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Hoshide S, Kario K, de la Sierra A, Bilo G, Schillaci G, Banegas JR, Gorostidi M, Segura J, Lombardi C, Omboni S, Ruilope L, Mancia G, Parati G. Ethnic Differences in the Degree of Morning Blood Pressure Surge and in Its Determinants Between Japanese and European Hypertensive Subjects. Hypertension 2015; 66:750-6. [DOI: 10.1161/hypertensionaha.115.05958] [Citation(s) in RCA: 72] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2015] [Accepted: 07/29/2015] [Indexed: 12/22/2022]
Abstract
Morning blood pressure (BP) surge has been reported to be a prognostic factor for cardiovascular events. Its determinants are still poorly defined, however. In particular, it is not clear whether ethnic differences play a role in determining morning surge (MS) size. Aim of our study was to explore whether differences exist in the size of MS between Japanese and Western European hypertensive patients. We included 2887 untreated hypertensive patients (age 62.3±8.8 years) from a European ambulatory BP monitoring database and 811 hypertensive patients from a Japanese database (Jichi Medical School Ambulatory Blood Pressure Monitoring WAVE1, age 72.3±9.8 years) following the same inclusion criteria. Their 24-hour ambulatory BP monitoring recordings were analyzed focusing on MS. Sleep-trough MS was defined as the difference between mean systolic BP during the 2 hours after awakening and mean systolic BP during the 1-hour night period that included the lowest sleep BP level. The sleep-trough MS was higher in Japanese than in European hypertensive patients after adjusting for age and 24-hour mean BP levels (40.1 [95% confidence interval 39.0–41.2] versus 23.0 [22.4–23.5] mm Hg;
P
<0.001). This difference remained significant after accounting for differences in night-time BP dipping. Age was independently associated with MS in the Japanese database, but not in the European subjects. Our results for the first time show the occurrence of substantial ethnic differences in the degree of MS. These findings may help in understanding the role of ethnic factors in cardiovascular risk assessment and in identifying possible ethnicity-related differences in the most effective measures to be implemented for prevention of BP-related cardiovascular events.
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Affiliation(s)
- Satoshi Hoshide
- From the Department of Cardiology, Jichi Medical University School of Medicine, Tochigi, Japan (S.H., K.K.); Department of Internal Medicine, Hospital Mutua Terrassa, University of Barcelona, Spain (A.d.l.S.); Department of Cardiovascular, Neural, and Metabolic Sciences, San Luca Hospital, Istituto Auxologico Italiano, Milan, Italy (G.B., C.L., G.M., G.P.); Unit of Internal Medicine, Department of Medicine, University of Perugia at Terni, Terni, Italy (G.S.); Department of Preventive Medicine and
| | - Kazuomi Kario
- From the Department of Cardiology, Jichi Medical University School of Medicine, Tochigi, Japan (S.H., K.K.); Department of Internal Medicine, Hospital Mutua Terrassa, University of Barcelona, Spain (A.d.l.S.); Department of Cardiovascular, Neural, and Metabolic Sciences, San Luca Hospital, Istituto Auxologico Italiano, Milan, Italy (G.B., C.L., G.M., G.P.); Unit of Internal Medicine, Department of Medicine, University of Perugia at Terni, Terni, Italy (G.S.); Department of Preventive Medicine and
| | - Alejandro de la Sierra
- From the Department of Cardiology, Jichi Medical University School of Medicine, Tochigi, Japan (S.H., K.K.); Department of Internal Medicine, Hospital Mutua Terrassa, University of Barcelona, Spain (A.d.l.S.); Department of Cardiovascular, Neural, and Metabolic Sciences, San Luca Hospital, Istituto Auxologico Italiano, Milan, Italy (G.B., C.L., G.M., G.P.); Unit of Internal Medicine, Department of Medicine, University of Perugia at Terni, Terni, Italy (G.S.); Department of Preventive Medicine and
| | - Grzegorz Bilo
- From the Department of Cardiology, Jichi Medical University School of Medicine, Tochigi, Japan (S.H., K.K.); Department of Internal Medicine, Hospital Mutua Terrassa, University of Barcelona, Spain (A.d.l.S.); Department of Cardiovascular, Neural, and Metabolic Sciences, San Luca Hospital, Istituto Auxologico Italiano, Milan, Italy (G.B., C.L., G.M., G.P.); Unit of Internal Medicine, Department of Medicine, University of Perugia at Terni, Terni, Italy (G.S.); Department of Preventive Medicine and
| | - Giuseppe Schillaci
- From the Department of Cardiology, Jichi Medical University School of Medicine, Tochigi, Japan (S.H., K.K.); Department of Internal Medicine, Hospital Mutua Terrassa, University of Barcelona, Spain (A.d.l.S.); Department of Cardiovascular, Neural, and Metabolic Sciences, San Luca Hospital, Istituto Auxologico Italiano, Milan, Italy (G.B., C.L., G.M., G.P.); Unit of Internal Medicine, Department of Medicine, University of Perugia at Terni, Terni, Italy (G.S.); Department of Preventive Medicine and
| | - José Ramón Banegas
- From the Department of Cardiology, Jichi Medical University School of Medicine, Tochigi, Japan (S.H., K.K.); Department of Internal Medicine, Hospital Mutua Terrassa, University of Barcelona, Spain (A.d.l.S.); Department of Cardiovascular, Neural, and Metabolic Sciences, San Luca Hospital, Istituto Auxologico Italiano, Milan, Italy (G.B., C.L., G.M., G.P.); Unit of Internal Medicine, Department of Medicine, University of Perugia at Terni, Terni, Italy (G.S.); Department of Preventive Medicine and
| | - Manuel Gorostidi
- From the Department of Cardiology, Jichi Medical University School of Medicine, Tochigi, Japan (S.H., K.K.); Department of Internal Medicine, Hospital Mutua Terrassa, University of Barcelona, Spain (A.d.l.S.); Department of Cardiovascular, Neural, and Metabolic Sciences, San Luca Hospital, Istituto Auxologico Italiano, Milan, Italy (G.B., C.L., G.M., G.P.); Unit of Internal Medicine, Department of Medicine, University of Perugia at Terni, Terni, Italy (G.S.); Department of Preventive Medicine and
| | - Julian Segura
- From the Department of Cardiology, Jichi Medical University School of Medicine, Tochigi, Japan (S.H., K.K.); Department of Internal Medicine, Hospital Mutua Terrassa, University of Barcelona, Spain (A.d.l.S.); Department of Cardiovascular, Neural, and Metabolic Sciences, San Luca Hospital, Istituto Auxologico Italiano, Milan, Italy (G.B., C.L., G.M., G.P.); Unit of Internal Medicine, Department of Medicine, University of Perugia at Terni, Terni, Italy (G.S.); Department of Preventive Medicine and
| | - Carolina Lombardi
- From the Department of Cardiology, Jichi Medical University School of Medicine, Tochigi, Japan (S.H., K.K.); Department of Internal Medicine, Hospital Mutua Terrassa, University of Barcelona, Spain (A.d.l.S.); Department of Cardiovascular, Neural, and Metabolic Sciences, San Luca Hospital, Istituto Auxologico Italiano, Milan, Italy (G.B., C.L., G.M., G.P.); Unit of Internal Medicine, Department of Medicine, University of Perugia at Terni, Terni, Italy (G.S.); Department of Preventive Medicine and
| | - Stefano Omboni
- From the Department of Cardiology, Jichi Medical University School of Medicine, Tochigi, Japan (S.H., K.K.); Department of Internal Medicine, Hospital Mutua Terrassa, University of Barcelona, Spain (A.d.l.S.); Department of Cardiovascular, Neural, and Metabolic Sciences, San Luca Hospital, Istituto Auxologico Italiano, Milan, Italy (G.B., C.L., G.M., G.P.); Unit of Internal Medicine, Department of Medicine, University of Perugia at Terni, Terni, Italy (G.S.); Department of Preventive Medicine and
| | - Luis Ruilope
- From the Department of Cardiology, Jichi Medical University School of Medicine, Tochigi, Japan (S.H., K.K.); Department of Internal Medicine, Hospital Mutua Terrassa, University of Barcelona, Spain (A.d.l.S.); Department of Cardiovascular, Neural, and Metabolic Sciences, San Luca Hospital, Istituto Auxologico Italiano, Milan, Italy (G.B., C.L., G.M., G.P.); Unit of Internal Medicine, Department of Medicine, University of Perugia at Terni, Terni, Italy (G.S.); Department of Preventive Medicine and
| | - Giuseppe Mancia
- From the Department of Cardiology, Jichi Medical University School of Medicine, Tochigi, Japan (S.H., K.K.); Department of Internal Medicine, Hospital Mutua Terrassa, University of Barcelona, Spain (A.d.l.S.); Department of Cardiovascular, Neural, and Metabolic Sciences, San Luca Hospital, Istituto Auxologico Italiano, Milan, Italy (G.B., C.L., G.M., G.P.); Unit of Internal Medicine, Department of Medicine, University of Perugia at Terni, Terni, Italy (G.S.); Department of Preventive Medicine and
| | - Gianfranco Parati
- From the Department of Cardiology, Jichi Medical University School of Medicine, Tochigi, Japan (S.H., K.K.); Department of Internal Medicine, Hospital Mutua Terrassa, University of Barcelona, Spain (A.d.l.S.); Department of Cardiovascular, Neural, and Metabolic Sciences, San Luca Hospital, Istituto Auxologico Italiano, Milan, Italy (G.B., C.L., G.M., G.P.); Unit of Internal Medicine, Department of Medicine, University of Perugia at Terni, Terni, Italy (G.S.); Department of Preventive Medicine and
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Yano Y, Fujimoto S, Kramer H, Sato Y, Konta T, Iseki K, Iseki C, Moriyama T, Yamagata K, Tsuruya K, Narita I, Kondo M, Kimura K, Asahi K, Kurahashi I, Ohashi Y, Watanabe T. Long-Term Blood Pressure Variability, New-Onset Diabetes Mellitus, and New-Onset Chronic Kidney Disease in the Japanese General Population. Hypertension 2015; 66:30-6. [PMID: 25987664 DOI: 10.1161/hypertensionaha.115.05472] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2015] [Accepted: 04/07/2015] [Indexed: 12/19/2022]
Abstract
Whether long-term blood pressure (BP) variability among individuals without diabetes mellitus is associated with new-onset chronic kidney disease (CKD) risk, independently of other BP parameters (eg, mean BP, cumulative exposure to BP) and metabolic profile changes during follow-up, remains uncertain. We used data from a nationwide study of 48 587 Japanese adults aged 40 to 74 years (mean age, 61.7 years; 39% men) without diabetes mellitus or CKD (estimated glomerular filtration rate <60 mL/min per 1.73 m2 or proteinuria by dipstick). BP was measured at baseline and during 3 annual follow-up visits (4 visits). BP variability was defined as standard deviation (SD) and average real variability during the 4 visits. At the year 3 follow-up visit, 6.3% of the population had developed CKD. In multivariable-adjusted logistic regression models, 1 SD increases in SDSBP (per 5 mmHg), SDDBP (per 3 mmHg), average real variabilitySBP (per 6 mmHg), and average real variabilityDBP (per 4 mmHg) were associated with new-onset CKD (odds ratios [ORs] and 95% confidence intervals, 1.15 [1.11-1.20], 1.08 [1.04-1.12], 1.13 [1.09-1.17], 1.06 [1.02-1.10], respectively; all P<0.01) after adjustment for clinical characteristics, and with mean BP from year 0 to year 3. The associations of SDBP and average real variabilityBP with CKD remained significant after additional adjustments for metabolic parameter changes during follow-up (ORs, 1.06-1.15; all P<0.01). Sensitivity analyses by sex, antihypertensive medication use, and the presence of hypertension showed similar conclusions. Among those in the middle-aged and elderly general population without diabetes mellitus, long-term BP variability during 3 years was associated with new-onset CKD risk, independently of mean or cumulative exposure to BP and metabolic profile changes during follow-up.
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Affiliation(s)
- Yuichiro Yano
- From the Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (Y.Y.); Department of Hemovascular Medicine and Artificial Organs, Faculty of Medicine (S.F.) and Dialysis Division, University of Miyazaki Hospital (Y.S.), University of Miyazaki, Miyazaki, Japan; Department of Public Health Sciences (H.K.) and Division of Nephrology and Hypertension (H.K.), Loyola Medical Center, Maywood, IL; Department of Cardiology, Pulmonology, and Nephrology, Yamagata University School of Medicine, Yamagata, Japan (T.K.); Dialysis Unit, University Hospital of the Ryukyus, Okinawa, Japan (K.I., C.I.); Health Care Center, Osaka University, Osaka, Japan (T.M.); Department of Nephrology (K.Y.) and Department of Health Care Policy and Health Economics (M.K.), Faculty of Medicine, University of Tsukuba, Ibarak, Japan; Department of Integrated Therapy for Chronic Kidney Disease, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan (K.T.); Division of Clinical Nephrology and Rheumatology, Niigata University Medical School, Nigata, Japan (I.N.); Division of Nephrology and Hypertension, Department of Internal Medicine, St. Marianna University School of Medicine, Kanagawa, Japan (K.K.); Department of Nephrology, Hypertension, Diabetology, Endocrinology and Metabolism, School of Medicine, Fukushima Medical University, Fukushima, Japan (K.A., T.W.); iAnalysis LLC, Tokyo, Japan (K.I); and Department of Integrated Science and Engineering for Sustainable Society, Chuo University, Tokyo, Japan (Y.O.).
| | - Shouichi Fujimoto
- From the Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (Y.Y.); Department of Hemovascular Medicine and Artificial Organs, Faculty of Medicine (S.F.) and Dialysis Division, University of Miyazaki Hospital (Y.S.), University of Miyazaki, Miyazaki, Japan; Department of Public Health Sciences (H.K.) and Division of Nephrology and Hypertension (H.K.), Loyola Medical Center, Maywood, IL; Department of Cardiology, Pulmonology, and Nephrology, Yamagata University School of Medicine, Yamagata, Japan (T.K.); Dialysis Unit, University Hospital of the Ryukyus, Okinawa, Japan (K.I., C.I.); Health Care Center, Osaka University, Osaka, Japan (T.M.); Department of Nephrology (K.Y.) and Department of Health Care Policy and Health Economics (M.K.), Faculty of Medicine, University of Tsukuba, Ibarak, Japan; Department of Integrated Therapy for Chronic Kidney Disease, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan (K.T.); Division of Clinical Nephrology and Rheumatology, Niigata University Medical School, Nigata, Japan (I.N.); Division of Nephrology and Hypertension, Department of Internal Medicine, St. Marianna University School of Medicine, Kanagawa, Japan (K.K.); Department of Nephrology, Hypertension, Diabetology, Endocrinology and Metabolism, School of Medicine, Fukushima Medical University, Fukushima, Japan (K.A., T.W.); iAnalysis LLC, Tokyo, Japan (K.I); and Department of Integrated Science and Engineering for Sustainable Society, Chuo University, Tokyo, Japan (Y.O.).
| | - Holly Kramer
- From the Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (Y.Y.); Department of Hemovascular Medicine and Artificial Organs, Faculty of Medicine (S.F.) and Dialysis Division, University of Miyazaki Hospital (Y.S.), University of Miyazaki, Miyazaki, Japan; Department of Public Health Sciences (H.K.) and Division of Nephrology and Hypertension (H.K.), Loyola Medical Center, Maywood, IL; Department of Cardiology, Pulmonology, and Nephrology, Yamagata University School of Medicine, Yamagata, Japan (T.K.); Dialysis Unit, University Hospital of the Ryukyus, Okinawa, Japan (K.I., C.I.); Health Care Center, Osaka University, Osaka, Japan (T.M.); Department of Nephrology (K.Y.) and Department of Health Care Policy and Health Economics (M.K.), Faculty of Medicine, University of Tsukuba, Ibarak, Japan; Department of Integrated Therapy for Chronic Kidney Disease, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan (K.T.); Division of Clinical Nephrology and Rheumatology, Niigata University Medical School, Nigata, Japan (I.N.); Division of Nephrology and Hypertension, Department of Internal Medicine, St. Marianna University School of Medicine, Kanagawa, Japan (K.K.); Department of Nephrology, Hypertension, Diabetology, Endocrinology and Metabolism, School of Medicine, Fukushima Medical University, Fukushima, Japan (K.A., T.W.); iAnalysis LLC, Tokyo, Japan (K.I); and Department of Integrated Science and Engineering for Sustainable Society, Chuo University, Tokyo, Japan (Y.O.)
| | - Yuji Sato
- From the Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (Y.Y.); Department of Hemovascular Medicine and Artificial Organs, Faculty of Medicine (S.F.) and Dialysis Division, University of Miyazaki Hospital (Y.S.), University of Miyazaki, Miyazaki, Japan; Department of Public Health Sciences (H.K.) and Division of Nephrology and Hypertension (H.K.), Loyola Medical Center, Maywood, IL; Department of Cardiology, Pulmonology, and Nephrology, Yamagata University School of Medicine, Yamagata, Japan (T.K.); Dialysis Unit, University Hospital of the Ryukyus, Okinawa, Japan (K.I., C.I.); Health Care Center, Osaka University, Osaka, Japan (T.M.); Department of Nephrology (K.Y.) and Department of Health Care Policy and Health Economics (M.K.), Faculty of Medicine, University of Tsukuba, Ibarak, Japan; Department of Integrated Therapy for Chronic Kidney Disease, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan (K.T.); Division of Clinical Nephrology and Rheumatology, Niigata University Medical School, Nigata, Japan (I.N.); Division of Nephrology and Hypertension, Department of Internal Medicine, St. Marianna University School of Medicine, Kanagawa, Japan (K.K.); Department of Nephrology, Hypertension, Diabetology, Endocrinology and Metabolism, School of Medicine, Fukushima Medical University, Fukushima, Japan (K.A., T.W.); iAnalysis LLC, Tokyo, Japan (K.I); and Department of Integrated Science and Engineering for Sustainable Society, Chuo University, Tokyo, Japan (Y.O.)
| | - Tsuneo Konta
- From the Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (Y.Y.); Department of Hemovascular Medicine and Artificial Organs, Faculty of Medicine (S.F.) and Dialysis Division, University of Miyazaki Hospital (Y.S.), University of Miyazaki, Miyazaki, Japan; Department of Public Health Sciences (H.K.) and Division of Nephrology and Hypertension (H.K.), Loyola Medical Center, Maywood, IL; Department of Cardiology, Pulmonology, and Nephrology, Yamagata University School of Medicine, Yamagata, Japan (T.K.); Dialysis Unit, University Hospital of the Ryukyus, Okinawa, Japan (K.I., C.I.); Health Care Center, Osaka University, Osaka, Japan (T.M.); Department of Nephrology (K.Y.) and Department of Health Care Policy and Health Economics (M.K.), Faculty of Medicine, University of Tsukuba, Ibarak, Japan; Department of Integrated Therapy for Chronic Kidney Disease, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan (K.T.); Division of Clinical Nephrology and Rheumatology, Niigata University Medical School, Nigata, Japan (I.N.); Division of Nephrology and Hypertension, Department of Internal Medicine, St. Marianna University School of Medicine, Kanagawa, Japan (K.K.); Department of Nephrology, Hypertension, Diabetology, Endocrinology and Metabolism, School of Medicine, Fukushima Medical University, Fukushima, Japan (K.A., T.W.); iAnalysis LLC, Tokyo, Japan (K.I); and Department of Integrated Science and Engineering for Sustainable Society, Chuo University, Tokyo, Japan (Y.O.)
| | - Kunitoshi Iseki
- From the Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (Y.Y.); Department of Hemovascular Medicine and Artificial Organs, Faculty of Medicine (S.F.) and Dialysis Division, University of Miyazaki Hospital (Y.S.), University of Miyazaki, Miyazaki, Japan; Department of Public Health Sciences (H.K.) and Division of Nephrology and Hypertension (H.K.), Loyola Medical Center, Maywood, IL; Department of Cardiology, Pulmonology, and Nephrology, Yamagata University School of Medicine, Yamagata, Japan (T.K.); Dialysis Unit, University Hospital of the Ryukyus, Okinawa, Japan (K.I., C.I.); Health Care Center, Osaka University, Osaka, Japan (T.M.); Department of Nephrology (K.Y.) and Department of Health Care Policy and Health Economics (M.K.), Faculty of Medicine, University of Tsukuba, Ibarak, Japan; Department of Integrated Therapy for Chronic Kidney Disease, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan (K.T.); Division of Clinical Nephrology and Rheumatology, Niigata University Medical School, Nigata, Japan (I.N.); Division of Nephrology and Hypertension, Department of Internal Medicine, St. Marianna University School of Medicine, Kanagawa, Japan (K.K.); Department of Nephrology, Hypertension, Diabetology, Endocrinology and Metabolism, School of Medicine, Fukushima Medical University, Fukushima, Japan (K.A., T.W.); iAnalysis LLC, Tokyo, Japan (K.I); and Department of Integrated Science and Engineering for Sustainable Society, Chuo University, Tokyo, Japan (Y.O.)
| | - Chiho Iseki
- From the Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (Y.Y.); Department of Hemovascular Medicine and Artificial Organs, Faculty of Medicine (S.F.) and Dialysis Division, University of Miyazaki Hospital (Y.S.), University of Miyazaki, Miyazaki, Japan; Department of Public Health Sciences (H.K.) and Division of Nephrology and Hypertension (H.K.), Loyola Medical Center, Maywood, IL; Department of Cardiology, Pulmonology, and Nephrology, Yamagata University School of Medicine, Yamagata, Japan (T.K.); Dialysis Unit, University Hospital of the Ryukyus, Okinawa, Japan (K.I., C.I.); Health Care Center, Osaka University, Osaka, Japan (T.M.); Department of Nephrology (K.Y.) and Department of Health Care Policy and Health Economics (M.K.), Faculty of Medicine, University of Tsukuba, Ibarak, Japan; Department of Integrated Therapy for Chronic Kidney Disease, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan (K.T.); Division of Clinical Nephrology and Rheumatology, Niigata University Medical School, Nigata, Japan (I.N.); Division of Nephrology and Hypertension, Department of Internal Medicine, St. Marianna University School of Medicine, Kanagawa, Japan (K.K.); Department of Nephrology, Hypertension, Diabetology, Endocrinology and Metabolism, School of Medicine, Fukushima Medical University, Fukushima, Japan (K.A., T.W.); iAnalysis LLC, Tokyo, Japan (K.I); and Department of Integrated Science and Engineering for Sustainable Society, Chuo University, Tokyo, Japan (Y.O.)
| | - Toshiki Moriyama
- From the Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (Y.Y.); Department of Hemovascular Medicine and Artificial Organs, Faculty of Medicine (S.F.) and Dialysis Division, University of Miyazaki Hospital (Y.S.), University of Miyazaki, Miyazaki, Japan; Department of Public Health Sciences (H.K.) and Division of Nephrology and Hypertension (H.K.), Loyola Medical Center, Maywood, IL; Department of Cardiology, Pulmonology, and Nephrology, Yamagata University School of Medicine, Yamagata, Japan (T.K.); Dialysis Unit, University Hospital of the Ryukyus, Okinawa, Japan (K.I., C.I.); Health Care Center, Osaka University, Osaka, Japan (T.M.); Department of Nephrology (K.Y.) and Department of Health Care Policy and Health Economics (M.K.), Faculty of Medicine, University of Tsukuba, Ibarak, Japan; Department of Integrated Therapy for Chronic Kidney Disease, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan (K.T.); Division of Clinical Nephrology and Rheumatology, Niigata University Medical School, Nigata, Japan (I.N.); Division of Nephrology and Hypertension, Department of Internal Medicine, St. Marianna University School of Medicine, Kanagawa, Japan (K.K.); Department of Nephrology, Hypertension, Diabetology, Endocrinology and Metabolism, School of Medicine, Fukushima Medical University, Fukushima, Japan (K.A., T.W.); iAnalysis LLC, Tokyo, Japan (K.I); and Department of Integrated Science and Engineering for Sustainable Society, Chuo University, Tokyo, Japan (Y.O.)
| | - Kunihiro Yamagata
- From the Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (Y.Y.); Department of Hemovascular Medicine and Artificial Organs, Faculty of Medicine (S.F.) and Dialysis Division, University of Miyazaki Hospital (Y.S.), University of Miyazaki, Miyazaki, Japan; Department of Public Health Sciences (H.K.) and Division of Nephrology and Hypertension (H.K.), Loyola Medical Center, Maywood, IL; Department of Cardiology, Pulmonology, and Nephrology, Yamagata University School of Medicine, Yamagata, Japan (T.K.); Dialysis Unit, University Hospital of the Ryukyus, Okinawa, Japan (K.I., C.I.); Health Care Center, Osaka University, Osaka, Japan (T.M.); Department of Nephrology (K.Y.) and Department of Health Care Policy and Health Economics (M.K.), Faculty of Medicine, University of Tsukuba, Ibarak, Japan; Department of Integrated Therapy for Chronic Kidney Disease, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan (K.T.); Division of Clinical Nephrology and Rheumatology, Niigata University Medical School, Nigata, Japan (I.N.); Division of Nephrology and Hypertension, Department of Internal Medicine, St. Marianna University School of Medicine, Kanagawa, Japan (K.K.); Department of Nephrology, Hypertension, Diabetology, Endocrinology and Metabolism, School of Medicine, Fukushima Medical University, Fukushima, Japan (K.A., T.W.); iAnalysis LLC, Tokyo, Japan (K.I); and Department of Integrated Science and Engineering for Sustainable Society, Chuo University, Tokyo, Japan (Y.O.)
| | - Kazuhiko Tsuruya
- From the Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (Y.Y.); Department of Hemovascular Medicine and Artificial Organs, Faculty of Medicine (S.F.) and Dialysis Division, University of Miyazaki Hospital (Y.S.), University of Miyazaki, Miyazaki, Japan; Department of Public Health Sciences (H.K.) and Division of Nephrology and Hypertension (H.K.), Loyola Medical Center, Maywood, IL; Department of Cardiology, Pulmonology, and Nephrology, Yamagata University School of Medicine, Yamagata, Japan (T.K.); Dialysis Unit, University Hospital of the Ryukyus, Okinawa, Japan (K.I., C.I.); Health Care Center, Osaka University, Osaka, Japan (T.M.); Department of Nephrology (K.Y.) and Department of Health Care Policy and Health Economics (M.K.), Faculty of Medicine, University of Tsukuba, Ibarak, Japan; Department of Integrated Therapy for Chronic Kidney Disease, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan (K.T.); Division of Clinical Nephrology and Rheumatology, Niigata University Medical School, Nigata, Japan (I.N.); Division of Nephrology and Hypertension, Department of Internal Medicine, St. Marianna University School of Medicine, Kanagawa, Japan (K.K.); Department of Nephrology, Hypertension, Diabetology, Endocrinology and Metabolism, School of Medicine, Fukushima Medical University, Fukushima, Japan (K.A., T.W.); iAnalysis LLC, Tokyo, Japan (K.I); and Department of Integrated Science and Engineering for Sustainable Society, Chuo University, Tokyo, Japan (Y.O.)
| | - Ichiei Narita
- From the Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (Y.Y.); Department of Hemovascular Medicine and Artificial Organs, Faculty of Medicine (S.F.) and Dialysis Division, University of Miyazaki Hospital (Y.S.), University of Miyazaki, Miyazaki, Japan; Department of Public Health Sciences (H.K.) and Division of Nephrology and Hypertension (H.K.), Loyola Medical Center, Maywood, IL; Department of Cardiology, Pulmonology, and Nephrology, Yamagata University School of Medicine, Yamagata, Japan (T.K.); Dialysis Unit, University Hospital of the Ryukyus, Okinawa, Japan (K.I., C.I.); Health Care Center, Osaka University, Osaka, Japan (T.M.); Department of Nephrology (K.Y.) and Department of Health Care Policy and Health Economics (M.K.), Faculty of Medicine, University of Tsukuba, Ibarak, Japan; Department of Integrated Therapy for Chronic Kidney Disease, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan (K.T.); Division of Clinical Nephrology and Rheumatology, Niigata University Medical School, Nigata, Japan (I.N.); Division of Nephrology and Hypertension, Department of Internal Medicine, St. Marianna University School of Medicine, Kanagawa, Japan (K.K.); Department of Nephrology, Hypertension, Diabetology, Endocrinology and Metabolism, School of Medicine, Fukushima Medical University, Fukushima, Japan (K.A., T.W.); iAnalysis LLC, Tokyo, Japan (K.I); and Department of Integrated Science and Engineering for Sustainable Society, Chuo University, Tokyo, Japan (Y.O.)
| | - Masahide Kondo
- From the Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (Y.Y.); Department of Hemovascular Medicine and Artificial Organs, Faculty of Medicine (S.F.) and Dialysis Division, University of Miyazaki Hospital (Y.S.), University of Miyazaki, Miyazaki, Japan; Department of Public Health Sciences (H.K.) and Division of Nephrology and Hypertension (H.K.), Loyola Medical Center, Maywood, IL; Department of Cardiology, Pulmonology, and Nephrology, Yamagata University School of Medicine, Yamagata, Japan (T.K.); Dialysis Unit, University Hospital of the Ryukyus, Okinawa, Japan (K.I., C.I.); Health Care Center, Osaka University, Osaka, Japan (T.M.); Department of Nephrology (K.Y.) and Department of Health Care Policy and Health Economics (M.K.), Faculty of Medicine, University of Tsukuba, Ibarak, Japan; Department of Integrated Therapy for Chronic Kidney Disease, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan (K.T.); Division of Clinical Nephrology and Rheumatology, Niigata University Medical School, Nigata, Japan (I.N.); Division of Nephrology and Hypertension, Department of Internal Medicine, St. Marianna University School of Medicine, Kanagawa, Japan (K.K.); Department of Nephrology, Hypertension, Diabetology, Endocrinology and Metabolism, School of Medicine, Fukushima Medical University, Fukushima, Japan (K.A., T.W.); iAnalysis LLC, Tokyo, Japan (K.I); and Department of Integrated Science and Engineering for Sustainable Society, Chuo University, Tokyo, Japan (Y.O.)
| | - Kenjiro Kimura
- From the Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (Y.Y.); Department of Hemovascular Medicine and Artificial Organs, Faculty of Medicine (S.F.) and Dialysis Division, University of Miyazaki Hospital (Y.S.), University of Miyazaki, Miyazaki, Japan; Department of Public Health Sciences (H.K.) and Division of Nephrology and Hypertension (H.K.), Loyola Medical Center, Maywood, IL; Department of Cardiology, Pulmonology, and Nephrology, Yamagata University School of Medicine, Yamagata, Japan (T.K.); Dialysis Unit, University Hospital of the Ryukyus, Okinawa, Japan (K.I., C.I.); Health Care Center, Osaka University, Osaka, Japan (T.M.); Department of Nephrology (K.Y.) and Department of Health Care Policy and Health Economics (M.K.), Faculty of Medicine, University of Tsukuba, Ibarak, Japan; Department of Integrated Therapy for Chronic Kidney Disease, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan (K.T.); Division of Clinical Nephrology and Rheumatology, Niigata University Medical School, Nigata, Japan (I.N.); Division of Nephrology and Hypertension, Department of Internal Medicine, St. Marianna University School of Medicine, Kanagawa, Japan (K.K.); Department of Nephrology, Hypertension, Diabetology, Endocrinology and Metabolism, School of Medicine, Fukushima Medical University, Fukushima, Japan (K.A., T.W.); iAnalysis LLC, Tokyo, Japan (K.I); and Department of Integrated Science and Engineering for Sustainable Society, Chuo University, Tokyo, Japan (Y.O.)
| | - Koichi Asahi
- From the Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (Y.Y.); Department of Hemovascular Medicine and Artificial Organs, Faculty of Medicine (S.F.) and Dialysis Division, University of Miyazaki Hospital (Y.S.), University of Miyazaki, Miyazaki, Japan; Department of Public Health Sciences (H.K.) and Division of Nephrology and Hypertension (H.K.), Loyola Medical Center, Maywood, IL; Department of Cardiology, Pulmonology, and Nephrology, Yamagata University School of Medicine, Yamagata, Japan (T.K.); Dialysis Unit, University Hospital of the Ryukyus, Okinawa, Japan (K.I., C.I.); Health Care Center, Osaka University, Osaka, Japan (T.M.); Department of Nephrology (K.Y.) and Department of Health Care Policy and Health Economics (M.K.), Faculty of Medicine, University of Tsukuba, Ibarak, Japan; Department of Integrated Therapy for Chronic Kidney Disease, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan (K.T.); Division of Clinical Nephrology and Rheumatology, Niigata University Medical School, Nigata, Japan (I.N.); Division of Nephrology and Hypertension, Department of Internal Medicine, St. Marianna University School of Medicine, Kanagawa, Japan (K.K.); Department of Nephrology, Hypertension, Diabetology, Endocrinology and Metabolism, School of Medicine, Fukushima Medical University, Fukushima, Japan (K.A., T.W.); iAnalysis LLC, Tokyo, Japan (K.I); and Department of Integrated Science and Engineering for Sustainable Society, Chuo University, Tokyo, Japan (Y.O.)
| | - Issei Kurahashi
- From the Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (Y.Y.); Department of Hemovascular Medicine and Artificial Organs, Faculty of Medicine (S.F.) and Dialysis Division, University of Miyazaki Hospital (Y.S.), University of Miyazaki, Miyazaki, Japan; Department of Public Health Sciences (H.K.) and Division of Nephrology and Hypertension (H.K.), Loyola Medical Center, Maywood, IL; Department of Cardiology, Pulmonology, and Nephrology, Yamagata University School of Medicine, Yamagata, Japan (T.K.); Dialysis Unit, University Hospital of the Ryukyus, Okinawa, Japan (K.I., C.I.); Health Care Center, Osaka University, Osaka, Japan (T.M.); Department of Nephrology (K.Y.) and Department of Health Care Policy and Health Economics (M.K.), Faculty of Medicine, University of Tsukuba, Ibarak, Japan; Department of Integrated Therapy for Chronic Kidney Disease, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan (K.T.); Division of Clinical Nephrology and Rheumatology, Niigata University Medical School, Nigata, Japan (I.N.); Division of Nephrology and Hypertension, Department of Internal Medicine, St. Marianna University School of Medicine, Kanagawa, Japan (K.K.); Department of Nephrology, Hypertension, Diabetology, Endocrinology and Metabolism, School of Medicine, Fukushima Medical University, Fukushima, Japan (K.A., T.W.); iAnalysis LLC, Tokyo, Japan (K.I); and Department of Integrated Science and Engineering for Sustainable Society, Chuo University, Tokyo, Japan (Y.O.)
| | - Yasuo Ohashi
- From the Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (Y.Y.); Department of Hemovascular Medicine and Artificial Organs, Faculty of Medicine (S.F.) and Dialysis Division, University of Miyazaki Hospital (Y.S.), University of Miyazaki, Miyazaki, Japan; Department of Public Health Sciences (H.K.) and Division of Nephrology and Hypertension (H.K.), Loyola Medical Center, Maywood, IL; Department of Cardiology, Pulmonology, and Nephrology, Yamagata University School of Medicine, Yamagata, Japan (T.K.); Dialysis Unit, University Hospital of the Ryukyus, Okinawa, Japan (K.I., C.I.); Health Care Center, Osaka University, Osaka, Japan (T.M.); Department of Nephrology (K.Y.) and Department of Health Care Policy and Health Economics (M.K.), Faculty of Medicine, University of Tsukuba, Ibarak, Japan; Department of Integrated Therapy for Chronic Kidney Disease, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan (K.T.); Division of Clinical Nephrology and Rheumatology, Niigata University Medical School, Nigata, Japan (I.N.); Division of Nephrology and Hypertension, Department of Internal Medicine, St. Marianna University School of Medicine, Kanagawa, Japan (K.K.); Department of Nephrology, Hypertension, Diabetology, Endocrinology and Metabolism, School of Medicine, Fukushima Medical University, Fukushima, Japan (K.A., T.W.); iAnalysis LLC, Tokyo, Japan (K.I); and Department of Integrated Science and Engineering for Sustainable Society, Chuo University, Tokyo, Japan (Y.O.)
| | - Tsuyoshi Watanabe
- From the Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (Y.Y.); Department of Hemovascular Medicine and Artificial Organs, Faculty of Medicine (S.F.) and Dialysis Division, University of Miyazaki Hospital (Y.S.), University of Miyazaki, Miyazaki, Japan; Department of Public Health Sciences (H.K.) and Division of Nephrology and Hypertension (H.K.), Loyola Medical Center, Maywood, IL; Department of Cardiology, Pulmonology, and Nephrology, Yamagata University School of Medicine, Yamagata, Japan (T.K.); Dialysis Unit, University Hospital of the Ryukyus, Okinawa, Japan (K.I., C.I.); Health Care Center, Osaka University, Osaka, Japan (T.M.); Department of Nephrology (K.Y.) and Department of Health Care Policy and Health Economics (M.K.), Faculty of Medicine, University of Tsukuba, Ibarak, Japan; Department of Integrated Therapy for Chronic Kidney Disease, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan (K.T.); Division of Clinical Nephrology and Rheumatology, Niigata University Medical School, Nigata, Japan (I.N.); Division of Nephrology and Hypertension, Department of Internal Medicine, St. Marianna University School of Medicine, Kanagawa, Japan (K.K.); Department of Nephrology, Hypertension, Diabetology, Endocrinology and Metabolism, School of Medicine, Fukushima Medical University, Fukushima, Japan (K.A., T.W.); iAnalysis LLC, Tokyo, Japan (K.I); and Department of Integrated Science and Engineering for Sustainable Society, Chuo University, Tokyo, Japan (Y.O.)
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