title: Clinical impact of albuminuria and glomerular filtration rate on renal and cardiovascular events, and all-cause mortality in Japanese patients with type 2 diabetes.
abstract: BACKGROUND
  The number of patients suffering from diabetic nephropathy resulting in end-stage kidney disease is increasing worldwide. In clinical settings, there are limited data regarding the impact of the urinary albumin-to-creatinine ratio (UACR) and reduced estimated glomerular filtration rate (eGFR) on renal and cardiovascular outcomes and all-cause mortality.
  
  
  METHODS
  We performed a historical cohort study of 4328 Japanese participants with type 2 diabetes from 10 centers. Risks for renal events (requirement for dialysis or transplantation, or half reduction in eGFR), cardiovascular events (cardiovascular death, nonfatal myocardial infarction, or nonfatal stroke), and all-cause mortality were assessed according to UACR and eGFR levels.
  
  
  RESULTS
  During follow-up (median 7.0 years, interquartile range 3.0-8.0 years), 419 renal events, 605 cardiovascular events and 236 deaths occurred. The UACR levels increased the risk and the adjusted hazard ratios for these three events. In addition to the effects of UACR levels, eGFR stages significantly increased the adjusted hazard ratios for renal events and all-cause mortality, especially in patients with macroalbuminuria. Diabetic nephropathy score, based on the prognostic factors, well predicted incidence rates per 1000 patient/year for each event.
  
  
  CONCLUSIONS
  Increased UACR levels were closely related to the increase in risks for renal, cardiovascular events and all-cause mortality in Japanese patients with type 2 diabetes, whereas the association between high levels of UACR and reduced eGFR was a strong predictor for renal events.
authors.affiliation: Division of Nephrology, Kanazawa University Hospital, Kanazawa, Japan, twada@m-kanazawa.jp.
authors.forename: Takashi
authors.initials: T
authors.lastname: Wada
authors.forename: Masakazu
authors.initials: M
authors.lastname: Haneda
authors.forename: Kengo
authors.initials: K
authors.lastname: Furuichi
authors.forename: Tetsuya
authors.initials: T
authors.lastname: Babazono
authors.forename: Hiroki
authors.initials: H
authors.lastname: Yokoyama
authors.forename: Kunitoshi
authors.initials: K
authors.lastname: Iseki
authors.forename: Shin-ichi
authors.initials: S
authors.lastname: Araki
authors.forename: Toshiharu
authors.initials: T
authors.lastname: Ninomiya
authors.forename: Shigeko
authors.initials: S
authors.lastname: Hara
authors.forename: Yoshiki
authors.initials: Y
authors.lastname: Suzuki
authors.forename: Masayuki
authors.initials: M
authors.lastname: Iwano
authors.forename: Eiji
authors.initials: E
authors.lastname: Kusano
authors.forename: Tatsumi
authors.initials: T
authors.lastname: Moriya
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Satoh
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Nakamura
authors.forename: Miho
authors.initials: M
authors.lastname: Shimizu
authors.forename: Tadashi
authors.initials: T
authors.lastname: Toyama
authors.forename: Akinori
authors.initials: A
authors.lastname: Hara
authors.forename: Hirofumi
authors.initials: H
authors.lastname: Makino
mesh_terms: D000368:Aged; D000419:Albuminuria / Q000175:diagnosis / Q000208:ethnology / Q000401:mortality* / Q000503:physiopathology / Q000628:therapy; D044466:Asian People; D015415:Biomarkers / Q000652:urine; D002318:Cardiovascular Diseases / Q000175:diagnosis / Q000208:ethnology / Q000401:mortality* / Q000503:physiopathology; D003404:Creatinine / Q000652:urine; D003924:Diabetes Mellitus, Type 2 / Q000175:diagnosis / Q000208:ethnology / Q000401:mortality* / Q000503:physiopathology; D003928:Diabetic Nephropathies / Q000175:diagnosis / Q000208:ethnology / Q000401:mortality* / Q000503:physiopathology / Q000628:therapy; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D007564:Japan / Q000453:epidemiology; D007668:Kidney / Q000503:physiopathology*; D007676:Kidney Failure, Chronic / Q000175:diagnosis / Q000208:ethnology / Q000401:mortality* / Q000503:physiopathology / Q000628:therapy; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011237:Predictive Value of Tests; D011379:Prognosis; D016016:Proportional Hazards Models; D006435:Renal Dialysis; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors
chemical_list: D015415:Biomarkers; D003404:Creatinine