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Minami K, Sakuma Y, Ogawa K, Takemura K, Takahashi H, Inoue T, Suzuki Y, Takahashi H, Shimura H, Sato Y, Watanabe S, Yoshida S, Ogino J, Hashimoto N. Risk factors for chronic kidney disease progression over 20 years for primary prevention in Japanese individuals at a preventive medicine research center: Focus on the influence of plasma glucose levels. J Diabetes Investig 2024. [PMID: 38953868 DOI: 10.1111/jdi.14259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Revised: 06/06/2024] [Accepted: 06/11/2024] [Indexed: 07/04/2024] Open
Abstract
AIMS/INTRODUCTION Chronic kidney disease (CKD) is a very important issue globally because of the risk of its progressing to end-stage renal disease. We aimed to identify factors contributing to long-term estimated glomerular filtration rate (eGFR) decline to determine an early diagnosis and prevent CKD progression. MATERIALS AND METHODS From January 2003 to December 2006, 5,507 individuals underwent health checkups at our hospital's Preventive Medicine Research Center. We ultimately enrolled 2,175 individuals. The eGFR was ≥60 mL/min/1.73 m2 at the start of observation period, which was 20 years. The event onset time was the day that the eGFR became <30 mL/min during the 20-year period. Baseline risk factors - in particular, the effect of plasma glucose levels on the eGFR - were extracted and evaluated by using Fine and Gray analysis. RESULTS During the 20-year observation, the hazard ratio (HR) of CKD progression was examined. A fasting plasma glucose (FPG) level ≥105 mg/dL was significantly associated with the risk of CKD progressing to an eGFR <30 mL/min. This trend was similar in the slope of eGFR. An FPG ≥105 mg/dL or an glycated hemoglobin level ≥6.5% was useful for intervening in CKD progression. Multivariate analysis showed that independent risk factors were an FPG level ≥105 mg/dL (HR 1.9; P < 0.001), age ≥60 years (HR 3.86; P < 0.001), obesity (HR 1.61; P < 0.01) and urinary protein (HR 1.55; P < 0.01). CONCLUSIONS For early intervention against a reduction in the eGFR, detecting mild increases in FPG ≥105 mg/dL in patients with CKD with or without diabetes is useful.
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Affiliation(s)
- Kento Minami
- Department of Diabetes and Metabolic Diseases, Asahi General Hospital, Asahi, Chiba, Japan
| | - Yukie Sakuma
- Clinical Research Support Center, Asahi General Hospital, Asahi, Chiba, Japan
| | - Kaoru Ogawa
- Department of Diabetes and Metabolic Diseases, Asahi General Hospital, Asahi, Chiba, Japan
| | - Koji Takemura
- Department of Diabetes and Metabolic Diseases, Asahi General Hospital, Asahi, Chiba, Japan
| | - Haruo Takahashi
- Clinical Research Support Center, Asahi General Hospital, Asahi, Chiba, Japan
| | - Takeshi Inoue
- Clinical Research Support Center, Asahi General Hospital, Asahi, Chiba, Japan
| | - Yoshifumi Suzuki
- Department of Diabetes and Metabolic Diseases, Asahi General Hospital, Asahi, Chiba, Japan
| | - Hidenori Takahashi
- Preventive Medicine Research Center, Asahi General Hospital, Asahi, Chiba, Japan
| | - Haruhisa Shimura
- Department of Internal Medicine, Asahi General Hospital, Asahi, Chiba, Japan
| | - Yasunori Sato
- Department of Preventive Medicine and Public Health, Keio University School of Medicine, Tokyo, Japan
| | - Saburo Watanabe
- Clinical Research Support Center, Asahi General Hospital, Asahi, Chiba, Japan
| | - Shouji Yoshida
- Department of Internal Medicine, Asahi General Hospital, Asahi, Chiba, Japan
| | - Jun Ogino
- Department of Diabetes and Metabolic Diseases, Asahi General Hospital, Asahi, Chiba, Japan
| | - Naotake Hashimoto
- Preventive Medicine Research Center, Asahi General Hospital, Asahi, Chiba, Japan
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Yoshimoto M, Sakuma Y, Ogino J, Iwai R, Watanabe S, Inoue T, Takahashi H, Suzuki Y, Kinoshita D, Takemura K, Takahashi H, Shimura H, Babazono T, Yoshida S, Hashimoto N. Sex differences in predictive factors for onset of type 2 diabetes in Japanese individuals: A 15-year follow-up study. J Diabetes Investig 2022; 14:37-47. [PMID: 36200977 PMCID: PMC9807159 DOI: 10.1111/jdi.13918] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 08/25/2022] [Accepted: 09/19/2022] [Indexed: 02/07/2023] Open
Abstract
AIMS/INTRODUCTION The increase in the number of patients with type 2 diabetes mellitus is an important concern worldwide. The goal of this study was to investigate factors involved in the onset of type 2 diabetes mellitus, and sex differences in long-term follow up of people with normal glucose tolerance. MATERIALS AND METHODS Of 1,309 individuals who underwent screening at our facility in 2004, 748 individuals without diabetes were enrolled. Correlations of metabolic markers including serum adiponectin (APN) with onset of type 2 diabetes mellitus were examined over 15 years in these individuals. RESULTS The Kaplan-Meier curve for onset of type 2 diabetes mellitus for 15 years in the decreased APN group was examined. Hazard ratios for the APN concentration for onset of diabetes were 1.78 (95% confidence interval [CI] 1.20-2.63, P = 0.004) in all participants, 1.48 (95% CI 0.96-2.29, P = 0.078) for men and 3.01 (95% CI 1.37-6.59, P = 0.006) for women. During the follow-up period of 15 years, body mass index, estimated glomerular filtration rate, fatty liver, C-reactive protein and alanine aminotransferase in men were significant in univariate analysis, but only estimated glomerular filtration rate and fatty liver were significantly related to onset of type 2 diabetes mellitus in multivariate analysis. In women, body mass index, systolic blood pressure, triglyceride, fatty liver and APN were significant in univariate analysis, and APN was the only significant risk factor in multivariate analysis (P < 0.05). CONCLUSIONS There are differences between men and women with regard to targets for intervention to prevent the onset of type 2 diabetes mellitus. Individuals requiring intensive intervention should be selected with this finding to maximize the use of limited social and economic resources.
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Affiliation(s)
- Mei Yoshimoto
- Department of Diabetes, Endocrine and Metabolic Diseases, Yachiyo Medical CenterTokyo Women's Medical UniversityYachiyo, ChibaJapan
| | - Yukie Sakuma
- Clinical Research Support CenterAsahi General HospitalAsahi, ChibaJapan
| | - Jun Ogino
- Department of Diabetes and Metabolic DiseasesAsahi General HospitalAsahi, ChibaJapan
| | - Rie Iwai
- Department of Clinical LaboratoryAsahi General HospitalAsahi, ChibaJapan
| | - Saburo Watanabe
- Clinical Research Support CenterAsahi General HospitalAsahi, ChibaJapan
| | - Takeshi Inoue
- Clinical Research Support CenterAsahi General HospitalAsahi, ChibaJapan
| | - Haruo Takahashi
- Clinical Research Support CenterAsahi General HospitalAsahi, ChibaJapan
| | - Yoshifumi Suzuki
- Department of Diabetes and Metabolic DiseasesAsahi General HospitalAsahi, ChibaJapan
| | - Daisuke Kinoshita
- Department of Diabetes and Metabolic DiseasesAsahi General HospitalAsahi, ChibaJapan
| | - Koji Takemura
- Department of Diabetes and Metabolic DiseasesAsahi General HospitalAsahi, ChibaJapan
| | - Hidenori Takahashi
- Preventive Medicine Research CenterAsahi General HospitalAsahi, ChibaJapan
| | - Haruhisa Shimura
- Preventive Medicine Research CenterAsahi General HospitalAsahi, ChibaJapan,Department of Internal MedicineAsahi General HospitalAsahi, ChibaJapan
| | - Tetsuya Babazono
- Department of Medicine, Diabetes Center, School of MedicineTokyo Women's Medical UniversityTokyoJapan
| | - Shouji Yoshida
- Department of Internal MedicineAsahi General HospitalAsahi, ChibaJapan
| | - Naotake Hashimoto
- Preventive Medicine Research CenterAsahi General HospitalAsahi, ChibaJapan
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