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Nigussie EW, Abera EG, Woldemariam MB. Burden and determinants of renal dysfunction and in-hospital mortality among acute stroke patients in Ethiopia: A hospital-based observational study. Medicine (Baltimore) 2024; 103:e39140. [PMID: 39058854 PMCID: PMC11272293 DOI: 10.1097/md.0000000000039140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2024] [Accepted: 07/09/2024] [Indexed: 07/28/2024] Open
Abstract
Stroke, a leading global cause of mortality and neurological impairment, is often complicated by renal failure, exacerbating in-hospital risks and mortality. Limited understanding exists regarding renal failure prevalence in Ethiopian acute stroke patients. This study examines renal function abnormalities in acute stroke patients at Jimma Medical Center (JMC). A hospital-based cross-sectional study was conducted at JMC from December 5, 2023, to March 15, 2024. A structured data collection tool was developed after comprehensive review of pertinent literature, encompassing variables pertinent to the study objectives. Following data quality assurance, information was coded and inputted into EpiData version 3.1, subsequently analyzed using Statistical Package for Social Sciences (SPSS) version 26.0. Multivariable logistic regression analysis was performed to adjust for confounding variables, with statistical significance set at P < .05. The mean age of participants was 60.5 ± 15.5 years, with 129 (64.5%) being male. Forty-five participants (22.5%, 95% confidence interval [CI] = 16.9, 28.9) exhibited renal dysfunction. Advanced age (≥70 years), hypertension, diabetes mellitus (DM), cardiac disease, history of transient ischemic attack (TIA)/stroke, and hemorrhagic stroke type were identified as significant predictors of renal dysfunction among hospitalized stroke patients. The mortality rate was 3.7 times higher in stroke patients with renal dysfunction compared to those with normal renal function (adjusted odds ratio [AOR] = 3.7, 95% CI: 1.41, 6.22). Renal function abnormalities were prevalent among hospitalized acute stroke patients, emphasizing the significance of renal dysfunction as a frequent comorbidity. Older age, hypertension, DM, cardiac disease, history of TIA/stroke, and hemorrhagic stroke type emerged as statistically significant predictors of renal dysfunction. Furthermore, renal dysfunction was identified as a significant predictor of in-hospital mortality following stroke.
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Affiliation(s)
| | - Eyob Girma Abera
- Department of Public Health, Jimma University, Jimma, Oromia, Ethiopia
- Jimma University Clinical Trial Unit, Jimma, Oromia, Ethiopia
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Okamura T, Tsukamoto K, Arai H, Fujioka Y, Ishigaki Y, Koba S, Ohmura H, Shoji T, Yokote K, Yoshida H, Yoshida M, Deguchi J, Dobashi K, Fujiyoshi A, Hamaguchi H, Hara M, Harada-Shiba M, Hirata T, Iida M, Ikeda Y, Ishibashi S, Kanda H, Kihara S, Kitagawa K, Kodama S, Koseki M, Maezawa Y, Masuda D, Miida T, Miyamoto Y, Nishimura R, Node K, Noguchi M, Ohishi M, Saito I, Sawada S, Sone H, Takemoto M, Wakatsuki A, Yanai H. Japan Atherosclerosis Society (JAS) Guidelines for Prevention of Atherosclerotic Cardiovascular Diseases 2022. J Atheroscler Thromb 2024; 31:641-853. [PMID: 38123343 DOI: 10.5551/jat.gl2022] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2023] Open
Affiliation(s)
- Tomonori Okamura
- Preventive Medicine and Public Health, Keio University School of Medicine
| | | | | | - Yoshio Fujioka
- Faculty of Nutrition, Division of Clinical Nutrition, Kobe Gakuin University
| | - Yasushi Ishigaki
- Division of Diabetes, Metabolism and Endocrinology, Department of Internal Medicine, Iwate Medical University
| | - Shinji Koba
- Division of Cardiology, Department of Medicine, Showa University School of Medicine
| | - Hirotoshi Ohmura
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine
| | - Tetsuo Shoji
- Department of Vascular Medicine, Osaka Metropolitan University Graduate school of Medicine
| | - Koutaro Yokote
- Department of Endocrinology, Hematology and Gerontology, Chiba University Graduate School of Medicine
| | - Hiroshi Yoshida
- Department of Laboratory Medicine, The Jikei University Kashiwa Hospital
| | | | - Juno Deguchi
- Department of Vascular Surgery, Saitama Medical Center, Saitama Medical University
| | - Kazushige Dobashi
- Department of Pediatrics, School of Medicine, University of Yamanashi
| | | | | | - Masumi Hara
- Department of Internal Medicine, Mizonokuchi Hospital, Teikyo University School of Medicine
| | - Mariko Harada-Shiba
- Cardiovascular Center, Osaka Medical and Pharmaceutical University
- Department of Molecular Pathogenesis, National Cerebral and Cardiovascular Center Research Institute
| | - Takumi Hirata
- Institute for Clinical and Translational Science, Nara Medical University
| | - Mami Iida
- Department of Internal Medicine and Cardiology, Gifu Prefectural General Medical Center
| | - Yoshiyuki Ikeda
- Department of Cardiovascular Medicine and Hypertension, Graduate School of Medical and Dental Sciences, Kagoshima University
| | - Shun Ishibashi
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Jichi Medical University, School of Medicine
- Current affiliation: Ishibashi Diabetes and Endocrine Clinic
| | - Hideyuki Kanda
- Department of Public Health, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University
| | - Shinji Kihara
- Medical Laboratory Science and Technology, Division of Health Sciences, Osaka University graduate School of medicine
| | - Kazuo Kitagawa
- Department of Neurology, Tokyo Women's Medical University Hospital
| | - Satoru Kodama
- Department of Prevention of Noncommunicable Diseases and Promotion of Health Checkup, Department of Hematology, Endocrinology and Metabolism, Niigata University Faculty of Medicine
| | - Masahiro Koseki
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine
| | - Yoshiro Maezawa
- Department of Endocrinology, Hematology and Gerontology, Chiba University Graduate School of Medicine
| | - Daisaku Masuda
- Department of Cardiology, Center for Innovative Medicine and Therapeutics, Dementia Care Center, Doctor's Support Center, Health Care Center, Rinku General Medical Center
| | - Takashi Miida
- Department of Clinical Laboratory Medicine, Juntendo University Graduate School of Medicine
| | | | - Rimei Nishimura
- Department of Diabetes, Metabolism and Endocrinology, The Jikei University School of Medicine
| | - Koichi Node
- Department of Cardiovascular Medicine, Saga University
| | - Midori Noguchi
- Division of Public Health, Department of Social Medicine, Graduate School of Medicine, Osaka University
| | - Mitsuru Ohishi
- Department of Cardiovascular Medicine and Hypertension, Graduate School of Medical and Dental Sciences, Kagoshima University
| | - Isao Saito
- Department of Public Health and Epidemiology, Faculty of Medicine, Oita University
| | - Shojiro Sawada
- Division of Metabolism and Diabetes, Faculty of Medicine, Tohoku Medical and Pharmaceutical University
| | - Hirohito Sone
- Department of Hematology, Endocrinology and Metabolism, Niigata University Faculty of Medicine
| | - Minoru Takemoto
- Department of Diabetes, Metabolism and Endocrinology, International University of Health and Welfare
| | | | - Hidekatsu Yanai
- Department of Diabetes, Endocrinology and Metabolism, National Center for Global Health and Medicine Kohnodai Hospital
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Tsubota-Utsugi M, Satoh M, Watanabe J, Takebayashi J, Oki T, Tatsumi Y, Asayama K, Kikuya M, Murakami T, Hirose T, Metoki H, Hara A, Nomura K, Hozawa A, Tsubono Y, Imai Y, Ohkubo T. Association between an Antioxidant-Rich Japanese Diet and Chronic Kidney Disease: The Ohasama Study. J Atheroscler Thromb 2024; 31:461-477. [PMID: 37853637 PMCID: PMC10999714 DOI: 10.5551/jat.64423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 09/04/2023] [Indexed: 10/20/2023] Open
Abstract
AIMS Although physiological effects of hydrophilic- (H-) and lipophilic- (L-) antioxidant capacities (AOCs) are suggested to differ, the association of an antioxidant-rich diet and chronic kidney disease (CKD) incidence has not been examined. We therefore explored the association between the H- or L-AOC of a whole Japanese diet and CKD risk in a general population. METHODS A total of 922 individuals without CKD (69.2% women; mean age, 59.5 years old) from Ohasama Town, Japan, were examined. CKD incidence was defined as the presence of proteinuria and/or an estimated glomerular filtration rate (eGFR) of <60 ml/min/1.73 m2. Consumption of H-/L-AOC was determined based on the oxygen radical absorbance capacity in a specially developed Japanese food AOC database. Hazard ratios (HRs) and 95% confidence intervals (CIs) were calculated for new-onset CKD using a Cox proportional hazards model. RESULTS During the median follow-up of 9.7 years, 137 CKD incidents were recorded. After adjusting for potential confounding variables, the highest quartile of L-AOC was significantly associated with a 51% reduced CKD risk among only women. An increased L-AOC intake was more effective in preventing eGFR reduction than in preventing proteinuria in women. These associations were not seen for H-AOC intake in both sexes and L-AOC intake in men. CONCLUSIONS A high intake of lipophilic antioxidants may be associated with a reduced CKD risk. The balance between dietary antioxidant intake and pro-oxidants induced by unhealthy lifestyles may be crucial for preventing future kidney deterioration.
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Affiliation(s)
- Megumi Tsubota-Utsugi
- Department of Hygiene and Public Health, Teikyo University School of Medicine, Tokyo, Japan
| | - Michihiro Satoh
- Division of Public Health, Hygiene and Epidemiology, Faculty of Medicine, Tohoku Medical and Pharmaceutical University, Sendai, Japan
- Department of Preventive Medicine and Epidemiology, Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan
| | - Jun Watanabe
- Department of Life and Food Sciences, Obihiro University of Agriculture and Veterinary Medicine, Hokkaido, Japan
| | - Jun Takebayashi
- Department of Food Function and Labeling, National Institutes of Biomedical Innovation, Health and Nutrition
| | - Tomoyuki Oki
- Department of Food Science, Graduate School of Nutritional Sciences, Nakamura Gakuen University, Fukuoka, Japan
| | - Yukako Tatsumi
- Department of Hygiene and Public Health, Teikyo University School of Medicine, Tokyo, Japan
| | - Kei Asayama
- Department of Hygiene and Public Health, Teikyo University School of Medicine, Tokyo, Japan
- Tohoku Institute for Management of Blood Pressure, Sendai, Japan
| | - Masahiro Kikuya
- Department of Hygiene and Public Health, Teikyo University School of Medicine, Tokyo, Japan
- Department of Preventive Medicine and Epidemiology, Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan
| | - Takahisa Murakami
- Division of Public Health, Hygiene and Epidemiology, Faculty of Medicine, Tohoku Medical and Pharmaceutical University, Sendai, Japan
- Department of Preventive Medicine and Epidemiology, Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan
- Division of Aging and Geriatric Dentistry, Department of Rehabilitation Dentistry, Tohoku University Graduate School of Dentistry, Sendai, Japan
| | - Takuo Hirose
- Department of Endocrinology and Applied Medical Science, Tohoku University Graduate School of Medicine, Sendai, Japan
- Division of Nephrology and Endocrinology, Faculty of Medicine, Tohoku Medical and Pharmaceutical University, Sendai, Japan
| | - Hirohito Metoki
- Division of Public Health, Hygiene and Epidemiology, Faculty of Medicine, Tohoku Medical and Pharmaceutical University, Sendai, Japan
- Department of Preventive Medicine and Epidemiology, Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan
- Tohoku Institute for Management of Blood Pressure, Sendai, Japan
| | - Azusa Hara
- Division of Drug Development and Regulatory Science, Faculty of Pharmacy, Keio University, Tokyo, Japan
| | - Kyoko Nomura
- Department of Environmental Health Science and Public Health, Akita University Graduate School of Medicine, Akita, Japan
| | - Atsushi Hozawa
- Department of Preventive Medicine and Epidemiology, Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan
- Division of Epidemiology, School of Public Health, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Yoshitaka Tsubono
- Department of Virology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Yutaka Imai
- Tohoku Institute for Management of Blood Pressure, Sendai, Japan
| | - Takayoshi Ohkubo
- Department of Hygiene and Public Health, Teikyo University School of Medicine, Tokyo, Japan
- Tohoku Institute for Management of Blood Pressure, Sendai, Japan
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Shiraishi YA, Ishikawa Y, Ishikawa J, Matsumura M, Ishikawa S. Age and sex differences in the risk of cardiovascular diseases by chronic kidney disease in a general Japanese population. Heart Vessels 2023:10.1007/s00380-023-02264-7. [PMID: 37039880 DOI: 10.1007/s00380-023-02264-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Accepted: 03/23/2023] [Indexed: 04/12/2023]
Abstract
The risk of cardiovascular diseases (CVD) by chronic kidney disease (CKD) stratified by age and sex has not been examined in detail in rural Japanese populations. Therefore, we herein investigated the long-term risk of CVD by CKD and performed an age- and sex-stratified risk analysis. We examined 5163 subjects who underwent health screening between 1992 and 1995 with calculated eGFR and follow-up information on CVD events. The mean follow-up period was 10 years. We analyzed the incidences of CVD events, including stroke and myocardial infarction (MI). We compared the risk of CVD between subjects with and without CKD using a Cox proportional hazards model adjusted for well-known CVD confounding factors. The total number of CVD events was 175. The hazard ratios (HRs) for all events, stroke, MI, and sudden death by CKD relative to non-CKD were 1.18 (95% C.I.:0.83-1.68), 0.96 (0.63-1.46), 3.02 (1.2-7.62), and 1.29 (0.43-3.87), respectively. HRs for MI were 7.24 in subjects < 65 years and 1.65 in those ≥ 65 years. HRs for MI by sex were 3.55 in men and 2.09 in women. A younger age and men sex were identified as independent risk factors for the risk of MI in the presence of CKD. These results suggest that among CKD patients, the management of a younger age group and men will effectively prevent MI.
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Affiliation(s)
- Yuko Ago Shiraishi
- Division of General Medicine, Center for Community Medicine, Jichi Medical University School of Medicine, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan.
| | - Yukiko Ishikawa
- Division of General Medicine, Center for Community Medicine, Jichi Medical University School of Medicine, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan
| | - Joji Ishikawa
- Department of Cardiology, Tokyo Metropolitan Geriatric Hospital and Institute of Gerontology, 35-2 Sakae, Itabashi, Tokyo, 173-0015, Japan
| | - Masami Matsumura
- Division of General Medicine, Center for Community Medicine, Jichi Medical University School of Medicine, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan
| | - Shizukiyo Ishikawa
- Division of Public Health, Center for Community Medicine, Jichi Medical University School of Medicine, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan
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5
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Luo H, Yang X, Chen K, Lan S, Liao G, Xu J. Blood creatinine and urea nitrogen at ICU admission and the risk of in-hospital death and 1-year mortality in patients with intracranial hemorrhage. Front Cardiovasc Med 2022; 9:967614. [PMID: 36440028 PMCID: PMC9685426 DOI: 10.3389/fcvm.2022.967614] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 10/27/2022] [Indexed: 11/11/2022] Open
Abstract
Background The relationship between renal function and clinical outcomes in patients with intracranial hemorrhage is controversial. Aims We investigated the associations of blood creatinine and urea nitrogen levels with hospital death and 1-year mortality in patients with intracranial hemorrhage treated in the intensive care unit (ICU). Methods A total of 2,682 patients with intracranial hemorrhage were included from the Medical Information Mart for Intensive Care III (MIMIC-III) database. Clinical variables, including admission creatinine, urea nitrogen, type of intracranial hemorrhage, underlying diseases and other blood biochemistry parameters, were collected. Multivariable correction analysis was conducted of the relationships between blood creatinine and urea nitrogen levels on admission with hospital death and 1-year mortality in the included patients with intracranial hemorrhage. Smooth curve and subgroup analyses were also performed for these associations. Results A total of 2,682 patients had their blood creatinine and urea nitrogen levels measured within the first 24 h after ICU admission, with median values of 0.80 and 15.00 mg/dL, respectively. We observed steeply linear relationships between creatinine and urea nitrogen levels and the risk of in-hospital death and 1-year mortality, but the risk of in-hospital mortality and 1-year mortality increased little or only slowly above creatinine levels > 1.9 mg/dL or urea nitrogen > 29 mg/d (the inflection points). Consistently, conditional logistic regression analysis suggested that these inflection points had significant modification effects on the associations between blood creatinine levels, as well as blood urea nitrogen, and the risk of in-hospital death (interaction value < 0.001) and 1-year mortality (interaction value < 0.001). Conclusion Our results supported the hypothesis that elevated blood creatinine and urea nitrogen levels on admission are associated with an increased risk of in-hospital death and 1-year mortality in patients with intracranial hemorrhage. Interestingly, these independent relationships existed only for lower levels of serum creatinine (<1.9 mg/dL) and uric acid (<29 mg/dL).
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Affiliation(s)
- Hai Luo
- Department of Neurosurgery, The First Affiliated Hospital, Nanchang University, Nanchang, China
| | - Xuanyong Yang
- Department of Neurosurgery, The First Affiliated Hospital, Nanchang University, Nanchang, China
| | - Kang Chen
- Department of Neurosurgery, The First Affiliated Hospital, Nanchang University, Nanchang, China
| | - Shihai Lan
- Department of Neurosurgery, The First Affiliated Hospital, Nanchang University, Nanchang, China
| | - Gang Liao
- Institute of Medicine, Nanchang University, Nanchang, China
| | - Jiang Xu
- Department of Neurosurgery, The First Affiliated Hospital, Nanchang University, Nanchang, China
- *Correspondence: Jiang Xu
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Low-Protein Diet: History and Use of Processed Low-Protein Rice for the Treatment of Chronic Kidney Disease. Foods 2021; 10:foods10102255. [PMID: 34681304 PMCID: PMC8534812 DOI: 10.3390/foods10102255] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Revised: 09/15/2021] [Accepted: 09/20/2021] [Indexed: 12/19/2022] Open
Abstract
The epidemiology of chronic kidney disease (CKD) shows increasing trends in prevalence and mortality and has become the leading health problem worldwide. Reducing the amount of proteins ingested from rice is an easy way to control the total intake of proteins, saving energy sources, particularly in rice-eating countries. In Japan, low-protein white rice had been developed, but the taste and function were not satisfactory for CKD patients. We reviewed the brief history of low-protein dietary therapy for renal diseases and the recent development of low-protein processed brown rice (LPBR). The new LPBR is characterized by a low-protein content, the same energy content as white rice, low potassium and phosphorus contents, and high amounts of dietary fibers, γ-oryzanol, and antioxidant activity. Dietary fibers and γ-oryzanol would stabilize intestinal microbiota and improve uremic dysbiosis and leaky gut syndrome. All these features suggest that the health benefits of LPBR extend to preventing CKD progression and enhancing the quality of life (QOL) of patients with CKD.
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Sata M, Okamura T, Harada S, Sugiyama D, Kuwabara K, Hirata A, Takeuchi A, Iida M, Kato S, Matsumoto M, Kurihara A, Takebayashi T. Association of the Estimated Coronary Artery Incidence Risk According to the Japan Atherosclerosis Society Guidelines 2017 with Cardio-Ankle Vascular Index. J Atheroscler Thromb 2021; 28:1266-1274. [PMID: 33678765 PMCID: PMC8629702 DOI: 10.5551/jat.58719] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Aims:
The categories in the comprehensive lipid and risk management guidelines were proposed by the Japan Atherosclerosis Society (JAS Guidelines 2017), which adopted the estimated 10 year absolute risk of coronary artery disease (CAD) incidence in the Suita score. We examined whether those categories were concordant with the degree of arterial stiffness.
Methods:
In 2014, the cardio-ankle vascular index (CAVI), an arterial stiffness parameter, was measured in 1,972 Japanese participants aged 35–74 years in Tsuruoka City, Yamagata Prefecture, Japan. We examined the mean CAVI and the proportion and odds ratios (ORs) of CAVI ≥ 9.0 on the basis of the following three management classifications using the analysis of variance and logistic regression: “Category I (Low risk),” “Category II (Middle risk),” and “Category III (High risk).”
Results:
The mean CAVI and proportion of CAVI ≥ 9.0 were 8.6 and 34.8% among males and 8.1 and 18.3% among females, respectively. The mean CAVI and proportion of CAVI ≥ 9.0 were associated with an estimated 10 year absolute risk for CAD among males and females, excluding High risk for females. These results were similar to the management classification by the guideline: the multivariable-adjusted ORs (95% confidence intervals) of CAVI ≥ 9.0 among Category II and Category III compared with those among Category I were 2.96 (1.61–5.43) and 7.33 (4.03–13.3) for males and 3.99 (2.55–6.24) and 3.34 (2.16–5.16) for females, respectively.
Conclusions:
The risk stratification, which was proposed in the JAS Guidelines 2017, is concordant with the arterial stiffness parameter.
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Affiliation(s)
- Mizuki Sata
- Department of Preventive Medicine and Public Health, Keio University School of Medicine
| | - Tomonori Okamura
- Department of Preventive Medicine and Public Health, Keio University School of Medicine
| | - Sei Harada
- Department of Preventive Medicine and Public Health, Keio University School of Medicine
| | - Daisuke Sugiyama
- Department of Preventive Medicine and Public Health, Keio University School of Medicine
| | - Kazuyo Kuwabara
- Department of Preventive Medicine and Public Health, Keio University School of Medicine
| | - Aya Hirata
- Department of Preventive Medicine and Public Health, Keio University School of Medicine
| | - Ayano Takeuchi
- Department of Preventive Medicine and Public Health, Keio University School of Medicine
| | - Miho Iida
- Department of Preventive Medicine and Public Health, Keio University School of Medicine
| | - Suzuka Kato
- Department of Preventive Medicine and Public Health, Keio University School of Medicine
| | - Minako Matsumoto
- Department of Preventive Medicine and Public Health, Keio University School of Medicine
| | - Ayako Kurihara
- Department of Preventive Medicine and Public Health, Keio University School of Medicine
| | - Toru Takebayashi
- Department of Preventive Medicine and Public Health, Keio University School of Medicine
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The Japanese Society of Hypertension Guidelines for the Management of Hypertension (JSH 2019). Hypertens Res 2020; 42:1235-1481. [PMID: 31375757 DOI: 10.1038/s41440-019-0284-9] [Citation(s) in RCA: 1059] [Impact Index Per Article: 264.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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Asada S, Sakakura K, Taniguchi Y, Yamamoto K, Tsukui T, Seguchi M, Wada H, Momomura SI, Fujita H. Association of the long fluoroscopy time with factors in contemporary primary percutaneous coronary interventions. PLoS One 2020; 15:e0237362. [PMID: 32776989 PMCID: PMC7416924 DOI: 10.1371/journal.pone.0237362] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 07/23/2020] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Since the long fluoroscopy time in primary PCI for ST-segment elevation myocardial infarction (STEMI) could be an indicator of delayed reperfusion, it should be important to recognize which types of lesions require longer fluoroscopy-time in primary PCI. The purpose of this study was to investigate the association of the long fluoroscopy-time with clinical factors in primary percutaneous coronary interventions (PCI). METHODS A total of 539 patients who underwent primary PCI were divided into the conventional fluoroscopy-time group (Q1-Q4: n = 434) and the long fluoroscopy-time group (Q5: n = 105) according to the quintile of the total fluoroscopy time in primary PCI. Univariate and multivariate logistic regression analyses were performed to find associations between clinical variables and the long fluoroscopy-time. RESULTS In univariate logistic regression analysis, prevalence of diabetes mellitus, hemodialysis, and previous CABG were significantly associated with the long fluoroscopy-time. In addition, complex lesion characteristics such as lesion length, lesion angle, tortuosity, and calcification were associated with the long fluoroscopy-time. In multivariable logistic regression analysis, lesion length [per 10 mm incremental: odds ratio (OR) 1.751, 95% confidence interval (CI) 1.397-2.195, P<0.001], moderate-excessive tortuosity (vs. mild tortuosity: OR 4.006, 95% CI 1.498-10.715, P = 0.006), and moderate to severe calcification (vs. none-mild calcification: OR 1.865, 95% CI 1.107-3.140, P = 0.019) were significantly associated with the long fluoroscopy-time. CONCLUSIONS In primary PCI for STEMI, diffuse long lesion, tortuosity, and moderate-severe calcification were associated with the long fluoroscopy-time. These complex features require special attention to reduce reperfusion time in primary PCI.
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Affiliation(s)
- Satoshi Asada
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, Shimotsuke, Japan
| | - Kenichi Sakakura
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, Shimotsuke, Japan
- * E-mail:
| | - Yousuke Taniguchi
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, Shimotsuke, Japan
| | - Kei Yamamoto
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, Shimotsuke, Japan
| | - Takunori Tsukui
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, Shimotsuke, Japan
| | - Masaru Seguchi
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, Shimotsuke, Japan
| | - Hiroshi Wada
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, Shimotsuke, Japan
| | - Shin-ichi Momomura
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, Shimotsuke, Japan
| | - Hideo Fujita
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, Shimotsuke, Japan
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10
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Recent status of self-measured home blood pressure in the Japanese general population: a modern database on self-measured home blood pressure (MDAS). Hypertens Res 2020; 43:1403-1412. [PMID: 32753754 DOI: 10.1038/s41440-020-0530-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2020] [Revised: 05/31/2020] [Accepted: 06/03/2020] [Indexed: 12/17/2022]
Abstract
Despite the clinical usefulness of self-measured home blood pressure (BP), reports on the characteristics of home BP have not been sufficient and have varied due to the measurement conditions in each study. We constructed a database on self-measured home BP, which included five Japanese general populations as subdivided aggregate data that were clustered and meta-analyzed according to sex, age category, and antihypertensive drug treatment at baseline (treated and untreated). The self-measured home BPs were collected after a few minutes of rest in a sitting position: (1) the morning home BP was measured within 1 h of waking, after urination, before breakfast, and before taking antihypertensive medication (if any); and (2) the evening home BP was measured just before going to bed. The pulse rate was simultaneously measured. Eligible data from 2000 onward were obtained. The morning BP was significantly higher in treated participants than in untreated people of the same age category, and the BP difference was more marked in women. Among untreated residents, home systolic/diastolic BPs measured in the morning were higher than those measured in the evening; the differences were 5.7/5.0 mmHg in women (ranges across the cohorts, 5.3-6.8/4.7-5.4 mmHg) and 7.3/7.7 mmHg in men (ranges, 6.4-8.5/7.0-8.7 mmHg). In contrast, the home pulse rate in women and men was 2.4 (range, 1.5-3.7) and 5.6 (range, 4.6-6.6) beats per minute, respectively, higher in the evening than in the morning. We demonstrated the current status of home BP and home pulse rate in relation to sex, age, and antihypertensive treatment status in the Japanese general population. The approach by which fine-clustered aggregate statistics were collected and integrated could address practical issues raised in epidemiological research settings.
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Okubo Y, Nakano Y, Tokuyama T, Hironobe N, Okamura S, Ikeuchi Y, Miyauchi S, Kihara Y. Increased Urinary Liver-Type Fatty Acid-Binding Protein Level Predicts Major Adverse Cardiovascular Events in Patients With Hypertension. Am J Hypertens 2020; 33:604-609. [PMID: 32155236 DOI: 10.1093/ajh/hpaa035] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Revised: 12/03/2019] [Accepted: 03/03/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Urinary liver-type fatty acid-binding protein (L-FABP) has been known as a potential biomarker for acute kidney injury. It has also been suggested to have an effective predictive value for cardiovascular mortality in patients with diabetes or critically ill condition. Therefore, this study aimed to examine the ability of urinary L-FABP in predicting mid-term cardiovascular morbidity and mortality in patients with hypertension. METHODS Urinary L-FABP levels in stable outpatients without diabetes who were treated with antihypertensive drugs were measured, and a 5-year follow-up was planned. The primary end-point was a combination of acute heart failure requiring hospitalization, myocardial infarction, stroke, and cardiovascular death. The secondary end-point was kidney disease progression defined as a relative decline in the estimated glomerular filtration rate of ≥30% from the baseline. RESULTS A total of 197 patients were recruited. Primary and secondary end-points occurred in 24 (12.2%) and 42 (21.3%) patients, respectively, during a median follow-up of 5.7 years. Patients with urinary L-FABP levels higher than the upper limit (8.4 µg/g creatinine) were more likely to reach the primary (30.43% vs. 9.77%; P = 0.003) and secondary end-points (56.52% vs. 16.67%; P < 0.001) than those with urinary L-FABP levels within the normal limits. Urinary L-FABP level was independently associated with both primary (hazard ratio (HR) 1.21; P = 0.03) and secondary end-points (HR 1.19; P = 0.02). CONCLUSIONS This study demonstrated that increased urinary L-FABP levels may predict adverse cardiovascular events and renal dysfunction progression even among stable nondiabetic patients with hypertension.
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Affiliation(s)
- Yousaku Okubo
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
- Department of Cardiovascular Medicine, Shimokamagari Public Hospital, Hiroshima, Japan
| | - Yukiko Nakano
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Takehito Tokuyama
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Naoya Hironobe
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Sho Okamura
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Yoshihiro Ikeuchi
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Shunsuke Miyauchi
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Yasuki Kihara
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
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Sonoda H, Nakamura K, Tamakoshi A. Ankle-Brachial Index is a Predictor of Future Incident Chronic Kidney Disease in a General Japanese Population. J Atheroscler Thromb 2019; 26:1054-1061. [PMID: 31061261 PMCID: PMC6927805 DOI: 10.5551/jat.47779] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Accepted: 02/28/2019] [Indexed: 12/17/2022] Open
Abstract
AIMS The ankle-brachial index (ABI) can be a prognostic marker for chronic kidney disease (CKD) in Western populations. Since there is little relevant evidence for Asian populations, we investigated the relationship between ABI and the risk of incident CKD in a general Japanese population. METHODS The cohort included 5,072 participants aged 30-79 without a history of renal disease or cerebro-cardiovascular disease. Incident CKD, defined as an estimated glomerular filtration rate <60 (mL/min/1.73 m2) and/or proteinuria (≥ 1+ on urine dipstick), was compared among participants grouped according to baseline ABI: 0.90-0.99, 1.00-1.09, 1.10-1.19, 1.20-1.29, and 1.30-1.39. Hazard ratios for incident CKD were estimated using a Cox proportional hazards model, with the ABI 1.10-1.19 group serving as the reference. RESULTS The CKD incidence rate (/100 person-years) was 1.80 during the mean follow-up period of 5.1 years. The CKD incidence rate was 3.04 in the ABI category 0.90-0.99, 1.58 in ABI 1.00-1.09, 1.72 in ABI 1.10-1.19, 2.01 in ABI 1.20-1.29, and 3.33 in ABI 1.30-1.39. The hazard ratios for developing CKD were 2.14 (95% confidence interval 1.16-3.92) in ABI 0.90-0.99, 1.08 (0.83-1.41) in ABI 1.00-1.09, 1.03 (0.83-1.29) in ABI 1.20-1.29, and 1.37 (0.77-2.47) in ABI 1.30-1.39, after adjusting for age, sex, systolic blood pressure, diabetes, and other confounding factors. CONCLUSIONS In a general Japanese population, an ABI of 0.90-0.99 was associated with an increased risk of incident CKD, independent of traditional cardiovascular risk factors.
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Affiliation(s)
- Hiroshi Sonoda
- Department of Public Health, Hokkaido University Graduate School of Medicine, Sapporo, Japan
- Keijinkai Maruyama Clinic, Sapporo, Japan
| | - Koshi Nakamura
- Department of Public Health, Hokkaido University Faculty of Medicine, Sapporo, Japan
| | - Akiko Tamakoshi
- Department of Public Health, Hokkaido University Faculty of Medicine, Sapporo, Japan
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Park JW, Yang PS, Bae HJ, Yang SY, Yu HT, Kim TH, Uhm JS, Joung B, Lee MH, Pak HN. Five-Year Change in the Renal Function After Catheter Ablation of Atrial Fibrillation. J Am Heart Assoc 2019; 8:e013204. [PMID: 31474174 PMCID: PMC6755838 DOI: 10.1161/jaha.119.013204] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Background Although it has been reported that renal function can improve after catheter ablation of atrial fibrillation (AF), long‐term changes in renal function and its relationship to rhythm outcomes have not yet been evaluated. We explored the 5‐year change in estimated glomerular filtration rate (eGFR) in AF patients depending on medical therapy and catheter ablation. Methods and Results Among 1963 patients who underwent AF catheter ablation and 14 056 with AF under medical therapy in the National Health Insurance Service database, we compared 571 with AF catheter ablation (59±10 years old, 72.3% male, and 66.5% paroxysmal AF) and 1713 with medical therapy after 1:3 propensity‐score matching. All participants had 5 years of serial eGFR data (Chronic Kidney Disease‐Epidemiology Collaboration [CKD‐EPI] method). Catheter ablation improved eGFR5 yrs (P<0.001), but medical therapy did not. In 2284 matched patients, age (adjusted odds ratio [OR], 0.98 [0.97–0.99]; P<0.001) and AF catheter ablation (adjusted OR, 2.02 [1.67–2.46]; P<0.001) were independently associated with an improved eGFR5 yrs. Among 571 patients who underwent AF ablation, freedom from AF/atrial tachycardia recurrence after the last AF ablation procedure was independently associated with an improved eGFR5 yrs (adjusted OR, 1.44 [1.01–2.04]; P=0.043), especially in patients without diabetes mellitus (adjusted OR, 1.78 [1.21–2.63]; P=0.003, P for interaction=0.012). Although underlying renal dysfunction (<60 mL/min/1.73m2) was associated with atrial structural remodeling (adjusted OR, 1.05 [1.00–1.11]; P=0.046), it did not affect the AF ablation rhythm outcome. Conclusions AF catheter ablation significantly improved renal function over a 5‐year follow‐up, especially in patients maintaining sinus rhythm without preexisting diabetes mellitus. See Editorial Wehner
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Affiliation(s)
- Je-Wook Park
- Yonsei University Health System Seoul Republic of Korea
| | - Pil-Sung Yang
- Division of Cardiology CHA University Seongnam Republic of Korea
| | - Han-Joon Bae
- Daegu Catholic University Medical Center Daegu Republic of Korea
| | - Song-Yi Yang
- Yonsei University Health System Seoul Republic of Korea
| | - Hee Tae Yu
- Yonsei University Health System Seoul Republic of Korea
| | - Tae-Hoon Kim
- Yonsei University Health System Seoul Republic of Korea
| | - Jae-Sun Uhm
- Yonsei University Health System Seoul Republic of Korea
| | - Boyoung Joung
- Yonsei University Health System Seoul Republic of Korea
| | | | - Hui-Nam Pak
- Yonsei University Health System Seoul Republic of Korea
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Nakamura S, Kawano Y, Nakajima K, Hase H, Joki N, Hatta T, Nishimura S, Moroi M, Nakagawa S, Kasai T, Kusuoka H, Takeishi Y, Momose M, Takehana K, Nanasato M, Yoda S, Nishina H, Matsumoto N, Nishimura T. Prognostic study of cardiac events in Japanese patients with chronic kidney disease using ECG-gated myocardial Perfusion imaging: Final 3-year report of the J-ACCESS 3 study. J Nucl Cardiol 2019; 26:431-440. [PMID: 28439760 PMCID: PMC6430747 DOI: 10.1007/s12350-017-0880-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2016] [Accepted: 03/23/2017] [Indexed: 11/26/2022]
Abstract
BACKGROUND Myocardial perfusion imaging (MPI) is considered useful for risk stratification among patients with chronic kidney disease (CKD), without renal deterioration by contrast media. METHODS AND RESULTS The Japanese Assessment of Cardiac Events and Survival Study by Quantitative Gated SPECT (J-ACCESS 3) is a multicenter, prospective cohort study investigating the ability of MPI to predict cardiac events in 529 CKD patients without a definitive coronary artery disease. All patients were assessed by stress and rest MPI with 99mTc-tetrofosmin and data were analyzed using a defect scoring method and QGS software. Major cardiac events were analyzed for 3 years after registration. The mean eGFR was 29.0 ± 12.8 (mL/minute/1.73 m2). The mean summed stress/rest/difference (SSS, SRS, SDS) scores were 1.9 ± 3.8, 1.1 ± 3.0, and 0.8 ± 1.8, respectively. A total of 60 cardiac events (three cardiac deaths, six sudden deaths, five nonfatal myocardial infarctions, 46 hospitalization cases for heart failure) occurred. The event-free survival rate was lower among patients with kidney dysfunction, higher SSS, and higher CRP values. Multivariate Cox regression analysis independently associated SSS ≥8, eGFR <15 (mL/minute/1.73 m2), and CRP ≥0.3 (mg/dL) with cardiac events. CONCLUSIONS Together with eGFR and CRP, MPI can predict cardiac events in patients with CKD.
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Affiliation(s)
- Satoko Nakamura
- Division of Hypertension and Nephrology, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Yuhei Kawano
- Division of Hypertension and Nephrology, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Kenichi Nakajima
- Department of Nuclear Medicine, Kanazawa University Hospital, Kanazawa, Japan
| | - Hiroki Hase
- Department of Nephrology, Toho University Ohashi Medical Center, Tokyo, Japan
| | - Nobuhiko Joki
- Department of Nephrology, Toho University Ohashi Medical Center, Tokyo, Japan
| | - Tsuguru Hatta
- Division of Nephrology, Department of Medicine, Ohmihachiman Community Medical Center, Ohmihachiman, Japan
| | | | - Masao Moroi
- Department of Cardiology, Toho University Ohashi Medical Center, Tokyo, Japan
| | - Susumu Nakagawa
- Department of Cardiology, Saiseikai Central Hospital, Tokyo, Japan
| | - Tokuo Kasai
- Department of Cardiology, Jikei Medical University Aoto Hospital, Tokyo, Japan
| | - Hideo Kusuoka
- National Hospital Organization Osaka National Hospital, Osaka, Japan
| | | | - Mitsuru Momose
- Department of Radiology, Tokyo Women’s Medical University, Tokyo, Japan
| | - Kazuya Takehana
- Department of Cardiology, Kansai Medical University, Hirakata, Japan
| | - Mamoru Nanasato
- Department of Cardiology, Nagoya Daini Red-Cross Hospital, Nagoya, Japan
| | - Syunichi Yoda
- Department of Cardiology, Nihon University Itabashi Hospital, Tokyo, Japan
| | - Hidetaka Nishina
- Department of Cardiology, Tsukuba Medical Center Hospital, Tsukuba, Japan
| | - Naoya Matsumoto
- Department of Cardiology, Suruga-dai Nihon University Hospital, Tokyo, Japan
| | - Tsunehiko Nishimura
- Department of Radiology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajiicho, Kawara-machi Hirokoji, Kamigyo-ku, 602-8566 Kyoto, Japan
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Mun KH, Yu GI, Choi BY, Kim MK, Shin MH, Shin DH. Association of Dietary Potassium Intake with the Development of Chronic Kidney Disease and Renal Function in Patients with Mildly Decreased Kidney Function: The Korean Multi-Rural Communities Cohort Study. Med Sci Monit 2019; 25:1061-1070. [PMID: 30733429 PMCID: PMC6376634 DOI: 10.12659/msm.913504] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Background Dietary potassium has negative outcomes in patients with mildly impaired kidney function, while having positive outcomes in patients with hypertension. The association of dietary potassium intake with chronic kidney disease (CKD) development, with presence of hypertension, was studied in the Korean rural population with mildly impaired kidney function. Material/Methods From 3 rural areas of Korea, 5064 participants age ≥40 with CKD stage 2 at baseline were recruited. Patients were classified according to the quartile of dietary potassium intake. Newly developed CKD, defined as estimated glomerular filtration rate (eGFR) of <60 mL/min/1.73 m2 at the time of follow-up, and eGFR decline, defined as eGFR decrease >15% at follow-up, were studied. The effect of dietary potassium on CKD development and eGFR decline were studied by Cox proportional hazard models. The association of potassium with blood pressures and C-reactive protein was also studied to examine the underlying mechanisms. Results Compared to 8.6% in normotensives, 15.7% of hypertensives developed CKD. The hazard ratio (HR) (95% confidence interval) of CKD was lower in high potassium diet only in hypertensives, with 0.60 (0.37–0.99) in the highest quartile. The eGFR decline was also lower in patients with higher potassium diet, with 0.70 (0.50–0.98) in Q3 and 0.54 (0.34–0.85) in Q4. Potassium intake has also been shown to decrease high diastolic blood pressure development (>90 mmHg) in hypertensives at 0.45 (0.25–0.83). Conclusions Dietary potassium was associated with lower risk of CKD development and eGFR decline, and this association was observed only in hypertensives.
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Affiliation(s)
- Kwang Ho Mun
- Department of Preventive Medicine, Keimyung University School of Medicine, Daegu, South Korea
| | - Gyeong Im Yu
- Department of Preventive Medicine, Keimyung University School of Medicine, Daegu, South Korea
| | - Bo Youl Choi
- Department of Preventive Medicine, Hanyang University College of Medicine, Seoul, South Korea
| | - Mi Kyung Kim
- Department of Preventive Medicine, Hanyang University College of Medicine, Seoul, South Korea
| | - Min-Ho Shin
- Department of Preventive Medicine, Chonnam National University Medical School, Gwangju, South Korea
| | - Dong Hoon Shin
- Department of Preventive Medicine, Keimyung University School of Medicine, Daegu, South Korea
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Che Q, Yang Y, Cheng G, Jia J, Fan F, Li J, Huo Y, Chen D, Zhang Y. Decreased GFR and its joint association with type 2 diabetes and hypertension with prevalence and severity of carotid plaque in a community population in China. Diabetes Metab Syndr Obes 2019; 12:1263-1273. [PMID: 31440071 PMCID: PMC6666373 DOI: 10.2147/dmso.s203545] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Accepted: 05/29/2019] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND Type 2 diabetes (T2DM), hypertension and kidney dysfunction are known risk factors for cardiovascular disease, but their combined effect on carotid plaque remains uncertain. This study aims to assess the associations between T2DM, hypertension, kidney dysfunction and carotid plaque, and further explore the combined effect of three diseases. PATIENTS AND METHODS We conducted a cross-sectional analysis among 3,815 community-dwelling adults in a Chinese atherosclerosis cohort. Estimated glomerular filtration rate (eGFR), hypertension and T2DM were evaluated as risk factors for carotid plaque. The presence, number and total area of carotid plaques were also assessed. Using logistic model, mutinomial logistic model and generalized linear regression model, the relationship between risk factors and carotid plaque was examined. RESULTS T2DM, hypertension, decreased GFR, and, inversely, eGFR, were independently associated with the presence, number and total area of carotid plaque. Stratified analysis by T2DM and hypertension showed T2DM attenuated the association between eGFR change and carotid plaque. There was a cumulative relationship between three risk factors and carotid plaque burden. The OR for the number of plaques was 1.0 (reference), 1.55 to 2.03, 1.94 to 3.14, and 3.69 (all P<0.05), respectively, for individuals with none, one, two, and three risk factors. Likewise, combining three risk factors was associated with greater increase in total plaque area (β, 20.63; 95% CI, 14.04-27.22). CONCLUSION The coexistence of decreased GFR, diabetes and hypertension is associated with increased risk of carotid plaque, and these comorbidities may contribute additively to the development of plaque.
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Affiliation(s)
- Qianzi Che
- Department of Epidemiology & Biostatistics, Peking University Health Science Center, Beijing, People’s Republic of China
| | - Ying Yang
- Department of Cardiology, Peking University First Hospital, Beijing, People’s Republic of China
| | - Guanliang Cheng
- Department of Cardiology, Peking University First Hospital, Beijing, People’s Republic of China
| | - Jia Jia
- Department of Cardiology, Peking University First Hospital, Beijing, People’s Republic of China
| | - Fangfang Fan
- Department of Cardiology, Peking University First Hospital, Beijing, People’s Republic of China
| | - Jianping Li
- Department of Cardiology, Peking University First Hospital, Beijing, People’s Republic of China
| | - Yong Huo
- Department of Cardiology, Peking University First Hospital, Beijing, People’s Republic of China
| | - Dafang Chen
- Department of Epidemiology & Biostatistics, Peking University Health Science Center, Beijing, People’s Republic of China
- Correspondence: Dafang ChenDepartment of Epidemiology and Biostatistics, Peking University Health Science Center, No. 38 Xueyuan Road, Haidian District, Beijing100191, People’s Republic of ChinaTel +86 108 280 2644Fax +86 108 280 2644Email
| | - Yan Zhang
- Department of Cardiology, Peking University First Hospital, Beijing, People’s Republic of China
- Yan ZhangDepartment of Cardiology, Peking University First Hospital, 8 Xishiku Street, Xicheng District,Beijing, People’s Republic of ChinaTel +86 010-83575728 Email
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Cardiac hypertrophy in chronic kidney disease—role of Aldosterone and FGF23. RENAL REPLACEMENT THERAPY 2018. [DOI: 10.1186/s41100-018-0152-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Renal dysfunction increases the risk of recurrent stroke in patients with acute ischemic stroke. Atherosclerosis 2018; 277:15-20. [PMID: 30170219 DOI: 10.1016/j.atherosclerosis.2018.07.033] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Revised: 06/11/2018] [Accepted: 07/25/2018] [Indexed: 01/24/2023]
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Blood pressure, heart rate, and double product in a pooled cohort: the Japan Arteriosclerosis Longitudinal Study. J Hypertens 2018; 35:1808-1815. [PMID: 28486272 DOI: 10.1097/hjh.0000000000001399] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To identify the characteristics of blood pressure (BP), heart rate (HR), and double product in a Japanese population sample. METHODS We pooled individual records from 1999 to 2005 for 111 007 participants in 25 community-based cohorts and seven worksite-based cohorts. The data were analyzed to provide information on BP, HR, and double product according to age-sex groups and use of antihypertensive medication. RESULTS Average BP was 130/77 mmHg among men and women combined. Among untreated individuals, SBP increased with age, whereas DBP reached a ceiling around the age of 60 years. The average SBP of treated participants was around 140 mmHg, irrespective of age, whereas DBP decreased linearly with age, and 56.4% of treated participants had a BP of 140/90 mmHg or over. HR did not differ across age groups or treatment status. The double product, also called the rate-pressure product, calculated by multiplying the SBP and the HR, increased with age among untreated individuals, whereas it first decreased and then increased with age among treated individuals. CONCLUSION Based on these collaborative data, insufficient BP control in Japan, where the average life expectancy is the longest in the world, was seen.
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Wang IK, Liu CH, Yen TH, Jeng JS, Sung SF, Huang PH, Li JY, Sun Y, Wei CY, Lien LM, Tsai IJ, Sung FC, Hsu CY, Liu CH, Tsai CH, Huang WS, Lu CT, Tsai TC, Tseng CH, Lin KH, Shyu WC, Yang YW, Liu YL, Cho DY, Chen CC, Jeng JS, Tang SC, Tsai LK, Yeh SJ, Chen CH, Tsai HH, Li JY, Chen HJ, Lu K, Hsu SP, Kuo HC, Tsou JC, Wang YT, Tai YC, Hsieh MT, Liliang PC, Liang CL, Wang HK, Tsai YT, Wang KW, Chen JS, Chen PY, Wang YC, Chen CH, Sung PS, Hsieh HC, Su HC, Chiu HC, Lien LM, Chen WH, Bai CH, Huang TH, Lau CI, Wu YY, Yeh HL, Chang A, Lin CH, Yen CC, Lin RT, Chen CH, Khor GT, Chao AC, Lin HF, Huang P, Lin HJ, Ke DS, Chang CY, Yeh PS, Lin KC, Cheng TJ, Chou CH, Yang CM, Shen HC, Chen AC, Tsai SJ, Lu TM, Kung SL, Lee MJ, Chou HH, Chang WL, Chiu PY, Hsu MH, Chan PC, Pan CH, Shoung HM, Lo YC, Wang FH, Chang WC, Lai TC, Yin JH, Wang CJ, Wang KC, Chen LM, Denq JC, Sun Y, Lu CJ, Lin CH, Huang CC, Liu CH, Chan HF, Lee SP, Sun MH, Ke LY, Chen PL, Lee YS, Sung SF, Ong CT, Wu CS, Hsu YC, Su YH, Hung LC, Lee JT, Lin JC, Hsu YD, Denq JC, Peng GS, Hsu CH, Lin CC, Yen CH, Cheng CA, Sung YF, Chen YL, Lien MT, Chou CH, Liu CC, Yang FC, Wu YC, Tso AC, Lai YH, Chiang CI, Tsai CK, Liu MT, Lin YC, Hsu YC, Chiang TR, Huang PH, Liao PW, Lee MC, Chen JT, Lie SK, Sun MC, Hsiao PJ, Chen WL, Chen TC, Chang CS, Lai CH, Chuang CS, Chen YY, Lin SK, Su YC, Shiao JL, Yang FY, Liu CY, Chiang HL, Chen GC, Hsu PJ, Chang CY, Lin IS, Chien CH, Chang YC, Chen PK, Chiu PY, Hsiao YJ, Fang CW, Chen YW, Lee KY, Lin YY, Li CH, Tsai HF, Hsieh CF, Yang CD, Liaw SJ, Liao HC, Yeh SJ, Wu LL, Hsieh LP, Lee YH, Chen CW, Hsu CS, Jhih YJ, Zhuang HY, Pan YH, Shih SA, Chen CI, Sung JY, Weng HY, Teng HW, Lee JE, Huang CS, Chao SP, Yuan RY, Sheu JJ, Yu JM, Ho CS, Lin TC, Yu SC, Chen JR, Tsai SY, Wei CY, Hung CH, Lee CF, Yang SK, Chen CL, Lin W, Tseng HP, Liu CH, Lin CL, Lin HC, Chen PT, Hu CJ, Chan L, Chi NF, Chern CM, Lin CJ, Wang SJ, Hsu LC, Wong WJ, Lee IH, Yen DJ, Tsai CP, Kwan SY, Soong BW, Chen SP, Liao KK, Lin KP, Chen C, Shan DE, Fuh JL, Wang PN, Lee YC, Yu YH, Huang HC, Tsai JY, Wu MH, Chiang SY, Wang CY, Hsu MC, Chen CC, Yeh PY, Tsai YT, Wang KY, Chen TS, Hsieh CY, Chen WF, Yip PK, Wang V, Wang KC, Tsai CF, Chen CC, Chen CH, Liu YC, Chen SY, Zhao ZH, Wei ZP, Wu SL, Liu CK, Lin RH, Chu CH, Yan SH, Lin YC, Chen PY, Hsiao SH, Yip BS, Tsai PC, Chou PC, Kuo TM, Lee YC, Chiu YP, Tsai KC, Liao YS, Tsai MJ, Kao HY. Renal function is associated with 1-month and 1-year mortality in patients with ischemic stroke. Atherosclerosis 2018; 269:288-293. [PMID: 29254692 DOI: 10.1016/j.atherosclerosis.2017.11.029] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2017] [Revised: 10/26/2017] [Accepted: 11/29/2017] [Indexed: 10/18/2022]
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Fukui S, Imazeki R, Amano Y, Kudo Y, Amari K, Yamamoto M, Todoroki K, Ikeya Y, Okazaki T, Yanagimachi N, Shizuma T, Fukuyama N, Johkura K, Mori H. Common and specific risk factors for ischemic stroke in elderly: Differences based on type of ischemic stroke and aging. J Neurol Sci 2017; 380:85-91. [DOI: 10.1016/j.jns.2017.07.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2016] [Revised: 06/21/2017] [Accepted: 07/03/2017] [Indexed: 10/19/2022]
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Usui T, Nagata M, Hata J, Mukai N, Hirakawa Y, Yoshida D, Kishimoto H, Kitazono T, Kiyohara Y, Ninomiya T. Serum Non-High-Density Lipoprotein Cholesterol and Risk of Cardiovascular Disease in Community Dwellers with Chronic Kidney Disease: the Hisayama Study. J Atheroscler Thromb 2017; 24:706-715. [PMID: 27840387 PMCID: PMC5517544 DOI: 10.5551/jat.37044] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2016] [Accepted: 09/26/2016] [Indexed: 11/11/2022] Open
Abstract
AIM It is not clear whether elevated serum non-high-density lipoprotein cholesterol (non-HDL-C) levels are a risk factor for cardiovascular disease (CVD) in subjects with chronic kidney disease (CKD) in the general population. METHODS A total of 2,630 community-dwelling Japanese subjects (1,107 men and 1,523 women) without history of CVD and aged ≥40 years were prospectively followed up for an average of 19 years, and the association between serum non-HDL-C levels and the incidence of type-specific CVD was estimated using a Cox proportional hazards model. CKD was defined as estimated glomerular filtration rate <60 mL/min/1.73 m2 or proteinuria (≥1+ on dipstick). RESULTS At baseline, 357 subjects had CKD. During the follow up, 186 coronary heart disease (CHD) and 277 stroke events occurred. The age- and sex-adjusted incidence of CHD was significantly higher in subjects with higher non-HDL-C levels, both in those with and without CKD. In the CKD group, the risk of CHD was significantly higher in those with non-HDL-C levels of 150- 189 mg/dL [adjusted hazard ratio (HR), 2.23; 95% confidence interval (CI), 1.04-4.77] and those with levels ≥190 mg/dL (adjusted HR, 3.20; 95% CI, 1.46-7.03) than in those with levels <150 mg/dL. In the non-CKD group, the risk of CHD was significantly higher only in those with nonHDL-C levels ≥190 mg/dL (adjusted HR, 2.12; 95% CI, 1.33-3.38). However, no such association was observed for the risk of stroke. CONCLUSIONS Our findings suggest that higher serum non-HDL-C levels are associated with greater risk of CHD in subjects with and without CKD and that this association is greater in subjects with CKD than in those without CKD.
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Affiliation(s)
- Tomoko Usui
- Department of Epidemiology and Public Health, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Masaharu Nagata
- Department of Epidemiology and Public Health, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Jun Hata
- Department of Epidemiology and Public Health, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
- Center for Cohort Studies, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Naoko Mukai
- Department of Epidemiology and Public Health, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
- Center for Cohort Studies, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Yoichiro Hirakawa
- Department of Epidemiology and Public Health, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Daigo Yoshida
- Department of Epidemiology and Public Health, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
- Center for Cohort Studies, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Hiro Kishimoto
- Department of Epidemiology and Public Health, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Takanari Kitazono
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
- Center for Cohort Studies, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Yutaka Kiyohara
- Hisayama Research Institute for Lifestyle Diseases, Fukuoka, Japan
| | - Toshiharu Ninomiya
- Department of Epidemiology and Public Health, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
- Center for Cohort Studies, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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Wang X, Wang Y, Patel UD, Barnhart HX, Li Z, Li H, Wang C, Zhao X, Liu L, Wang Y, Laskowitz DT. Comparison of Associations of Reduced Estimated Glomerular Filtration Rate With Stroke Outcomes Between Hypertension and No Hypertension. Stroke 2017; 48:1691-1694. [PMID: 28438908 DOI: 10.1161/strokeaha.117.016864] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Revised: 03/06/2017] [Accepted: 03/08/2017] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE We compared the association of low estimated glomerular filtration rate (eGFR) with stroke outcomes among patients with hypertension and without hypertension. METHODS We used the China stroke registry to identify patients on discharge with the diagnosis of stroke in 2012 and 2013. Low eGFR was defined as <60 mL/min/1.73 m2. Multivariable analysis was used to evaluate the association of low eGFR with 1-year all-cause mortality, recurrent stroke, poor functional outcome defined as 3 to 6 in modified Rankin Scale (mRS), and ordinal mRS, where the interaction of eGFR category and hypertension status was investigated. RESULTS Of 5082 patients without hypertension, 221 patients (4.4%) had low eGFR, as compared with 1378 patients (8.6%) previously diagnosed with hypertension. In patients without hypertension, the adjusted odds ratios with 95% confidence interval of low eGFR was 1.88 (1.23-2.88) for all-cause mortality, 1.36 (0.66-2.83) for recurrent stroke, 2.14 (1.45-3.16) for poor functional outcome, and 2.07 (1.58-2.70) for ordinal mRS. In patients with hypertension, low eGFR was associated with all stroke outcomes: 1.80 (1.50-2.16) for all-cause mortality, 1.52 (1.20-1.91) for recurrent stroke, 1.30 (1.11-1.52) for poor functional outcome, and 1.31 (1.18-1.46) for ordinal mRS. The significant interaction between eGFR categories and hypertension was only found for poor functional outcome (P=0.046) and ordinal mRS (P=0.002). CONCLUSIONS Effect of low eGFR on all-cause mortality and recurrent stroke in patients without hypertension was not significantly different from that in patients with hypertension, but low-eGFR patients without hypertension had a higher risk of stroke-related disability than those with hypertension.
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Affiliation(s)
- Xianwei Wang
- From the Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, China (X.W., Yilong Wang, Z.L., H.L., C.W., X.Z., L.L., Yongjun Wang); Department of Neurology, Duke University Medical Center, Durham, NC (X.W., D.T.L.); and Department of Medicine (U.D.P.) and Department of Biostatistics and Bioinformatics (H.X.B.), Duke University, Durham, NC
| | - Yilong Wang
- From the Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, China (X.W., Yilong Wang, Z.L., H.L., C.W., X.Z., L.L., Yongjun Wang); Department of Neurology, Duke University Medical Center, Durham, NC (X.W., D.T.L.); and Department of Medicine (U.D.P.) and Department of Biostatistics and Bioinformatics (H.X.B.), Duke University, Durham, NC
| | - Uptal D Patel
- From the Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, China (X.W., Yilong Wang, Z.L., H.L., C.W., X.Z., L.L., Yongjun Wang); Department of Neurology, Duke University Medical Center, Durham, NC (X.W., D.T.L.); and Department of Medicine (U.D.P.) and Department of Biostatistics and Bioinformatics (H.X.B.), Duke University, Durham, NC
| | - Huiman Xie Barnhart
- From the Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, China (X.W., Yilong Wang, Z.L., H.L., C.W., X.Z., L.L., Yongjun Wang); Department of Neurology, Duke University Medical Center, Durham, NC (X.W., D.T.L.); and Department of Medicine (U.D.P.) and Department of Biostatistics and Bioinformatics (H.X.B.), Duke University, Durham, NC
| | - Zixiao Li
- From the Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, China (X.W., Yilong Wang, Z.L., H.L., C.W., X.Z., L.L., Yongjun Wang); Department of Neurology, Duke University Medical Center, Durham, NC (X.W., D.T.L.); and Department of Medicine (U.D.P.) and Department of Biostatistics and Bioinformatics (H.X.B.), Duke University, Durham, NC
| | - Hao Li
- From the Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, China (X.W., Yilong Wang, Z.L., H.L., C.W., X.Z., L.L., Yongjun Wang); Department of Neurology, Duke University Medical Center, Durham, NC (X.W., D.T.L.); and Department of Medicine (U.D.P.) and Department of Biostatistics and Bioinformatics (H.X.B.), Duke University, Durham, NC
| | - Chunxue Wang
- From the Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, China (X.W., Yilong Wang, Z.L., H.L., C.W., X.Z., L.L., Yongjun Wang); Department of Neurology, Duke University Medical Center, Durham, NC (X.W., D.T.L.); and Department of Medicine (U.D.P.) and Department of Biostatistics and Bioinformatics (H.X.B.), Duke University, Durham, NC
| | - Xingquan Zhao
- From the Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, China (X.W., Yilong Wang, Z.L., H.L., C.W., X.Z., L.L., Yongjun Wang); Department of Neurology, Duke University Medical Center, Durham, NC (X.W., D.T.L.); and Department of Medicine (U.D.P.) and Department of Biostatistics and Bioinformatics (H.X.B.), Duke University, Durham, NC
| | - Liping Liu
- From the Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, China (X.W., Yilong Wang, Z.L., H.L., C.W., X.Z., L.L., Yongjun Wang); Department of Neurology, Duke University Medical Center, Durham, NC (X.W., D.T.L.); and Department of Medicine (U.D.P.) and Department of Biostatistics and Bioinformatics (H.X.B.), Duke University, Durham, NC
| | - Yongjun Wang
- From the Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, China (X.W., Yilong Wang, Z.L., H.L., C.W., X.Z., L.L., Yongjun Wang); Department of Neurology, Duke University Medical Center, Durham, NC (X.W., D.T.L.); and Department of Medicine (U.D.P.) and Department of Biostatistics and Bioinformatics (H.X.B.), Duke University, Durham, NC.
| | - Daniel T Laskowitz
- From the Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, China (X.W., Yilong Wang, Z.L., H.L., C.W., X.Z., L.L., Yongjun Wang); Department of Neurology, Duke University Medical Center, Durham, NC (X.W., D.T.L.); and Department of Medicine (U.D.P.) and Department of Biostatistics and Bioinformatics (H.X.B.), Duke University, Durham, NC.
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WATANABE S. Low-protein diet for the prevention of renal failure. PROCEEDINGS OF THE JAPAN ACADEMY. SERIES B, PHYSICAL AND BIOLOGICAL SCIENCES 2017; 93:1-9. [PMID: 28077806 PMCID: PMC5406621 DOI: 10.2183/pjab.93.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Accepted: 10/27/2016] [Indexed: 06/06/2023]
Abstract
The prevalence of chronic kidney disease (CKD) is estimated to be 8-16% worldwide, and it is increasing. CKD is a risk factor for heart attack and stroke, and it can progress to kidney failure requiring dialysis or transplantation. Recently, diabetic nephropathy has become the most common cause of CKD. In Japan, the cumulative probability of requiring hemodialysis by the age 80 years is 1/50 in males and 1/100 in females. The number of patients under hemodialysis in Japan exceeded 320,000 in 2014, among which 38,000 were newcomers and 27,000 died.The annual medical costs of hemodialysis are 1.25 trillion yen in Japan, representing 4% of the total national medical expenditures in 2014. A low-protein diet (less than 0.5 g/kg b.wt.) is a very effective intervention. Low-protein rice (1/10 to 1/25 of the normal protein contents) is helpful to control the consumption of proteins, decreasing at the same time the intake of potassium and phosphate.Protein restriction is indicated as soon as the eGFR becomes lower than 60 ml/min/1.73 m2 body surface, in order, to slow disease progression. The newly developed low-protein Indica rice is expected to help many CKD patients in China and Southeast Asia.
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Affiliation(s)
- Shaw WATANABE
- President, Life Science Promoting Association, Tokyo, Japan
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25
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Low glomerular filtration rate and risk of myocardial infarction: A systematic review and meta-analysis. Int J Cardiol 2016; 223:401-409. [PMID: 27543718 DOI: 10.1016/j.ijcard.2016.07.175] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2016] [Accepted: 07/27/2016] [Indexed: 11/23/2022]
Abstract
BACKGROUND Chronic kidney disease is increasing in prevalence. The association between low baseline estimated glomerular filtration rate (eGFR) and future myocardial infarction has not been comprehensively assessed. METHODS A systematic review and meta-analysis of observational studies evaluating the risk for future myocardial infarction associated with eGFR <60 and 60-90ml/min/1.73m2 was completed. Data sources included PubMed, EMBASE, and the Cochrane Library. Included studies were required to have prospectively collected data, followed subjects for at least 6months, and reported baseline eGFR levels and the multivariable-adjusted relative risk for future myocardial infarction. A random effects model was used and subgroup analyses were conducted. RESULTS 26 publications representing 41 observational cohorts were selected. In total, 1,986,850 participants with more than 35,752 documented myocardial infarctions (follow-up range: 9months to ~20years) were evaluated. eGFR <60ml/min/1.73m2 was associated with a relative risk of 1.52 (95% confidence interval 1.39-1.67; p<0.00001) while eGFR 60-90ml/min/1.73m2 was associated with a relative risk of 1.21 (1.09-1.34; p=0.0002) for myocardial infarction. Significant heterogeneity existed among both eGFR groups. Subgroup analysis found a further increase in risk for myocardial infarction as eGFR declined from 30 to 60 to <30ml/min/1.73m2 (1.40, 95% confidence interval, 1.21-1.61 vs.1.94, 95% confidence interval, 1.51-2.50; p=0.03). CONCLUSIONS Decreased baseline eGFR is independently associated with increased future myocardial infarction, and the risk increases with advanced renal insufficiency. Clinicians should be wary of acute coronary syndromes in patients with CKD.
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Nakata T, Hashimoto A, Moroi M, Tamaki N, Nishimura T, Hasebe N, Kikuchi K, Nakatani E. Sudden death prediction by C-reactive protein, electrocardiographic findings, and myocardial fatty acid uptake in haemodialysis patients: analysis of a multicentre prospective cohort sub-study. Eur Heart J Cardiovasc Imaging 2015; 17:1394-1404. [DOI: 10.1093/ehjci/jev294] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2015] [Accepted: 10/11/2015] [Indexed: 11/14/2022] Open
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Smoking increases the risk of all-cause and cardiovascular mortality in patients with chronic kidney disease. Kidney Int 2015. [DOI: 10.1038/ki.2015.212] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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28
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Associations between increased renal resistive index and cardiovascular events. J Med Ultrason (2001) 2015; 43:263-70. [PMID: 27033870 DOI: 10.1007/s10396-015-0680-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2015] [Accepted: 10/01/2015] [Indexed: 01/14/2023]
Abstract
BACKGROUND AND PURPOSE Chronic kidney disease is a risk factor for cardiovascular disease (CVD). Renal resistive index (RI) measured by Doppler ultrasonography is associated with renal impairment. We investigated the relationship between RI and cardiac function, and evaluated the utility of RI for predicting cardiac events in patients with CVD. METHODS AND RESULTS Renal Doppler ultrasonography and echocardiography were performed in a total of 452 patients with CVD. Correlations of RI with serum creatinine and estimated glomerular filtration rate (eGFR) were significant but not strong (r = 0.37, p < 0.001; r = -0.42, p < 0.001, respectively). RI correlated positively with age, left atrial volume index, left ventricular mass index, and early transmitral velocity to mitral annular early diastolic velocity (e') ratio (E/e'), and showed significant negative correlations with e' and diastolic blood pressure. Between two subgroups-112 patients hospitalized with cardiovascular events (Group A) and 200 age- and eGFR-matched controls (Group B)-RI was significantly higher in Group A than in Group B, although age and eGFR were similar. CONCLUSIONS RI reflects the impairment of intrarenal hemodynamics that cannot be adequately elucidated by eGFR alone. Assessment of renal RI may be useful in conjunction with prognostic estimates for patients with CVD.
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Kokubo Y, Iwashima Y. Higher blood pressure as a risk factor for diseases other than stroke and ischemic heart disease. Hypertension 2015; 66:254-9. [PMID: 26077565 DOI: 10.1161/hypertensionaha.115.03480] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2015] [Accepted: 05/25/2015] [Indexed: 01/01/2023]
Affiliation(s)
- Yoshihiro Kokubo
- From the Department of Preventive Cardiology (Y.K.) and Division of Hypertension and Nephrology, Department of Medicine (Y.I.), National Cerebral and Cardiovascular Center, Suita, Japan.
| | - Yoshio Iwashima
- From the Department of Preventive Cardiology (Y.K.) and Division of Hypertension and Nephrology, Department of Medicine (Y.I.), National Cerebral and Cardiovascular Center, Suita, Japan
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Gu X, Fang X, Hua Y, Tang Z, Ji X, Guan S, Wu X, Liu H, Liu B, Wang C, Zhang Z. Association Between Kidney Dysfunction and Carotid Atherosclerosis in Community-Based Older Adults in China. Angiology 2015; 67:252-8. [PMID: 25985787 DOI: 10.1177/0003319715586505] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
We investigated the association between kidney dysfunction and carotid atherosclerosis in community-based older adults. This study consisted of 1257 participants, aged 55 years and older and free of cardiovascular disease. Kidney dysfunction was classified as mild, moderate, and severe (estimated glomerular filtration rate, 45-59, 30-44, and <30 mL/min/1.73 m2, respectively). We found that the mean common carotid artery intima–media thickness (CCA-IMT) progressively increased with decrement in kidney function ( P < .001). Even mild kidney dysfunction was significantly associated with CCA-IMT thickening (CCA-IMT ≥1.0 mm; odds ratio [OR] 1.52; 95% confidence interval [CI] 1.16-1.99) compared to normal kidney function. A significantly increased presence of heterogeneous plaque was observed in relation to decreased kidney function ( P for trend = .011), that is, even a mild kidney dysfunction was a potential independent risk factor for heterogeneous plaque (OR 1.43; 95% CI 1.04-1.98). Mild kidney dysfunction may be a predictor of early or accelerated carotid atherosclerosis in older adults.
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Affiliation(s)
- Xiang Gu
- Evidence-Based Medical Center, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Xianghua Fang
- Evidence-Based Medical Center, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Yang Hua
- Department of Vascular Ultrasonography, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Zhe Tang
- Evidence-Based Medical Center, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Xunming Ji
- Department of Neurological Surgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Shaochen Guan
- Evidence-Based Medical Center, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Xiaoguang Wu
- Evidence-Based Medical Center, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Hongjun Liu
- Evidence-Based Medical Center, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Beibei Liu
- Department of Vascular Ultrasonography, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Chunxiu Wang
- Evidence-Based Medical Center, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Zhongying Zhang
- Evidence-Based Medical Center, Xuanwu Hospital, Capital Medical University, Beijing, China
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Sai E, Shimada K, Miyauchi K, Masaki Y, Kojima T, Miyazaki T, Kurata T, Ogita M, Tsuboi S, Yoshihara T, Miyazaki T, Ohsaka A, Daida H. Increased cystatin C levels as a risk factor of cardiovascular events in patients with preserved estimated glomerular filtration rate after elective percutaneous coronary intervention with drug-eluting stents. Heart Vessels 2015; 31:694-701. [PMID: 25863806 DOI: 10.1007/s00380-015-0674-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2014] [Accepted: 04/01/2015] [Indexed: 11/29/2022]
Abstract
Chronic kidney disease (CKD) is an important risk factor for coronary artery disease (CAD) and cardiovascular events. Cystatin C (CysC) has been proposed as a sensitive marker for CKD. However, the predictive value of CysC for cardiovascular events in CAD patients with preserved estimated glomerular filtration rate (eGFR) is unclear. We enrolled 277 consecutive patients undergoing elective percutaneous coronary intervention with sirolimus-eluting stents (SES). Patients with an eGFR ≤60 ml/min/1.73 m(2) were excluded. Serum CysC levels were measured immediately before SES implantation. Major adverse cardiac and cerebrovascular events (MACCE) were defined as cardiovascular death, acute coronary syndrome, stroke, and hospitalization because of congestive heart failure. After a median follow-up of 63 months, 29 patients had MACCE. The subjects were divided into 2 groups based on median serum CysC levels and eGFR (0.637 mg/L and 72.43 ml/min/1.73 m(2), respectively). Kaplan-Meier curves showed that the high CysC group had a significantly higher occurrence of MACCE than the low CysC group (p = 0.006), although a low level of eGFR was not significantly associated with an increased risk for occurrence of MACCE. Multivariate analysis revealed that serum CysC levels were an independent predictor of MACCE [hazards ratio: 1.30 per 0.1 mg/L (1.01-1.63), p = 0.038]. These data suggested that serum CysC level is an independent predictor of MACCE, even in patients with preserved eGFR after elective SES implantation.
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Affiliation(s)
- Eiryu Sai
- Department of Cardiology, Juntendo University Graduate School of Medicine, 2-1-1 Hongo Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Kazunori Shimada
- Department of Cardiology, Juntendo University Graduate School of Medicine, 2-1-1 Hongo Bunkyo-ku, Tokyo, 113-8421, Japan.
| | - Katsumi Miyauchi
- Department of Cardiology, Juntendo University Graduate School of Medicine, 2-1-1 Hongo Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Yoshiyuki Masaki
- Department of Cardiology, Juntendo University Graduate School of Medicine, 2-1-1 Hongo Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Takahiko Kojima
- Department of Cardiology, Juntendo University Graduate School of Medicine, 2-1-1 Hongo Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Tadashi Miyazaki
- Department of Cardiology, Juntendo University Graduate School of Medicine, 2-1-1 Hongo Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Takeshi Kurata
- Department of Cardiology, Juntendo University Graduate School of Medicine, 2-1-1 Hongo Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Manabu Ogita
- Department of Cardiology, Juntendo University Graduate School of Medicine, 2-1-1 Hongo Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Shuta Tsuboi
- Department of Cardiology, Juntendo University Graduate School of Medicine, 2-1-1 Hongo Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Takuma Yoshihara
- Department of Cardiology, Juntendo University Graduate School of Medicine, 2-1-1 Hongo Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Tetsuro Miyazaki
- Department of Cardiology, Juntendo University Graduate School of Medicine, 2-1-1 Hongo Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Akimichi Ohsaka
- Department of Transfusion Medicine and Stem Cell Regulation, Juntendo University School of Medicine, 2-1-1 Hongo Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Hiroyuki Daida
- Department of Cardiology, Juntendo University Graduate School of Medicine, 2-1-1 Hongo Bunkyo-ku, Tokyo, 113-8421, Japan
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Shimizu R, Torii H, Yasuda D, Hiraoka Y, Kitada N, Hashida T, Yoshimoto A, Kita T, Kume N. Serum Lipid Goal Attainment in Chronic Kidney Disease (CKD) Patients under the Japan Atherosclerosis Society (JAS) 2012 Guidelines. J Atheroscler Thromb 2015; 22:949-57. [PMID: 25843151 DOI: 10.5551/jat.29165] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
AIM According to the Japan Atherosclerosis Society 2012 guidelines (JAS2012-GL), chronic kidney disease (CKD) has newly been added to the high-risk group in terms of atherosclerotic cardiovascular diseases. We therefore explored the lipid target level achievement rates under the JAS2012-GL in real-world clinical practice. METHODS We retrospectively reviewed the medical charts of patients who were hospitalized at the Nephrology Department at Kobe City Medical Center General Hospital in the period from April 1, 2012 to May 31, 2013 and explored the serum lipid target level achievement rates. Patients without lipid data or those undergoing regular dialysis because of chronic renal failure were excluded. In this study, the CKD group (CKD-G) did not include CKD patients under secondary prevention for coronary heart disease (CHD) or diabetes mellitus (DM). RESULTS The CKD-G included 146 (81.1%) of the 180 enrolled patients. According to the JAS2012-GL, 100% of the CKD-G patients were categorized into the high-risk group, although only 12.1% of the CKD-G subjects were at high risk according to the JAS2007-GL. Under the JAS2012-GL, the LDL cholesterol (LDL-C) and non-HDL cholesterol (non-HDL-C) target level achievement rates for CKD-G were 71.4% and 68.1%, respectively. According to the JAS2007-GL, these rates were 81.3% and 79.1%, respectively, and, under both guidelines, these rates were 71.7% and 72.1% for primary prevention DM and 66.7% and 66.7% for CHD, respectively. CONCLUSIONS After the revision of the JAS-GL in 2012, the LDL-C and non-HDL-C target level achievement rates for CKD-G were reduced by approximately 10%; however, they remained similar to those for DM and higher than those for CHD.
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Affiliation(s)
- Rumiko Shimizu
- Division of Clinical Pharmacy, Faculty of Pharmaceutical Sciences, Kobe Gakuin University
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Ishimitsu T, Ishikawa Y, Honda T. [Hypertension: The Points of Management of Hypertension for All Physicians--Based on the JSH 2014 Hypertension Guidelines--.Topics; III. Key points of antihypertensive treatment-life-style modification and drug therapy]. NIHON NAIKA GAKKAI ZASSHI. THE JOURNAL OF THE JAPANESE SOCIETY OF INTERNAL MEDICINE 2015; 104:218-231. [PMID: 26571700 DOI: 10.2169/naika.104.218] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
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Tsutsui M, Tanimoto A, Tamura M, Mukae H, Yanagihara N, Shimokawa H, Otsuji Y. Significance of nitric oxide synthases: Lessons from triple nitric oxide synthases null mice. J Pharmacol Sci 2014; 127:42-52. [PMID: 25704017 DOI: 10.1016/j.jphs.2014.10.002] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2014] [Revised: 10/17/2014] [Accepted: 10/23/2014] [Indexed: 01/22/2023] Open
Abstract
Nitric oxide (NO) is synthesized by three distinct NO synthases (neuronal, inducible, and endothelial NOSs), all of which are expressed in almost all tissues and organs in humans. The regulatory roles of NOSs in vivo have been investigated in pharmacological studies with non-selective NOS inhibitors. However, the specificity of the inhibitors continues to be an issue of debate, and the authentic significance of NOSs is still poorly understood. To address this issue, we generated mice in which all three NOS genes are completely disrupted. The triple NOSs null mice exhibited cardiovascular abnormalities, including hypertension, arteriosclerosis, myocardial infarction, cardiac hypertrophy, diastolic heart failure, and reduced EDHF responses, with a shorter survival. The triple NOSs null mice also displayed metabolic abnormalities, including metabolic syndrome and high-fat diet-induced severe dyslipidemia. Furthermore, the triple NOSs null mice showed renal abnormalities (nephrogenic diabetes insipidus and pathological renal remodeling), lung abnormalities (accelerated pulmonary fibrosis), and bone abnormalities (increased bone mineral density and bone turnover). These results provide evidence that NOSs play pivotal roles in the pathogenesis of a wide variety of disorders. This review summarizes the latest knowledge on the significance of NOSs in vivo, based on lessons learned from experiments with our triple mutant model.
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Affiliation(s)
- Masato Tsutsui
- Department of Pharmacology, Graduate School of Medicine, University of the Ryukyus, 207 Uehara, Nishihara, Okinawa 903-0215, Japan.
| | - Akihide Tanimoto
- Department of Pathology, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima 890-8544, Japan
| | - Masahito Tamura
- Second Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health, Kitakyushu 807-8555, Japan
| | - Hiroshi Mukae
- Department of Respiratory Medicine, School of Medicine, University of Occupational and Environmental Health, Kitakyushu 807-8555, Japan
| | - Nobuyuki Yanagihara
- Department of Pharmacology, School of Medicine, University of Occupational and Environmental Health, Kitakyushu 807-8555, Japan
| | - Hiroaki Shimokawa
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai 980-8574, Japan
| | - Yutaka Otsuji
- Second Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health, Kitakyushu 807-8555, Japan
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Uchida T, Furuno Y, Tanimoto A, Toyohira Y, Arakaki K, Kina-Tanada M, Kubota H, Sakanashi M, Matsuzaki T, Noguchi K, Nakasone J, Igarashi T, Ueno S, Matsushita M, Ishiuchi S, Masuzaki H, Ohya Y, Yanagihara N, Shimokawa H, Otsuji Y, Tamura M, Tsutsui M. Development of an experimentally useful model of acute myocardial infarction: 2/3 nephrectomized triple nitric oxide synthases-deficient mouse. J Mol Cell Cardiol 2014; 77:29-41. [PMID: 25265498 DOI: 10.1016/j.yjmcc.2014.09.021] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2014] [Revised: 09/09/2014] [Accepted: 09/17/2014] [Indexed: 01/27/2023]
Abstract
We investigated the effect of subtotal nephrectomy on the incidence of acute myocardial infarction (AMI) in mice deficient in all three nitric oxide synthases (NOSs). Two-thirds nephrectomy (NX) was performed on male triple NOSs(-/-) mice. The 2/3NX caused sudden cardiac death due to AMI in the triple NOSs(-/-) mice as early as 4months after the surgery. The 2/3NX triple NOSs(-/-) mice exhibited electrocardiographic ST-segment elevation, reduced heart rate variability, echocardiographic regional wall motion abnormality, and accelerated coronary arteriosclerotic lesion formation. Cardiovascular risk factors (hypertension, hypercholesterolemia, and hyperglycemia), an increased number of circulating bone marrow-derived vascular smooth muscle cell (VSMC) progenitor cells (a pro-arteriosclerotic factor), and cardiac up-regulation of stromal cell-derived factor (SDF)-1α (a chemotactic factor of the progenitor cells) were noted in the 2/3NX triple NOSs(-/-) mice and were associated with significant increases in plasma angiotensin II levels (a marker of renin-angiotensin system activation) and urinary 8-isoprostane levels (a marker of oxidative stress). Importantly, combined treatment with a clinical dosage of an angiotensin II type 1 receptor blocker, irbesartan, and a calcium channel antagonist, amlodipine, markedly prevented coronary arteriosclerotic lesion formation and the incidence of AMI and improved the prognosis of those mice, along with ameliorating all those pro-arteriosclerotic parameters. The 2/3NX triple NOSs(-/-) mouse is a new experimentally useful model of AMI. Renin-angiotensin system activation, oxidative stress, cardiovascular risk factors, and SDF-1α-induced recruitment of bone marrow-derived VSMC progenitor cells appear to be involved in the pathogenesis of AMI in this model.
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Affiliation(s)
- Taro Uchida
- Department of Pharmacology, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
| | - Yumi Furuno
- Second Department of Internal Medicine, School of Medicine, Institute of Industrial Ecological Sciences, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Akihide Tanimoto
- Department of Pathology, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Yumiko Toyohira
- Department of Pharmacology, School of Medicine, Institute of Industrial Ecological Sciences, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Kumiko Arakaki
- Third Department of Internal Medicine, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
| | - Mika Kina-Tanada
- Department of Pharmacology, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
| | - Haruaki Kubota
- Department of Pharmacology, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
| | - Mayuko Sakanashi
- Department of Pharmacology, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
| | - Toshihiro Matsuzaki
- Department of Pharmacology, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
| | - Katsuhiko Noguchi
- Department of Pharmacology, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
| | - Junko Nakasone
- Department of Pharmacology, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
| | - Tomonori Igarashi
- Department of Occupational Toxicology, Institute of Industrial Ecological Sciences, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Susumu Ueno
- Department of Occupational Toxicology, Institute of Industrial Ecological Sciences, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Masayuki Matsushita
- Department of Physiology, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
| | - Shogo Ishiuchi
- Department of Neurosurgery, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
| | - Hiroaki Masuzaki
- Second Department of Internal Medicine, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
| | - Yusuke Ohya
- Third Department of Internal Medicine, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
| | - Nobuyuki Yanagihara
- Department of Pharmacology, School of Medicine, Institute of Industrial Ecological Sciences, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Hiroaki Shimokawa
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Yutaka Otsuji
- Second Department of Internal Medicine, School of Medicine, Institute of Industrial Ecological Sciences, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Masahito Tamura
- Second Department of Internal Medicine, School of Medicine, Institute of Industrial Ecological Sciences, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Masato Tsutsui
- Department of Pharmacology, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan.
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Takeuchi T, Nemoto KI, Takahashi O, Urayama KY, Deshpande GA, Izumo H. Comparison of cardiovascular disease risk associated with 3 lipid measures in Japanese adults. J Clin Lipidol 2014; 8:501-9. [DOI: 10.1016/j.jacl.2014.06.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2014] [Revised: 05/19/2014] [Accepted: 06/09/2014] [Indexed: 01/19/2023]
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Toyoda K, Ninomiya T. Stroke and cerebrovascular diseases in patients with chronic kidney disease. Lancet Neurol 2014; 13:823-33. [DOI: 10.1016/s1474-4422(14)70026-2] [Citation(s) in RCA: 176] [Impact Index Per Article: 17.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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Bao YS, Jia XB, Ji Y, Yang J, Zhao SL, Na SP. High prevalence and risk factors for kidney dysfunction in patients with atherosclerotic cardio-cerebrovascular disease. QJM 2014; 107:443-9. [PMID: 24448380 DOI: 10.1093/qjmed/hcu007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Patients with atherosclerotic cardio-cerebrovascular disease are at high risk of kidney dysfunction because of the overlap of several risk factors. The purpose of this study is to examine the prevalence and characteristics and risk factors for kidney dysfunction in the cardio-cerebrovascular disease population. METHODS Renal functions of 1012 patients with the cardio-cerebrovascular disease were evaluated with the purpose of evaluating characteristics of the incidence, risk factors for kidney dysfunction in the cardio-cerebrovascular disease population. RESULTS In the univariate analysis, the major risk factors for kidney dysfunction in the patients with the cardio-cerebrovascular disease were age, gender, hypertension, diabetes mellitus, dyslipidemia and serum uric acid. In the patients with both hypertension and diabetes mellitus the percentages of significantly decreased eGFR were 25.6%. Results of multivariable analysis showed that diabetes mellitus (odds ratio (OR) 1.609, 95% confidence intervals (CI) 1.08-2.398, P = 0.019), hypertension (OR 1.547, 95% CI 1.049-2.281, P = 0.028) and serum uric acid (OR 1.009, 95% CI 1.007-1.010, P < 0.001) were independent risk factors for reduced kidney function. CONCLUSIONS In the context of the cardio-cerebrovascular disease kidney dysfunction is common and has a high prevalence. Patients with both cardio-cerebrovascular disease and kidney dysfunction at any stage should be recognized as high-risk population.
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Affiliation(s)
- Y-S Bao
- From the Department of Nephrology, The First Affiliated Hospital of Harbin Medical University, Harbin Medical University, Harbin 150001, China
| | - X-B Jia
- From the Department of Nephrology, The First Affiliated Hospital of Harbin Medical University, Harbin Medical University, Harbin 150001, China
| | - Y Ji
- From the Department of Nephrology, The First Affiliated Hospital of Harbin Medical University, Harbin Medical University, Harbin 150001, China
| | - J Yang
- From the Department of Nephrology, The First Affiliated Hospital of Harbin Medical University, Harbin Medical University, Harbin 150001, China
| | - S-L Zhao
- From the Department of Nephrology, The First Affiliated Hospital of Harbin Medical University, Harbin Medical University, Harbin 150001, China
| | - S-P Na
- From the Department of Nephrology, The First Affiliated Hospital of Harbin Medical University, Harbin Medical University, Harbin 150001, China
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Joki N, Hase H, Kawano Y, Nakamura S, Nakajima K, Hatta T, Nishimura S, Moroi M, Nakagawa S, Kasai T, Kusuoka H, Takeishi Y, Momose M, Takehana K, Nanasato M, Yoda S, Nishina H, Matsumoto N, Nishimura T. Myocardial perfusion imaging for predicting cardiac events in Japanese patients with advanced chronic kidney disease: 1-year interim report of the J-ACCESS 3 investigation. Eur J Nucl Med Mol Imaging 2014; 41:1701-9. [PMID: 24827603 DOI: 10.1007/s00259-014-2781-z] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2013] [Accepted: 04/03/2014] [Indexed: 12/17/2022]
Abstract
PURPOSE Whether myocardial perfusion imaging (MPI) can predict cardiac events in patients with advanced conservative chronic kidney disease (CKD) remains unclear. METHODS The present multicenter prospective cohort study aimed to clarify the ability of MPI to predict cardiac events in 529 patients with CKD and estimated glomerular filtration rates (eGFR) < 50 ml/min per 1.73(2) without a definitive diagnosis of coronary artery disease. All patients were assessed by stress-rest MPI with (99m)Tc-tetrofosmin and analyzed using summed defect scores and QGS software. Cardiac events were analyzed 1 year after registration. RESULTS Myocardial perfusion abnormalities defined as summed stress score (SSS) ≥4 and ≥8 were identified in 19 and 7 % of patients, respectively. At the end of the 1-year follow-up, 33 (6.2 %) cardiac events had occurred that included cardiac death, sudden death, nonfatal myocardial infarction, and hospitalization due to heart failure. The event-free rates at that time were 0.95, 0.90, and 0.81 for groups with SSS 0-3, 4-7, and ≥8, respectively (p = 0.0009). Thus, patients with abnormal SSS had a higher incidence of cardiac events. Multivariate Cox regression analysis showed that SSS significantly impacts the prediction of cardiac events independently of eGFR and left ventricular ejection fraction. CONCLUSION MPI would be useful to stratify patients with advanced conservative CKD who are at high risk of cardiac events without adversely affecting damaged kidneys.
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Affiliation(s)
- Nobuhiko Joki
- Department of Nephrology, Toho University Ohashi Medical Center, Tokyo, Japan
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Chapter 6. Hypertension associated with organ damage. Hypertens Res 2014. [DOI: 10.1038/hr.2014.9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Chapter 1. Epidemiology of hypertension. Hypertens Res 2014. [DOI: 10.1038/hr.2014.4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Li R, Hao P, Chen Y, Zhang Y. Association of cystatin C level and cardiovascular prognosis for patients with preexisting coronary heart disease: a meta-analysis. CHINESE SCIENCE BULLETIN-CHINESE 2014. [DOI: 10.1007/s11434-013-0071-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Sonoda M, Shoji T, Kimoto E, Okute Y, Shima H, Naganuma T, Motoyama K, Morioka T, Mori K, Fukumoto S, Shioi A, Koyama H, Emoto M, Inaba M. Kidney Function, Cholesterol Absorption and Remnant Lipoprotein Accumulation in Patients with Diabetes Mellitus. J Atheroscler Thromb 2014; 21:346-54. [DOI: 10.5551/jat.20594] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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Hojs Fabjan T, Hojs R. Stroke and renal dysfunction. Eur J Intern Med 2014; 25:18-24. [PMID: 24070520 DOI: 10.1016/j.ejim.2013.08.710] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2013] [Revised: 08/28/2013] [Accepted: 08/30/2013] [Indexed: 10/26/2022]
Abstract
Stroke is the most frequent neurological disease and represents a continuously evolving medical and social problem. Chronic kidney disease (CKD) is also an important worldwide public health problem. Renal dysfunction carries a substantial risk of cardiovascular morbidity and mortality and an independent, graded association between renal function and cardiovascular events was found. In the last 15years the link between CKD and cerebrovascular disease has become more apparent. Patients with end stage renal disease treated with maintenance hemodialysis have a much higher incidence of stroke than the general population and stroke is one of the major causes of death in these patients. Nowadays ischemic subtype of stroke is present in approximately 70% of dialysis patients. In population based studies conflicting results have been reported about the association between stroke and CKD before replacement therapy. However, in high risk patients, defined by the presence of either cardiovascular disease or cardiovascular risk factors, different stages of CKD are clearly associated with subsequent stroke. In patients with stroke the exact prevalence of renal dysfunction is not known. Reported prevalence from a few published studies is up to 38% and it is higher than that in age-matched control groups. Furthermore, in patients suffering from stroke renal dysfunction is associated with short and long term mortality. The most effective treatment of stroke in patients with CKD is not known and further studies are needed.
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Affiliation(s)
- Tanja Hojs Fabjan
- Dept. of Neurology, University Clinical Centre Maribor, Maribor, Slovenia; University of Maribor, Faculty of Medicine, Maribor, Slovenia
| | - Radovan Hojs
- Clinic for Internal Medicine, Dept. of Nephrology, University Clinical Centre Maribor, Maribor, Slovenia; University of Maribor, Faculty of Medicine, Maribor, Slovenia.
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Micozkadioglu H, Ozelsancak R, Giray S, Arlier Z. CKD is associated with recurrent ischemia but not with hemorrhagic transformation in acute ischemic stroke patients. Ren Fail 2013; 36:217-21. [PMID: 24168712 DOI: 10.3109/0886022x.2013.846794] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND We investigated the associations of Recurrent Ischemic Stroke (RIS) and Hemorrhagic Transformation (HT) with CKD in acute ischemic stroke patients. METHOD The subjects were 160 patients, divided into two groups: with eGFR <60 mL/min/1.73 m2 (CKD), with eGFR ≥60 mL/min/1.73 m2 (without CKD). RESULTS Subjects having DM (p = 0.018), CKD (p = 0.025) and treated with ACEI/ARB (p = 0.039) revealed association with RIS. Regression analysis disclosed only CKD (p = 0.04). Carotid artery stenosis (p = 0.030) and serum calcium levels (p = 0.013) showed significant association with HT. CONCLUSION Our results disclosed that CKD could be a risk factor for RIS. There is no relation between CKD and HT.
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Akaishi M, Hiroe M, Hada Y, Suzuki M, Tsubakihara Y, Akizawa T. Effect of anemia correction to the modestly high hemoglobin level in patients with chronic kidney disease on left ventricular hypertrophy. J Cardiol 2013; 62:249-56. [DOI: 10.1016/j.jjcc.2013.04.008] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2012] [Revised: 04/15/2013] [Accepted: 04/22/2013] [Indexed: 01/12/2023]
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Bao YS, Song LT, Zhong D, Song AX, Jia XB, Liu RC, Xie RJ, Na SP. Epidemiology and risk factors for chronic kidney disease in patients with ischaemic stroke. Eur J Clin Invest 2013; 43:829-35. [PMID: 23869408 DOI: 10.1111/eci.12113] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2012] [Accepted: 04/30/2013] [Indexed: 12/15/2022]
Abstract
BACKGROUND There is growing evidence for an association between chronic renal disease (CKD) and adverse cerebrovascular events because of the overlap of several risk factors. The purpose of this study is to examine the epidemiology of CKD and the characteristics of risk factors for CKD in the population with ischaemic stroke. METHODS This retrospective study included 571 patients with ischaemic stroke. Estimated glomerular filtration rate (eGFR) was calculated by the Modification of Diet in Renal Disease (MDRD) study equation. Renal function was assessed according to the Kidney Disease Outcomes Quality Initiative (K/DOQI)-CKD classification. RESULTS Study demonstrated that the major factors associated with CKD in the ischaemic stroke patients were age, diabetes mellitus, hypertension, systolic blood pressure, LDL cholesterol and serum uric acid. Diabetes mellitus (OR 4·146, 95% CI 1·047-16·418, P = 0·043), hypertension and diabetes mellitus (OR 3·574, 95% CI 1·248-10·234, P = 0·018), serum uric acid (OR 1·010, 95% CI 1·006-1·013, P < 0·001) and LDL cholesterol (OR 1·431, 95% CI 1·063-1·928, P = 0·018) were independent risk factors associated with CKD in the patients with ischaemic stroke. CONCLUSIONS The patients with ischaemic stroke may be considered as a high-risk population for CKD and be aggressively managed for CKD prevention. The high prevalence of CKD in population with ischaemic stroke prompts the need for greater public awareness about risks of CKD.
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Affiliation(s)
- Yu-Shi Bao
- Department of Nephrology, The First Affiliated Hospital of Harbin Medical University, Harbin Medical University, Harbin, China
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Teramoto T, Sasaki J, Ishibashi S, Birou S, Daida H, Dohi S, Egusa G, Hiro T, Hirobe K, Iida M, Kihara S, Kinoshita M, Maruyama C, Ohta T, Okamura T, Yamashita S, Yokode M, Yokote K. Absolute risk of cardiovascular disease and lipid management targets. J Atheroscler Thromb 2013; 20:689-97. [PMID: 23892530 DOI: 10.5551/jat.17392] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Affiliation(s)
- Tamio Teramoto
- Committee for Epidemiology and Clinical Management of Atherosclerosis
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Koya D, Campese VM. Statin use in patients with diabetes and kidney disease: the Japanese experience. J Atheroscler Thromb 2013; 20:407-24. [PMID: 23518468 DOI: 10.5551/jat.16261] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Diabetes is a leading cause of chronic kidney disease (CKD) and end-stage renal disease (ESRD) in developed nations, including Japan and the United States. Japan has the unenviable distinction of having one of the world's highest rates of dialysis: in 2011, there were over 300,000 dialysis patients (2,383 per million people), with diabetic patients accounting for almost half of all incident cases. Concomitance of CKD and diabetes predicts a greater risk of cardiovascular disease (CVD) than either condition in isolation. Hence, appropriate management of modifiable cardiovascular (CV) risk factors, including dyslipidemia, is paramount in this high-risk group. The United States and Japan have distinct approaches to cholesterol management, with more stringent therapeutic targets for lipid control advocated in US guidelines. However, upward trends in cholesterol levels and coronary heart disease incidence in Japan may provide justification for more intensive CV risk factor management strategies by Japanese physicians to achieve maximum benefit. Attainment of recommended lipid goals in Japan is poor, particularly in patients with diabetes and/or CKD in whom CV risk factors are often undertreated. Statin therapy has been shown to be safe and effective in reducing CV risk in patients with diabetes and/or CKD stages 1-5. Moreover, statins may impart a renoprotective effect by preventing or delaying progressive loss of kidney function. This review summarizes evidence from studies in Western and Japanese populations to highlight the CV and renal benefits of lipid-lowering agents in CKD patients, including those with diabetes.
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Affiliation(s)
- Daisuke Koya
- Division of Diabetology and Endocrinology, Kanazawa Medical University, Japan.
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