Diabetic Retinopathy and Microalbuminuria Can Predict Macroalbuminuria and Renal Function Decline in Japanese Type 2 Diabetic Patients
Open Access
- 13 August 2013
- journal article
- research article
- Published by American Diabetes Association in Diabetes Care
- Vol. 36 (9), 2803-2809
- https://doi.org/10.2337/dc12-2327
Abstract
OBJECTIVE To examine the interactive relationship between diabetic retinopathy (DR) and diabetic nephropathy (DN) in type 2 diabetic patients and to elucidate the role of DR and microalbuminuria on the onset of macroalbuminuria and renal function decline. RESEARCH DESIGN AND METHODS We explored the effects of DR and microalbuminuria on the progression of DN from normoalbuminuria and low microalbuminuria (n = 773), normoalbuminuria with DR [NA(DR+)] (n = 279), microalbuminuria without DR [MA(DR−)] (n = 277), and microalbuminuria with DR [MA(DR+)] (n = 146). Basal urinary albumin-to-creatinine ratio and DR status were determined at baseline and followed for a median of 8.0 years. RESULTS Annual incidence rates of macroalbuminuria were 1.6/1,000 person-years (9 incidences), 3.9/1,000 person-years (8 incidences), 18.4/1,000 person-years (34 incidences), and 22.1/1,000 person-years (22 incidences) in the four groups, respectively. Multivariate-adjusted hazard ratios of the progression to macroalbuminuria were 2.48 (95% CI 0.94–6.50; P = 0.07), 10.40 (4.91–22.03; P < 0.01), and 11.55 (5.24–25.45; P < 0.01) in NA(DR+), MA(DR−), and MA(DR+), respectively, in comparison with NA(DR−). Decline in estimated glomerular filtration rate (GFR) per year was two to three times faster in MA(DR+) (−1.92 mL/min/1.73 m2/year) than in the other groups. CONCLUSIONS In normo- and low microalbuminuric Japanese type 2 diabetic patients, presence of microalbuminuria at baseline was associated with higher risk of macroalbuminuria in 8 years. Patients with microalbuminuria and DR showed the fastest GFR decline. Albuminuria and DR should be considered as risk factors of renal prognosis in type 2 diabetic patients. An open sharing of information will benefit both ophthalmologists and diabetologists.Keywords
This publication has 38 references indexed in Scilit:
- More Impact of Microalbuminuria on Retinopathy Than Moderately Reduced GFR Among Type 2 Diabetic PatientsDiabetes Care, 2012
- Proliferative retinopathy predicts nephropathy: a 25-year follow-up study of type 1 diabetic patientsActa Diabetologica, 2011
- Is Diabetic Retinopathy Related to Subclinical Cardiovascular Disease?Ophthalmology, 2011
- Diabetic Retinopathy Predicts All-Cause Mortality and Cardiovascular Events in Both Type 1 and 2 DiabetesDiabetes Care, 2011
- Low transition rate from normo- and low microalbuminuria to proteinuria in Japanese type 2 diabetic individuals: the Japan Diabetes Complications Study (JDCS)Diabetologia, 2011
- The relationship of retinal vessel diameter to changes in diabetic nephropathy structural variables in patients with type 1 diabetesDiabetologia, 2010
- Long-term lifestyle intervention lowers the incidence of stroke in Japanese patients with type 2 diabetes: a nationwide multicentre randomised controlled trial (the Japan Diabetes Complications Study)Diabetologia, 2010
- Revised Equations for Estimated GFR From Serum Creatinine in JapanAmerican Journal of Kidney Diseases, 2009
- Nephropathy in Patients with Type 2 Diabetes MellitusThe New England Journal of Medicine, 1999
- Predicting Diabetic Nephropathy in Insulin-Dependent PatientsThe New England Journal of Medicine, 1984