Primacy of lowered baseline glomerular filtration rate as a risk for incident chronic kidney disease: A longitudinal study in Japanese subjects.
OBJECTIVE
Risk profile for incident chronic kidney disease (CKD) in Japanese subjects has not been established. Our aim was to identify risk factors for CKD in Japanese.


METHODS
Consecutive 171 536 health examinees (median age 49 years and estimated glomerular filtration rate (eGFR) 78.2 mL/min per 1.73 m2) without CKD were re-examined after a median period of 6.2 years. Results of Cox proportional hazards models in randomly assigned two thirds (Derivation cohort) were verified in the rest (Validation cohort). CKD was defined as eGFR <60 mL/min per 1.73 m2or positive dipstick proteinuria.


RESULTS
In the Derivation cohort, CKD developed in 1002 (5.8%) subjects. Seven variables such as lower eGFR, male gender, higher uric acid concentration, lower red cell count and higher age and systolic blood pressure were identified as significant risks for CKD, with lowered eGFR being an overwhelmingly strong risk: adjusted hazard ratio for those with the baseline eGFR <70 mL/min per 1.73 m2was as high as 90.1. Performance of prediction of CKD by the probability on the basis of the seven risk factors combined was only marginally preferable to eGFR alone. The area under the receiver operating characteristic curve (95% CI) for the prediction was 0.846 (0.826-0.864) and 0.822 (0.802-0.840) (P < 0.01), the kappa statistic was 0.263 and 0.250 (n.s.), and the mean absolute difference between "predicted probability" and "observed" CKD was 1.4% and 1.9% (P = 0.14) by the combined model and eGFR alone, respectively.


CONCLUSIONS
Seven risk factors for incident CKD were identified in Japanese health examinees. However, lowered baseline eGFR outweighed other risks to the degree that eGFR alone was suffice for CKD prediction.
Diabetes Centre, Aizawa Hospital, Matsumoto, Japan.
Takahiro
T
Miyakoshi
Diabetes Centre, Aizawa Hospital, Matsumoto, Japan.
Yasuto
Y
Nakasone
Diabetes Centre, Aizawa Hospital, Matsumoto, Japan.
Yuka
Y
Sato
Diabetes Centre, Aizawa Hospital, Matsumoto, Japan.
Keishi
K
Yamauchi
Health Centre, Aizawa Hospital, Matsumoto, Japan.
Rie
R
Hashikura
Central Clinical Laboratory, Aizawa Hospital, Matsumoto, Japan.
Masayuki
M
Takayama
Health Centre, Aizawa Hospital, Matsumoto, Japan.
Kazuko
K
Hirabayashi
Health Centre, Aizawa Hospital, Matsumoto, Japan.
Hideo
H
Koike
Health Care Centre, Kitasato University, Sagamihara, Kanagawa, Japan.
Tatsumi
T
Moriya
Diabetes Centre, Aizawa Hospital, Matsumoto, Japan.
Toru
T
Aizawa
D000328:Adult; D019540:Area Under Curve; D016009:Chi-Square Distribution; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D015994:Incidence; D007564:Japan / Q000453:epidemiology; D007668:Kidney / Q000503:physiopathology*; D016015:Logistic Models; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011379:Prognosis; D016016:Proportional Hazards Models; D011507:Proteinuria / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology; D012372:ROC Curve; D051436:Renal Insufficiency, Chronic / Q000175:diagnosis / Q000453:epidemiology* / Q000503:physiopathology*; D012307:Risk Factors; D013997:Time Factors
Japanese; chronic kidney disease; epidemiology; estimated glomerular filtration rate; risk factor