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Zhu W, Liu Q, Liu F, Jiao C, Zhang L, Xie H. High remnant cholesterol as a risk factor for developing chronic kidney disease in patients with prediabetes and type 2 diabetes: a cross-sectional study of a US population. Acta Diabetol 2024; 61:735-743. [PMID: 38436703 PMCID: PMC11101368 DOI: 10.1007/s00592-024-02249-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2023] [Accepted: 01/29/2024] [Indexed: 03/05/2024]
Abstract
AIMS To examine any potential links between remnant cholesterol (RC) and comorbid chronic kidney disease (CKD) in individuals with prediabetes and type 2 diabetes mellitus (T2DM). METHODS We used data from 2709 American people aged > 20 years from the National Health and Nutrition Examination Survey (NHANES) during 2011-2018. Subjects were categorized according to whether they had comorbid CKD. Logistic regression models and smoothed curve fitting methods were employed to assess the association of RC with comorbid CKD in patients with prediabetes and T2DM. RESULTS The 2709 participants included 1473 patients with T2DM and 1236 with prediabetes [impaired glucose tolerance (IGT) and impaired fasting glucose (IFG)], of whom 744 (27.46%) had comorbid CKD. In multivariate-adjusted analysis, both RC and triglycerides (TG) were significantly associated with an increased risk of comorbid CKD, and a 1 mmol/L elevation of RC increased the risk by 38.1% [OR (95% CI) 1.636 (1.242, 2.156)], which was higher than the risk associated with a 1 mmol/L increase in TG [1.255 (1.106, 1.424)]. Additionally, those in the highest quartile of RC had a 43.6% higher risk of concomitant renal damage than those in the lowest quartile. RC was linearly and positively associated with the incidence of comorbid CKD in this population. CONCLUSIONS RC is an independent risk factor for comorbid CKD in patients with prediabetes and T2DM. This finding provides a novel insight into the management and early detection of renal disease in patients with impaired glucose metabolism.
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Affiliation(s)
- Wenting Zhu
- National Clinical Research Center of Kidney Diseases, Jinling Hospital, Nanjing Medical Univerisity, Nanjing, 210016, China
| | - Qiushi Liu
- The Department of Urology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
- Institute of Urology and Anhui Province Key Laboratory of Genitourinary Diseases, Anhui Medical University, Hefei, China
| | - Fang Liu
- National Clinical Research Center of Kidney Diseases, Jinling Hospital, Nanjing Medical Univerisity, Nanjing, 210016, China
| | - Chenfeng Jiao
- National Clinical Research Center of Kidney Diseases, Jinling Hospital, Nanjing Medical Univerisity, Nanjing, 210016, China
| | - Lihua Zhang
- National Clinical Research Center of Kidney Diseases, Jinling Hospital, Nanjing Medical Univerisity, Nanjing, 210016, China
| | - Honglang Xie
- National Clinical Research Center of Kidney Diseases, Jinling Hospital, Nanjing Medical Univerisity, Nanjing, 210016, China.
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2
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Nakasone Y, Miyakoshi T, Sakuma T, Toda S, Yamada Y, Oguchi T, Hirabayashi K, Koike H, Yamashita K, Aizawa T. Hemoglobin Glycation Index: A Novel Risk Factor for Incident Chronic Kidney Disease in an Apparently Healthy Population. J Clin Endocrinol Metab 2024; 109:e1055-e1060. [PMID: 37931239 PMCID: PMC10876385 DOI: 10.1210/clinem/dgad638] [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: 06/01/2023] [Revised: 09/12/2023] [Accepted: 11/01/2023] [Indexed: 11/08/2023]
Abstract
CONTEXT Chronic kidney disease (CKD) is a worldwide health problem. Recent literature has shown an association of hemoglobin glycation index (HGI) and CKD in patients with dysglycemia. OBJECTIVE The aim of this study was to reveal the impact of HGI as a predictor for incident CKD in the general population. METHODS CKD was defined as dipstick proteinuria or estimated glomerular rate (eGFR) < 60 mL/min/1.73 m2. Impact of HGI on incident CKD was assessed using the data from CKD-free health examinees (N = 23 467, 4.1% with diabetes) followed for a mean of 5.1 years: Cox proportional hazards model was employed with multivariate adjustment for age, systolic blood pressure, eGFR, fasting plasma glucose, body mass index, log[alanine aminotransferase], log[triglycerides], high-density lipoprotein cholesterol, platelet counts, smoking, and sex. Elevated level of HGI in subjects with CKD was ascertained after propensity score matching of another group of health examinees (N = 2580, 7.6% with diabetes). RESULTS In the former group, CKD developed in 2540 subjects and HGI was the second most robust predictor for CKD, following low eGFR. With adjustment for the 11 covariates, the hazard ratio of HGI (95% CI) for CKD was 1.293 (1.238 to 1.349) (P < .0001). The population attributable risk of HGI for CKD was 4.2%. In the latter group, among 708 subjects matched 1:1 for 9 covariates, HGI was significantly elevated in subjects with CKD (median [interquartile range] -0.208 [-0.504 to -0.156] vs -0.284 [-0.582 to 0.052], P = .03). CONCLUSION HGI was a novel risk factor for CKD in the general population.
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Affiliation(s)
| | | | - Takahiro Sakuma
- Department of Internal Medicine, Ina Central Hospital,
Ina 3960033, Japan
| | - Shigeru Toda
- Kidney Disease and Hemodialysis Center, Aizawa Hospital,
Matsumoto 3908510, Japan
| | - Yosuke Yamada
- Kidney Disease and Hemodialysis Center, Aizawa Hospital,
Matsumoto 3908510, Japan
| | - Tomomasa Oguchi
- Kidney Disease and Hemodialysis Center, Aizawa Hospital,
Matsumoto 3908510, Japan
| | | | - Hideo Koike
- Health Center, Aizawa Hospital, Matsumoto
3908510, Japan
| | - Koh Yamashita
- Diabetes Center, Aizawa Hospital, Matsumoto
3908510, Japan
| | - Toru Aizawa
- Diabetes Center, Aizawa Hospital, Matsumoto
3908510, Japan
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3
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Gao J, Liu Y, Ning N, Wang J, Li X, Wang A, Chen S, Guo L, Wu Z, Qin X, Ma Y, Wu S. Better Life's Essential 8 Is Associated With Lower Risk of Diabetic Kidney Disease: A Community-Based Study. J Am Heart Assoc 2023; 12:e029399. [PMID: 37646221 PMCID: PMC10547362 DOI: 10.1161/jaha.123.029399] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Accepted: 07/18/2023] [Indexed: 09/01/2023]
Abstract
Background Diabetic kidney disease (DKD) is a common diabetic complication and increases the complexity of diabetes management. No prospective study has focused on the association between DKD and Life's Essential 8 (LE8). Our study aims to examine the association between LE8 and DKD risk. Methods and Results A total of 7605 participants, aged 54.32±9.77 years, and 4688 participants, aged 56.11±10.38 years, were included in the longitudinal and trajectory analyses, respectively, from 2006 to 2020. The DKD was confirmed using data collected during each follow-up. LE8 was based on 4 health behaviors and 4 health factors. The range of each metric was 0 to 100, and the overall LE8 score was calculated as the unweighted average of all 8 component metric scores. The trajectories of LE8 during 2006 to 2010 were classified using latent mixture models. Cox models and restricted cubic splines were applied. After a median follow-up of 12.41 and 6.71 years in longitudinal and trajectory analyses, respectively, the DKD incidence decreased, with the LE8 level increasing (P-trend<0.05), and the linearity assumption for this relationship (P-nonlinear=0.685) had been satisfied. Adjusted hazard ratios (HRs) for the highest tertile were 0.77 (95% CI, 0.69-0.87) and 0.70 (95% CI, 0.62-0.78) in baseline and time-updated LE8 scores, respectively, compared with the lowest tertile. Adjusted HR was 0.53 (95% CI, 0.41-0.69) for the stable-high pattern compared with the stable-low pattern. Conclusions Although LE8 is an indicator of cardiovascular health, the beneficial impact of a high LE8 score is also evident in the protection of renal health among patients with diabetes.
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Affiliation(s)
- Jingli Gao
- Department of Intensive Care UnitKailuan General HospitalTangshanHebeiChina
| | - Yang Liu
- Department of Epidemiology and Biostatistics, School of Public HealthChina Medical UniversityShenyangLiaoningChina
| | - Ning Ning
- Department of Epidemiology and Biostatistics, School of Public HealthChina Medical UniversityShenyangLiaoningChina
| | - Jing Wang
- Peking University Medical Informatics Center, Peking UniversityBeijingChina
| | - Xiaolan Li
- Department of Intensive Care UnitKailuan General HospitalTangshanHebeiChina
| | - Aitian Wang
- Department of Intensive Care UnitKailuan General HospitalTangshanHebeiChina
| | - Shuohua Chen
- Department of CardiologyKailuan General HospitalTangshanHebeiChina
| | - Liang Guo
- Department of CardiologyRenmin Hospital of Wuhan UniversityWuhanHubeiChina
- Cardiovascular Research Institute of Wuhan UniversityWuhanChina
- Hubei Key Laboratory of CardiologyWuhanChina
| | - Zhaogui Wu
- Department of CardiologyTianjin Medical University, General HospitalTianjinChina
| | - Xueying Qin
- Department of Epidemiology and Biostatistics, School of Public HealthPeking UniversityBeijingChina
| | - Yanan Ma
- Department of Epidemiology and Biostatistics, School of Public HealthChina Medical UniversityShenyangLiaoningChina
| | - Shouling Wu
- Department of CardiologyKailuan General HospitalTangshanHebeiChina
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4
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Iwasaki T, Kimura H, Tanaka K, Asahi K, Iseki K, Moriyama T, Yamagata K, Tsuruya K, Fujimoto S, Narita I, Konta T, Kondo M, Kasahara M, Shibagaki Y, Watanabe T, Kazama JJ. Association between height loss and mortality in the general population. Sci Rep 2023; 13:3593. [PMID: 36869154 PMCID: PMC9984491 DOI: 10.1038/s41598-023-30835-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 03/02/2023] [Indexed: 03/05/2023] Open
Abstract
Height loss is caused by osteoporosis, vertebral fractures, disc reduction, postural changes, and kyphosis. Marked long-term height loss is reportedly associated with cardiovascular disease and mortality in the elderly. The present study investigated the relationship between short-term height loss and the risk of mortality using the longitudinal cohort data of the Japan Specific Health Checkup Study (J-SHC). Included individuals were aged 40 years or older and received periodic health checkups in 2008 and 2010. The exposure of interest was height loss over the 2 years, and the outcome was all-cause mortality over subsequent follow up. Cox proportional hazard models were used to examine the association between height loss and all-cause mortality. Of the 222,392 individuals (88,285 men, 134,107 women) included in this study, 1436 died during the observation period (mean 4.8 ± 1.1 years). The subjects were divided into two groups based on a cut-off value of height loss of 0.5 cm over 2 years. The adjusted hazard ratio (95% confidence interval) was 1.26 (1.13-1.41) for exposure to height loss ≥ 0.5 cm compared to height loss < 0.5 cm. Height loss ≥ 0.5 cm correlated significantly with an increased risk of mortality compared to height loss < 0.5 cm in both men and women. Even a small decrease in height over 2 years was associated with the risk of all-cause mortality and might be a helpful marker for stratifying mortality risk.
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Affiliation(s)
- Tsuyoshi Iwasaki
- Department of Nephrology and Hypertension, Fukushima Medical University, 1 Hikariga-oka, Fukushima, Fukushima, 960-1295, Japan
| | - Hiroshi Kimura
- Department of Nephrology and Hypertension, Fukushima Medical University, 1 Hikariga-oka, Fukushima, Fukushima, 960-1295, Japan
| | - Kenichi Tanaka
- Department of Nephrology and Hypertension, Fukushima Medical University, 1 Hikariga-oka, Fukushima, Fukushima, 960-1295, Japan.
| | - Koichi Asahi
- Steering Committee of The Japan Specific Health Checkups (J-SHC) Study Group, Fukushima, Japan
| | - Kunitoshi Iseki
- Steering Committee of The Japan Specific Health Checkups (J-SHC) Study Group, Fukushima, Japan
| | - Toshiki Moriyama
- Steering Committee of The Japan Specific Health Checkups (J-SHC) Study Group, Fukushima, Japan
| | - Kunihiro Yamagata
- Steering Committee of The Japan Specific Health Checkups (J-SHC) Study Group, Fukushima, Japan
| | - Kazuhiko Tsuruya
- Steering Committee of The Japan Specific Health Checkups (J-SHC) Study Group, Fukushima, Japan
| | - Shouichi Fujimoto
- Steering Committee of The Japan Specific Health Checkups (J-SHC) Study Group, Fukushima, Japan
| | - Ichiei Narita
- Steering Committee of The Japan Specific Health Checkups (J-SHC) Study Group, Fukushima, Japan
| | - Tsuneo Konta
- Steering Committee of The Japan Specific Health Checkups (J-SHC) Study Group, Fukushima, Japan
| | - Masahide Kondo
- Steering Committee of The Japan Specific Health Checkups (J-SHC) Study Group, Fukushima, Japan
| | - Masato Kasahara
- Steering Committee of The Japan Specific Health Checkups (J-SHC) Study Group, Fukushima, Japan
| | - Yugo Shibagaki
- Steering Committee of The Japan Specific Health Checkups (J-SHC) Study Group, Fukushima, Japan
| | - Tsuyoshi Watanabe
- Steering Committee of The Japan Specific Health Checkups (J-SHC) Study Group, Fukushima, Japan
| | - Junichiro J Kazama
- Department of Nephrology and Hypertension, Fukushima Medical University, 1 Hikariga-oka, Fukushima, Fukushima, 960-1295, Japan
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5
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Ledeganck KJ, Van Eyck A, Wouters K, Vermeiren E, De Winter BY, Verhulst S, Van Hoorenbeeck K, France A, Dotremont H, den Brinker M, Trouet D. Urinary epidermal growth factor reflects vascular health in boys with either obesity or type 1 diabetes. A role for renin, or beyond? PLoS One 2023; 18:e0283716. [PMID: 36996194 PMCID: PMC10062545 DOI: 10.1371/journal.pone.0283716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Accepted: 03/15/2023] [Indexed: 04/01/2023] Open
Abstract
An increased blood pressure is a known comorbidity of both type 1 diabetes (T1DM) and obesity in children. Increasing evidence suggests a subtle interplay between epidermal growth factor (EGF) and renin along the juxtaglomerular system, regulating the impact of blood pressure on kidney health and the cardiovascular system. In this study, we investigated the relation between urinary EGF, serum renin and blood pressure in children with obesity or T1DM. 147 non-obese children with T1DM and 126 children with obesity, were included. Blood pressure was measured and mean arterial pressure (MAP) and the pulse pressure (PP) were calculated. Serum renin and urinary EGF levels were determined with a commercial ELISA kit. Partial Spearman rank correlation coefficients and multiple linear regression models were used to study the association between renin, the urinary EGF/urinary creatinine ratio and blood pressure parameters. The urinary EGF/urinary creatinine ratio is correlated with the SBP and the MAP in boys with obesity as well as in boys with T1DM. Multiple regression analysis showed that sex and pulse pressure in male subjects were found to be independently associated with renin. Sex, the presence of diabetes, age, the glomerular filtration rate and both pulse pressure and mean arterial pressure in male subjects were independently associated with urinary EGF/urinary creatinine. In conclusion, in boys with either obesity or diabetes, pulse pressure and mean arterial pressure are negatively associated with the functional integrity of the nephron, which is reflected by a decreased expression of urinary EGF.
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Affiliation(s)
- Kristien J Ledeganck
- Laboratory of Experimental Medicine and Paediatrics and Member of the Infla-Med Centre of Excellence, University of Antwerp, Antwerp, Belgium
| | - Annelies Van Eyck
- Laboratory of Experimental Medicine and Paediatrics and Member of the Infla-Med Centre of Excellence, University of Antwerp, Antwerp, Belgium
- Department of Gastroenterology and Hepatology, Antwerp University Hospital, Edegem, Belgium
| | - Kristien Wouters
- Clinical Trial Center, Clinical Research Center Antwerp, Antwerp University Hospital, University of Antwerp, Edegem, Belgium
| | - Eline Vermeiren
- Laboratory of Experimental Medicine and Paediatrics and Member of the Infla-Med Centre of Excellence, University of Antwerp, Antwerp, Belgium
| | - Benedicte Y De Winter
- Laboratory of Experimental Medicine and Paediatrics and Member of the Infla-Med Centre of Excellence, University of Antwerp, Antwerp, Belgium
- Department of Gastroenterology and Hepatology, Antwerp University Hospital, Edegem, Belgium
| | - Stijn Verhulst
- Laboratory of Experimental Medicine and Paediatrics and Member of the Infla-Med Centre of Excellence, University of Antwerp, Antwerp, Belgium
- Department of Gastroenterology and Hepatology, Antwerp University Hospital, Edegem, Belgium
| | - Kim Van Hoorenbeeck
- Laboratory of Experimental Medicine and Paediatrics and Member of the Infla-Med Centre of Excellence, University of Antwerp, Antwerp, Belgium
- Department of Paediatrics, Antwerp University Hospital, Edegem, Belgium
| | - Annick France
- Department of Paediatric Endocrinology, Antwerp University Hospital, Antwerp, Belgium
| | - Hilde Dotremont
- Department of Paediatric Endocrinology, Antwerp University Hospital, Antwerp, Belgium
| | - Marieke den Brinker
- Department of Paediatric Endocrinology, Antwerp University Hospital, Antwerp, Belgium
| | - Dominique Trouet
- Laboratory of Experimental Medicine and Paediatrics and Member of the Infla-Med Centre of Excellence, University of Antwerp, Antwerp, Belgium
- Department of Paediatric Nephrology, Antwerp University Hospital, Antwerp, Belgium
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6
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Kimura H, Asahi K, Tanaka K, Iseki K, Moriyama T, Yamagata K, Tsuruya K, Fujimoto S, Narita I, Konta T, Kondo M, Kasahara M, Shibagaki Y, Watanabe T, Kazama JJ. Health-related behavioral changes and incidence of chronic kidney disease: The Japan Specific Health Checkups (J-SHC) Study. Sci Rep 2022; 12:16319. [PMID: 36175537 PMCID: PMC9522825 DOI: 10.1038/s41598-022-20807-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 09/19/2022] [Indexed: 12/04/2022] Open
Abstract
The transtheoretical model (TTM) is a commonly used model of health-related behavioral change. However, the practical effect of using this model for chronic kidney disease (CKD) self-management remains unclear. This study aimed to investigate the association between stages of change for lifestyle behavior and the incidence of CKD in the general Japanese population. A retrospective cohort study was conducted among 178,780 non-CKD participants aged 40–74 years who underwent annual health check-ups for two consecutive years between 2008 and 2009. Health behavior change was determined using questionnaires based on the TTM, which consists of five stages of change (precontemplation, contemplation, preparation, action, and maintenance). The exposure of interest was the change in stages between two years. Participants were categorized into 3 groups ‘improved’, ‘unchanged’, or ‘deteriorated’. The association between the change in stages and the incidence of CKD was examined using logistic regression analysis. After one year of follow-up, 20.0% of participants developed CKD. Participants in the deteriorated group showed a significantly higher risk of CKD incidence than in the improved group. Promoting the stage of change for healthy lifestyle behaviors evaluated by the TTM was associated with a risk reduction for the incidence of CKD.
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Affiliation(s)
- Hiroshi Kimura
- Department of Nephrology and Hypertension, Fukushima Medical University, 1 Hikariga-oka, Fukushima City, 960-1295, Japan.
| | - Koichi Asahi
- Division of Nephrology and Hypertension, Iwate Medical University, Yahaba, Japan.,Steering Committee of The Japan Specific Health Checkups (J-SHC) Study Group, Fukushima, Japan
| | - Kenichi Tanaka
- Department of Nephrology and Hypertension, Fukushima Medical University, 1 Hikariga-oka, Fukushima City, 960-1295, Japan
| | - Kunitoshi Iseki
- Steering Committee of The Japan Specific Health Checkups (J-SHC) Study Group, Fukushima, Japan
| | - Toshiki Moriyama
- Steering Committee of The Japan Specific Health Checkups (J-SHC) Study Group, Fukushima, Japan
| | - Kunihiro Yamagata
- Steering Committee of The Japan Specific Health Checkups (J-SHC) Study Group, Fukushima, Japan
| | - Kazuhiko Tsuruya
- Steering Committee of The Japan Specific Health Checkups (J-SHC) Study Group, Fukushima, Japan
| | - Shouichi Fujimoto
- Steering Committee of The Japan Specific Health Checkups (J-SHC) Study Group, Fukushima, Japan
| | - Ichiei Narita
- Steering Committee of The Japan Specific Health Checkups (J-SHC) Study Group, Fukushima, Japan
| | - Tsuneo Konta
- Steering Committee of The Japan Specific Health Checkups (J-SHC) Study Group, Fukushima, Japan
| | - Masahide Kondo
- Steering Committee of The Japan Specific Health Checkups (J-SHC) Study Group, Fukushima, Japan
| | - Masato Kasahara
- Steering Committee of The Japan Specific Health Checkups (J-SHC) Study Group, Fukushima, Japan
| | - Yugo Shibagaki
- Steering Committee of The Japan Specific Health Checkups (J-SHC) Study Group, Fukushima, Japan
| | - Tsuyoshi Watanabe
- Steering Committee of The Japan Specific Health Checkups (J-SHC) Study Group, Fukushima, Japan
| | - Junichiro J Kazama
- Department of Nephrology and Hypertension, Fukushima Medical University, 1 Hikariga-oka, Fukushima City, 960-1295, Japan
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7
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Aizawa T, Nakasone Y, Murai N, Oka R, Nagasaka S, Yamashita K, Sakuma T, Kiyosawa K. Hepatic Steatosis and High-normal Fasting Glucose as Risk Factors for Incident Prediabetes. J Endocr Soc 2022; 6:bvac110. [PMID: 35958436 PMCID: PMC9359444 DOI: 10.1210/jendso/bvac110] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Indexed: 11/26/2022] Open
Abstract
Context The role of hepatic steatosis (HS) in the initial stages of developing type 2 diabetes remains unclear. Objective We aimed to clarify the impact of HS indexed by Fatty Liver Index (FLI) and high-normal fasting plasma glucose (FPG) as risk factors for incident prediabetes in a nonobese cohort. Methods Data from 1125 participants with ADA-defined normal glucose metabolism (median age 52 years; BMI 23.1 kg/m2) were used for retrospective analysis. In the entire population, correlation between normal FPG and FLI was evaluated by multiple regression adjusted for age and sex. Follow-up data from 599 participants in whom 75-g OGTT was repeated 3.7 years later showed that 169 developed prediabetes. This was analyzed by the multivariate Cox proportional hazards model. Results In the entire population, FLI was positively correlated with FPG (P < 0.01): mean FLI increased from 15.8 at FPG 4.2 mmol/L to 31.6 at FPG 5.5 mmol/L. Analysis of the 599 participants (2061 person-years) by Cox model, adjusted for sex, age, family history of diabetes, ISIMATSUDA, and Stumvoll-1, clarified an increased risk of prediabetes with high-normal FPG and FLI. Risk was increased 2.2 times with FLI ≥ 16.5 vs FLI < 16.5, P < 0.001, and increased 2.1 times in participants with FPG ≥ 5.3 mmol/L, P < 0.001. Cutoff values (unadjusted) were obtained by ROC at the point of the largest Youden’s index using the entire range of the variables. Conclusion Even among nonobese individuals, HS indexed by FLI and a high-normal FPG (≥ 5.3 mmol/L) are risk factors for prediabetes, independently from insulin.
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Affiliation(s)
- Toru Aizawa
- Diabetes Center, Aizawa Hospital , Matsumoto, Japan
| | | | - Norimitsu Murai
- Division of Diabetes, Metabolism and Endocrinology, Showa University Fujigaoka Hospital , Yokohama, Japan
| | - Rie Oka
- Department of Internal Medicine, Hokuriku Central Hospital , Toyama, Japan
| | - Shoichiro Nagasaka
- Division of Diabetes, Metabolism and Endocrinology, Showa University Fujigaoka Hospital , Yokohama, Japan
| | | | - Takahiro Sakuma
- Department of Internal Medicine, Ina Central Hospital , Ina, Japan
| | - Kendo Kiyosawa
- Department of Gastroenterology, Aizawa Hospital , Matsumoto, Japan
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8
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Yan P, Xu Y, Miao Y, Bai X, Wu Y, Tang Q, Zhang Z, Yang J, Wan Q. Association of remnant cholesterol with chronic kidney disease in middle-aged and elderly Chinese: a population-based study. Acta Diabetol 2021; 58:1615-1625. [PMID: 34181081 DOI: 10.1007/s00592-021-01765-z] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Accepted: 06/14/2021] [Indexed: 12/20/2022]
Abstract
AIMS Limited data regarding the association between remnant cholesterol (RC) and chronic kidney disease (CKD), largely based on an estimated glomerular filtration rate (eGFR) of < 60 mL/min/1.73 m2 (low eGFR), have yielded inconsistent results, and no report has demonstrated the relationship of RC with CKD [defined as low eGFR and/or albuminuria (defined as urinary albumin-to-creatinine ratio (ACR) ≥ 30 mg/g)] in Chinese general middle-aged and elderly population. Hence, we aimed to investigate the association between RC and CKD in such population. METHODS In total, 7356 Chinese participants aged ≥ 40 years were recruited from five regional communities in Luzhou city between May 2011 and December 2011. Fasting RC was calculated from the lipid profile measured by standard laboratory procedures. Multivariate logistic regression models were used to evaluate the possible association between RC and CKD. RESULTS Participants in the highest quartile of RC had higher body mass index, systolic and diastolic blood pressure, total cholesterol, triglyceride, low-density lipoprotein cholesterol (LDL-C), fasting and 2-h postload blood glucose, glycated hemoglobin A1C, prevalence of prediabetes, type 2 diabetes mellitus (T2DM), hypertension, CKD, albuminuria, low eGFR, and lower high-density lipoprotein cholesterol (HDL-C) and eGFR compared with those in the lowest quartile (all P for trend < 0.01). Multivariate logistic regression analysis demonstrated that the risk of CKD gradually increased across RC quartiles (P for trend < 0.01), and participants in the highest quartile of RC were at a significantly increased risk of prevalent CKD compared to those in the lowest quartile in total subjects (odds rate: 1.344, 95% confidence intervals 1.097-1.648, P < 0.01). In subgroup analysis, significant relation between RC level and increased risk of prevalent CKD was detected in women, subjects with overweight/obesity, non-prediabetes, hypertension, normal HDL-C, appropriate and high LDL-C, and without cardiovascular disease (CVD) events after multiple adjustments. CONCLUSIONS Higher RC is independently associated with increased risk of prevalent CKD, and RC might serve as a new risk biomarker for CKD in a general middle-aged and elderly Chinese population, especially in women, subjects with overweight/obesity, non-prediabetes, hypertension, normal HDL-C, appropriate and high LDL-C, and without CVD events.
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Affiliation(s)
- Pijun Yan
- Department of Endocrinology, The Affiliated Hospital of Southwest Medical University, Luzhou, 646000, Sichuan, China
| | - Yong Xu
- Department of Endocrinology, The Affiliated Hospital of Southwest Medical University, Luzhou, 646000, Sichuan, China
| | - Ying Miao
- Department of Endocrinology, The Affiliated Hospital of Southwest Medical University, Luzhou, 646000, Sichuan, China
| | - Xue Bai
- Department of Endocrinology, The Affiliated Hospital of Southwest Medical University, Luzhou, 646000, Sichuan, China
| | - Yuru Wu
- Department of Endocrinology, The Affiliated Hospital of Southwest Medical University, Luzhou, 646000, Sichuan, China
| | - Qian Tang
- Department of Endocrinology, The Affiliated Hospital of Southwest Medical University, Luzhou, 646000, Sichuan, China
| | - Zhihong Zhang
- Department of General Medicine, The Affiliated Hospital of Southwest Medical University, Luzhou, 646000, Sichuan, China
| | - Jiong Yang
- Southwest Medical University, Luzhou, 646000, Sichuan, China
| | - Qin Wan
- Department of Endocrinology, The Affiliated Hospital of Southwest Medical University, Luzhou, 646000, Sichuan, China.
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9
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Iseki K, Konta T, Asahi K, Yamagata K, Fujimoto S, Tsuruya K, Narita I, Kasahara M, Shibagaki Y, Moriyama T, Kondo M, Iseki C, Watanabe T. Impact of Metabolic Syndrome on the Mortality Rate among Participants in a Specific Health Check and Guidance Program in Japan. Intern Med 2020; 59:2671-2678. [PMID: 32669499 PMCID: PMC7691040 DOI: 10.2169/internalmedicine.4975-20] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Objective In Japan, the Specific Health Check and Guidance (Tokutei-Kenshin) program was started in 2008 to decrease the social burden related to metabolic syndrome (MetS). However, so far this program has not been found to have any impact on the mortality rate. Methods The subjects consisted of individuals who participated in the Tokutei-Kenshin in seven districts between 2008 and 2015. Using a National database of death certificates, we identified those who might have died and then further confirmed such deaths with the collaboration of the regional National Health Insurance agency and public health nurses. The diagnosis of MetS was made according to the Japanese criteria. The causes of death were classified by ICD-10. Mortality risk was evaluated after adjusting for age, sex, smoking, alcohol intake and past medical history such as stroke, heart disease and kidney disease. Results Among the total of 664,926 subjects, we identified 8,051 fatal cases by the end of 2015. The crude death rate was 1.6% for those with MetS, 1.3% for those with preliminary metabolic syndrome, and 1.1% those without MetS. In MetS, the adjusted hazard ratio (95% confidence interval) was 1.08 (1.02-1.15) for all-cause and 1.39 (1.22-1.58) for cardiovascular disease mortality when the reference was for those without MetS. Conclusion The death rate was found to be significantly higher among the participants with MetS.
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Affiliation(s)
| | - Tsuneo Konta
- Department of Public Health and Hygiene, Yamagata University School of Medicine, Japan
| | - Koichi Asahi
- Division of Nephrology and Hypertension, Iwate Medical University, Japan
| | - Kunihiro Yamagata
- Division of Nephrology, Faculty of Medicine, Tsukuba University, Japan
| | - Shouichi Fujimoto
- Department of Hemovascular Medicine and Artificial Organs, Faculty of Medicine, University of Miyazaki, Japan
| | | | - Ichiei Narita
- Division of Nephrology and Rheumatology, Kidney Research Center, Niigata University Graduate School of Medicine and Dental Sciences, Japan
| | - Masato Kasahara
- Institute for Clinical and Translational Science, Nara Medical University Hospital, Japan
| | - Yugo Shibagaki
- Division of Nephrology and Hypertension, St. Marianna University School of Medicine, Japan
| | | | - Masahide Kondo
- Graduate School of Comprehensive Human Science, University of Tsukuba, Japan
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10
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Tannenbaum J, Bittner V, Waters DD. When Diastole Lets You Down: Clinical Relevance of a Widened Pulse Pressure. Can J Cardiol 2020; 36:593-595. [PMID: 32007351 DOI: 10.1016/j.cjca.2019.10.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Accepted: 10/25/2019] [Indexed: 11/27/2022] Open
Affiliation(s)
- Jordan Tannenbaum
- Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Vera Bittner
- Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - David D Waters
- Division of Cardiology, Zuckerberg San Francisco General Hospital, and Department of Medicine, University of California, San Francisco, California, USA.
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11
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Nagai K, Yamagata K, Iseki K, Moriyama T, Tsuruya K, Fujimoto S, Narita I, Konta T, Kondo M, Kasahara M, Shibagaki Y, Asahi K, Watanabe T. Antihypertensive treatment and risk of cardiovascular mortality in patients with chronic kidney disease diagnosed based on the presence of proteinuria and renal function: A large longitudinal study in Japan. PLoS One 2019; 14:e0225812. [PMID: 31800605 PMCID: PMC6892527 DOI: 10.1371/journal.pone.0225812] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Accepted: 11/13/2019] [Indexed: 11/18/2022] Open
Abstract
Several recent clinical trials and meta-analyses have shown that lowering blood pressure reduces the risk of cardiovascular disease. However, current evidence that describes general demographics in blood pressure and mortality with chronic kidney disease is sparse in Japan. Using a population-based longitudinal cohort that received annual health checkups in Japan in 2008, hypertensive status, self-reported use of antihypertensive drugs, and prognosis were examined through 2012. Chronic kidney disease was defined as positive proteinuria or estimated glomerular filtration rate <60 ml/min/1.73 m2. Subjects were 40 to 74 years old (n = 227,204) with median 3.6 years follow-up period, and patients with and without chronic kidney disease were analyzed separately (n = 183,586 and n = 43,618, respectively). Cardiovascular disease mortality, comprising coronary heart diseases and stroke as entered in the national death registry using ICD-10 coding, was examined. Among all subjects, 346 deaths (96 in chronic kidney disease and 250 in non-chronic kidney disease) due to cardiovascular disease occurred. Compared with cardiovascular disease mortality in chronic kidney disease patients with untreated normal blood pressure, the multivariable adjusted hazard ratio was 3.08 (95% confidence interval: 1.75–5.41) for those with untreated hypertension, 2.30 (1.31–4.03) for those who became normotensive after treatment, and 3.28 (1.91–5.64) for those who remained hypertensive despite treatment. In non-chronic kidney disease subjects, the ratios were 1.90 (1.33–5.41), 1.95 (1.35–2.80), and 1.77 (1.18–2.66), respectively. These results from a nationwide cohort could be one of representative demographics of controlling blood pressure and cardiovascular disease deaths when treating patients with chronic kidney disease in Japan in recent years. Even after development and spread of anti-hypertensive drugs, preventing development of hypertension is preferable, because any hypertension treatment status comparing untreated normal blood pressure was a risk of cardiovascular mortality at baseline year.
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Affiliation(s)
- Kei Nagai
- University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Kunihiro Yamagata
- University of Tsukuba, Tsukuba, Ibaraki, Japan
- The Steering Committee for “Design of the Comprehensive Health Care System for Chronic Kidney Disease (CKD) Based on the Individual Risk Assessment by Specific Health Checkups”, Tsukuba, Ibaraki, Japan
- * E-mail:
| | - Kunitoshi Iseki
- The Steering Committee for “Design of the Comprehensive Health Care System for Chronic Kidney Disease (CKD) Based on the Individual Risk Assessment by Specific Health Checkups”, Tsukuba, Ibaraki, Japan
- Okinawa Heart and Renal Association, Okinawa, Japan
| | - Toshiki Moriyama
- The Steering Committee for “Design of the Comprehensive Health Care System for Chronic Kidney Disease (CKD) Based on the Individual Risk Assessment by Specific Health Checkups”, Tsukuba, Ibaraki, Japan
- Health Care Center, Osaka University, Suita, Japan
| | - Kazuhiko Tsuruya
- The Steering Committee for “Design of the Comprehensive Health Care System for Chronic Kidney Disease (CKD) Based on the Individual Risk Assessment by Specific Health Checkups”, Tsukuba, Ibaraki, Japan
- Nara Medical University, Nara, Japan
| | - Shouichi Fujimoto
- The Steering Committee for “Design of the Comprehensive Health Care System for Chronic Kidney Disease (CKD) Based on the Individual Risk Assessment by Specific Health Checkups”, Tsukuba, Ibaraki, Japan
- University of Miyazaki, Miyazaki, Japan
| | - Ichiei Narita
- The Steering Committee for “Design of the Comprehensive Health Care System for Chronic Kidney Disease (CKD) Based on the Individual Risk Assessment by Specific Health Checkups”, Tsukuba, Ibaraki, Japan
- Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Tsuneo Konta
- The Steering Committee for “Design of the Comprehensive Health Care System for Chronic Kidney Disease (CKD) Based on the Individual Risk Assessment by Specific Health Checkups”, Tsukuba, Ibaraki, Japan
- Yamagata University Graduate School of Medical Science, Yamagata, Japan
| | - Masahide Kondo
- University of Tsukuba, Tsukuba, Ibaraki, Japan
- The Steering Committee for “Design of the Comprehensive Health Care System for Chronic Kidney Disease (CKD) Based on the Individual Risk Assessment by Specific Health Checkups”, Tsukuba, Ibaraki, Japan
| | - Masato Kasahara
- The Steering Committee for “Design of the Comprehensive Health Care System for Chronic Kidney Disease (CKD) Based on the Individual Risk Assessment by Specific Health Checkups”, Tsukuba, Ibaraki, Japan
- Institute for Clinical and Translational Science, Nara Medical University Hospital, Nara, Japan
| | - Yugo Shibagaki
- The Steering Committee for “Design of the Comprehensive Health Care System for Chronic Kidney Disease (CKD) Based on the Individual Risk Assessment by Specific Health Checkups”, Tsukuba, Ibaraki, Japan
- St. Marianna University School of Medicine, Kawasaki, Kanagawa, Japan
| | - Koichi Asahi
- The Steering Committee for “Design of the Comprehensive Health Care System for Chronic Kidney Disease (CKD) Based on the Individual Risk Assessment by Specific Health Checkups”, Tsukuba, Ibaraki, Japan
- Iwate Medical University, Morioka, Japan
| | - Tsuyoshi Watanabe
- The Steering Committee for “Design of the Comprehensive Health Care System for Chronic Kidney Disease (CKD) Based on the Individual Risk Assessment by Specific Health Checkups”, Tsukuba, Ibaraki, Japan
- Fukushima Rosai Hospital, Iwaki, Japan
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12
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Akin S, Aydin Z, Cakir O, Kazan S. Correlation between pulse pressure and urinary albumin excretion in type 2 diabetic patients without microalbuminuria. GAZZETTA MEDICA ITALIANA ARCHIVIO PER LE SCIENZE MEDICHE 2019. [DOI: 10.23736/s0393-3660.18.03973-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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13
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Vasan RS, Short MI, Niiranen TJ, Xanthakis V, DeCarli C, Cheng S, Seshadri S, Mitchell GF. Interrelations Between Arterial Stiffness, Target Organ Damage, and Cardiovascular Disease Outcomes. J Am Heart Assoc 2019; 8:e012141. [PMID: 31303106 PMCID: PMC6662123 DOI: 10.1161/jaha.119.012141] [Citation(s) in RCA: 56] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Accepted: 06/03/2019] [Indexed: 01/01/2023]
Abstract
Background Excess transmission of pressure pulsatility caused by increased arterial stiffness may incur microcirculatory damage in end organs (target organ damage [TOD] ) and, in turn, elevate risk for cardiovascular disease ( CVD ) events. Methods and Results We related arterial stiffness measures (carotid-femoral pulse wave velocity, mean arterial pressure, central pulse pressure) to the prevalence and incidence of TOD (defined as albuminuria and/or echocardiographic left ventricular hypertrophy) in up to 6203 Framingham Study participants (mean age 50±15 years, 54% women). We then related presence of TOD to incident CVD in multivariable Cox regression models without and with adjustment for arterial stiffness measures. Cross-sectionally, greater arterial stiffness was associated with a higher prevalence of TOD (adjusted odds ratios ranging from 1.23 to 1.54 per SD increment in arterial stiffness measure, P<0.01). Prospectively, increased carotid-femoral pulse wave velocity was associated with incident albuminuria (odds ratio per SD 1.28, 95% CI, 1.02-1.61; P<0.05), whereas higher mean arterial pressure and central pulse pressure were associated with incident left ventricular hypertrophy (odds ratio per SD 1.37 and 1.45, respectively; P<0.01). On follow-up, 297 of 5803 participants experienced a first CVD event. Presence of TOD was associated with a 33% greater hazard of incident CVD (95% CI , 0-77%; P<0.05), which was attenuated upon adjustment for baseline arterial stiffness measures by 5-21%. Conclusions Elevated arterial stiffness is associated with presence of TOD and may partially mediate the relations of TOD with incident CVD . Our observations in a large community-based sample suggest that mitigating arterial stiffness may lower the burden of TOD and, in turn, clinical CVD .
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Affiliation(s)
- Ramachandran S. Vasan
- National Heart, Lung, and Blood Institute's and Boston University's Framingham Heart StudyFraminghamMA
- Section of Preventive MedicineDepartment of MedicineBoston University School of MedicineBostonMA
- Section of CardiologyDepartment of MedicineBoston University School of MedicineBostonMA
- Department of EpidemiologyBoston University School of Public HealthBostonMA
| | - Meghan I. Short
- Department of BiostatisticsBoston University School of Public HealthBostonMA
| | - Teemu J. Niiranen
- National Heart, Lung, and Blood Institute's and Boston University's Framingham Heart StudyFraminghamMA
- Department of MedicineTurku University Hospital and University of TurkuFinland
- Department of Public Health SolutionsNational Institute for Health and WelfareTurkuFinland
| | - Vanessa Xanthakis
- National Heart, Lung, and Blood Institute's and Boston University's Framingham Heart StudyFraminghamMA
- Section of Preventive MedicineDepartment of MedicineBoston University School of MedicineBostonMA
- Department of BiostatisticsBoston University School of Public HealthBostonMA
| | | | - Susan Cheng
- National Heart, Lung, and Blood Institute's and Boston University's Framingham Heart StudyFraminghamMA
- Smidt Heart InstituteCedars‐Sinai Medical CenterLos AngelesCA
| | - Sudha Seshadri
- National Heart, Lung, and Blood Institute's and Boston University's Framingham Heart StudyFraminghamMA
- Biggs Institute for Alzheimer's DiseaseUniversity of Texas Health Sciences Center at San AntonioTX
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14
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Hirai T, Shuji Y, Takiyama M, Hanada K, Itoh T. Renin-angiotensin system inhibitors for countering proteinuria induced by angiogenesis inhibitors: a retrospective observational analysis. Cancer Chemother Pharmacol 2019; 84:195-202. [PMID: 31119376 DOI: 10.1007/s00280-019-03876-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Accepted: 05/14/2019] [Indexed: 12/20/2022]
Abstract
PURPOSE Occurrence of proteinuria could result in cessation of bevacizumab and ramucirumab treatments. Renin-angiotensin system (RAS) inhibitors exert a renoprotective effect by countering proteinuria. However, the association between renoprotective effect of RAS inhibitors and blood pressure control is unclear. This study assessed the risk factors for proteinuria induced by bevacizumab or ramucirumab and the relationship between renoprotective effect of RAS inhibitors and blood pressure control. METHODS A retrospective observational analysis was conducted at Tokyo Women's Medical University, Medical Center East from June 2015 to May 2018. Multivariate logistic regression analysis was used to identify risk factors for proteinuria induced by treatment with bevacizumab and ramucirumab. Renoprotective effect was assessed by analyzing blood pressure data in association with the use of RAS inhibitors. RESULTS Out of 208 patients included in this study, proteinuria was observed in 50 (24%) patients. Body mass index ≥ 24 kg/m2 (OR = 2.45, 95% CI 1.21-4.96, p = 0.01), colorectal cancer (OR = 1.95, 95% CI 1.00-3.80, p < 0.05), and use of RAS inhibitors (OR = 0.25 95% CI 0.07-0.92, p = 0.04) were associated with proteinuria induced by treatment with bevacizumab and ramucirumab. A change in systolic blood pressure at second visit was higher in patients with RAS inhibitors compared with those in patients without RAS inhibitors (25 mmHg vs - 5 mmHg, p = 0.04). CONCLUSION Although RAS inhibitors protected patients from proteinuria induced by bevacizumab or ramucirumab, RAS inhibitors could not adequately control their blood pressures in patients with proteinuria.
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Affiliation(s)
- Toshinori Hirai
- Department of Pharmacy, Tokyo Women's Medical University, Medical Center East, 2-1-10, Nishiogu, Arakawa-ku, Tokyo, 116-0011, Japan.
| | - Yukari Shuji
- Department of Pharmacy, Tokyo Women's Medical University, Medical Center East, 2-1-10, Nishiogu, Arakawa-ku, Tokyo, 116-0011, Japan
| | - Megumi Takiyama
- Department of Pharmacy, Tokyo Women's Medical University, Medical Center East, 2-1-10, Nishiogu, Arakawa-ku, Tokyo, 116-0011, Japan
| | - Kazuhiko Hanada
- Department of Pharmacometrics and Pharmacokinetics, Meiji Pharmaceutical University, 2-522-1 Noshio, Kiyose, Tokyo, 204-8588, Japan
| | - Toshimasa Itoh
- Department of Pharmacy, Tokyo Women's Medical University, Medical Center East, 2-1-10, Nishiogu, Arakawa-ku, Tokyo, 116-0011, Japan
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15
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Abstract
See Article Yamamoto et al
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Affiliation(s)
- Anthony M Dart
- 1 Department of Cardiovascular Medicine Alfred Hospital Melbourne Victoria Australia
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16
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Iseki K, Konta T, Asahi K, Yamagata K, Fujimoto S, Tsuruya K, Narita I, Kasahara M, Shibagaki Y, Moriyama T, Kondo M, Iseki C, Watanabe T. Dipstick proteinuria and all-cause mortality among the general population. Clin Exp Nephrol 2018; 22:1331-1340. [PMID: 29869754 DOI: 10.1007/s10157-018-1587-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Accepted: 05/10/2018] [Indexed: 02/06/2023]
Abstract
BACKGROUND Dipstick proteinuria, but not albuminuria, is used for general health screening in Japan. How the results of dipstick proteinuria tests correlate with mortality and, however, is not known. METHODS Subjects were participants of the 2008 Tokutei-Kenshin (Specific Health Check and Guidance program) in six districts in Japan. On the basis of the national database of death certificates from 2008 to 2012, we used a personal identifier in two computer registries to identify participants who might have died. The hazard ratio (95% confidence interval, CI) was calculated by Cox-proportional hazard analysis. RESULTS Among a total of 140,761 subjects, we identified 1641 mortalities that occurred by the end of 2012. The crude mortality rates were 1.1% for subjects who were proteinuria (-), 1.5% for those with proteinuria (+/-), 2.0% for those with proteinuria (1+), 3.5% for those with proteinuria (2+), and 3.7% for those with proteinuria (≥ 3+). After adjusting for sex, age, body mass index, estimated glomerular filtration rate, comorbid condition, past history, and lifestyle, the hazard ratio (95% CI) for dipstick proteinuria was 1.262 (1.079-1.467) for those with proteinuria (+/-), 1.437 (1.168-1.748) for those with proteinuria (1+), 2.201 (1.688-2.867) for those with proteinuria (2+), and 2.222 (1.418-3.301) for those with proteinuria (≥ 3+) compared with the reference of proteinuria (-). CONCLUSION Dipstick proteinuria is an independent predictor of death among Japanese community-based screening participants.
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Affiliation(s)
- Kunitoshi Iseki
- Clinical Research Support Center, Tomishiro Central Hospital, Ueda 25, Tomigusuku, Okinawa, 901-0243, Japan. .,Steering Committee of Research on Design of the Comprehensive Health Care System for Chronic Kidney Disease (CKD) Based on the Individual Risk Assessment by Specific Health Check, Fukushima, Japan. .,Okinawa Heart and Renal Association (OHRA), Okinawa, Japan.
| | - Tsuneo Konta
- Steering Committee of Research on Design of the Comprehensive Health Care System for Chronic Kidney Disease (CKD) Based on the Individual Risk Assessment by Specific Health Check, Fukushima, Japan
| | - Koichi Asahi
- Steering Committee of Research on Design of the Comprehensive Health Care System for Chronic Kidney Disease (CKD) Based on the Individual Risk Assessment by Specific Health Check, Fukushima, Japan
| | - Kunihiro Yamagata
- Steering Committee of Research on Design of the Comprehensive Health Care System for Chronic Kidney Disease (CKD) Based on the Individual Risk Assessment by Specific Health Check, Fukushima, Japan
| | - Shouichi Fujimoto
- Steering Committee of Research on Design of the Comprehensive Health Care System for Chronic Kidney Disease (CKD) Based on the Individual Risk Assessment by Specific Health Check, Fukushima, Japan
| | - Kazuhiko Tsuruya
- Steering Committee of Research on Design of the Comprehensive Health Care System for Chronic Kidney Disease (CKD) Based on the Individual Risk Assessment by Specific Health Check, Fukushima, Japan
| | - Ichiei Narita
- Steering Committee of Research on Design of the Comprehensive Health Care System for Chronic Kidney Disease (CKD) Based on the Individual Risk Assessment by Specific Health Check, Fukushima, Japan
| | - Masato Kasahara
- Steering Committee of Research on Design of the Comprehensive Health Care System for Chronic Kidney Disease (CKD) Based on the Individual Risk Assessment by Specific Health Check, Fukushima, Japan
| | - Yugo Shibagaki
- Steering Committee of Research on Design of the Comprehensive Health Care System for Chronic Kidney Disease (CKD) Based on the Individual Risk Assessment by Specific Health Check, Fukushima, Japan
| | - Toshiki Moriyama
- Steering Committee of Research on Design of the Comprehensive Health Care System for Chronic Kidney Disease (CKD) Based on the Individual Risk Assessment by Specific Health Check, Fukushima, Japan
| | - Masahide Kondo
- Steering Committee of Research on Design of the Comprehensive Health Care System for Chronic Kidney Disease (CKD) Based on the Individual Risk Assessment by Specific Health Check, Fukushima, Japan
| | - Chiho Iseki
- Okinawa Heart and Renal Association (OHRA), Okinawa, Japan
| | - Tsuyoshi Watanabe
- Steering Committee of Research on Design of the Comprehensive Health Care System for Chronic Kidney Disease (CKD) Based on the Individual Risk Assessment by Specific Health Check, Fukushima, Japan
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17
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Bacci S, di Lorenzo A, Greco EV, Tinti MG, Rauseo A, Palena AP, Vendemiale G, De Cosmo S. BMI correlates with pulse pressure in offspring of patients with type 2 diabetes and albuminuria. Nutr Metab Cardiovasc Dis 2018; 28:643-644. [PMID: 29699813 DOI: 10.1016/j.numecd.2018.01.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Revised: 01/25/2018] [Accepted: 01/26/2018] [Indexed: 10/17/2022]
Affiliation(s)
- S Bacci
- Department of Clinical Sciences I.R.C.C.S, "Casa Sollievo Della Sofferenza", Viale Cappuccini 1, 71013, San Giovanni Rotondo, FG, Italy.
| | - A di Lorenzo
- Department of Clinical Sciences I.R.C.C.S, "Casa Sollievo Della Sofferenza", Viale Cappuccini 1, 71013, San Giovanni Rotondo, FG, Italy
| | - E V Greco
- Department of Clinical Sciences I.R.C.C.S, "Casa Sollievo Della Sofferenza", Viale Cappuccini 1, 71013, San Giovanni Rotondo, FG, Italy
| | - M G Tinti
- Department of Clinical Sciences I.R.C.C.S, "Casa Sollievo Della Sofferenza", Viale Cappuccini 1, 71013, San Giovanni Rotondo, FG, Italy
| | - A Rauseo
- Department of Clinical Sciences I.R.C.C.S, "Casa Sollievo Della Sofferenza", Viale Cappuccini 1, 71013, San Giovanni Rotondo, FG, Italy
| | - A P Palena
- Department of Clinical Sciences I.R.C.C.S, "Casa Sollievo Della Sofferenza", Viale Cappuccini 1, 71013, San Giovanni Rotondo, FG, Italy
| | - G Vendemiale
- Department of Medical and Surgical Sciences, University of Foggia, Viale Luigi Pinto 1, 71122, Foggia, Italy
| | - S De Cosmo
- Department of Clinical Sciences I.R.C.C.S, "Casa Sollievo Della Sofferenza", Viale Cappuccini 1, 71013, San Giovanni Rotondo, FG, Italy
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18
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Mortality risk among screened subjects of the specific health check and guidance program in Japan 2008-2012. Clin Exp Nephrol 2017; 21:978-985. [PMID: 28258498 DOI: 10.1007/s10157-017-1392-y] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2017] [Accepted: 02/09/2017] [Indexed: 10/20/2022]
Abstract
BACKGROUND In Japan, the Specific Health Check and Guidance (Tokutei-Kenshin) has started in 2008. However, the relationship between the baseline characteristics and mortality has not been examined. METHODS Subjects were those who participated at the 2008 Tokutei-Kenshin in six districts with baseline data of serum creatinine. Using National database of death certificate from 2008 to 2012, we identified those who might have died and confirmed further with the collaborations of the regional National Health Insurance agency and public health nurses. The data was released to the research team supported by the Ministry of Health, Labor, and Welfare of Japan, and is governed by strict regulation and is completely encrypted with the individual's name and residence. Causes of death were classified by ICD-10. RESULTS Among the total of 295,297 subjects, we identified 3764 fatal cases by end of 2012. The median BMI was 23.8 kg/m2 in men and 22.5 kg/m2 in women, respectively. Proteinuria, dipstick 1+ and over, was positive in 5.3%. The median eGFR was 73.8 ml/min/1.73 m2 among those with data available in 81% of the total cohort (N = 239,274). The leading cause of death was neoplasm in both genders. It was 51.6% of the total, 50.4% in men and 53.7% in women. The second cause of death was circulatory; 20.4% of the total, 21.1% in men and 19.2% in women. CONCLUSION Half of the causes of death was related to neoplasm among the cohort of the Tokutei-Kenshin. Effects of baseline demographics such as lifestyle and CKD remained to be studied.
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19
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Charvat H, Goto A, Goto M, Inoue M, Heianza Y, Arase Y, Sone H, Nakagami T, Song X, Qiao Q, Tuomilehto J, Tsugane S, Noda M, Inoue M. Impact of population aging on trends in diabetes prevalence: A meta-regression analysis of 160,000 Japanese adults. J Diabetes Investig 2015; 6:533-42. [PMID: 26417410 PMCID: PMC4578492 DOI: 10.1111/jdi.12333] [Citation(s) in RCA: 92] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2014] [Revised: 01/06/2015] [Accepted: 01/16/2015] [Indexed: 12/20/2022] Open
Abstract
AIMS/INTRODUCTION To provide age- and sex-specific trends, age-standardized trends, and projections of diabetes prevalence through the year 2030 in the Japanese adult population. MATERIALS AND METHODS In the present meta-regression analysis, we included 161,087 adults from six studies and nine national health surveys carried out between 1988 and 2011 in Japan. We assessed the prevalence of diabetes using a recorded history of diabetes or, for the population of individuals without known diabetes, either a glycated hemoglobin level of ≥6.5% (48 mmol/mol) or the 1999 World Health Organization criteria (i.e., a fasting plasma glucose level of ≥126 mg/dL and/or 2-h glucose level of ≥200 mg/dL in the 75-g oral glucose tolerance test). RESULTS For both sexes, prevalence appeared to remain unchanged over the years in all age categories except for men aged 70 years or older, in whom a significant increase in prevalence with time was observed. Age-standardized diabetes prevalence estimates based on the Japanese population of the corresponding year showed marked increasing trends: diabetes prevalence was 6.1% among women (95% confidence interval [CI] 5.5-6.7), 9.9% (95% CI 9.2-10.6) among men, and 7.9% (95% CI 7.5-8.4) among the total population in 2010, and was expected to rise by 2030 to 6.7% (95% CI 5.2-9.2), 13.1% (95% CI 10.9-16.7) and 9.8% (95% CI 8.5-12.0), respectively. In contrast, the age-standardized diabetes prevalence using a fixed population appeared to remain unchanged. CONCLUSIONS This large-scale meta-regression analysis shows that a substantial increase in diabetes prevalence is expected in Japan during the next few decades, mainly as a result of the aging of the adult population.
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Affiliation(s)
- Hadrien Charvat
- Epidemiology and Prevention Group, Research Center for Cancer Prevention and Screening, National Cancer CenterTokyo, Japan
| | - Atsushi Goto
- Department of Diabetes Research, National Center for Global Health and MedicineTokyo, Japan
| | - Maki Goto
- Department of Diabetes Research, National Center for Global Health and MedicineTokyo, Japan
| | - Machiko Inoue
- General Medical Education Center, Teikyo UniversityTokyo, Japan
| | - Yoriko Heianza
- Department of Internal Medicine, Faculty of Medicine, Niigata UniversityNiigata, Japan
| | - Yasuji Arase
- Health Management Center, Toranomon HospitalTokyo, Japan
| | - Hirohito Sone
- Department of Internal Medicine, Faculty of Medicine, Niigata UniversityNiigata, Japan
| | - Tomoko Nakagami
- Diabetes Center, Tokyo Women's Medical UniversityTokyo, Japan
| | - Xin Song
- Department of Public Health, University of HelsinkiHelsinki, Finland
- Department of Chronic Disease Prevention, National Institute for Health and WelfareHelsinki, Finland
| | - Qing Qiao
- Department of Public Health, University of HelsinkiHelsinki, Finland
- Department of Chronic Disease Prevention, National Institute for Health and WelfareHelsinki, Finland
- R&D AstraZeneca ABMölndal, Sweden
| | - Jaakko Tuomilehto
- Department of Chronic Disease Prevention, National Institute for Health and WelfareHelsinki, Finland
- Center for Vascular Prevention, Danube University KremsKrems, Austria
- King Abdulaziz UniversityJeddah, Saudi Arabia
| | - Shoichiro Tsugane
- Epidemiology and Prevention Group, Research Center for Cancer Prevention and Screening, National Cancer CenterTokyo, Japan
| | - Mitsuhiko Noda
- Department of Diabetes Research, National Center for Global Health and MedicineTokyo, Japan
| | - Manami Inoue
- AXA Department of Health and Human Security, Graduate School of Medicine, The University of TokyoTokyo, Japan
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Nagai K, Yamagata K, Ohkubo R, Saito C, Asahi K, Iseki K, Kimura K, Moriyama T, Narita I, Fujimoto S, Tsuruya K, Konta T, Kondo M, Watanabe T. Annual decline in estimated glomerular filtration rate is a risk factor for cardiovascular events independent of proteinuria. Nephrology (Carlton) 2015; 19:574-80. [PMID: 24899111 DOI: 10.1111/nep.12286] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/01/2014] [Indexed: 11/28/2022]
Abstract
AIMS Chronic kidney disease is a risk factor of the development of cardiovascular disease (CVD). However, it is not clear whether decline of glomerular filtration rate (GFR), not reduced GFR, is a risk factor for the incidence of CVD independent of proteinuria. METHODS By using a population-based 521 123 person-years longitudinal cohort receiving annual health checkups from 2008 to 2010, we examined whether the annual decline of estimated GFR is a risk factor for CVD development independent of proteinuria. RESULTS During the follow-up period, there were 12 041 newly developed CVD events, comprising 4426 stroke events and/or 8298 cardiac events. As expected, both reduced estimated GFR and proteinuria were risk factors for the development of CVD in our study population. Moreover, annual decline of estimated GFR was a significant and independent risk factor for the incidence of CVD (HR [95% CI], 1.23 [1.18-1.28] in males or 1.14 [1.10-1.18] in females for -10% per year) with covariant adjustment for proteinuria and reduced estimated GFR. CONCLUSION Annual decline of GFR is an independent risk factor for CVD. Serial measurement of both creatinine and proteinuria would be better to predict the incidence of CVD in the general population.
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Affiliation(s)
- Kei Nagai
- Department of Nephrology, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
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A high normal ankle-brachial index is associated with proteinuria in a screened cohort of Japanese: the Okinawa Peripheral Arterial Disease Study. J Hypertens 2015; 32:1435-43; discussion 1443. [PMID: 24733028 DOI: 10.1097/hjh.0000000000000196] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES We hypothesized that ankle-brachial index (ABI) increased with age as a result of arterial stiffness, and decreased when flow-limiting atherosclerotic stenosis occurred in the lower limbs. As arterial stiffness is associated with proteinuria, we investigated the relationship between ABI and prevalence of proteinuria. METHODS A cross-sectional study of ABI and proteinuria with 13,193 participants aged 21-89 years (53% women) from health checkups between July 2003 and March 2010 was conducted. ABI was measured using the automatic oscillometric method, and stratified into four groups: ABI ≤ 0.9 (low); 0.9 < ABI <1.0 (borderline low); 1.0 ≤ ABI <1.2 (normal); and 1.2 ≤ ABI <1.4 (high normal). RESULTS In participants with ABI at least 1.0, ABI was positively correlated with SBP, pulse pressure, and brachial-ankle pulse wave velocity. In participants with ABI less than 1.0, all indices were negatively correlated with ABI. The prevalence of proteinuria, defined as ≥ 1+ by dipstick, was significantly higher in low (23%) and high normal ABI (10%) compared with borderline low (6%) and normal ABI (7%). In participants at least 60 years, proteinuria was significantly associated with only low ABI [odds ratio (OR) 3.22, 95% confidence interval 1.34-7.41] compared with normal ABI before and after multivariable adjustment. In participants less than 60 years, adjusted OR for proteinuria was only significantly associated with high normal ABI (OR 1.32, 95% confidence interval 1.01-1.74). CONCLUSION High normal ABI in younger participants may be a result of arterial stiffness and associated with proteinuria.
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Kuo TH, Yang DC, Lin WH, Tseng CC, Chen JY, Ho CS, Cheng MF, Tsai WC, Wang MC. Compliance Index, a Marker of Peripheral Arterial Stiffness, may Predict Renal Function Decline in Patients with Chronic Kidney Disease. Int J Med Sci 2015; 12:530-7. [PMID: 26180508 PMCID: PMC4502056 DOI: 10.7150/ijms.12164] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2015] [Accepted: 05/18/2015] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Compliance index derived from digital volume pulse (CI-DVP), measuring the relationship between volume and pressure changes in fingertip, is a surrogate marker of peripheral arterial stiffness. This study investigated if CI-DVP can predict renal function deterioration, cardiovascular events and mortality in patients with chronic kidney disease (CKD). METHODS In this prospective observational study, 149 CKD patients were included for final analysis. CI-DVP and brachial-ankle pulse wave velocity (baPWV) were measured, decline in renal function was assessed by the estimated glomerular filtration rate (eGFR) slope. Composite renal and cardiovascular outcomes were evaluated, including ≥50% eGFR decline, start of renal replacement therapy, and major adverse events. RESULTS Patients in CKD stages 3b to 5 had higher baPWV and lower CI-DVP values than those in patients with CKD stages 1 to 3a. Stepwise multivariate linear regression analysis showed that lower CI-DVP (p =0.0001) and greater proteinuria (p =0.0023) were independent determinants of higher eGFR decline rate. Multivariate Cox regression analysis revealed that CI-DVP (HR 0.68, 95% CI 0.46-1.00), baseline eGFR (HR 0.96, 95% CI 0.94-0.98) and serum albumin (HR 0.17, 95% CI 0.07-0.42) were independent predictors for composite renal and cardiovascular outcomes. CONCLUSIONS Compliance index, CI-DVP, was significantly associated with renal function decline in patients with CKD. A higher CI-DVP may have independent prognostic value in slower renal function decline and better composite renal and cardiovascular outcomes in CKD patients.
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Affiliation(s)
- Te-Hui Kuo
- 1. Division of Nephrology, Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Deng-Chi Yang
- 2. Division of Geriatrics and Gerontology, Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Wei-Hung Lin
- 3. Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan ; 4. Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Chin-Chung Tseng
- 1. Division of Nephrology, Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Ju-Yi Chen
- 5. Division of Cardiology, Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Chin-Shan Ho
- 6. Graduate Institute of Sports Science, National Taiwan Sport University, Taoyuan, Taiwan
| | - Meng-Fu Cheng
- 1. Division of Nephrology, Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Wei-Chuan Tsai
- 5. Division of Cardiology, Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Ming-Cheng Wang
- 1. Division of Nephrology, Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan ; 7. Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan
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Sato Y, Fujimoto S, Konta T, Iseki K, Moriyama T, Yamagata K, Tsuruya K, Kimura K, Narita I, Kondo M, Asahi K, Kurahashi I, Ohashi Y, Watanabe T. Significance of estimated glomerular filtration rate in predicting brain or heart attacks in obese and non-obese populations. Clin Exp Nephrol 2014; 19:790-6. [PMID: 25433815 DOI: 10.1007/s10157-014-1062-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2014] [Accepted: 11/20/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND The Japanese Specific Health Checkup mainly focuses on metabolic syndrome for preventing cardiovascular events. Subjects are stratified by measuring waist circumference, body mass index, blood pressure, triglycerides, and fasting plasma glucose. However, estimated glomerular filtration rate (eGFR) is not considered essential. METHODS A longitudinal cohort study assessed the association of eGFR with new-onset brain or heart attacks in a large Japanese nationwide Specific Health Checkup database. A total of 109,349 Japanese subjects (mean age 63.2 years, 39.5 % men) were examined for the events 2 years later. The odds ratios were calculated for new events in the total and subgroup populations divided by BMI < or ≥25 kg/m(2), obese and non-obese, respectively. RESULTS Obese subjects were more often male and had proteinuria (dipstick test ≥1+), lower eGFR, and higher systolic and diastolic BP, fasting plasma glucose, hemoglobin A1c, and triglycerides (TG). Rates of new-onset brain or heart attacks were 3.1 and 4.0 % in the groups of non-obese and obese subjects, respectively. In the total population, eGFR as well as higher BMI (≥25 kg/m(2)), higher BP (high-normal hypertension or greater), higher TG (≥150 mg/dl), and proteinuria were significant risk factors for developing brain or heart attacks. The eGFR was significant in non-obese subjects, but not in the obese. CONCLUSION As the ultimate aim of 'Specific Health Checkup' is to prevent cardiovascular events, our study suggests that eGFR should be evaluated in non-obese subjects.
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Affiliation(s)
- Yuji Sato
- Dialysis Division, University of Miyazaki Hospital, 5200 Kihara, Kiyotake, Miyazaki, 889-1692, Japan.
| | - Shouichi Fujimoto
- Department of Hemovascular Medicine and Artificial Organs, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
| | - Tsuneo Konta
- Steering Committee for "Design of the comprehensive health care system for chronic kidney disease (CKD) based on the individual risk assessment by Specific Health Checkups", Fukushima, Japan
| | - Kunitoshi Iseki
- Steering Committee for "Design of the comprehensive health care system for chronic kidney disease (CKD) based on the individual risk assessment by Specific Health Checkups", Fukushima, Japan
| | - Toshiki Moriyama
- Steering Committee for "Design of the comprehensive health care system for chronic kidney disease (CKD) based on the individual risk assessment by Specific Health Checkups", Fukushima, Japan
| | - Kunihiro Yamagata
- Steering Committee for "Design of the comprehensive health care system for chronic kidney disease (CKD) based on the individual risk assessment by Specific Health Checkups", Fukushima, Japan
| | - Kazuhiko Tsuruya
- Steering Committee for "Design of the comprehensive health care system for chronic kidney disease (CKD) based on the individual risk assessment by Specific Health Checkups", Fukushima, Japan
| | - Kenjiro Kimura
- Steering Committee for "Design of the comprehensive health care system for chronic kidney disease (CKD) based on the individual risk assessment by Specific Health Checkups", Fukushima, Japan
| | - Ichiei Narita
- Steering Committee for "Design of the comprehensive health care system for chronic kidney disease (CKD) based on the individual risk assessment by Specific Health Checkups", Fukushima, Japan
| | - Masahide Kondo
- Steering Committee for "Design of the comprehensive health care system for chronic kidney disease (CKD) based on the individual risk assessment by Specific Health Checkups", Fukushima, Japan
| | - Koichi Asahi
- Steering Committee for "Design of the comprehensive health care system for chronic kidney disease (CKD) based on the individual risk assessment by Specific Health Checkups", Fukushima, Japan
| | | | - Yasuo Ohashi
- Department of Integrated Science and Engineering for Sustainable Society, Chuo University, Tokyo, Japan
| | - Tsuyoshi Watanabe
- Steering Committee for "Design of the comprehensive health care system for chronic kidney disease (CKD) based on the individual risk assessment by Specific Health Checkups", Fukushima, Japan
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Abstract
BACKGROUND The obesity epidemic is driving the increased prevalence of type 2 diabetes mellitus (T2DM), and the vast majority of patients with T2DM are overweight or obese. Excess body weight is associated with the risk of cardiometabolic complications, which are major causes of morbidity and mortality in T2DM. AIMS To review evidence about effects of weight loss in pre-diabetes and established T2DM. RESULTS In prediabetes, weight loss has been shown to delay the onset or decrease the risk of T2DM, while in established T2DM weight loss has been shown to improve glycaemic control, with severe calorie restriction even reversing the progression of T2DM. Observational studies support the reduction in cardiovascular risk factors following weight loss in patients with T2DM. However, data from the randomised Look AHEAD trial revealed intensive weight loss interventions did not reduce the rate of cardiovascular events in overweight or obese adults with T2DM, and secondary analyses of other large cardiovascular outcomes trials have also been inconclusive. However, besides cardiovascular risk, other documented benefits of weight loss in T2DM include improvements in quality of life, mobility, and physical and sexual function. CONCLUSIONS Physicians should encourage weight loss in all overweight patients with or at risk of T2DM, and should consider the impact on weight when choosing the most appropriate glucose-lowering therapies for these patients.
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Sato Y, Fujimoto S, Konta T, Iseki K, Moriyama T, Yamagata K, Tsuruya K, Yoshida H, Asahi K, Kurahashi I, Ohashi Y, Watanabe T. U-shaped association between body mass index and proteinuria in a large Japanese general population sample. Clin Exp Nephrol 2013; 18:75-86. [PMID: 23652829 DOI: 10.1007/s10157-013-0809-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2013] [Accepted: 04/10/2013] [Indexed: 11/30/2022]
Abstract
BACKGROUND There is little data on the association between body mass index (BMI) and proteinuria. METHODS This was a cross-sectional cohort study assessing the association between BMI and proteinuria in a large Japanese population. Using a nationwide health check-up database of 212,251 Japanese aged >20 years with no pre-existing cardiovascular diseases (185,183 men, median age 66 years; 127,068 women, median age 65 years), we examined the association between BMI and proteinuria (≥ 1+ on dipstick). RESULTS Subjects were divided into 11 subgroups by BMI grading in 1 kg/m(2) intervals from 18.5-27.5 kg/m(2). A BMI of approximately 22 ± 0.5 kg/m(2) was considered optimal for Japanese; therefore, this subgroup was set as a reference when logistic analysis was applied. Age, waist circumference, height, weight, smoking and drinking habits, use of medications such as antihypertensive, antidiabetic, or antihyperlipidemic, as well as proteinuria, estimated glomerular filtration rate (eGFR), chemistry data, and blood pressure levels were significantly different between subgroups in both genders. The odds ratio for proteinuria showed a U-shape in men and women, even after adjustment for significant covariates such as age, waist circumference, systolic blood pressure, eGFR, fasting plasma glucose, triglyceride, low-density lipoprotein, antihypertensive use, antidiabetic use, antihyperlipidemic use, and lifestyle factors (smoking and drinking). Gender differences were also prominent--a BMI <20.4 kg/m(2) was significantly associated with proteinuria in men compared to a BMI <18.4 kg/m(2) in women. On the other hand, a BMI ≥ 25.5 kg/m(2) was also significantly associated with proteinuria in men compared to a BMI ≥ 22.5 kg/m(2) in women. CONCLUSIONS We found that BMI levels were associated with proteinuria in a U-shaped manner and showed marked gender differences. Health guidance should not only focus on higher BMI subjects, but also on thin subjects, in terms of the prevention of chronic kidney disease.
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Affiliation(s)
- Yuji Sato
- Dialysis Division, University of Miyazaki Hospital, Miyazaki, Japan,
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Yano Y, Kario K, Ishikawa S, Ojima T, Gotoh T, Kayaba K, Tsutsumi A, Shimada K, Nakamura Y, Kajii E. Associations between diabetes, leanness, and the risk of death in the Japanese general population: the Jichi Medical School Cohort Study. Diabetes Care 2013; 36:1186-92. [PMID: 23250802 PMCID: PMC3631853 DOI: 10.2337/dc12-1736] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To examine the BMI-stratified associations between diabetes and the risks of all-cause death, cardiovascular disease (CVD) death, and cancer death. RESEARCH DESIGN AND METHODS Using a prospective study with 12 rural Japanese general populations (n = 3,641, mean age, 53.7 years; 33.5% men), we examined the associations between diabetes and the risk of all-cause death, CVD death, and cancer death. We also examined the effects of BMI and age on such associations. RESULTS During an average duration of 10.2 years (37,278 person-years), 240 deaths occurred (54 deaths from CVD, 101 from cancer, and 85 from other causes). Cox regression analysis showed leanness (defined as the lowest quartile of entire BMI; mean, 19.5 kg/m(2)), but not obesity (BMI ≥25 kg/m(2)), and diabetes were independently associated with an increased risk of all-cause death (hazard ratio [HR] 1.70 and 1.65, respectively; both P < 0.01.). Stratification with cause-specific deaths showed that leanness and obesity were associated with CVD death (HR 3.77 and 2.94, respectively), whereas diabetes was associated with cancer death (HR 1.87; all P < 0.05). The increased risk of all-cause death in diabetes was substantially higher in lean subjects aged <65 years (HR 3.4) or those aged ≥65 years (HR 4.2), whereas the risk in obese diabetes patients was significant only in subjects aged <65 years (HR 2.32; all P < 0.05). CONCLUSIONS Among the Japanese general population, diabetes confers an increased risk of all-cause death. Particular attention must be paid to the pronounced high mortality in diabetes accompanied with leanness, regardless of age.
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Affiliation(s)
- Yuichiro Yano
- Department of Medicine, Jichi Medical University School of Medicine, Tochigi, Japan
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Kim JK, Ju YS, Moon SJ, Song YR, Kim HJ, Kim SG. High pulse pressure and metabolic syndrome are associated with proteinuria in young adult women. BMC Nephrol 2013; 14:45. [PMID: 23433013 PMCID: PMC3610196 DOI: 10.1186/1471-2369-14-45] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2012] [Accepted: 02/19/2013] [Indexed: 01/21/2023] Open
Abstract
Background Obesity and metabolic syndrome play causative roles in the increasing prevalence of proteinuria in the general population. However, in young adult women the clinical significance of incidentally discovered proteinuria and its association with metabolic syndrome are unclear. We investigated the prevalence and risk factors for proteinuria in this population. Methods A total of 10,385 women aged 20 to 39 years who underwent health screenings were surveyed. Each patient was tested for proteinuria with a dipstick (−, ±, 1+, 2+, or 3+), and proteinuria was defined as 1+ or greater. Persistent proteinuria was established by confirming proteinuria in a subsequent test. Metabolic syndrome was defined in accordance with the updated National Cholesterol Education Program Adult Treatment Panel III criteria for Asia. Results The mean age was 28.9 ± 5.5 years, and the prevalence of persistent proteinuria was 1.0%. Among these subjects with persistent proteinuria, obesity and metabolic syndrome were found in 10.4% and 5.2%, respectively. Metabolic syndrome, as well as its components of hypertension, hyperglycemia, central obesity, low high-density lipoprotein levels, and high triglyceride levels, was closely related to the presence of proteinuria. In addition, a wide pulse pressure of ≥40 mmHg was another independent risk factor for proteinuria [odds ratio (OR) 3.29, 95% confidence interval (CI) 1.03–11.91)]. This had an additive effect on metabolic syndrome in terms of predicting proteinuria. Even in subjects without metabolic syndrome, the influence of an increased pulse pressure was consistent (OR 2.75, 95% CI 1.03–8.61). Conclusions Specific attention to proteinuria may be necessary in asymptomatic young women aged 20 to 39 years if they have metabolic syndrome or a wide pulse pressure.
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Affiliation(s)
- Jwa-Kyung Kim
- Department of Internal Medicine, Hallym University Sacred Heart Hospital, Kidney Research Institute, Hallym University College of Medicine, 896, Pyeongchon-dong, Anyang-si 431-070, Dongan-gu, Korea
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28
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Sato Y, Yano Y, Fujimoto S, Konta T, Iseki K, Moriyama T, Yamagata K, Tsuruya K, Yoshida H, Asahi K, Kurahashi I, Ohashi Y, Watanabe T. Glycohemoglobin not as predictive as fasting glucose as a measure of prediabetes in predicting proteinuria. Nephrol Dial Transplant 2012; 27:3862-8. [PMID: 22859789 DOI: 10.1093/ndt/gfs324] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND There is little data on the assessment of prediabetes with proteinuria. METHODS This is a cross-sectional cohort study assessing prediabetes with proteinuria in a large Japanese population. Using a nationwide health checkup database of 228 778 Japanese aged ≥20 years (median 66 years; 39.3% were men; none had pre-existing cardiovascular disease), we examined the association between prediabetes and proteinuria (≥1+ on dipstick) separately in prediabetes subjects diagnosed with the new hemoglobin A1c (HbA1c) criterion only (PD-A1c), the impaired fasting plasma glucose only (PD-IFG) and fulfilling both criteria (PD-Both). RESULTS According to the American Diabetes Association's (ADA's) criterion of 5.7-6.4% HbA1c and/or 100-125 mg/dL fasting plasma glucose, 43.8% of the subjects were judged as having prediabetes. Prediabetes subjects were divided into subclasses of PD-A1c (53.7%), PD-IFG (21.7%) and PD-Both (24.5%), respectively. Therefore, 21.7% of prediabetes subjects were missed using the new HbA1c criterion only. Compared with subjects with normal glucose tolerance (as a reference), the odds ratio (OR) [95% confidence interval (95% CI)] for the increased risk of proteinuria (≥1+) in diabetes itself was 2.191 (2.081-2.307) and in whole prediabetes was 1.093 (1.046-1.142); when prediabetes was subdivided, the OR for proteinuria in PD-IFG was 1.217 (1.140-1.300) and that in PD-Both was 1.249 (1.174-1.329), but that in PD-A1c was not significant, even after adjustment for significant covariates, such as age, sex, body mass index, systolic blood pressure, antihypertensive medication, eGFR, lifestyle and lipid profile. CONCLUSIONS Prediabetes is a significant risk factor for proteinuria compared with completely normal glucose level, and subjects with prediabetes defined using IFG are at significantly higher risk for proteinuria than those defined by HbA1c only.
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Affiliation(s)
- Yuji Sato
- Department of Internal Medicine, University of Miyazaki, Miyazaki,Japan.
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Muslih AI. Reduction of mean arterial pressure and proteinuria by the effect of ACEIs (Lisinopril) in Kurdish hypertensive patients in Hawler City. Glob J Health Sci 2012; 4:14-9. [PMID: 22980373 PMCID: PMC4776933 DOI: 10.5539/gjhs.v4n5p14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2012] [Accepted: 06/30/2012] [Indexed: 11/12/2022] Open
Abstract
The angiotensin converting enzyme inhibitors (ACEIs) are a group of pharmaceuticals that are used primarily in treatment of hypertension and congestive heart failure, in some cases as the drugs of first choice. The renin-angiotensin system is activated in response to hypotension, decreased sodium concentration in the distal tubule, decreased blood volume and in renal sympathetic nerve stimulation. This study examines the effects of angiotensin converting enzyme inhibitor (Lisinopril) on blood pressure (BP) 131 ± 2.4 and proteinuria 0.198 ± 0.005 in Kurd hypertensive patients, mean arterial blood pressure and proteinuria excretion were measured weekly along the period of 12 weeks. Lisinopril significantly reduced mean arterial blood pressure, and attenuated proteinuria level in patients subjected to this study in lisinopril 10mg dose dependent manner (p<0.05, n=24). In conclusion, lisinopril is of beneficial of renoprotection and in lowering BP.
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Affiliation(s)
- A I Muslih
- Department of Pharmacology, College of Pharmacy, Hawler Medical University, Irag.
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30
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Association between high pulse pressure and proteinuria in Japanese individuals with diabetes. Nat Rev Nephrol 2012. [DOI: 10.1038/nrneph.2012.69] [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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