Abstract
AIMS/INTRODUCTION: This study aimed to identify clinical predictors associated with sustained decline in estimated glomerular filtration rate (eGFR) among Japanese individuals diagnosed with diabetes mellitus. MATERIALS AND METHODS: We conducted a retrospective analysis using J-DREAMS (Japan Diabetes compREhensive database project based on an Advanced Electronic Medical record System), a large-scale registry integrated with electronic medical records. The study population included adults (≥18 years) with diabetes who had at least one documented visit at a referral institution between December 1, 2015, and March 31, 2021, with concurrent measurements of serum creatinine and hemoglobin. RESULTS: A total of 12,416 and 11,157 patients were eligible for assessment of eGFR change at 1 and 2 years, respectively. Multivariable logistic regression identified several consistent risk factors for ≥30% eGFR reduction at both time points: low serum albumin, elevated triglycerides, anemia as defined by JSDT, diabetic retinopathy, CKD Stage G4 or higher, albuminuria category A3, and chronic heart failure. Additional predictors at 1 year included age under 65 and elevated HbA1c, while smoking, hypertension, and diabetic neuropathy were significant only at 2 years. CONCLUSION: Beyond retinopathy and advanced kidney disease, anemia, hypoalbuminemia, and heart failure independently contributed to persistent eGFR decline, supporting the clinical relevance of cardio-renal anemia syndrome in diabetic populations.