title: Annual decline in estimated glomerular filtration rate is a risk factor for cardiovascular events independent of proteinuria.
abstract: OBJECTIVE
  Chronic kidney disease is a risk factor of the development of cardiovascular disease (CVD). However, it is not clear whether decline of glomerular filtration rate (GFR), not reduced GFR, is a risk factor for the incidence of CVD independent of proteinuria.
  
  
  METHODS
  By using a population-based 521 123 person-years longitudinal cohort receiving annual health checkups from 2008 to 2010, we examined whether the annual decline of estimated GFR is a risk factor for CVD development independent of proteinuria.
  
  
  RESULTS
  During the follow-up period, there were 12 041 newly developed CVD events, comprising 4426 stroke events and/or 8298 cardiac events. As expected, both reduced estimated GFR and proteinuria were risk factors for the development of CVD in our study population. Moreover, annual decline of estimated GFR was a significant and independent risk factor for the incidence of CVD (HR [95% CI], 1.23 [1.18-1.28] in males or 1.14 [1.10-1.18] in females for -10% per year) with covariant adjustment for proteinuria and reduced estimated GFR.
  
  
  CONCLUSIONS
  Annual decline of GFR is an independent risk factor for CVD. Serial measurement of both creatinine and proteinuria would be better to predict the incidence of CVD in the general population.
authors.affiliation: Department of Nephrology, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan.
authors.forename: Kei
authors.initials: K
authors.lastname: Nagai
authors.forename: Kunihiro
authors.initials: K
authors.lastname: Yamagata
authors.forename: Reiko
authors.initials: R
authors.lastname: Ohkubo
authors.forename: Chie
authors.initials: C
authors.lastname: Saito
authors.forename: Koichi
authors.initials: K
authors.lastname: Asahi
authors.forename: Kunitoshi
authors.initials: K
authors.lastname: Iseki
authors.forename: Kenjiro
authors.initials: K
authors.lastname: Kimura
authors.forename: Toshiki
authors.initials: T
authors.lastname: Moriyama
authors.forename: Ichiei
authors.initials: I
authors.lastname: Narita
authors.forename: Shouichi
authors.initials: S
authors.lastname: Fujimoto
authors.forename: Kazuhiko
authors.initials: K
authors.lastname: Tsuruya
authors.forename: Tsuneo
authors.initials: T
authors.lastname: Konta
authors.forename: Masahide
authors.initials: M
authors.lastname: Kondo
authors.forename: Tsuyoshi
authors.initials: T
authors.lastname: Watanabe
mesh_terms: D000328:Adult; D000368:Aged; D002318:Cardiovascular Diseases / Q000175:diagnosis / Q000453:epidemiology* / Q000503:physiopathology; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D015994:Incidence; D007564:Japan / Q000453:epidemiology; D007668:Kidney / Q000503:physiopathology*; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016016:Proportional Hazards Models; D011507:Proteinuria / Q000175:diagnosis / Q000453:epidemiology* / Q000503:physiopathology; D051436:Renal Insufficiency, Chronic / Q000175:diagnosis / Q000453:epidemiology* / Q000503:physiopathology; D012307:Risk Factors; D013997:Time Factors
keywords: cardiovascular diseases; chronic kidney diseases; glomerular filtration rate; proteinuria; risk factor