title: Chronic kidney disease categories and renal-cardiovascular outcomes in type 2 diabetes without prevalent cardiovascular disease: a prospective cohort study (JDDM25).
abstract: OBJECTIVE
  In type 2 diabetic patients at low risk for cardiovascular disease (CVD), the relationship between the clinical course of nephropathy by stage of chronic kidney disease (CKD) and onset of CVD remains unclear. Clarification of this relationship is important for clinical decision-making for both low- and high-risk diabetic patients.
  
  
  METHODS
  This 4 year prospective study enrolled 2,954 type 2 diabetic patients with no prevalent CVD, and serum creatinine <176.8 μmol/l. The risk for CVD onset (non-fatal and fatal CVD and stroke, and peripheral arterial disease) was assessed according to CKD stage categorised by urinary albumin-to-creatinine ratio (ACR; mg/mmol) and estimated GFR (eGFR; ml min(-1) 1.73 m(-2)). Association of progression from 'no CKD' stage (ACR <3.5 mg/mmol and eGFR ≥ 90 ml min(-1) 1.73 m(-2)) with risk for CVD onset was also evaluated.
  
  
  RESULTS
  During follow-up (median 3.8 years), 89 CVD events occurred. Compared with patients with 'no CKD' as reference, those with ACR ≥ 35.0 mg/mmol with co-existing eGFR 60-89 ml min(-1) 1.73 m(-2) or <60 ml min(-1) 1.73 m(-2) showed increased risk for CVD onset, whereas those with eGFR ≥ 90 ml min(-1) 1.73 m(-2) did not. Those with ACR <3.5 mg/mmol and eGFR <60 ml min(-1) 1.73 m(-2) did not show any increased risk. Among patients with 'no CKD' stage at baseline, those who progressed to ACR ≥ 3.5 mg/mmol during follow-up showed an increased risk compared with those who did not, whereas those who progressed to eGFR <90 ml min(-1) 1.73 m(-2) did not have increased risk.
  
  
  CONCLUSIONS
  The risk for CVD was associated with progression of albuminuria stage rather than eGFR stage in type 2 diabetic patients at relatively low risk for CVD.
authors.affiliation: Jiyugaoka Medical Clinic, Internal Medicine, West 6, South 6-4-3, Obihiro 080-0016, Japan. dryokoyama@yokoyamanaika.com
authors.forename: H
authors.initials: H
authors.lastname: Yokoyama
authors.forename: S
authors.initials: S
authors.lastname: Araki
authors.forename: M
authors.initials: M
authors.lastname: Haneda
authors.forename: M
authors.initials: M
authors.lastname: Matsushima
authors.forename: K
authors.initials: K
authors.lastname: Kawai
authors.forename: K
authors.initials: K
authors.lastname: Hirao
authors.forename: M
authors.initials: M
authors.lastname: Oishi
authors.forename: K
authors.initials: K
authors.lastname: Sugimoto
authors.forename: H
authors.initials: H
authors.lastname: Sone
authors.forename: H
authors.initials: H
authors.lastname: Maegawa
authors.forename: A
authors.initials: A
authors.lastname: Kashiwagi
mesh_terms: D000419:Albuminuria / Q000097:blood; D002318:Cardiovascular Diseases / Q000097:blood / Q000401:mortality* / Q000503:physiopathology; D015331:Cohort Studies; D003404:Creatinine / Q000097:blood; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000150:complications* / Q000401:mortality* / Q000503:physiopathology; D003925:Diabetic Angiopathies / Q000097:blood / Q000209:etiology / Q000401:mortality* / Q000503:physiopathology; D003928:Diabetic Nephropathies / Q000097:blood / Q000209:etiology / Q000401:mortality* / Q000503:physiopathology; D018450:Disease Progression; D005260:Female; D005919:Glomerular Filtration Rate; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D011320:Primary Health Care; D011446:Prospective Studies; D051436:Renal Insufficiency, Chronic / Q000097:blood / Q000401:mortality* / Q000503:physiopathology; D012307:Risk Factors
chemical_list: D003404:Creatinine; D006442:Glycated Hemoglobin; C517652:hemoglobin A1c protein, human