title: Comparison of Clinical Trajectories before Initiation of Renal Replacement Therapy between Diabetic Nephropathy and Nephrosclerosis on the KDIGO Guidelines Heat Map.
abstract: This study investigated differences between the clinical trajectories of diabetic nephropathy and nephrosclerosis using the Kidney Disease: Improving Global Outcomes (KDIGO) heat map and the clinical characteristics between the two diseases at RRT initiation. This single-center, retrospective study enrolled 100 patients whose estimated glomerular filtration rate (eGFR) was ≥45 mL/min/1.73 m(2) at their first visit and who were initiated on RRT. Fifty consecutive patients were assigned to each of the diabetic nephropathy and nephrosclerosis groups. All data for simultaneously measured eGFR and urinary albumin to creatinine ratio (UACR) were collected from first visit to RRT initiation and were plotted on the KDIGO heat map. Diabetic nephropathy was characterized by higher blood pressure and UACR and lower age, eGFR, and serum albumin levels compared with nephrosclerosis at RRT initiation. The vast majority of patients with diabetic nephropathy and eGFR < 60 mL/min/1.73 m(2) had concomitant macroalbuminuria, whereas for patients with nephrosclerosis, even when eGFR was <45 mL/min/1.73 m(2), many still had normoalbuminuria or microalbuminuria. The rate of decline of eGFR was significantly faster in the diabetic nephropathy group than that in the nephrosclerosis group. The clinical trajectories of diabetic nephropathy and nephrosclerosis differed markedly on the KDIGO heat map.
authors.affiliation: Division of Nephrology, Hypertension and Endocrinology, Department of Internal Medicine, Nihon University School of Medicine, Tokyo 173-8610, Japan.
authors.forename: Masanori
authors.initials: M
authors.lastname: Abe
authors.affiliation: Division of Nephrology, Hypertension and Endocrinology, Department of Internal Medicine, Nihon University School of Medicine, Tokyo 173-8610, Japan.
authors.forename: Kazuyoshi
authors.initials: K
authors.lastname: Okada
authors.affiliation: Division of Nephrology, Hypertension and Endocrinology, Department of Internal Medicine, Nihon University School of Medicine, Tokyo 173-8610, Japan.
authors.forename: Noriaki
authors.initials: N
authors.lastname: Maruyama
authors.affiliation: Division of Nephrology, Hypertension and Endocrinology, Department of Internal Medicine, Nihon University School of Medicine, Tokyo 173-8610, Japan.
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Takashima
authors.affiliation: Division of Nephrology, Hypertension and Endocrinology, Department of Internal Medicine, Nihon University School of Medicine, Tokyo 173-8610, Japan.
authors.forename: Osamu
authors.initials: O
authors.lastname: Oikawa
authors.affiliation: Division of Nephrology, Hypertension and Endocrinology, Department of Internal Medicine, Nihon University School of Medicine, Tokyo 173-8610, Japan; Division of General Medicine, Department of Internal Medicine, Nihon University School of Medicine, Tokyo 173-8610, Japan.
authors.forename: Masayoshi
authors.initials: M
authors.lastname: Soma
mesh_terms: D000328:Adult; D000368:Aged; D000419:Albuminuria / Q000378:metabolism; D001706:Biopsy; D003404:Creatinine / Q000652:urine; D003924:Diabetes Mellitus, Type 2 / Q000097:blood; D003928:Diabetic Nephropathies / Q000473:pathology / Q000628:therapy*; D018450:Disease Progression; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D007668:Kidney / Q000503:physiopathology; D007677:Kidney Function Tests; D008297:Male; D008875:Middle Aged; D009398:Nephrology / Q000379:methods; D009400:Nephrosclerosis / Q000378:metabolism / Q000628:therapy*; D017410:Practice Guidelines as Topic; D017582:Renal Replacement Therapy; D012189:Retrospective Studies; D012709:Serum Albumin / Q000032:analysis
chemical_list: D012709:Serum Albumin; D003404:Creatinine
references.citation: Nephrol Dial Transplant. 2009 Apr;24(4):1212-9
references.pmid: 18984626
references.citation: Lancet. 1983 May 28;1(8335):1175-9
references.pmid: 6133986
references.citation: BMJ. 2004 May 8;328(7448):1105
references.pmid: 15096438
references.citation: Ther Apher Dial. 2013 Dec;17(6):567-611
references.pmid: 24330555
references.citation: Am J Kidney Dis. 2012 Apr;59(4):513-22
references.pmid: 22305760
references.citation: Clin Exp Nephrol. 2014 Apr;18(2):305-12
references.pmid: 24081589
references.citation: Am J Kidney Dis. 2014 Feb;63(2 Suppl 2):S39-62
references.pmid: 24461729
references.citation: Nephron Clin Pract. 2011;118(4):c367-74
references.pmid: 21325868
references.citation: Bull World Health Organ. 2008 Mar;86(3):229-37
references.pmid: 18368211
references.citation: Diabetes Care. 2014;37(1):226-34
references.pmid: 23939543
references.citation: JAMA. 2014 Jun 25;311(24):2518-2531
references.pmid: 24892770
references.citation: Nat Rev Nephrol. 2015 May;11(5):302-13
references.pmid: 25848881
references.citation: Am J Kidney Dis. 2012 Apr;59(4):504-12
references.pmid: 22284441
references.citation: Diabetes Care. 2006 Jul;29(7):1560-6
references.pmid: 16801579
references.citation: Kidney Int. 2015 Jan;87(1):20-30
references.pmid: 24786708
references.citation: Diabetes Care. 2015 Jun;38(6):954-62
references.pmid: 25998286
references.citation: Diabetes. 2005 Jul;54(7):2164-71
references.pmid: 15983218
references.citation: Hypertens Res. 2009 Jan;32(1):3-107
references.pmid: 19300436
references.citation: Diabetes Care. 1998 Nov;21(11):1848-55
references.pmid: 9802732
references.citation: Diabetes. 2005 Oct;54(10):2983-7
references.pmid: 16186402
references.citation: Diabetes Care. 2005 Nov;28(11):2733-8
references.pmid: 16249548
references.citation: Nephrol Dial Transplant. 2004 Nov;19(11):2784-8
references.pmid: 15328385
references.citation: Kidney Int. 2012 Sep;82(5):589-97
references.pmid: 22622493
references.citation: Diabetes Care. 2007 Aug;30(8):2034-9
references.pmid: 17485574
references.citation: Am J Kidney Dis. 2009 Jun;53(6):982-92
references.pmid: 19339088
references.citation: J Hypertens. 2011 Sep;29(9):1802-9
references.pmid: 21738053
references.citation: Kidney Int. 2011 Jul;80(1):17-28
references.pmid: 21150873
references.citation: Kidney Int Suppl (2011). 2017 Dec;7(3):e1
references.pmid: 30681074
references.citation: Am J Kidney Dis. 2013 Jan;61(1 Suppl 1):A7, e1-476
references.pmid: 23253259
references.citation: N Engl J Med. 2003 Jun 5;348(23):2285-93
references.pmid: 12788992