High urinary albumin excretion (UAE) and low glomerular filtration rate (GFR) are risk factors for progressive renal function loss in type 2 diabetic patients. In addition, diabetic retinopathy (DR) is also a risk factor for progressive renal function decline in microalbuminuric type 2 diabetic patients. We aimed to elucidate factors, including DR, associated with more severe situation, hemodialysis (HD) induction or mortality in 325 type 2 diabetic patients whose GFRs were measured by the iohexol injection in 1995-1997. Two-hundred and sixty were followed for >5 years (mean follow-up period, 16±6 years). The UAE levels were classified as normoalbuminuria (NA; n=130), microalbuminuria (MA, n=96), and macroalbuminuria (ON; n=34). Patients were also divided into the normofiltration (NF; n=213) and low filtration (LF; n=47) groups according to the age-appropriate GFR range. One hundred patients had DR and 119 had hypertension. During the study period, 25 patients received HD induction and 39 died. The HD induction and mortality rates in the LF, ON, and DR groups were significantly higher than those in the NF, NA and MA, and no-DR groups, respectively. A Kaplan-Meier analysis revealed LF (log rank p<0.001), ON (p<0.001) and DR (p<0.001) were associated with a significantly higher risk of HD induction than NF, NA and MA and no-DR, respectively. A Kaplan-Meier analysis revealed that LF (p<0.001), ON (p<0.001) and DR (p=0.008) were associated with a significantly higher risk of mortality than NF, NA and MA and no DR, respectively. A stepwise regression analysis revealed LF (F=28.0, p=0.000), ON (F=34.4, p=0.000) and DR (F=7.9, p=0.005) affected the HD induction, but hypertension did not (F=0.2, p=0.6). LF (F=13.2, p=0.000), ON (F=4.4, p=0.04) and DR (F=6.4, p=0.01) affected the mortality, but hypertension did not (F=1.6, p=0.2). DR should also be considered as a risk factor to no small extent for HD induction and mortality in addition to UAE and GFR in type 2 diabetic patients.
T. Moriya: None. M. Matsubara: None. M. Ouchi: None.