Baseline characteristics and prevalence of cardiovascular disease in newly visiting or referred chronic kidney disease patients to nephrology centers in Japan: a prospective cohort study

Abstract

BackgroundAbout 39,000 patients were newly prescribed renal replacement therapy in Japan in 2011, resulting in a total of more than 300,000 patients being treated with dialysis. This high prevalence of treated end stage kidney disease (ESKD) patients is an emergent problem that requires immediate attention. We launched a prospective cohort study to evaluate population specific characteristics of the progression of chronic kidney disease (CKD). In this report, we describe the baseline characteristics and risk factors for cardiovascular disease (CVD) prevalence among this cohort.MethodsNew patients from 16 nephrology centers who were older than 20 years of age and who visited or were referred for the treatment of CKD stage 2–5, but were not on dialysis therapy, were recruited in this study. At enrollment, medical history, lifestyle behaviors, functional status and current medications were recorded, and blood and urine samples were collected. Estimated glomerular filtration rate (eGFR) was calculated by a modified three-variable equation.ResultsWe enrolled 1138 patients, 69.6% of whom were male, with a mean age of 68 years. Compared with Western cohorts, patients in this study had a lower body mass index (BMI) and higher proteinuria. The prevalence of CVD was 26.8%, which was lower than that in Western cohorts but higher than that in the general Japanese population. Multivariate analysis demonstrated the following association with CVD prevalence: hypertension (adjusted odds ratio (aOR) 3.57; 95% confidence interval (CI) 1.82-7.02); diabetes (aOR 2.45; 95% CI 1.86-3.23); hemoglobin level less than 11 g/dl (aOR 1.61; 95% CI 1.21-2.15); receiving anti-hypertensive agents (aOR 3.54; 95% CI 2.27-5.53); and statin therapy (aOR 2.73; 95% CI 2.04-3.66). The combination of decreased eGFR and increased proteinuria was also associated with a higher prevalence of CVD.ConclusionsThe participants in this cohort had a lower BMI, higher proteinuria and lower prevalence of CVD compared with Western cohorts. Lower eGFR and high proteinuria were associated with CVD prevalence. Prospective follow up of these study patients will contribute to establishment of individual population-based treatment of CKD.

Prevalence and risk factors for cardiovascular disease among chronic kidney disease patients: results from the Chinese cohort study of chronic kidney disease (C-STRIDE)

“…In the Chinese cohort, urine protein was not significantly associated with CVD in CKD ( P  = 0.526) (Table 4). This is different from the results found in Japan [20] and US [21], where increased proteinuria was associated with a higher CVD prevalence.…”

“…Deserving additional attention is the prominence of cerebrovascular disease among C-STRIDE participants exhibiting CVD. This is similar to the findings of the ROUTE study (Japan) [20], but different from the MERENA (Spain) [5] and CRIC (USA) [21] studies, in which heart disease and PAD constituted the majority of CVD events. There are two possible explanations for the high incidence of cerebrovascular disease.…”

Anaemia management and mortality risk in newly visiting patients with chronic kidney disease in Japan: The CKD‐ROUTE study

“…The CKD‐ROUTE study was a prospective, observational cohort of a representative Japanese population with CKD G2–G5 who were not undergoing dialysis. Details of the study design have been previously reported . Over 1000 participants were enrolled at the Tokyo Medical and Dental University Hospital and its 15 affiliated hospitals in the Tokyo area.…”

“…At enrollment, the medical history and current medications for each patient were recorded. Blood and urine samples were collected to measure clinical variables . The estimated glomerular filtration rate (eGFR) was calculated using the modified three‐variable Modification of Diet in Renal Disease (MDRD) equation developed by the Japanese Society of Nephrology to adjust for Japanese physical characteristics: eGFR = 194 × serum creatinine −1.094 × age −0.287 (if female, ×0.739).…”

“…We have recently established a large prospective cohort study of Japanese patients with CKD called Chronic Kidney Disease Research of Outcomes in Treatment and Epidemiology (CKD‐ROUTE study) . The specific aim of the CKD‐ROUTE study was to evaluate the relationships of CKD progression, cardiovascular outcomes and mortality with patient characteristics, complications, and treatment.…”