Kidney dysfunction as a risk factor for first symptomatic stroke events in a general Japanese population—the Ohasama study

• Published in: Nephrology, dialysis, transplantation Vol. 22; no. 7; pp. 1910 - 1915
• Main Authors: Nakayama, Masaaki, Metoki, Hirohito, Terawaki, Hiroyuki, Ohkubo, Takayoshi, Kikuya, Masahiro, Sato, Toshinobu, Nakayama, Keisuke, Asayama, Kei, Inoue, Ryusuke, Hashimoto, Junichiro, Totsune, Kazuhito, Hoshi, Haruhisa, Ito, Sadayoshi, Imai, Yutaka
• Format: Journal Article
• Language: English
• Published: Oxford Oxford University Press 01.07.2007; Oxford Publishing Limited (England)
• Subjects: Aged; Aged, 80 and over; Albuminuria - complications; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Asian Continental Ancestry Group; Biological and medical sciences; chronic kidney disease; Emergency and intensive care: renal failure. Dialysis management; Female; Follow-Up Studies; Humans; Intensive care medicine; Japanese general population; Kidney Diseases - complications; Kidney Diseases - ethnology; Kidneys; Male; Medical sciences; Middle Aged; Nephrology. Urinary tract diseases; Proportional Hazards Models; Risk Factors; stroke; Stroke - ethnology; Stroke - etiology; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the urinary system; Tumors of the urinary system; stroke; chronic kidney disease; Japanese general population; Kidney disease; Nervous system diseases; Stroke; Urinary system disease; Hemodialysis; Cardiovascular disease; Japanese; Cerebral disorder; Vascular disease; Extrarenal dialysis; Central nervous system disease; Risk factor; Renal failure; Cerebrovascular disease
• ISSN: 0931-0509; 1460-2385
• DOI: 10.1093/ndt/gfm051

Background. Chronic Kidney Disease (CKD) has been shown to be a risk factor for mortality as well as for morbidity such as cardiovascular disease (CVD) in the general population. However, in the context of CVD events, there is a difference in the incidence of cardiac and stroke events between Western and Asian populations. Although a high prevalence of stroke is a characteristic feature in Japanese populations, it is unclear whether CKD constitutes a risk for stroke events. Methods. To clarify this issue, we estimated creatinine clearance and obtained dipstick tests from spot-urine samples in 1977 subjects (mean 62.9-years-old, men/women: 731/1246) from a general Japanese population. First symptomatic stroke events and all-cause mortality were analysed according to stratification of kidney function and by positive tests for macroalbuminuria using a Cox proportional hazards regression model adjusted for possible confounding factors. Results. During the observation period (mean 7.76 years), we recorded 112 events of first symptomatic stroke and 187 deaths (58 cases due to CVD). After adjustment for all variables, we found that increases in relative hazard (RH) for the first symptomatic stroke events were associated with decreasing kidney function (RH, 3.1; 95% CI, 1.24–7.84 in Ccr < 40 ml/min, 1.9; 95% CI, 1.06–3.75 in Ccr 40–70 ml/min, ref in Ccr > 70 ml/min) and with the presence of macroalbuminuria (RH, 1.4; 95% CI, 0.80–2.41). Conclusion. Decreased kidney function increased the risk of first symptomatic stroke events in a general Japanese population. The high prevalence of stroke in this population prompts the need for greater public awareness about risks for CKD.