Department of Medicine, Shiga University of Medical Science, Otsu, Japan.
Department of Diabetology & Endocrinology, Kanazawa Medical University, Ishikawa, Japan.
J Diabetes Investig. 2019 Jul;10(4):1032-1040. doi: 10.1111/jdi.12977. Epub 2019 Jan 1.
AIMS/INTRODUCTION: Diabetic kidney disease is characterized by increased albuminuria and/or a reduced glomerular filtration rate (GFR). We analyzed secular changes in the prevalence of albuminuria and reduced estimated GFR (eGFR) in Japanese patients with type 2 diabetes, and identified factors associated with these changes.
Using 1996, 2001, 2006 and 2014 cohort data from the Japanese serial cross-sectional studies conducted at Shiga University of Medical Science, secular changes in the prevalence of diabetic kidney disease (albuminuria and/or reduced eGFR), patient characteristics and their associations were analyzed.
The prevalence of microalbuminuria and macroalbuminuria decreased over time, whereas the prevalence of moderately reduced eGFR (30-60 mL/min/1.73 m ) and severely reduced eGFR (<30 mL/min/1.73 m ) increased. Severely reduced eGFR was observed mainly in the patients with macroalbuminuria, regardless of year. Conversely, the prevalence of moderately reduced eGFR increased in the patients without macroalbuminuria. Both macroalbuminuria and moderately reduced eGFR without macroalbuminuria in the 2014 cohort were refractory to the recently recommended intensive therapy. Finally, we showed that obesity accompanied by vascular dysfunction was a risk factor for the development of albuminuria, and that age-dependent arterial stiffness was associated with reduced eGFR without macroalbuminuria in the 2014 cohort.
During the past 20 years in Japan, the prevalence of albuminuria declined, whereas that of reduced eGFR increased. Additionally, obesity- and high age-related vascular damage seems to be associated with macroalbuminuria and reduced eGFR without macroalbuminuria, respectively.
目的/引言：糖尿病肾病的特征是白蛋白尿增加和/或肾小球滤过率（GFR）降低。我们分析了日本 2 型糖尿病患者白蛋白尿和估算肾小球滤过率（eGFR）降低的患病率随时间的变化，并确定了与这些变化相关的因素。
利用来自日本滋贺医科大学进行的 1996 年、2001 年、2006 年和 2014 年队列研究的数据，分析了糖尿病肾病（白蛋白尿和/或 eGFR 降低）患病率、患者特征及其相关性的随时间变化。
微量白蛋白尿和大量白蛋白尿的患病率随时间逐渐降低，而中度降低的 eGFR（30-60 mL/min/1.73 m ）和严重降低的 eGFR（<30 mL/min/1.73 m ）的患病率则增加。严重降低的 eGFR 主要见于伴有大量白蛋白尿的患者，与年份无关。相反，不伴有大量白蛋白尿的患者中度降低的 eGFR 患病率增加。2014 年队列中伴有或不伴有大量白蛋白尿的中度降低的 eGFR 均对最近推荐的强化治疗有抵抗性。最后，我们表明肥胖伴血管功能障碍是白蛋白尿发生的危险因素，而年龄依赖性动脉僵硬与 2014 年队列中不伴有大量白蛋白尿的 eGFR 降低有关。
在过去的 20 年中，日本的白蛋白尿患病率下降，而 eGFR 降低的患病率增加。此外，肥胖和与年龄相关的血管损伤似乎分别与大量白蛋白尿和不伴有大量白蛋白尿的 eGFR 降低有关。
