The usefulness of the revised classification for chronic kidney disease by the KDIGO for determining the frequency of diabetic micro- and macroangiopathies in Japanese patients with type 2 diabetes mellitus☆
Introduction
It is well-known that albuminuria is a major risk factor for atherosclerotic diseases, as well as end-stage renal disease (Gerstein et al., 2001, Sarnak et al., 2003). Type 2 diabetes mellitus is also an independent predictor of vascular events. We previously reported that the frequencies diabetic micro- and macroangiopathies were elevated with the progression of the chronic kidney disease (CKD) stage grading by the glomerular filtration rate (GFR) in 1197 Japanese patients with type 2 diabetes mellitus, even among the individuals without albuminuria (Ito, Takeuchi, Ishida, Antoku et al., 2010).
A new classification of CKD was proposed by the Kidney Disease: Improving Global Outcomes (KDIGO) in 2011 (Levey et al., 2011). The major point in revising this classification was the introduction of a two-dimensional staging of the CKD according to the urinary albumin excretion rate (UAE), in addition to the GFR. Furthermore, the previous CKD stage 3 was divided into the two stages based on the GFR level (G3a; 60 mL/min/1.73 m2 > GFR ≥ 45 mL/min/1.73 m2 and G3b; 45 mL/min/1.73 m2 > GFR ≥ 30 mL/min/1.73 m2). Although the risk for mortality and progression of renal dysfunction were not substantially different between the groups, the stage with an albumin-to-creatinine ratio (ACR) < 30 mg/g creatinine (A1 stage) equivalent to normoalbuminuria of diabetic nephropathy was also divided into two subgroups with ACR < 10 mg/g creatinine and 10 ≤ ACR < 30 mg/g creatinine. The aim of this study was to examine the frequency of diabetic micro- and macroangiopathies in patients with type 2 diabetes using the new classification of the CKD in a cross-sectional design study.
Section snippets
Study population and methods
A population of 2018 patients diagnosed with type 2 diabetes mellitus who underwent consecutive evaluations, including blood pressure, urinalysis and determination of the serum creatinine levels, in the Department of Diabetes, Metabolism and Kidney Disease of Edogawa Hospital, Tokyo, Japan between April 2008 and March 2011 was recruited for the study.
The obese individuals were defined as those having a BMI ≥ 25 kg/m2 (Examination Committee of Criteria for 'Obesity Disease' in Japan and Japan
Results
Table 1 shows the clinical characteristics and laboratory parameters of the patients. Table 2 shows the distribution of the patients staged by the eGFR and ACR levels. As shown in Table 3, all of the diabetic micro- and macroangiopathies significantly more common in the later stages of both the eGFR and albuminuria (P < 0.01). When the χ2 test were performed among the A1 (A1a + A1b) stage patients, the number of subjects showing an eGFR < 60 mL/min/1.73 m2 (G3a + G3b + G4 + G5) was significantly lower in the
Discussion
In the present cross-sectional study, the incidence of diabetic micro- and macroangiopathies was higher in the G3b group than in the G3a group. Furthermore, the level of baPWV, one of the surrogate markers for atherosclerosis, was significantly higher in the G3b group. It is therefore considered to be useful to subdivide the CKD stage 3 patients in order to better evaluate the risk of vascular complications for diabetic patients. On the other hand, no remarkable differences in diabetic
Acknowledgments
The authors thank Ms. Tomoko Koyanagi of the secretarial section of Edogawa Hospital for her valuable help in the data collection.
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Conflict of interest statement: The authors declare that they have no conflict of interest.