We found that BMI was associated with an increased risk of the development of ESRD in men in the general population in Okinawa. The maintenance of optimal body weight may reduce the risk of ESRD.

Proteinuria was a strong, independent predictor of ESRD in a mass screening setting. Even a slight increase in proteinuria was an independent risk factor for ESRD. Therefore, asymptomatic proteinuria warrants further work-up and intervention.

No abstract

A high level of serum creatinine (S-Cr) is a predictor of end-stage renal disease (ESRD), but only a few studies have investigated the prevalence of high S-Cr and its correlates in a large population. We analyzed the data collected from 6,403 subjects (4,222 men and 2,181 women) who participated in the Okinawa General Health Maintenance Association (OGHMA) screening both at 1997 and 1999. The computer-saved data included sex, age, blood chemistries, blood pressure, medical histories, and lifestyles. Multivariate Cox proportional hazard analyses were performed to identify the correlates of developing high S-Cr levels: > or = 1.4 mg/dl in men and > or = 1.2 mg/dl in women. The prevalence of high S-Cr was 3.0% (N=193), which was 4.1% in men (N=175) and 0.8% in women (N=18), and increased with age in both sexes at the 1997 screening. Among those who showed normal levels of S-Cr in 1997 (N=6,210), 241 subjects (223 men and 18 women) developed high S-Cr. The 2-year cumulative incidence of high S-Cr was 5.5% in men and 0.8% in women. Other than sex, serum uric acid was the most significant correlate for developing high S-Cr. The adjusted relative risk (95% confidence interval) of those with serum uric acid 8.0 mg/dl and over was 2.91 (1.79-4.75) in men and 10.39 (1.91-56.62) in women when compared to those with serum uric acid less than 5.0 mg/dl. Prevalence of high levels of S-Cr was relatively high in men. Other than gender, serum uric acid was a significant positive correlate of developing high S-Cr in this sample of the Japanese population.

Hypocholesterolemia was an independent predictor of death in patients on chronic hemodialysis. This impact of hypercholesterolemia on survival was only evident in a subgroup of patients whose serum albumin was more than 4.5 g/dL.

Screenees with hyperuricemia were associated with a greater incidence of ESRD. Hyperuricemia (serum uric acid > or = 6.0 mg/dL [> or =357 micromol/L]) was an independent predictor of ESRD in women. Strategies to control serum uric acid levels in the normal range may reduce the population burden of ESRD.

Abstract-Blood pressure as a risk factor for development of end-stage renal disease has not been fully studied, particularly in women. We studied the development of end-stage renal disease from 1983 through 2000 in 98 759 subjects, 46 881 men and 51 878 women, 20 to 98 years of age, who were screened in 1983 in Okinawa, Japan. Data for all dialysis patients registered from 1983 to 2000 in Okinawa were used to identify the screened subjects in whom end-stage renal disease developed. In follow-up, 400 subjects, 231 men and 169 women, had end-stage renal disease. Age, body mass index, and adjusted relative risk for systolic and diastolic blood pressure for both men and women were measured. When these results were compared with an optimal blood pressure, the relative risk of development of end-stage renal disease for those with high-normal blood pressure and hypertension were significant in both men and women. Hypertension is a significant risk factor for development of end-stage renal disease not only in men but also in women. Control of blood pressure within normal levels should be stressed as a strategy to prevent end-stage renal disease in both men and women. Key Words: blood pressure Ⅲ epidemiology Ⅲ kidney failure Ⅲ risk factors Ⅲ women T he number of new dialysis patients is increasing annually, and the reasons for this increase are not clear. The prevalence of dialysis patients was 1752 per million persons in Okinawa, Japan. 1 Higher blood pressure was a significant predictor of end-stage renal disease (ESRD) in hypertensive men. 2 In men screened for the Multiple Risk Factor Intervention Trial, high-normal and high blood pressure were judged to be strong independent risk factors for ESRD. 3 However, these data concerned men only 2,3 or were not stratified by gender. 4 We previously reported from the 10-year follow-up of a screened cohort in Okinawa that high diastolic blood pressure (DBP) was a significant predictor of ESRD but that systolic blood pressure (SBP) was not. 4 In the current study, we extended the follow-up period in our cohort by 6 years and prospectively studied the development of ESRD in 46 876 men and 51 878 women screened by the Okinawa General Health Maintenance Association in 1983; we also examined the effect of blood pressure on the risk of development of ESRD in women. Methods Study DesignAll individuals who were from 20 to 98 years of age and who participated in the 1983 mass health screening examination in Okinawa, Japan, were eligible for the study. Dialysis patients who had been among the 1983 mass screening participants and who became dialysis patients from 1983 to 2000 were identified through the Okinawa Dialysis Study (OKIDS) registry. 1 Furthermore, patient identification was verified by reviewing the medical records of the dialysis unit. The cumulative incidence of ESRD and the relative risk (RR) of developing ESRD according to blood pressure levels taken from the mass screening registry were determined. Mass Screening RegistryThe large community-based health examination progr...

Abstract-In this prospective, randomized, open-label, blinded end point study, we aimed to establish whether strict blood pressure control (Ͻ140 mm Hg) is superior to moderate blood pressure control (Ն140 mm Hg to Ͻ150 mm Hg) in reducing cardiovascular mortality and morbidity in elderly patients with isolated systolic hypertension. We divided 3260 patients aged 70 to 84 years with isolated systolic hypertension (sitting blood pressure 160 to 199 mm Hg) into 2 groups, according to strict or moderate blood pressure treatment. A composite of cardiovascular events was evaluated for Ն2 years. The strict control (1545 patients) and moderate control (1534 patients) groups were well matched (mean age: 76.1 years; mean blood pressure: 169.5/81.5 mm Hg). Median follow-up was 3.07 years. At 3 years, blood pressure reached 136.6/74.8 mm Hg and 142.0/76.5 mm Hg, respectively. The blood pressure difference between the 2 groups was 5.4/1.7 mm Hg. The overall rate of the primary composite end point was 10.6 per 1000 patient-years in the strict control group and 12.0 per 1000 patient-years in the moderate control group (hazard ratio: 0.89; [95% CI: 0.60 to 1.34]; Pϭ0.38). In summary, blood pressure targets of Ͻ140 mm Hg are safely achievable in relatively healthy patients Ն70 years of age with isolated systolic hypertension, although our trial was underpowered to definitively determine whether strict control was superior to less stringent blood pressure targets. Key Words: isolated systolic hypertension Ⅲ elderly Ⅲ blood pressure Ⅲ prognosis Ⅲ valsartan H igh blood pressure (BP) is well known to be a major risk factor for cardiovascular events, such as stroke and myocardial infarction, 1 and linear relationships between cardiovascular risk and both systolic and diastolic BPs, unrelated to age, have also been reported based on a meta-analysis of large cohort studies conducted worldwide. 2 In particular, systolic BP predominantly affects cardiovascular events in elderly people. 3 Numerous large clinical trials, such as the Systolic Hypertension in the Elderly Program, 4 Swedish Trial in Old Patients, 5 Medical Research Council, 6 Systolic Hypertension in Europe, 7 and Systolic Hypertension in China, 8 have provided evidence of the benefits of reducing BP in the elderly. Meta-analysis of clinical trials showed that treatment of hypertension in older adults is as beneficial as that in younger adults. 9 A recent study performed in hypertensive patients aged Ն80 years of age, the Hypertension in the Very Elderly Trial, showed that antihypertensive treatment is beneficial to reduce the risks of death from stroke, death from any cause, and heart failure. 10 These observations indicate that antihypertensive treatment is beneficial even in very elderly patients.To reduce cardiovascular risks, in general BP should be kept as low as possible based on evidence from numerous clinical trials and epidemiological data. 11 On the other hand, several epidemiological studies in the elderly, such as Vantaa and Leinden 85-Plus, reported a poor progno...