title: Cardiovascular events and death in Japanese patients with chronic kidney disease.
abstract: The incidence of cardiovascular disease (CVD) is higher in patients with chronic kidney disease (CKD) than in the general population, and the risk of CVD increases with reductions in renal function. However, the incidence of CVD in Japanese patients with CKD has not been sufficiently investigated. To measure this we conducted the Chronic Kidney Disease Japan Cohort (CKD-JAC) Study over four years in 2,966 Japanese patients with CKD to examine the incidence of CVD and all-cause death. These patients had an estimated glomerular filtration rate (eGFR) of 10-59 ml/min/1.73 m2, were under nephrologist care, and pooled from 17 medical institutions in Japan. At the median follow-up of 3.9 years, 69 patients had died, 217 had cardiovascular events, and 514 started maintenance dialysis therapy. The incidences of cardiovascular events were 11.9, 19.1, 25.0, and 39.4 per 1,000 person-years at eGFRs of 45-59, 30-44, 15-29, and under 15 ml/min/1.73 m2, respectively. The adjusted Cox proportional hazards models showed that the risk of cardiovascular events increased as the eGFR decreased, with a significant difference only between CKD stage G5 (eGFR: under 15 ml/min/1.73 m2) and CKD stage G3a (eGFR: 45-59 ml/min/1.73 m2) (hazard ratio 3.16, 95% confidence interval 1.28 to 7.76). Thus, the risk of CVD and all-cause death was related to the decrease in eGFR, but not necessarily elevated in proportion to progression of the CKD stage in Japanese patients with predialysis CKD under a nephrologist's care.
authors.affiliation: Department of Nephrology and Hypertension, Fukushima Medical University, Fukushima, Fukushima, Japan. Electronic address: kennichi@fmu.ac.jp.
authors.forename: Kenichi
authors.initials: K
authors.lastname: Tanaka
authors.affiliation: Department of Nephrology and Hypertension, Fukushima Medical University, Fukushima, Fukushima, Japan.
authors.forename: Tsuyoshi
authors.initials: T
authors.lastname: Watanabe
authors.affiliation: Department of Preventive Medicine and Public Health, Keio University, Shinjuku-ku, Tokyo, Japan.
authors.forename: Ayano
authors.initials: A
authors.lastname: Takeuchi
authors.affiliation: Department of Integreated Science and Engineering for Sustainable Society, Chuo University, Bunkyo-ku, Tokyo, Japan.
authors.forename: Yasuo
authors.initials: Y
authors.lastname: Ohashi
authors.affiliation: Fourth Department of Internal Medicine, Tokyo Women's Medical University, Shinjuku-ku, Tokyo, Japan.
authors.forename: Kosaku
authors.initials: K
authors.lastname: Nitta
authors.affiliation: Division of Nephrology, Department of Medicine, Showa University, Shinagawa-ku, Tokyo, Japan.
authors.forename: Tadao
authors.initials: T
authors.lastname: Akizawa
authors.affiliation: Department of Nephrology, Nagoya University, Nagoya, Aichi, Japan.
authors.forename: Seiichi
authors.initials: S
authors.lastname: Matsuo
authors.affiliation: Nakayamadera Imai Clinic, Takarazuka, Hyogo, Japan.
authors.forename: Enyu
authors.initials: E
authors.lastname: Imai
authors.affiliation: Okayama University, Okayama, Okayama, Japan.
authors.forename: Hirofumi
authors.initials: H
authors.lastname: Makino
authors.affiliation: Yaizu City Hospital, Yaizu, Shizuoka, Japan.
authors.forename: Akira
authors.initials: A
authors.lastname: Hishida
mesh_terms: D000328:Adult; D002318:Cardiovascular Diseases / Q000453:epidemiology* / Q000209:etiology; D002423:Cause of Death; D003404:Creatinine / Q000097:blood; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate; D006801:Humans; D015994:Incidence; D007564:Japan / Q000453:epidemiology; D053208:Kaplan-Meier Estimate; D008297:Male; D016016:Proportional Hazards Models; D011446:Prospective Studies; D006435:Renal Dialysis; D051436:Renal Insufficiency, Chronic / Q000097:blood / Q000150:complications / Q000453:epidemiology* / Q000628:therapy; D012307:Risk Factors; D014481:United States / Q000453:epidemiology
chemical_list: D003404:Creatinine
keywords: CKD-JAC; cardiovascular disease; chronic kidney disease; cohort study