Prediction of Cardiovascular Disease Mortality by Proteinuria and Reduced Kidney Function: Pooled Analysis of 39,000 Individuals From 7 Cohort Studies in Japan

• Published in: American journal of epidemiology Vol. 178; no. 1; pp. 1 - 11
• Main Authors: Nagata, M., Ninomiya, T., Kiyohara, Y., Murakami, Y., Irie, F., Sairenchi, T., Miura, K., Okamura, T., Ueshima, H.
• Format: Journal Article
• Language: English
• Published: Cary, NC Oxford University Press 01.07.2013; Oxford Publishing Limited (England)
• Subjects: Adult; Aged; Aged, 80 and over; Biological and medical sciences; Cardiology. Vascular system; Cardiovascular disease; Cardiovascular diseases; Cardiovascular Diseases - complications; Cardiovascular Diseases - mortality; Coronary heart disease; Epidemiology; Female; General aspects; Glomerular Filtration Rate; Health risks; Heart; Humans; Japan - epidemiology; Kidney Diseases - complications; Kidney Diseases - mortality; Kidneys; Male; Medical sciences; Middle Aged; Miscellaneous; Mortality; Nephrology. Urinary tract diseases; Proportional Hazards Models; Proteins; Proteinuria - complications; Proteinuria - mortality; Public health. Hygiene; Public health. Hygiene-occupational medicine; Risk Factors; Systematic review; Urinary system involvement in other diseases. Miscellaneous; Urinary tract. Prostate gland; Urine; Asia; Japan; Kidney disease; Human; coronary artery disease; Urinary system disease; Renal function; renal insufficiency; Evidence-based practice; Prediction; meta-analysis; Cardiovascular disease; Coronary heart disease; Epidemiology; Evidence-based medicine; Metaanalysis; Reduction; Cohort study; Renal failure; Pool; Predictive factor; Public health; Proteinuria; cardiovascular disease; proteinuria
• ISSN: 0002-9262; 1476-6256; 1476-6256
• DOI: 10.1093/aje/kws447

There are limited studies addressing whether proteinuria and estimated glomerular filtration rate (eGFR) are independently associated with cardiovascular disease in Asia. Using data from 7 prospective cohorts recruited between 1980 and 1994 in Japan, we assessed the influence of proteinuria (≥1+ on dipstick) and reduced eGFR on the risk of cardiovascular disease mortality in 39,405 participants (40-89 years) without kidney failure. During a 10.1-year follow-up, 1,927 subjects died from cardiovascular disease. Proteinuria was associated with a 1.75-fold (95% confidence interval (CI): 1.44, 2.11) increased risk of cardiovascular disease mortality after adjustment for potential confounding factors. Additionally, the multivariate-adjusted hazard ratio of cardiovascular disease mortality increased linearly with lower eGFR levels (P(trend) < 0.001): Subjects with eGFR of <45 mL/minute/1.73 m² had a 2.22-fold (95% CI: 1.60, 3.07) greater risk of cardiovascular disease mortality than those with eGFR of ≥90 mL/minute/1.73 m². Subjects with both proteinuria and eGFR of <45 mL/minute/1.73 m² had a 4.05-fold (95% CI: 2.55, 6.43) higher risk of cardiovascular disease mortality compared with those with neither of these risk factors. There was no evidence of interaction in the relationship between proteinuria and lower eGFR (P(interaction) = 0.77). The present results suggest that proteinuria and lower eGFR are independent risk factors for cardiovascular disease mortality in the Japanese population.