Dipstick Proteinuria as a Predictor of End-Stage Renal Disease in Japanese Adults With and Without Diabetes Mellitus (DM)

Abstract

Although proteinuria is an established potent predictor of the initiation of dialysis, it is unclear whether the impact and clinical relevance of widely used dipstick proteinuria on dialysis differs between adults with and without DM. To clarify this, we longitudinally analyzed a nationwide claim-based database that included 138,554 people aged 18-72 y in Japan. Urinary protein was assessed by test strip, the results of which ± corresponds to ≥15 mg/dL. During the 7-y period, there were 46 and 20 incident cases of dialysis among people with and without DM, respectively. Multivariate Cox analysis showed that, among people without proteinuria, those with DM had a 3.4-fold increased dialysis risk than those without DM whereas, even among individuals without DM, dipstick proteinuria confers a far higher risk of around 20 fold (Table, upper). DM and dipstick proteinuria seemed to additively affect (Table, middle) the initiation of dialysis although those with both DM and proteinuria did not have a significantly higher risk of dialysis than those without DM but with proteinuria (Table, lower). Proteinuria detected by dipstick confers a far higher risk of subsequent dialysis than diabetes per se, but clinicians should be aware of the greatly increased risk for dialysis in those with both DM and dipstick proteinuria, which implies the necessity of intensified interventions.Table Adjusted HRs (95% CI) for initiation of dialysis in individuals with and without DM according to presence or absence of dipstick proteinuria(events / n)Non-DM (46/128,529)DM (20/10,015)Dipstick proteinuriaHR (95% CI)P-valueHR (95% CI)P-value-ref3.37 (1.02-11.1)0.046± or moreref1.98 (0.76-5.13)0.16-ref3.51 (1.35-9.46)<0.01± or more19.0 (10.5-34.3)<0.0135.7 (14.1-90.1)<0.01-0.(0.03-0.10)<0.010.19 (0.07-0.48)<0.01± or moreref1.88 (0.79-4.49)0.15Adjusted for age, sex, BMI, WC, SBP, HbA1c, smoking, HDL-C, LDL-C, TG Disclosure A. Furuya: None. K. Fujihara: None. T. Osawa: None. M. Yamamoto: None. M. Harada: None. M. Ishizawa: None. H. Seida: None. N. Yamanaka: None. Y. Matsubayashi: None. H. Sone: Research Support; Self; Novo Nordisk Inc., Eli Lilly and Company, MSD K.K., Chugai Pharmaceutical Co., Ltd., Taisho Pharmaceutical Co., Ltd., Takeda Development Center Asia, Pte. Ltd., Daiichi Sankyo Company, Limited, Ono Pharmaceutical Co., Ltd., Kyowa Hakko Kirin Co., Ltd., Sanofi, Kowa Pharmaceuticals America, Inc., Eisai Inc..