Investigation of clinical factors associated with development of chronic kidney disease and eGFR decline in Japanese patients with type 2 diabetes mellitus

Abstract

The aim of our study was to investigate clinical factors associated with the development of chronic kidney disease (CKD) in Japanese type 2 diabetes patients diagnosed by the new equation established by the Japanese Society of Nephrology. We analyzed data collected from 653 Japanese patients with type 2 diabetes who were followed at Juntendo University Hospital for 2 years to determine the risk factors for new-onset CKD and 2-year eGFR decline from the baseline. CKD developed de novo in 56 diabetic patients, whereas 288 patients showed no signs of CKD at the end of the 2-year follow-up period. The 2-year cumulative incidence of newly diagnosed cases with CKD was 8.6%. Of these, the transition rate to albuminuria was 73.2%, the proportion of patients who developed low eGFR (<60 ml/min/1.73 m2) was 19.7%, and the proportion of patients with both albuminuria and low eGFR was 7.1%. Multiple logistic regression analysis showed that age (odds ratio = 1.97, P < 0.001), mean blood pressure (odds ratio = 1.56, P = 0.024), HbA1c (odds ratio = 1.21, P = 0.039) and urinary albumin-to-creatinine ratio (UACR) (odds ratio = 2.65 P < 0.001) were independent predictors for new-onset CKD, and multiple linear regression analysis identified HbA1c and BMI as independent predictors for subsequent eGFR decline (β = −0.94, P < 0.001 and β = −0.24, P = 0.035, respectively). Age, mean blood pressure, HbA1c and albuminuria are independent risk factors for new onset of CKD with type 2 diabetes. In addition, HbA1c and BMI are associated with a future eGFR decline in type 2 diabetes.