Characteristics, risk factors, and vascular outcomes of diabetic kidney disease with type 2 diabetes: Analysis of data from clinic-based patient registry (J-DOME) in Japan.

Aims

Diabetic kidney disease (DKD) encompasses patients with an atypical clinical course, where GFR declines precedes albuminuria. This study investigated the characteristics, risk factors, and vascular outcomes of DKD subgroups among 2,733 patients with type 2 diabetes mellitus.

Methods

Using data from a Japan-wide patients registry (J-DOME), we classified patients by albuminuria and eGFR, analyzed annual trends in eGFR and evaluated the incidence of new vascular complications.

Results

The prevalence of DKD was 45%, one-third of whom had low eGFR/normoalbuminuria. Although the low eGFR/normoalbuminuria group showed similar glycemic control to the no DKD group, the albuminuria/normal eGFR group had poorer control of lifestyle-related risk factors. Both DKD subgroups had a higher prevalence of microvascular and macrovascular disorders at baseline. During a mean follow-up of 2.5 years, compared with the no DKD group, the low eGFR/normoalbuminuria group showed a slower rate of renal function decline, while the albuminuria/normal eGFR group exhibited a faster rate of renal function decline. In contrast, the incidence of vascular diseases did not differ between either DKD subgroup and the no DKD group.

Conclusions

The albuminuria/normal eGFR group exhibited accelerated renal function decline compared with the no DKD group, highlighting albuminuria as a marker of active renal injury in type 2 diabetes. In contrast, the low eGFR/normoalbuminuria group showed short-term renal stability despite a high baseline prevalence of vascular complications, representing a distinct clinical phenotype.