Abstract: FR-PO662

Relationship between Transition in CKD Category and Renal Outcome in Japanese Type 2 Diabetic Patients with Biopsy-Proven Diabetic Nephropathy

Session Information

Category: Diabetes

  • 502 Diabetes Mellitus and Obesity: Clinical

Authors

  • Funamoto, Tomoaki, Kanazawa University Hospital, Kanazawa, Ishikawa, Japan
  • Shimizu, Miho, Kanazawa University Hospital, Kanazawa, Ishikawa, Japan
  • Toyama, Tadashi, Kanazawa University Hospital, Kanazawa, Ishikawa, Japan
  • Kitajima, Shinji, Kanazawa University Hospital, Kanazawa, Ishikawa, Japan
  • Furuichi, Kengo, Kanazawa University Hospital, Kanazawa, Ishikawa, Japan
  • Wada, Takashi, Kanazawa University Hospital, Kanazawa, Ishikawa, Japan
Background

We examined the association between transition in chronic kidney disease (CKD) category over 5 years and 10 years after renal biopsy and renal outcome in Japanese type 2 diabetic patients with biopsy-proven diabetic nephropathy.

Methods

Based on up to 5 years and 10 years observation after renal biopsy, we determined transition in CKD category. We first evaluated the association of renal composite events (requirement of dialysis, or a 50% decline in estimated glomerular filtration rate (eGFR) from baseline (at the time of renal biopsy)) with progression of CKD categories over 5-years (n=54) and 10-years (n=54) after renal biopsy in patients with normo-/microalbuminuria with eGFR ≥ 15 mL/min per 1.73m2. We subsequently evaluated the association of renal composite events with remission of macroalbuminuria to normo-/microalbuminuria over 5-years (n=58) and 10-years (n=42) after renal biopsy in patients with macroalbuminuria.

Results

(1) In the 5-year analysis in patients with normo-/microalbuminuria with eGFR ≥ 15 mL/min per 1.73m2, 8 patients showed progression of albuminuria stage, whereas 9 patients showed progression of eGFR stage. The corresponding numbers in the 10-year analysis were 12 patients and 16 patients, respectively. Cumulative incidences of renal composite events in patients with progression of albuminuria stage and eGFR stage were higher than no progression. The risk for renal composite events was associated with progression of albuminuria stage rather than eGFR stage. The progression of albuminuria was associated with nodular lesions, whereas the progression of eGFR stage was associated with diffuse lesions. (2) In the 5-year analysis, 10 patients showed remission of macroalbuminuria. The corresponding number in the 10-year analysis was 16 patients. Cumulative incidences of renal composite events in patients with remission were lower than no remission. In the 10-year analysis, remission was a determinant for renal composite events. Low urinary protein excretion at renal biopsy and female were the determinants for remission.

Conclusion

Our study suggests that transition in CKD category over 5-years and 10-years as well as diabetic kidney lesions add significant prognostic information about risk for renal outcome in type 2 diabetes.