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. 2023 May;46(5):1075-1089.
doi: 10.1038/s41440-023-01185-2. Epub 2023 Feb 2.

Current status of the rapid decline in renal function due to diabetes mellitus and its associated factors: analysis using the National Database of Health Checkups in Japan

Makoto Fujii  1 , Yuko Ohno  2 , Asuka Ikeda  2 , Kayo Godai  2 , Yaya Li  2 , Yuko Nakamura  2 , Daisuke Yabe  3 , Kazuyo Tsushita  4 , Naoki Kashihara  5 , Kei Kamide  2 , Mai Kabayama  2
Affiliations

Current status of the rapid decline in renal function due to diabetes mellitus and its associated factors: analysis using the National Database of Health Checkups in Japan

Makoto Fujii et al. Hypertens Res. 2023 May.

Abstract

The increasing number of patients undergoing dialysis due to diabetes mellitus (DM) is causing serious economic problems, and its reduction is an urgent policy issue in developed countries, including Japan. We aimed to assess the association between the annual rapid decline in renal function and health checkup measures, including blood pressure, to identify health guidance targets for preventing diabetic nephropathy (DN) and diabetic kidney disease (DKD) among individuals in a medical checkup system ("Tokuteikenshin" program) in 2018. This longitudinal analysis included 3,673,829 individuals who participated in the "Tokuteikenshin" program in 2018, had hemoglobin A1c (HbA1c) levels ≥5.6%, were available for follow-up, and underwent estimated glomerular filtration rate (eGFR) evaluation. We estimated the incidence of the relative annual decrease in eGFR ≥10% per 1000 person-years and odds ratios to evaluate the rapid decline in renal function and determine health guidance goals and their role in preventing DN and DKD. Overall, 20.83% of patients with DM had a rapid decline in renal function within the observation period. A rapid decline in renal function was associated with high systolic blood pressure, poor or strict DM control, increased urinary protein excretion, and decreased blood hemoglobin levels. The incidence of rapid decline in renal function is higher in DM, and appropriate systolic blood pressure and glycemic control are important to prevent the progression to DN or DKD. Our findings will be useful for researchers, clinicians, and other public health care members in establishing effective health guidance and guidelines for CKD prevention.

Keywords: Diabetes mellitus; Diabetic kidney disease; Diabetic nephropathy; National Database of Health Checkups; Renal function.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Flowchart of the study participants
Fig. 2
Fig. 2
Distribution of the relative decrease in renal function
See this image and copyright information in PMC

Comment in

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