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- Title
Diabetic Retinopathy and Microalbuminuria Can Predict Macroalbuminuria and Renal Function Decline in Japanese Type 2 Diabetic Patients.
- Authors
TATSUMI MORIYA; SHIRO TANAKA; RYO KAWASAKI; YASUO OHASHI; YASUO AKANUMA; NOBUHIRO YAMADA; HIROHITO SONE; HIDETOSHI YAMASHITA; SHIGEHIRO KATAYAMA
- Abstract
OBJECTIVE--To examine the interactive relationship between diabetic retinopathy (DR) and diabetic nephropathy (DN) in type 2 diabetic patients and to elucidate the role of DR and microalbuminuria on the onset of macroalbuminuria and renal function decline. RESEARCH DESIGN AND METHODS--We explored the effects of DR and microalbuminuria on the progression of DN from normoalbuminuria and low microalbuminuria (<150 mg/gCr) to macroalbuminuria or renal function decline in the Japan Diabetes Complications Study (JDCS), which is a nationwide randomized controlled study of type 2 diabetic patients focusing on lifestyle modification. Patients were divided into four groups according to presence or absence of DR and MA: normoalbuminuria without DR [NA(DR2)] (n = 773), normoalbuminuria with DR [NA(DR+)] (n = 279), microalbuminuriawithout DR [MA(DR2)] (n = 277), and microalbuminuria with DR [MA(DR+)] (n = 146). Basal urinary albumin-to-creatinine ratio and DR status were determined at baseline and followed for a median of 8.0 years. RESULTS--Annual incidence rates of macroalbuminuria were 1.6/1,000 person-years (9 incidences), 3.9/1,000 person-years (8 incidences), 18.4/1,000 person-years (34 incidences), and 22.1/1,000 person-years (22 incidences) in the four groups, respectively. Multivariate-adjusted hazard ratios of the progression to macroalbuminuria were 2.48 (95% CI 0.94-6.50; P = 0.07), 10.40 (4.91-22.03; P < 0.01), and 11.55 (5.24-25.45; P < 0.01) in NA(DR+), MA(DR2), and MA(DR+), respectively, in comparison with NA(DR2). Decline in estimated glomerular filtration rate (GFR) per year was two to three times faster in MA(DR+) (21.92 mL/min/1.73m²/year) than in the other groups. CONCLUSIONS--In normo- and low microalbuminuric Japanese type 2 diabetic patients, presence ofmicroalbuminuria at baseline was associated with higher risk ofmacroalbuminuria in 8 years. Patients with microalbuminuria and DR showed the fastest GFR decline. Albuminuria and DR should be considered as risk factors of renal prognosis in type 2 diabetic patients. An open sharing of information will benefit both ophthalmologists and diabetologists.
- Publication
Diabetes Care, 2013, Vol 36, Issue 9, p2803
- ISSN
0149-5992
- Publication type
Academic Journal
- DOI
10.2337/dc12-2327