Examination of long-term blood glucose and blood pressure in a large cohort for prevention of renal failure and dialysis transition in diabetic patients

• Project/Area Number: 18K08521
• Research Category: Grant-in-Aid for Scientific Research (C)
• Allocation Type: Multi-year Fund
• Section: 一般
• Review Section: Basic Section 54040:Metabolism and endocrinology-related
• Research Institution: Kumamoto University
• Principal Investigator: Soejima Hirofumi 熊本大学, 保健センター, 准教授 (80332881)
• Project Period (FY): 2018-04-01 – 2021-03-31
• Project Status: Completed (Fiscal Year 2020)
• Budget Amount: ¥4,290,000 (Direct Cost: ¥3,300,000、Indirect Cost: ¥990,000); Fiscal Year 2020: ¥1,300,000 (Direct Cost: ¥1,000,000、Indirect Cost: ¥300,000); Fiscal Year 2019: ¥1,560,000 (Direct Cost: ¥1,200,000、Indirect Cost: ¥360,000); Fiscal Year 2018: ¥1,430,000 (Direct Cost: ¥1,100,000、Indirect Cost: ¥330,000)
• Keywords: 蛋白尿定性 / 心血管イベント / 危険因子 / 糖尿病 / 透析移行 / 蛋白尿 / eGFR / 血圧 / ヘモグロビンA1ｃ / 慢性腎不全 / 透析 / レニン・アンジオテンシン系抑制薬 / 腎不全 / 血液透析 / コホート研究

Outline of Final Research Achievements

The Japanese primary prevention of atherosclerosis with aspirin for diabetes (JPAD) trial was a multi-center, randomized, clinical trial done from 2002 to 2008. After completion of the JPAD trial, we followed up the patients until 2019. We defined late-stage kidney disease (LSKD) as eGFR <30 ml min-1 1.73m-2 or hemodialysis.
Based on the mean value of systolic blood pressure (SBP) obtained average 7 times during the follow-up, we divided the patients into three groups: a high SBP group (SBP≧140 mm Hg); a moderate SBP group (140>SBP≧130 mm Hg); or a low SBP group (SBP<130 mm Hg).
There was no significant deference in the mean eGFR among the high SBP, moderate SBP, and low SBP groups on registration. The incidence rate of LSKD was significantly higher in the high SBP and moderate SBP groups than in the low SBP group. Cox proportional hazards model analysis revealed that the high SBP and moderate SBP were independent factors after adjustment for confounding factors.

Academic Significance and Societal Importance of the Research Achievements

アルブミン尿は糖尿病患者の危険因子であることは知られている。しかし尿中アルブミンの測定にはコストがかかり、また多くのクリニックは外注をしているため数日後にしか患者に結果を示すことが出来ない。テストテープの蛋白尿定性では、安価でいつでもどこでもすぐに結果を出すことができる。この蛋白尿定性検査で糖尿病患者のリスク評価が出来るのは大変有意義であると考える。また、高血圧診療のガイドラインでは心血管イベント抑制の観点から大部分の患者には130 mm Hg未満が推奨されている。本研究では、高血圧患者において収縮期血圧130 mm Hg未満に抑えることで腎不全および透析移行を抑制できることが証明された。

Research Products

• [Journal Article] Proteinuria is independently associated with the incidence of primary cardiovascular events in diabetic patients. (2020)
  • Author(s): Soejima H, Ogawa H, Morimoto T, Okada S, Matsumoto C, Nakayama M, Masuda I, Jinnouchi H, Waki M, Saito Y; JPAD Trial Investigators.
  • Journal Title: Journal of Cardiology Volume: 75 Issue: 4 Pages: 387-393
  • DOI: 10.1016/j.jjcc.2019.08.021
  • Peer Reviewed
• [Journal Article] Sex Difference in Effects of Low-Dose Aspirin on Prevention of Dementia in Patients With Type 2 Diabetes: A Long-term Follow-up Study of a Randomized Clinical Trial. (2020)
  • Author(s): Matsumoto C, Ogawa H, Saito Y, Okada S, Soejima H, Sakuma M, Masuda I, Nakayama M, Doi N, Jinnouchi H, Waki M, Morimoto T; JPAD Trial Investigators; JPAD Trial Investigators
  • Journal Title: Diabetes Care Volume: 42 Issue: 2 Pages: 314-320
  • DOI: 10.2337/dc19-1188
  • Peer Reviewed / Open Access
• [Journal Article] One quarter of total myocardial infarctions are silent manifestation in patients with type 2 diabetes mellitus. (2019)
  • Author(s): Soejima H, Ogawa H, Morimoto T, Okada S, Sakuma M, Nakayama M, Masuda I, Doi N, Uemura S, Jinnouchi H, Sugiyama S, Waki M, Saito Y; JPAD Trial Investigators.
  • Journal Title: Journal of Cardiology Volume: 73 Issue: 1 Pages: 33-37
  • DOI: 10.1016/j.jjcc.2018.05.017
  • Peer Reviewed
• [Presentation] Proteinuria Decreased the Estimated Glomerular Filtration Rate in Diabetic Patients: 12-Year-Follow-Up Study (2020)
  • Author(s): Hirofumi Soejima, Takeshi Morimoto, Sadanori Okada, Chisa Matsumoto, Masafumi Nakayama, Izuru Masuda, Hideaki Jinnouchi, Masako Waki, Yoshihiko Saito, Hisao Ogawa
  • Organizer: American Heart Association Scientific Sessions 2020
  • Int'l Joint Research
• [Presentation] Continuous Blood Pressure Control Inhibits Progression of Proteinuria in 10-year Follow-Up Diabetic Patients：Results From JPAD Cohort Study (2020)
  • Author(s): Hirofumi Soejima, Takeshi Morimoto, Sadanori Okada, Chisa Matsumoto, Masafumi Nakayama, Izuru Masuda, Hideaki Jinnouchi, Masako Waki, Yoshihiko Saito, Hisao Ogawa
  • Organizer: 第84回日本循環器学会学術集会
  • Int'l Joint Research
• [Presentation] Proteinuria Decreased the Estimated Glomerular Filtration Rate Speed in Diabetic Patients: 12 Year Follow-Up Study (2019)
  • Author(s): Soejima H, Morimoto T, Okada S, Matsumoto C, Nakayama M, Jinnouchi H, Waki M, Masuda I, Saito Y, Ogawa H,
  • Organizer: American Hear Association Scientific Sessions 2019
  • Int'l Joint Research
• [Presentation] Continuous Blood pressure control inhibits new presence of proteinuria in diabetic patients (2019)
  • Author(s): Hirofumi Soejima, Takeshi Morimoto, Sadanori Okada, Mio Sakuma, Chisa Matsumoto, Masafumi Nakayama, Hideaki Jinnouchi, Masako Waki, Izuru Masuda, Yoshihiko Saito, Hisao Ogawa
  • Organizer: 第83回日本循環器学会学術集会
• [Presentation] Proteinuria is a significant risk factor for cardiovascular events in diabetic patients without atherosclerotic diseases (2018)
  • Author(s): Soejima H, Morimoto T, Okada S, Sakuma M, Matsumoto C, Nakayama M, Masuda I, Jinnouchi H, Sugiyama S, Waki M, Saito Y, Ogawa H.
  • Organizer: America Heart Association Scientific Sessions 2018
  • Int'l Joint Research