An association between serum γ-glutamyltransferase and proteinuria in drinkers and non-drinkers: a Japanese nationwide cross-sectional survey

Analyzing Longitudinal Health Screening Data with Feature Ensemble and Machine Learning Techniques: Investigating Diagnostic Risk Factors of Metabolic Syndrome for Chronic Kidney Disease Stages 3a to 3b

Longitudinal data, while often limited, contain valuable insights into features impacting clinical outcomes. To predict the progression of chronic kidney disease (CKD) in patients with metabolic syndrome, particularly those transitioning from stage 3a to 3b, where data are scarce, utilizing feature ensemble techniques can be advantageous. It can effectively identify crucial risk factors, influencing CKD progression, thereby enhancing model performance. Machine learning (ML) methods have gained popularity due to their ability to perform feature selection and handle complex feature interactions more effectively than traditional approaches. However, different ML methods yield varying feature importance information. This study proposes a multiphase hybrid risk factor evaluation scheme to consider the diverse feature information generated by ML methods. The scheme incorporates variable ensemble rules (VERs) to combine feature importance information, thereby aiding in the identification of important features influencing CKD progression and supporting clinical decision making. In the proposed scheme, we employ six ML models-Lasso, RF, MARS, LightGBM, XGBoost, and CatBoost-each renowned for its distinct feature selection mechanisms and widespread usage in clinical studies. By implementing our proposed scheme, thirteen features affecting CKD progression are identified, and a promising AUC score of 0.883 can be achieved when constructing a model with them.

Association between elevated serum transaminase and moderately increased albuminuria: a cross-sectional study in western Tokushima, Japan

BACKGROUND

This study aimed to identify the factors relating to moderately increased albuminuria among middle-aged and older individuals in Japan.

METHODS

We conducted specific health examinations in which we measured albuminuria levels, and administered a questionnaire survey to record participants' lifestyles in western Tokushima Prefecture, Japan. A total of 1,660 people whose albuminuria was less than 300 mg/g creatinine (Cr) were analyzed. We divided participants into two groups-those with normal albuminuria (< 30 mg/gCr) and those with moderately increased albuminuria (≥ 30 mg/gCr, > 300 mg/gCr)-and compared their characteristics. To investigate all relevant factors, we conducted a multivariate logistic regression analysis.

RESULTS

The moderately increased albuminuria group were significantly older and had, among them, significantly higher percentages of a body mass index (BMI) ≥ 25 kg/m2, diabetes, hypertension, and mild liver disorder (aspartate transaminase ≥ 31 U/L or alanine aminotransferase ≥ 31 U/L or gamma-glutamyl transferase ≥ 51 U/L). (p < 0.01) In a multivariate logistic regression analysis that used microalbuminuria as an independent variable, we found the adjusted odds ratio (AOR) and 95% confidence interval (CI) to be significantly higher among individuals with diabetes (AOR: 2.04, 95% CI: 1.40-2.99); hypertension (AOR: 1.90, 95% CI: 1.36-2.65); BMI ≥ 25 kg/m2 (AOR: 1.76, 95% CI: 1.27-2.44); and mild liver disorder (AOR: 1.54, 95% CI: 1.10-2.18).

CONCLUSIONS

In addition to diabetes, hypertension, and BMI ≥ 25 kg/m2, this study found that among the middle-aged and older general population living in western Tokushima Prefecture, there were cases of mild liver disorder (elevated serum transaminase), which independently associated with moderately increased albuminuria. Therefore, in health checkups targeting the general population, there is a need to consider measuring albuminuria, even in those who have only mild liver dysfunction (health guidance level).

TRIAL REGISTRATION

N/A.

Cigarette smoking is a risk factor for the onset of fatty liver disease in nondrinkers: A longitudinal cohort study

Background

The effect of cigarette smoking on the onset of nonalcoholic fatty liver disease (NAFLD) is unclear, especially that associated with drinking small amounts of alcohol. We conducted a longitudinal study to investigate the relationship between cigarette smoking and NAFLD onset, which was stratified according to the amount of alcohol consumed.

Methods

We enrolled 7,905 Japanese subjects who had received annual health checkups more than twice between April 2003 and August 2013, 4,045 of whom met at least one of the following exclusion criteria and were excluded: (a) fatty liver at baseline; (b) hepatitis B or hepatitis C; (c) alcohol consumption (men: ≥210 g/wk; women: ≥140 g/wk); (d) change in alcohol drinking status between baseline and the study’s endpoint; (e) change in cigarette smoking habits between baseline and the study’s endpoint; or (f) current treatment with antidiabetic agents, antihypertensive agents, and/or lipid-lowering agents. The remaining 3,860 subjects (1,512 men, 2,348 women) were divided into two groups based on average alcohol consumption.

Results

After adjusting for the variables associated with metabolic disease, smoking was associated with fatty liver disease onset compared with nonsmokers in nondrinkers (adjusted hazard ratio = 1.988, 95% confidence interval 1.057–3.595; p = 0.034). No association was found between smoking and fatty liver disease onset in the low alcohol consumption group (men: <210 g alcohol/week; women: <140 g alcohol/week). The fatty liver disease incidence increased significantly among the nondrinkers as the number of cigarettes smoked increased (p = 0.001).

Conclusions

Cigarette smoking may be a significant risk factor associated with NAFLD onset in nondrinkers. These results may help clinicians to identify patients who are at a high risk of developing NAFLD and to prevent the progression of NAFLD by promoting earlier interventions that help people discontinue unhealthy lifestyle habits.

Burden of Proteinuria and Risk Factors of Chronic Kidney Disease among Adult Population in Urban Puducherry, India

INTRODUCTION

In the recent times, Chronic Kidney Diseases (CKDs) are emerging as a serious problem all over the world along with diabetes mellitus and hypertension. The presence of proteinuria is considered as an indicator of increased risk of progressive kidney diseases.

AIM

To determine the prevalence of proteinuria among an adult population of a tertiary care institute of Puducherry, India.

MATERIALS AND METHODS

A cross-sectional study was carried out in the field practice areas of an urban health centre of a tertiary care institute, in Puducherry, India. A total of 215 study respondents were selected by systematic random sampling. All adults aged above 18 years who were residing for at least a year in Puducherry were included in the study. The study period was from July 2015 to October 2015. All the categorical variables were described as proportions. Chi square test was done to compare between two proportions. Univariate analysis was done to estimate the Odds Ratio (OR) with 95% CI.

RESULTS

The mean age of the study participants was 38.5±12.8 years. Majority, 145 (67.4%) of the study participants were females. The prevalence of proteinuria was found to be 9.3%. While 4.7% and 11.2% of participants used tobacco and alcohol respectively, 13.5% and 27.9% had diabetes mellitus and hypertension respectively. Elderly age, diabetes mellitus and hypertension were found to be statistically significant predictors for proteinuria.

CONCLUSION

The prevalence of proteinuria was high in our study population (9.3%) and hypertension and diabetes mellitus were also found to be risk factors for CKD. Routine screening among the general population for proteinuria in community-based settings might be an effective step to bring down the rate of progression of CKD.

Body Mass Index Modifies an Association between Self-Reported Regular Exercise and Proteinuria

AIM

Regular exercise habits are well-known to exert a favorable effect on the metabolic syndrome, which may cause proteinuria and chronic kidney disease (CKD). However, it remains unknown if exercise exerts a favorable effect on proteinuria and kidney dysfunction. The aim of this study was to reveal the association between exercise and the prevalence of proteinuria and kidney dysfunction and the attenuation by obesity.

METHODS

This study was a cross-sectional cohort study that included 292,013 participants who underwent the Specific Health Check and Guidance in Japan. The exercise score (range 0-3) was based on the number of positive answers to three questions regarding exercise habits. The outcome was defined as urinary protein detected by a dipstick test and kidney dysfunction [estimated glomerular filtration rate (GFR) less than 45 ml/min/1.73 m(2)].

RESULTS

The exercise score was significantly associated with the prevalence of proteinuria in both males [vs. exercise score 0; exercise score 1, multivariate-adjusted odds ratio 0.86 (95% confidence interval 0.81-0.92), P<0.001; exercise score 2, 0.84 (0.79-0.90), P<0.001; exercise score 3, 0.77 (0.72-0.82), P<0.001] and females (same as in males). After the male subjects were divided into quintiles according to body mass index (BMI) in more than three groups (22.9<BMI<24.1), there was no significant association between the exercise score and the prevalence of proteinuria. In females, a higher exercise score was associated with a lower prevalence of proteinuria, regardless of BMI. The association between the exercise score and kidney dysfunction was as similar as that between the exercise score and proteinuria, except the attenuation of BMI.

CONCLUSION

Exercise may associate with a lower prevalence of proteinuria and kidney dysfunction, and a high BMI may attenuate this association between exercise and proteinuria in male subjects.