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Relationship between kidney function decline and initial risk factors for the progression of diabetic kidney disease: a retrospective analysis of 91 Japanese patients with type 2 diabetes

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Abstract

Background

Diabetic kidney disease (DKD) is the leading cause of end-stage renal disease (ESRD) in Japan. The clinical course and factors related to the progression of DKD to ESRD are important issues when treating patients with DKD.

Methods

Ninety-one type 2 diabetic patients with DKD that had progressed from chronic kidney disease (CKD) stages G1–3 on their initial clinical visit to ESRD were enrolled. The decline in the estimated glomerular filtration rate (eGFR) was analyzed and the initial clinical factors that influenced the decline rate were explored.

Results

There was a linear decline in eGFR before progression to ESRD, with a median annual decline rate (∆eGFR) of 9.2 mL/min/1.73 m2. In all patients, a history of coronary artery disease and increased levels of initial eGFR and high-density lipoprotein cholesterol (HDL-C) were positive predictors of log ∆eGFR, whereas age, history of cerebral infarction (CI), and an increased level of serum albumin were negative predictors of log ∆eGFR. In patients with CKD stages G1–2 on their first visit, male sex and increased diastolic blood pressure were positive predictors. In patients with CKD stage G3 on their first visit, an increased level of LDL-C was a positive predictor, whereas a history of CI and an increased level of serum total bilirubin (TBil) were negative predictors.

Conclusion

In addition to the common risk factors, initial eGFR, HDL-C, and TBil were identified as novel risk factors for ESRD. These risk factors may differ between patients with early and advanced stages of CKD.

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Author information

Authors and Affiliations

  1. Sato Clinic, 2138-1 Wakamatsu-cho, Wakaba-ku, Chiba, 264-0021, Japan

    Toshiharu Ishizuka & Sumihiko Sato

  2. Kashiwado Hospital, 2-21-8 Nagasu, Chuo-ku, Chiba, 260-0854, Japan

    Yoshiharu Tokuyama

  3. Chiba Central Medical Center, Diabetes Center, 1835-1 Kasori-cho, Wakaba-ku, Chiba, 264-0017, Japan

    Atsuya Horie, Yukiko Hatanaka & Azuma Kanatsuka

Authors
  1. Toshiharu Ishizuka
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  2. Yoshiharu Tokuyama
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  3. Atsuya Horie
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  4. Yukiko Hatanaka
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  5. Sumihiko Sato
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  6. Azuma Kanatsuka
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Corresponding author

Correspondence to Toshiharu Ishizuka.

Ethics declarations

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1964 and later versions. Informed consent or its substitute was obtained from all patients before they were included in the study.

Conflict of interest

There was no financial sponsor for this study.

Financial disclosure

Toshiharu Ishizuka, none. Yoshiharu Tokuyama, none. Atsuya Horie, none. Yukiko Hatanaka, none. Sumihiko Sato, none. Azuma Kanatsuka, none.

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Ishizuka, T., Tokuyama, Y., Horie, A. et al. Relationship between kidney function decline and initial risk factors for the progression of diabetic kidney disease: a retrospective analysis of 91 Japanese patients with type 2 diabetes. Diabetol Int 7, 432–439 (2016). https://doi.org/10.1007/s13340-016-0270-2

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  • DOI: https://doi.org/10.1007/s13340-016-0270-2

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