title: Patients with biopsy-proven nephrosclerosis and moderately impaired renal function have a higher risk for cardiovascular disease: 15 years' experience in a single, kidney disease center.
abstract: BACKGROUND
  Nephrosclerosis progresses slowly to end-stage renal disease (ESRD) in only a small percentage of patients. However, because hypertension and nephrosclerosis are normally found simultaneously, nephrosclerosis is a risk factor for cardiovascular disease (CVD). In turn, the onset of CVD may progress to further renal impairment.
  
  
  OBJECTIVE
  To evaluate clinical outcomes and the association between nephrosclerosis and CVD in the long term.
  
  
  METHODS
  Prospective study
  
  
  METHODS
  We prospectively assessed 35 patients (male/female: 19/16) with nephrosclerosis aged >30 years at disease onset, attending the Kidney Disease Center, Saitama Medical University, in a single teaching hospital center between 1995 and 2014. Nephrosclerosis was diagnosed in accordance with the criteria outlined in the World Health Organization (WHO) monograph of renal diseases. All patients were followed by means of registries for 10 years to record subsequent events, if any.
  
  
  RESULTS
  The primary study outcome was correlating the occurrence of CVD, defined as a composite of cardiovascular deaths, nonfatal and fatal myocardial infarction, and stroke, with the development of ESRD or death.
  
  
  RESULTS
  The mean age of patients at the time of biopsy was 54.8 ± 12.7 years (range 33-72 years). Of these patients, seven were affected by nonfatal CVD and two died due to CVD. Only one patient developed ESRD during the follow-up period. Using Kaplan-Meier analysis, risk factors for the primary study outcome were estimated to include an estimated glomerular filtration rate (eGFR) < 60 ml/min/1.73 m(2), systolic blood pressure > 130 mmHg and proteinuria > 1 g/g creatinine. Univariate analysis was used for the assessment of the relative risk for the primary study endpoint of several covariates: age, systolic blood pressure, eGFR and proteinuria at time of renal biopsy. eGFR was found to be the strongest factor determining an event-free period [relative risk (RR) =1.931, p = 0.014].
  
  
  CONCLUSIONS
  Patients with nephrosclerosis are at high risk of CVD when they have moderately advanced renal impairment.
authors.affiliation: Department of Nephrology, Saitama Medical University, 38 Moroyama-machi, Iruma-gun, Saitama, 350-0495 Japan iromichi@saitama-med.ac.jp.
authors.forename: Hiromichi
authors.initials: H
authors.lastname: Suzuki
authors.affiliation: Department of Nephrology, Saitama Medical University, Saitama, Japan.
authors.forename: Kazuhio
authors.initials: K
authors.lastname: Kobayashi
authors.affiliation: Department of Nephrology, Saitama Medical University, Saitama, Japan.
authors.forename: Yuji
authors.initials: Y
authors.lastname: Ishida
authors.affiliation: Department of Nephrology, Saitama Medical University, Saitama, Japan.
authors.forename: Tomohiro
authors.initials: T
authors.lastname: Kikuta
authors.affiliation: Department of Nephrology, Saitama Medical University, Saitama, Japan.
authors.forename: Tsutomu
authors.initials: T
authors.lastname: Inoue
authors.affiliation: Community Health Science Center, Saitama Medical University, Saitama, Japan.
authors.forename: Ukihiro
authors.initials: U
authors.lastname: Hamada
authors.affiliation: Department of Nephrology, Saitama Medical University, Saitama, Japan.
authors.forename: Hirokazu
authors.initials: H
authors.lastname: Okada
mesh_terms: D000328:Adult; D000368:Aged; D001706:Biopsy; D002318:Cardiovascular Diseases / Q000175:diagnosis* / Q000503:physiopathology; D005260:Female; D005919:Glomerular Filtration Rate / Q000502:physiology; D006801:Humans; D007668:Kidney / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D009400:Nephrosclerosis / Q000175:diagnosis* / Q000503:physiopathology; D011446:Prospective Studies; D011507:Proteinuria / Q000175:diagnosis; D012307:Risk Factors
keywords: eGFR; hypertension; proteinuria; renin angiotensin inhibitors; risk factors