539-P: The Trend of Diabetic Kidney Disease with Low eGFR and Absence of Albuminuria in Type 2 Diabetic Patients in Japan from 1996-2015
Authors: KAKUTANI YOSHINORI , EMOTO MASANORI , MORI KATSUHITO , YAMAZAKI YUKO , OCHI AKINOBU , MORIOKA TOMOAKI , FUKUMOTO SHINYA , SHIOI ATSUSHI , SHOJI TETSUO , INABA MASAAKI 
Published: June 2019

Diabetic kidney disease is now attracting great attention from the trend of an increase of diabetic patients with decreased eGFR (mL/min/1.73m2) and absence of albuminuria (ACR, mg/gCre) in the United States over the last 20 years. However, it remains to be clarified whether such trends are common or not in other regions. The aim of the present study is to investigate the prevalence of type 2 diabetic (T2D) patients with low eGFR of less than 60 and ACR less than 30 as normoalbuminuria (NA) from 1996 to 2015 in Japan. We enrolled 2233 T2D subjects who received diabetic complication check programs at our diabetes center and divided into 4 groups by the 5-year periods (P1, 1996-2000, n = 331; P2, 2001-2005, n = 891; P3, 2006-2010, n = 500; P4, 2011-2015, n = 511, respectively). The median age was increased and HbA1c was decreased from P1 to P4 (both p &lt;0.001). The statin or RAS inhibitors (RASI) user was also increased over the period. The prevalence of low eGFR was increased from P1 to P4 (P1 18.7%, P2 26.2%, P3 36.4%, P4 38.0%, p&lt;0.001). Similarly, the prevalence of NA was increased (P1 60.1%, P2 57.7%, P3 61.6%, P4 66.4%, p=0.016) in conjunction with the decrease of microalbuminuria (p=0.015). Finally, the prevalence of subjects with low eGFR and NA was increased from P1 to P4 (P1 2.1%, P2 5.7%, P3 12.6%, P4 18.8%, p&lt;0.001). In multivariate logistic analysis for the prevalence of subjects with low eGFR and NA, odds ratios (95% CI) of P3 and P4 as a reference period of P1 were found to be significant (P3, 3.04 (1.17-7.91) and P4, 5.22 (2.02-13.5)) even after adjusting by age, sex, duration, the use of statin or RASI, BMI, blood pressure, HbA1c and non-HDL-C.
In conclusion, the prevalence with low eGFR and NA was also increased among T2D patients in Japan from 1996 to 2015. There might be unknown clinical factors or situations contributing to such trends other than conventional factors such as aging, use of RASI and/or improved metabolic states of HbA1c and lipid profile.

Disclosure
Y. Kakutani: None. M. Emoto: Research Support; Self; Ono Pharmaceutical Co., Ltd., Sumitomo Dainippon Pharma Co., Ltd. Speaker's Bureau; Self; Astellas Pharma Inc., Boehringer Ingelheim Pharmaceuticals, Inc., Daiichi Sankyo Company, Limited, Eli Lilly and Company, Kowa Pharmaceutical Co., Ltd., Kyowa Hakko Kirin Co., Ltd., Novartis Pharmaceuticals Corporation, Novo Nordisk Inc., Ono Pharmaceutical Co., Ltd., Sanofi, Sumitomo Dainippon Pharma Co., Ltd., Taisho Toyama Pharmaceutical CO., Ltd., Takeda Pharmaceutical Company Limited. K. Mori: Speaker's Bureau; Self; Boehringer Ingelheim International GmbH, Eli Lilly and Company, Mitsubishi Tanabe Pharma Corporation, Ono Pharmaceutical Co., Ltd. Y. Yamazaki: None. A. Ochi: None. T. Morioka: Research Support; Self; Eli Lilly and Company, Merck & Co., Inc., Mitsubishi Tanabe Pharma Corporation, Novartis Pharmaceuticals Corporation, Sanofi K.K., Takeda Pharmaceutical Company Limited. Speaker's Bureau; Self; Astellas Pharma Inc., AstraZeneca, Boehringer Ingelheim Pharmaceuticals, Inc., Eli Lilly and Company, Merck & Co., Inc., Novo Nordisk Inc., Roche Diagnostics K.K., Sanofi K.K., Sumitomo Dainippon Pharma Co., Ltd., Taisho Pharmaceutical Co., Ltd., Takeda Pharmaceutical Company Limited. Other Relationship; Self; Ono Pharmaceutical Co., Ltd. S. Fukumoto: Research Support; Self; Astellas Pharma Inc., Chugai Pharmaceutical Co., Ltd., Kowa Pharmaceutical Europe Co. Ltd., Mitsubishi Tanabe Pharma Corporation, Taisho Toyama Pharmaceutical Co., Ltd., Takeda Pharmaceutical Company Limited. Speaker's Bureau; Self; Novo Nordisk Inc., Sanofi K.K. A. Shioi: None. T. Shoji: Research Support; Self; Bayer Yakuhin, Ltd., Chugai Pharmaceutical Co., Ltd., Ono Pharmaceutical Co., Ltd. Speaker's Bureau; Self; Kissei Pharmaceutical Co., Ltd., Kowa, Kyowa Hakko Kirin Co., Ltd. M. Inaba: None.