Significance of estimated glomerular filtration rate in predicting brain or heart attacks in obese and non-obese populations

Anemia as a risk factor for all-cause mortality: obscure synergic effect of chronic kidney disease

BACKGROUND

Anemia is common in chronic kidney disease (CKD) and may be associated with mortality in CKD patients. However, few studies have examined this relationship in Asian populations.

METHODS

A total of 62,931 Japanese people (age 64.0 ± 8.0 years; men 38.5%) were followed up from 2008 to 2012. Participants were divided into six groups in accordance with their estimated glomerular filtration rate (eGFR) (<45, 45-59, ≥60 mL/min/1.73 m²) and by hemoglobin levels (13.0 g/dL for men; 12.0 g/dL for women). Hazard ratio and confidence interval (CI) for mortality with a combination of eGFR and anemia were calculated. After matching using propensity score (PS) for anemia, survival analysis between anemic and non-anemic people, independent from some variables, including eGFR, was performed.

RESULTS

A total of 828 (1.3%) participants died (non-anemic vs. anemic, 1.2 vs. 2.3%, p < 0.01). Multivariable Cox analysis showed that, independent of eGFR levels, anemic people had significantly higher mortality. Anemic people were found to have significantly poorer survival than non-anemic people as per a log-rank test (p < 0.01) for the PS-matching cohort. Further stratified logistic analysis using PS in the overall cohort odds ratio (95% CI) showed 2.25 (1.89-2.67) with p < 0.01.

CONCLUSION

The results of the present study showed that anemia was an independent risk factor of all-cause mortality.

Body shape index: Sex-specific differences in predictive power for all-cause mortality in the Japanese population

Background

While body mass index (BMI) is the most widely used anthropometric measure, its association with all-cause mortality is generally J-shaped or U-shaped. A body shape index (ABSI) is a recently formulated anthropometric measure that shows linear relationship to all-cause mortality, especially in Caucasian cohorts. We aimed to address the relationship between ABSI and all-cause mortality in Asians and to assess the influence of sex difference and of chronic kidney disease (CKD) on this relationship.

Methods

This was a longitudinal cohort study assessing the association of ABSI, BMI, waist circumference (WC), and waist-to-height ratio (WHtR) with all-cause mortality in a Japanese nationwide Specific Health Checkup database. The study enrolled 160,625 participants followed-up between 2008 and 2012. We calculated the all-cause mortality risk associated with a 1-standard deviation increase (+1SD) in ABSI, BMI, WC, or WHtR in cohorts stratified by sex and the presence of CKD.

Results

During the 4-year follow up, 1.3% of participants died. In men, ABSI (+1SD) significantly increased the risk for all-cause mortality after adjusting for other known risk factors including CKD; hazard ratio (HR) and 95% confidence intervals (CI) of non-CKD cohort, 1.30 (1.18 to 1.43), p<0.01; HR and 95%CI of CKD cohort, 1.16 (1.01 to 1.34), p = 0.04. In women, ABSI (+1SD) did not show significant association with all-cause mortality, especially in the CKD cohort; HR and 95% CI of non-CKD cohort, 1.07 (0.99 to 1.17), p = 0.09; HR and 95%CI of CKD cohort, 0.98 (0.84 to 1.14), p = 0.78. Conversely, BMI (+1SD) was associated with significantly lower risk in men, although minimal association was found in women. WC and WHtR showed little association with all-cause mortality. On stratification per ABSI quartiles, mortality risk increased linearly and significantly with ABSI in men, but not in women with CKD. Both BMI and WC showed significant but U-shaped association with mortality in the non-CKD cohort and in men with CKD. WHtR also showed significant U-shaped association with mortality in men.

Conclusions

In the Japanese population, ABSI showed significant and linear correlation with mortality risk in men but not in women, especially in the presence of CKD.

Influence of chronic kidney disease on hospitalization, chronic dialysis, and mortality in Japanese men: a longitudinal analysis

BACKGROUND

Little is known concerning the risk of hospitalization and the risk of death before receiving dialysis by the stage of chronic kidney disease (CKD) in Japan.

METHODS

The subjects comprised a total of 13,911 Japanese men (mean age 49.2 ± 9.9 years). Based on the results of a health checkup performed in 2006, they were divided into 5 groups according to their estimated glomerular filtration rate (GFR) levels and dialysis status: GFR ≥60, 45-59, 30-44, <30 mL/min/1.73 m², and undergoing dialysis. From 2006 through to 2013, we investigated their hospitalization, dialysis initiation, and cause-specific death. The adjusted hazard ratios (HRs) for each end point were calculated compared with the GFR ≥60 mL/min/1.73 m² group using a Cox proportional hazard model.

RESULTS

A lower GFR was independently associated with higher risks of overall hospitalization, dialysis initiation, and all-cause death. In particular, the HRs for long-term hospitalization (≥1 month a year), dialysis, and cardiovascular disease (CVD) death markedly increased along with a decreased GFR. The rate ratios of dialysis to all-cause death (calculated based on the incidences of dialysis and death per 1000 person-years) were 0.03 (0.11 vs. 3.19), 0.08 (0.29 vs. 3.62), 0.51 (12.5 vs. 24.7), and 4.50 (179.8 vs. 40.0) for GFR ≥60, 45-59, 30-44, and <30 mL/min/1.73 m², respectively.

CONCLUSION

In Japanese men, although the risk of CVD death before dialysis initiation can never be ignored, CKD patients aged <60 years with a GFR of <30 mL/min/1.73 m² are more likely to undergo dialysis prior to death.

Psychological impact of lifestyle-related disease disclosure at general checkup: a prospective cohort study

BACKGROUND

Little is known about psychological impact of disclosing lifestyle-related diseases. Previous studies discussed the long-term psychological impact of disease disclosure, and a significant psychological impact was not observed. This study clarified the psychological impact on anxiety state of patients when lifestyle-related diseases are disclosed at general checkups for local residents. In particular, this study evaluated the short-term impact on patients, and how the notification of abnormal values and the disclosure of disease at general checkups affect patients' subsequent behavioral changes.

METHODS

The study design was a prospective cohort study. We compared the anxiety state of participants using a self-administered anxiety assessment scale, State-Trait Anxiety Inventory (STAI), before and after Physician's explanation of abnormal values in markers of lifestyle-related diseases. The participants were those between the age of 40 and 75 years who underwent general checkups at two primary care facilities. In addition, we assessed the effects on lifestyle habits and the psychological impact caused by general checkup using STAI and a survey on behavioral changes one month after the checkup.

RESULTS

The valid response rate at the survey of the general checkup was 92% (534/578). Of those who showed abnormal levels in markers of lifestyle-related diseases, anxiety was augmented significantly among those who responded that the physician had told them of their diagnosis compared to those who responded that the physician had not told them of their diagnosis (Wilcoxon rank-sum test, P < 0.007). The percentage of patients whose state anxiety scale of STAI increased ≥5 points was 30% in the disease disclosed group (33/111) and 17% in the disease undisclosed group (27/159), respectively. The risk ratio was 1.5 (95% CI: 1.1-2.0). One month after the general checkup, overall anxiety diminished regardless of whether diagnosis of lifestyle-related diseases was disclosed to patients notified of abnormal values. In addition, improvements in daily life behaviors as a result of notification of abnormalities or disclosure of diagnosis at general checkup were not observed.

CONCLUSION

Even in a general checkup for the general population, disclosing non-critical diseases such as lifestyle-related diseases exacerbated anxiety as a short-term psychological impact.