Increased risk of renal deterioration associated with low e-GFR in type 2 diabetes mellitus only in albuminuric subjects.
OBJECTIVE
The significance of estimated glomerular filtration rate (e-GFR) in diabetic nephropathy has yet to be clearly determined. We therefore compared albuminuria and e-GFR for usefulness in predicting progressive decline in renal function.


METHODS
A total of 1,303 subjects with type 2 diabetes mellitus whose e-GFR was more than 30 mL/min/1.73 m(2) were followed for three years. Associations of clinical staging based on AER and that based on e-GFR with progression of renal insufficiency (e-GFR <30 mL/min/1.73 m(2)) were evaluated.


RESULTS
On univariate analysis, both clinical stages based on e-GFR and AER were significant variables (p<0.05). On multiple logistic regression analysis, the odds ratio for macroalbuminuria was 132.3, and that for microalbuminuria was 10.3 while that for e-GFR less than 60 mL/min/1.73 m(2) was 9.0 for further deterioration of renal function. On the other hand, subjects without albuminuria exhibited a rate of disease progression of less than 1% irrespective of e-GFR level.


CONCLUSIONS
Both albuminuria and reduced e-GFR are significant and independent risk factors for further deterioration of diabetic nephropathy, though albuminuria had a greater odds ratio than reduced e-GFR for deterioration of renal function over a three-year period. e-GFR exhibited additive risk for deterioration of diabetic nephropathy within three years only when albuminuria was present.
Department of Internal Medicine, Saiseikai Central Hospital, Tokyo. shumeg1580083@yahoo.co.jp
Shu
S
Meguro
Toshikatsu
T
Shigihara
Yusuke
Y
Kabeya
Masuomi
M
Tomita
Yoshihito
Y
Atsumi
D000368:Aged; D000419:Albuminuria / Q000150:complications / Q000503:physiopathology*; D015331:Cohort Studies; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000503:physiopathology*; D003928:Diabetic Nephropathies / Q000209:etiology / Q000503:physiopathology*; D005260:Female; D005919:Glomerular Filtration Rate / Q000502:physiology*; D006801:Humans; D007668:Kidney / Q000502:physiology; D007676:Kidney Failure, Chronic / Q000209:etiology / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012307:Risk Factors