title: Influence of chronic kidney disease on hospitalization, chronic dialysis, and mortality in Japanese men: a longitudinal analysis.
abstract: BACKGROUND
  Little is known concerning the risk of hospitalization and the risk of death before receiving dialysis by the stage of chronic kidney disease (CKD) in Japan.
  
  
  METHODS
  The subjects comprised a total of 13,911 Japanese men (mean age 49.2 ± 9.9 years). Based on the results of a health checkup performed in 2006, they were divided into 5 groups according to their estimated glomerular filtration rate (GFR) levels and dialysis status: GFR ≥60, 45-59, 30-44, <30 mL/min/1.73 m2, and undergoing dialysis. From 2006 through to 2013, we investigated their hospitalization, dialysis initiation, and cause-specific death. The adjusted hazard ratios (HRs) for each end point were calculated compared with the GFR ≥60 mL/min/1.73 m2group using a Cox proportional hazard model.
  
  
  RESULTS
  A lower GFR was independently associated with higher risks of overall hospitalization, dialysis initiation, and all-cause death. In particular, the HRs for long-term hospitalization (≥1 month a year), dialysis, and cardiovascular disease (CVD) death markedly increased along with a decreased GFR. The rate ratios of dialysis to all-cause death (calculated based on the incidences of dialysis and death per 1000 person-years) were 0.03 (0.11 vs. 3.19), 0.08 (0.29 vs. 3.62), 0.51 (12.5 vs. 24.7), and 4.50 (179.8 vs. 40.0) for GFR ≥60, 45-59, 30-44, and <30 mL/min/1.73 m2, respectively.
  
  
  CONCLUSIONS
  In Japanese men, although the risk of CVD death before dialysis initiation can never be ignored, CKD patients aged <60 years with a GFR of <30 mL/min/1.73 m2are more likely to undergo dialysis prior to death.
authors.affiliation: Center of Medical Checkup, Shinko Hospital, 1-4-47 Wakinohamacho, Chuo-ku, Kobe, 651-0072, Japan. nishikawa.kyyh@gmail.com.|Department of Environmental Epidemiology, Institute of Industrial Ecological Sciences, University of Occupational and Environmental Health, 1-1 Iseigaoka, Yahatanishi-ku, Kitakyushu, 807-8555, Japan. nishikawa.kyyh@gmail.com.
authors.forename: Kunihito
authors.initials: K
authors.lastname: Nishikawa
authors.affiliation: Department of Environmental Epidemiology, Institute of Industrial Ecological Sciences, University of Occupational and Environmental Health, 1-1 Iseigaoka, Yahatanishi-ku, Kitakyushu, 807-8555, Japan.
authors.forename: Ken
authors.initials: K
authors.lastname: Takahashi
authors.affiliation: Center of Medical Checkup, Shinko Hospital, 1-4-47 Wakinohamacho, Chuo-ku, Kobe, 651-0072, Japan.
authors.forename: Ryoji
authors.initials: R
authors.lastname: Yamada
authors.affiliation: Center of Medical Checkup, Shinko Hospital, 1-4-47 Wakinohamacho, Chuo-ku, Kobe, 651-0072, Japan.
authors.forename: Tsuyoshi
authors.initials: T
authors.lastname: Kinaga
authors.affiliation: Center of Medical Checkup, Shinko Hospital, 1-4-47 Wakinohamacho, Chuo-ku, Kobe, 651-0072, Japan.
authors.forename: Matsumoto
authors.initials: M
authors.lastname: Masato
authors.affiliation: Center of Medical Checkup, Shinko Hospital, 1-4-47 Wakinohamacho, Chuo-ku, Kobe, 651-0072, Japan.
authors.forename: Masayuki
authors.initials: M
authors.lastname: Yamamoto
mesh_terms: D000328:Adult; D002318:Cardiovascular Diseases / Q000401:mortality; D002423:Cause of Death; D005919:Glomerular Filtration Rate; D006760:Hospitalization; D006801:Humans; D007564:Japan / Q000453:epidemiology; D007668:Kidney / Q000503:physiopathology*; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016016:Proportional Hazards Models; D006435:Renal Dialysis / Q000009:adverse effects / Q000401:mortality*; D051436:Renal Insufficiency, Chronic / Q000175:diagnosis / Q000401:mortality* / Q000503:physiopathology / Q000628:therapy*; D018570:Risk Assessment; D012307:Risk Factors; D012737:Sex Factors; D013997:Time Factors; D016896:Treatment Outcome
keywords: Chronic kidney disease; Dialysis; Epidemiology; Hospitalization; Mortality