Moriya Tatsumi, Tanaka Shiro, Sone Hirohito, Ishibashi Shun, Matsunaga Satoshi, Ohashi Yasuo, Akanuma Yasuo, Haneda Masakazu, Katayama Shigehiro
Health Care Center, Kitasato University, Kanagawa, Japan.
Department of Pharmacoepidemiology, Graduate School of Medicine and Public Health, Kyoto University, Kyoto, Japan.
J Diabetes Complications. 2017 Feb;31(2):473-478. doi: 10.1016/j.jdiacomp.2016.06.020. Epub 2016 Jun 29.
The Japan Diabetes Complications Study (JDCS), a nation-wide, multicenter, prospective study of patients with type 2 diabetes, reported that hemoglobin A (HbA), 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.
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).
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/1.73m (rapid decliners) increased as the baseline eGFR increased. Advanced age, high HbA, 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/1.73m at the follow-up amounted to 31.1% in the rapid decliners, which was higher than 12% in the non-rapid decliners.
In normo- and microalbuminuric patients with type 2 diabetes, extra careful attention should be paid to patients with eGFR ≥120ml/min/1.73m to detect cases with rapidly decreased GFR under the normal range.
日本糖尿病并发症研究（JDCS）是一项针对2型糖尿病患者的全国性、多中心前瞻性研究，该研究报告称糖化血红蛋白（HbA）、收缩压和吸烟是大量白蛋白尿发病的危险因素。本研究探讨了JDCS患者肾小球滤过率（GFR）下降的危险因素。
我们对1407例JDCS患者（667例女性，平均年龄59岁，974例正常白蛋白尿患者，433例微量白蛋白尿患者）进行了检查，这些患者在基线时测定了尿白蛋白与肌酐比值（UACR）和估算肾小球滤过率（eGFR），并进行了8年的随访。我们根据基线eGFR将所有患者分为四组：G1组（120≤eGFR），G2组（90≤eGFR<120），G3组（60≤eGFR<90），G4组（eGFR<60）。
与基线时相比，G1组和G2组患者的eGFR在随访时下降。随着基线eGFR的升高，年eGFR下降率≥3ml/min/1.73m²（快速下降者）的风险增加。高龄、高HbA、UACR或基线时的糖尿病视网膜病变是快速下降者的危险因素。特别是G1组快速下降者的风险显著。随访时GFR<60ml/min/1.73m²的患者在快速下降者中的比例为31.1%，高于非快速下降者中的12%。
在2型糖尿病正常白蛋白尿和微量白蛋白尿患者中，对于eGFR≥120ml/min/1.73m²的患者应格外关注，以便在正常范围内检测出GFR快速下降的病例。
