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Diabetes mellitus as a cause or comorbidity of chronic kidney disease and its outcomes: the Gonryo study

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Abstract

Background

Diabetes mellitus (DM) is a major cause of end-stage kidney disease (ESKD). However, the difference in renal outcomes between DM patients with non-diabetic renal disease (DM and NDRD) and those with diabetic nephropathy (DN) is controversial. The aim of the present study was to evaluate the differences among patients with DN, DM, and NDRD, and non-DM chronic kidney disease (CKD) in a prospective observational study.

Methods

We extracted the data of 2484 patients from 11 nephrology care centers and categorized into three groups as described above. The primary outcome was ESKD requiring renal replacement therapy.

Results

During the median follow-up of 4.44 years, 281 patients (11.3%) developed ESKD. Renal outcomes of DM and NDRD patients were similar to those of non-DM patients (p ≥ 0.05). At CKD stage G3b, the hazard ratios (95% confidence intervals) of ESKD were 7.10 (2.46–20.49) in DN patients and 0.89 (0.19–4.24) in DM and NDRD. The annual change in the estimated glomerular filtration rate (eGFR) in DN patients was significantly larger than that in other groups at stage G3b (−9.7%/year).

Conclusions

We found that DN patients have a higher risk for ESKD than DM and NDRD or non-DM patients. In particular, GFR rapidly declined in DN at stage G3b. DM and NDRD patients can accomplish equally beneficial renal outcomes as non-DM CKD, regardless of their similar metabolic profiles as DN. In conclusion, we should prudentially consider the risk stratification of DM whether cause or comorbidity of CKD.

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Acknowledgements

Contributors: Gonryo Study investigators: Yoshio Taguma and Toshinobu Sato (Japan Community Health care Organization Sendai Hospital), Masato Matsushima (Tokyo Jikeii Medical University), Katsuya Obara (Tohoku Kosai Hospital), Isao Kurihara (Tohoku Kosai Miyagino Hospital), Yasumichi Kinoshita, Kazuto Sato, and Tasuku Nagasawa (Japanese Red Cross Ishinomaki Hospital), Kazuro Kaise and Yoshihide Arihara (Sendai Medical Center), Akira Sugiura and Masahiro Miyata (Osaki Citizen Hospital), Kazuhisa Takeuchi (Koujinkai Central Clinic), Kenji Nakayama and Naoki Akiu (Sendai City Hospital), and Tetsuya Otaka (Katta General Hospital). The authors express special thanks to Ms. Yumi Yamaguchi and Ms. Ayuko Momoi for administrative assistance.

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Authors and Affiliations

  1. Clinical Pharmacology and Therapeutics, Tohoku University Graduate School of Pharmaceutical Sciences, Sendai, Japan

    Toshiki Iwai & Hiroshi Sato

  2. Division of Nephrology, Endocrinology and Vascular Medicine, Tohoku University Graduate School of Medicine, 1-1 Seiryomachi, Aoba-ku, Sendai, 980-8574, Japan

    Mariko Miyazaki, Gen Yamada, Tae Yamamoto, Hiroshi Sato & Sadayoshi Ito

  3. Research Division of Chronic Kidney Disease and Dialysis Treatment, Tohoku University Hospital, Sendai, Japan

    Masaaki Nakayama

  4. United Centers for Advanced Research and Translational Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan

    Masaaki Nakayama

  5. Department of Public Health, Hygiene and Epidemiology, Faculty of Medicine, Tohoku Medical and Pharmaceutical University, Sendai, Japan

    Michihiro Satoh

Authors
  1. Toshiki Iwai
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  2. Mariko Miyazaki
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  3. Gen Yamada
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  4. Masaaki Nakayama
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  5. Tae Yamamoto
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  6. Michihiro Satoh
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  7. Hiroshi Sato
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  8. Sadayoshi Ito
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Corresponding author

Correspondence to Mariko Miyazaki.

Ethics declarations

Ethical approval

The study was approved by the institutional review board of Tohoku University, Graduate School of Medicine (No. 2006-10), and the study protocol was approved by the respective participating hospitals. All patients provided written informed consent.

Conflict of interest

The authors declare that they have no conflict of interest.

Support and funding

Astellas Pharmaceutical. Miyagi Kidney Foundation.

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None.

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Iwai, T., Miyazaki, M., Yamada, G. et al. Diabetes mellitus as a cause or comorbidity of chronic kidney disease and its outcomes: the Gonryo study. Clin Exp Nephrol 22, 328–336 (2018). https://doi.org/10.1007/s10157-017-1451-4

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  • DOI: https://doi.org/10.1007/s10157-017-1451-4

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