title: Patients with type 2 diabetes having higher glomerular filtration rate showed rapid renal function decline followed by impaired glomerular filtration rate: Japan Diabetes Complications Study.
abstract: OBJECTIVE
  The Japan Diabetes Complications Study (JDCS), a nation-wide, multicenter, prospective study of patients with type 2 diabetes, reported that hemoglobin A1c(HbA1c), systolic blood pressure, and smoking were risk factors for the onset of macroalbuminuria. This study explored the risk factors for glomerular filtration rate (GFR) decline in the JDCS patients.
  
  
  METHODS
  We examined the 1407 JDCS patients (667 women, mean age 59years, 974 normoalbuminuria, 433 microalbuminuria) whose urinary albumin-to-creatinine ratio (UACR) and estimated GFR (eGFR) were determined at baseline with an 8-year follow-up. We divided all the patients into four groups according to baseline eGFR: G1 (120≤eGFR), G2 (90≤eGFR<120), G3 (60≤eGFR<90), G4 (eGFR<60).
  
  
  RESULTS
  The eGFRs in groups G1 and G2 decreased at follow-up compared to those at the baseline. The risk of annual eGFR decline rate≥3ml/min/1.73m2(rapid decliners) increased as the baseline eGFR increased. Advanced age, high HbA1c, and UACR, or diabetic retinopathy at baseline were risk factors for the rapid decliners. Especially the G1 group had a significant risk for the rapid decliners. The frequency of the patients with GFR<60ml/min/1.73m2at the follow-up amounted to 31.1% in the rapid decliners, which was higher than 12% in the non-rapid decliners.
  
  
  CONCLUSIONS
  In normo- and microalbuminuric patients with type 2 diabetes, extra careful attention should be paid to patients with eGFR ≥120ml/min/1.73m2to detect cases with rapidly decreased GFR under the normal range.
authors.affiliation: Health Care Center, Kitasato University, Kanagawa, Japan. Electronic address: moriy@kitasato-u.ac.jp.
authors.forename: Tatsumi
authors.initials: T
authors.lastname: Moriya
authors.affiliation: Department of Pharmacoepidemiology, Graduate School of Medicine and Public Health, Kyoto University, Kyoto, Japan.
authors.forename: Shiro
authors.initials: S
authors.lastname: Tanaka
authors.affiliation: Department of Hematology, Endocrinology and Metabolism, Niigata University Faculty of Medicine, Niigata, Japan.
authors.forename: Hirohito
authors.initials: H
authors.lastname: Sone
authors.affiliation: Division of Endocrinology and Metabolism, Jichii Medical University School of Medicine, Tochigi, Japan.
authors.forename: Shun
authors.initials: S
authors.lastname: Ishibashi
authors.affiliation: Department of Hematology, Endocrinology and Metabolism, Niigata University Faculty of Medicine, Niigata, Japan.
authors.forename: Satoshi
authors.initials: S
authors.lastname: Matsunaga
authors.affiliation: Department of Integrated Science and Engineering for Sustainable Society, Chuo University, Tokyo, Japan.
authors.forename: Yasuo
authors.initials: Y
authors.lastname: Ohashi
authors.affiliation: The Institute for Adult Disease, Asahi Life Foundation, Tokyo, Japan.
authors.forename: Yasuo
authors.initials: Y
authors.lastname: Akanuma
authors.affiliation: Department of Medicine, Asahikawa Medical University, Hokkaido, Japan.
authors.forename: Masakazu
authors.initials: M
authors.lastname: Haneda
authors.affiliation: Kawagoe Clinic, Saitama Medical University, Saitama, Japan.
authors.forename: Shigehiro
authors.initials: S
authors.lastname: Katayama
mesh_terms: D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D000375:Aging; D000419:Albuminuria / Q000517:prevention & control; D015331:Cohort Studies; D003131:Combined Modality Therapy; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000628:therapy; D003928:Diabetic Nephropathies / Q000453:epidemiology / Q000503:physiopathology / Q000517:prevention & control / Q000652:urine; D003930:Diabetic Retinopathy / Q000150:complications / Q000503:physiopathology / Q000517:prevention & control; D018450:Disease Progression; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate; D006442:Glycated Hemoglobin / Q000032:analysis; D006943:Hyperglycemia / Q000517:prevention & control; D007564:Japan / Q000453:epidemiology; D007668:Kidney / Q000503:physiopathology; D051437:Renal Insufficiency / Q000150:complications / Q000453:epidemiology / Q000503:physiopathology / Q000517:prevention & control; D051436:Renal Insufficiency, Chronic / Q000150:complications / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control; D012307:Risk Factors; D012720:Severity of Illness Index
chemical_list: D006442:Glycated Hemoglobin; C517652:hemoglobin A1c protein, human
keywords: Diabetic nephropathy; Glomerular filtration rate; Glomerular hyperfiltration; Rapid GFR decliner; Renal function decline