Abstract
We retrospectively analyzed the CoDiC data from 39 institutes in the JDDM in order to clarify the progression of kidney dysfunction over 5 years and factors related to this progression among type 2 diabetes patients progressing to stage 4 diabetic nephropathy. The present study clarified that 1) about 1.7 times more patients recovered from the stage 4 to the stage 3 than those who remained in stage 4, 2) the estimated glomerular filtration rate (eGFR) in 37.4 % of patients who remained in stage 4 progressively declined with a mean rate of −3.6 mL/min/year over 5 years, while that in the rest of patients was maintained at roughly the starting value (initially 25.8; 5 years later 24.4 mL/min/1.73 m2). On comparing the patient profiles between the decliners and the non-decliners, a younger age, a low eGFR just before the study, a high systolic blood pressure and a high non-HDL cholesterol level were significantly associated with a severe decline (P<0.01). However, a propensity score matching analysis further clarified that the influence of these four risk factors on a severe decline was slight. These findings suggested that direct causes provoked the stage 4 by acute kidney injury were important for the kidney function prognosis, in addition to the genetic and pathological background characteristics of each patient.
