Published in:
01-06-2013 | Original article
Survey of urinary albumin level and estimated GFR in Japanese patients with type 2 diabetes mellitus
Published in: Diabetology International | Issue 2/2013
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Aims
To (1) measure urinary albumin and estimated glomerular filtration rate (eGFR) in patients with type 2 diabetes mellitus (DM) in Kanagawa Prefecture, (2) assess the validity of the diabetic nephropathy (DN) stage classification system and current chronic kidney disease (CKD) stage classification system from the Kidney Disease Outcomes Quality Initiative—Kidney Disease: Improving Global Outcomes (K/DOQI-KDIGO), and (3) validate the new CKD stage classification system of KIDIGO 2009.
Subjects and methods
The Kanagawa Physicians Association conducted a survey across 255 medical institutions over six months and measured urinary creatinine-corrected urinary albumin levels in 4,885 subjects, in addition to height, weight, blood pressure, sex, age, urinalysis, urinary albumin, blood glucose, hemoglobin A1c, and serum creatinine levels.
Results
In stages 1 and 2 of the DN classification system, many patients with urinary albumin <300 mg/g Cr had low eGFR. More than 1,000 such cases were unclassifiable. Similarly, many patients had inconsistent urinary albumin levels and eGFRs and thus could not be classified. Using the current CKD stage classification system, 735 patients (15.0 %) were unclassifiable as they had normoalbuminuria with stage 1 renal function, and 1,921 patients (about 40 %) were excluded based on normoalbuminuria with stage 2 renal function. However, all patients were successfully classified by the new CKD stage classification system.
Conclusions
All of the patients were successfully classified by the new CKD stage classification system. However, many patients were elderly and hypertensive and thus likely to have diseases other than DN. Regular monitoring of diabetics for urinary albumin and eGFR should enhance the early detection of DN and enable appropriate intervention.