title: Risk of macrovascular disease stratified by stage of chronic kidney disease in type 2 diabetic patients: critical level of the estimated glomerular filtration rate and the significance of hyperuricemia.
abstract: BACKGROUND
  Although a high prevalence of macrovascular disease (MVD) has been reported in patients with stage 3 chronic kidney disease (CKD), few studies have reported its risk with respect to the underlying cause of kidney disease. This study investigated the prevalence of MVD in type 2 diabetic patients with CKD stratified by CKD stage, as defined by estimated glomerular filtration rate (eGFR), as well as the risk factors for MVD.
  
  
  METHODS
  1493 patients with diabetic CKD (1273 males, 220 females) were stratified by CKD stage (stage 1: 39, stage 2: 272, stage 3: 1052, stage 4: 101, stage 5: 29) based on eGFR calculated by the Japanese formula and averaged over 8 months. MVD was defined as one of the following: coronary heart disease (CHD), stroke or arteriosclerosis obliterans (ASO).
  
  
  RESULTS
  The prevalence of MVD was 18.6%. A significant increasing trend in MVD prevalence was observed from stage 3 (17.78%) to 4 (52.48%). According to a receiver operating characteristic curve analysis on MVD prevalence in stage 3 patients, an eGFR of 46.4 ml/min/1.73 m(2) was determined to be a critical cut-off level. Proteinuria, eGFR <60 ml/min/1.73 m(2) and hyperuricemia were independent risk factors for MVD.
  
  
  CONCLUSIONS
  In patients with diabetic CKD, a significant increase in MVD prevalence was observed from stage 3 to 4. An eGFR of 46.4 ml/min/1.73 m(2) is a critical level that affects MVD prevalence. From the perspective of cardiorenal association, CKD stage 3 should be divided into two substages. As hyperuricemia is related to an increased risk of MVD, uric acid control may be important in reducing MVD risk in diabetic CKD.
authors.affiliation: Division of Diabetes and Metabolism, The Institute for Adult Diseases, Asahi Life Foundation, 1-6-1 Marunouchi, Chiyoda-ku, Tokyo, 100-0005, Japan. kentarot@oak.ocn.ne.jp.|Department of Nephrology, Toho University School of Medicine, Tokyo, Japan. kentarot@oak.ocn.ne.jp.
authors.forename: Kentaro
authors.initials: K
authors.lastname: Tanaka
authors.affiliation: Division of Diabetes and Metabolism, The Institute for Adult Diseases, Asahi Life Foundation, 1-6-1 Marunouchi, Chiyoda-ku, Tokyo, 100-0005, Japan.|Kidney Center and Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Tokyo, Japan.
authors.forename: Shigeko
authors.initials: S
authors.lastname: Hara
authors.affiliation: Division of Diabetes and Metabolism, The Institute for Adult Diseases, Asahi Life Foundation, 1-6-1 Marunouchi, Chiyoda-ku, Tokyo, 100-0005, Japan.
authors.forename: Akifumi
authors.initials: A
authors.lastname: Kushiyama
authors.affiliation: Kidney Center and Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Tokyo, Japan.
authors.forename: Yoshifumi
authors.initials: Y
authors.lastname: Ubara
authors.affiliation: Division of Diabetes and Metabolism, The Institute for Adult Diseases, Asahi Life Foundation, 1-6-1 Marunouchi, Chiyoda-ku, Tokyo, 100-0005, Japan.
authors.forename: Yoko
authors.initials: Y
authors.lastname: Yoshida
authors.affiliation: Department of Nephrology, Toho University School of Medicine, Tokyo, Japan.
authors.forename: Sonoo
authors.initials: S
authors.lastname: Mizuiri
authors.affiliation: Department of Nephrology, Toho University School of Medicine, Tokyo, Japan.
authors.forename: Atsushi
authors.initials: A
authors.lastname: Aikawa
authors.affiliation: Division of Diabetes and Metabolism, The Institute for Adult Diseases, Asahi Life Foundation, 1-6-1 Marunouchi, Chiyoda-ku, Tokyo, 100-0005, Japan.
authors.forename: Shouji
authors.initials: S
authors.lastname: Kawatzu
mesh_terms: D000368:Aged; D001162:Arteriosclerosis Obliterans / Q000209:etiology; D003327:Coronary Disease / Q000209:etiology; D003924:Diabetes Mellitus, Type 2 / Q000150:complications*; D003928:Diabetic Nephropathies / Q000453:epidemiology; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D033461:Hyperuricemia / Q000150:complications*; D007564:Japan / Q000453:epidemiology; D007674:Kidney Diseases / Q000150:complications; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D051436:Renal Insufficiency, Chronic / Q000150:complications* / Q000503:physiopathology; D012307:Risk Factors; D020521:Stroke / Q000209:etiology; D014652:Vascular Diseases / Q000453:epidemiology / Q000209:etiology*