Background: To prevent the end-stage renal failure, it is important to identify the high-risk patients with rapid decline of renal function (RDRF).

Aim: We intended to clarify the risk factors for RDRF in Japanese patients with diabetes.

Methods: One hundred sixteen out-patients with diabetes (type 1/2, 38/78; M/F, 60/56; age 60.1±12.3 years; BMI, 25.3±4.8; HbA1c, 7.3±1.0%; eGFR, 68±22mL/min/1.73m2) were enrolled in this study, and were followed for one year. We defined RDRF as more than 20% of annual decline of eGFR. The sodium intake was estimated from the urine sodium excretion from early morning urine specimen according to previous report (J Hum Hypertens. 2002). The visceral fat area (VFA) was determined by the impedance method (HDS-2000, Omron Healthcare, Japan)

Results: 8.6% of participants were matched to the criteria of RDRF. In subjects with RDRF, the energy intake (45.6±10.6 kcal/kg BW/day), sodium intake (12.5±1.8 g/day), VFA (157±51 cm2) and prevalence of hypertension (100%) were higher than those without RDRF. Annual decline of eGFR was significantly correlated with the stage of diabetic nephropathy, VFA, systolic and diastolic blood pressure, urinary albumin excretion rate, triglyceride, and daily intake of energy, sodium and protein (p<0.05). The logistic regression analysis revealed that the independent determinants of RDRF were energy intake, sodium intake, and visceral fat area. In addition, the Receiver Operating Characteristic (ROC) analysis revealed that the cut-off values of these parameters were 46.8kcal/ kg BW/ day of energy intake (AUC 0.84, p<0.01), 11.8g/day of sodium intake (AUC 0.90, p<0.01), and 117cm2 of visceral fat area (AUC 0.88, p<0.01).

Conclusion: Visceral obesity, and high intake of energy and sodium contributed to rapid decline of renal function in Japanese patients with diabetes. Body weight management with adequate energy and sodium intake, therefore, may contribute to prevent progression of diabetic kidney disease.

Disclosure

M. Matsuhisa: None. H. Mori: None. M. Ohishi: None. M. Ishizu: None. R. Suzuki: None. I. Takikawa: None. S. Taniguchi: None. M. Tamaki: None. Y. Akehi: None. K. Kurahashi: None. S. Yoshida: None. I. Endo: None. K. Aihara: None. M. Funaki: Research Support; Self; Otsuka Holdings Co., Ltd., The Knowledge Cluster from the Ministry of Education, Science, and Culture of Japan. Board Member; Self; Mechanogenic C.C.. A. Kuroda: None.

© 2018 by the American Diabetes Association.
2018
Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered. More information is available at http://www.diabetesjournals.org/content/license.