It is important to elucidate which factors are associated with the progression of diabetic nephropathy (DN) toward end-stage renal disease, i.e., hemodialysis (HD) as early stage of DN as possible. We hypothesized that different grades of diabetic retinopathy (DR) affect the progression toward HD in persons with type 2 diabetes with normoalbuminuria (NA) or microalbuminuria (MA), and normal renal function.278 NA and 170 MA persons with type 2 diabetes with normal renal function (GFR≥60 ml/min/1.73m2) whose GFRs had been measured by iohexol injection in 1995-2013 and followed for over 5 years were analyzed (n=448). At the baseline, HbA1c levels was divided into HbA1c≥7.0 (n=327) and <7.0 (n=121) groups. 86 subjects had simple DR (SDR), and 65 had proliferative DR (PDR). 217 had hypertension. The subjects were followed up for 16 ± 6 years. During the study period, 7 subjects in NA and 11 subjects in MA started to receive HD. A Kaplan-Meier analysis revealed that DR (Wilcoxon 5.82, p=0.016), PDR (Wilcoxon 8.53, p=0.014) and MA (Wilcoxon 5.87, p=0.015) were associated with a significantly higher risk of HD induction than no DR, SDR, and NA, respectively while HbA1c and hypertension were not associated with the risk of HD induction in whole diabetic subjects. In the multivariate analysis, DR (p=0.042), but not MA, was significantly associated with the HD induction in all the subjects. As each group analysis, a Kaplan-Meier analysis demonstrated that PDR was associated with HD induction in NA. However, SDR and PDR were not associated with HD in MA. HbA1c or hypertension did not affect HD induction in each group. In conclusions, MA itself is a risk factor of HD induction, and DR is a more predominant predictor for HD induction at the early stage of DN. PDR is a risk factor for HD induction even in NA subjects with normal renal function.


T.Moriya: None. A.Suzuki: None. A.Hayashi: Research Support; Abbott Japan Co., Ltd., Roche Diabetes Care, Speaker's Bureau; Abbott Japan Co., Ltd., Medtronic, Terumo Corporation. M.Matsubara: None. T.Miyatsuka: Speaker's Bureau; Eli Lilly Japan K.K., Novo Nordisk, Sanofi K.K., Mitsubishi Tanabe Pharma Corporation, Sumitomo Dainippon Pharma Co., Ltd., Teijin Pharma Limited, Sanwa Kagaku Kenkyusho, Daiichi Sankyo.

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