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Risk factors for persistent decline in eGFR of Japanese patients with diabetes: Analysis using a large-scale diabetes
Kota Yamada1,2, Mitsuru Ohsugi1,3, Yuichiro Ito4
1Department of Diabetes, Endocrinology and Metabolism, National Center for Global Health and Medicine (Currently National Center for Global Health and Medicine, Japan Institute for Health Security), Center Hospital, Toyama, Shinjuku-ku, Tokyo, Japan.
Aims/Introduction:
This study aimed to identify clinical predictors associated with sustained decline in estimated glomerular filtration rate (eGFR) among Japanese individuals diagnosed with diabetes mellitus.
Materials And Methods:
We conducted a retrospective analysis using J-DREAMS (Japan Diabetes compREhensive database project based on an Advanced Electronic Medical record System), a large-scale registry integrated with electronic medical records. The study population included adults (≥18 years) with diabetes who had at least one documented visit at a referral institution between December 1, 2015, and March 31, 2021, with concurrent measurements of serum creatinine and hemoglobin.
Results:
A total of 12,416 and 11,157 patients were eligible for assessment of eGFR change at 1 and 2 years, respectively. Multivariable logistic regression identified several consistent risk factors for ≥30% eGFR reduction at both time points: low serum albumin, elevated triglycerides, anemia as defined by JSDT, diabetic retinopathy, CKD Stage G4 or higher, albuminuria category A3, and chronic heart failure. Additional predictors at 1 year included age under 65 and elevated HbA1c, while smoking, hypertension, and diabetic neuropathy were significant only at 2 years.
Conclusion:
Beyond retinopathy and advanced kidney disease, anemia, hypoalbuminemia, and heart failure independently contributed to persistent eGFR decline, supporting the clinical relevance of cardio-renal anemia syndrome in diabetic populations.
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