patients with nonproteinuria (urine albumin-to-creatinine ratio [UACR] <300 mg/g) had lower systolic blood pressure and less severe pathological lesions compared with 164 propensity score–matched patients with proteinuria (UACR ‡300 mg/g). After a median follow-up of 1.9 years (interquartile range 0.9–5.0 years) from the date of renal biopsy, the 5-year CKD progression-free survival was 86.6% (95% CI 72.5–93.8) for the nonproteinuric group and 30.3% (95% CI 22.4–38.6) for the proteinuric group (log-rank test P < 0.001). The lower renal risk was consistent across all subgroup analyses. The all-cause mortality was also lower in the nonproteinuric group (log-rank test P 5 0.005). CONCLUSIONS Patients with nonproteinuric diabetic kidney disease had better-controlled blood pressure and fewer typical morphological changes and were at lower risk of CKD progression and all-cause mortality.

AB - OBJECTIVE Clinicopathological characteristics, renal prognosis, and mortality in patients with type 2 diabetes and reduced renal function without overt proteinuria are scarce. RESEARCH DESIGN AND METHODS We retrospectively assessed 526 patients with type 2 diabetes and reduced renal function (estimated glomerular filtration rate [eGFR] <60 mL/min/1.73 m2), who underwent clinical renal biopsy and had follow-up data, from Japan’s nationwide multicenter renal biopsy registry. For comparative analyses, we derived one-to-two cohorts of those without proteinuria versus those with proteinuria using propensity score–matching methods addressing the imbalances of age, sex, diabetes duration, and baseline eGFR. The primary end point was progression of chronic kidney disease (CKD) defined as new-onset end-stage renal disease, decrease of eGFR by ‡50%, or doubling of serum creatinine. The secondary end point was all-cause mortality. RESULTS Eighty-two patients with nonproteinuria (urine albumin-to-creatinine ratio [UACR] <300 mg/g) had lower systolic blood pressure and less severe pathological lesions compared with 164 propensity score–matched patients with proteinuria (UACR ‡300 mg/g). After a median follow-up of 1.9 years (interquartile range 0.9–5.0 years) from the date of renal biopsy, the 5-year CKD progression-free survival was 86.6% (95% CI 72.5–93.8) for the nonproteinuric group and 30.3% (95% CI 22.4–38.6) for the proteinuric group (log-rank test P < 0.001). The lower renal risk was consistent across all subgroup analyses. The all-cause mortality was also lower in the nonproteinuric group (log-rank test P 5 0.005). CONCLUSIONS Patients with nonproteinuric diabetic kidney disease had better-controlled blood pressure and fewer typical morphological changes and were at lower risk of CKD progression and all-cause mortality.

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