Details

Autor(en) / Beteiligte

• 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

Titel

Nonproteinuric Versus Proteinuric Phenotypes in Diabetic Kidney Disease: A Propensity Score-Matched Analysis of a Nationwide, Biopsy-Based Cohort Study

Ist Teil von

• Diabetes care, 2019-05, Vol.42 (5), p.891-902

Ort / Verlag

United States: American Diabetes Association

Erscheinungsjahr

2019

Quelle

MEDLINE

Beschreibungen/Notizen

• Clinicopathological characteristics, renal prognosis, and mortality in patients with type 2 diabetes and reduced renal function without overt proteinuria are scarce. We retrospectively assessed 526 patients with type 2 diabetes and reduced renal function (estimated glomerular filtration rate [eGFR] <60 mL/min/1.73 m ), 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. 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 < 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 = 0.005). 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.