title: Kidney dysfunction as a risk factor for first symptomatic stroke events in a general Japanese population--the Ohasama study.
abstract: 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).
  
  
  CONCLUSIONS
  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.
authors: Department of Clinical Pharmacology and Therapeutics, Tohoku University Graduate School of Pharmaceutical Sciences and Medicine, Sendai, and Ohasama Hospital, Iwate, Japan. mnakayama@mail.tains.tohoku.ac.jp
authors: Masaaki
authors: M
authors: Nakayama
authors: Hirohito
authors: H
authors: Metoki
authors: Hiroyuki
authors: H
authors: Terawaki
authors: Takayoshi
authors: T
authors: Ohkubo
authors: Masahiro
authors: M
authors: Kikuya
authors: Toshinobu
authors: T
authors: Sato
authors: Keisuke
authors: K
authors: Nakayama
authors: Kei
authors: K
authors: Asayama
authors: Ryusuke
authors: R
authors: Inoue
authors: Junichiro
authors: J
authors: Hashimoto
authors: Kazuhito
authors: K
authors: Totsune
authors: Haruhisa
authors: H
authors: Hoshi
authors: Sadayoshi
authors: S
authors: Ito
authors: Yutaka
authors: Y
authors: Imai
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000419:Albuminuria / Q000150:complications; D044466:Asian People; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007674:Kidney Diseases / Q000150:complications* / Q000208:ethnology*; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D012307:Risk Factors; D020521:Stroke / Q000208:ethnology* / Q000209:etiology*