Effect of Chronic Kidney Disease or Anemia or Both on Cardiovascular Mortality in a 25-Year Follow-Up Study of Japanese General Population (From NIPPON DATA90)

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The relation between chronic kidney disease (CKD) and cardiovascular disease (CVD) in the general population is well elucidated. In patients with CKD, anemia is associated with adverse outcomes. However, the effects of CKD and anemia on CVD in the general population remains poorly explored, especially in Asian populations. This study aimed to investigate the effect of CKD and/or anemia on CVD mortality in a long-term cohort study involving Japanese community dwellers. We assessed 7,339 participants (aged ≥30 years) with no CVD history. These participants were divided into 4 categories according to their CKD (estimated glomerular filtration rate <60 or urine protein >1+ by dipstick qualitative test) and/or anemia (hemoglobin: <13 g/100 ml [men], <12 g/100 ml [women]) statuses. For each category, we calculated the hazard ratios (HRs) of CVD mortality by using the Cox proportional hazards model after adjusting for age, body mass index, hypertension, diabetes, dyslipidemia, smoking, and alcohol drinking. Within 25 years of follow-up, 637 participants died because of CVD. The HRs of CVD in patients with CKD only, anemia only, and both were 1.27, 1.59, and 2.60 (95% confidence intervals [CI] 1.06 to 1.53, 1.34 to 1.90, and 1.80 to 3.76) in men and 1.42, 1.08, and 2.00 (95% CI 1.19 to 1.69, 0.99 to 1.18, and 1.54 to 2.60) in women, respectively. In conclusion, CKD with anemia is associated with an increased risk for CVD mortality in a general population in Japan.

Introduction

Chronic kidney disease (CKD), a cause of end-stage renal disease, has been a global public health problem in the aging society.1 In a large community-based population, CKD increases the risks of mortality, cardiovascular events, and hospitalization.2 Numerous patient-based studies3, 4, 5, 6, 7, 8, 9, 10, 11 described that anemia in patients with kidney disease worsens the prognosis. However, the effect of CKD and anemia on cardiovascular disease (CVD) in general populations is still insufficiently examined. Anderson et al12 investigated CKD with anemia and showed reduced survival in patients with established CVD. The management of CKD and anemia is an important public health concern. However, to our knowledge, only a few studies have investigated the association between CKD and CVD mortality with and without anemia in community-dwelling general populations. Hence, we aimed to conduct a 25-year follow-up study on such association in a representative sample of the Japanese general population.

Section snippets

Methods

NIPPON DATA is a collection of cohort studies that followed up individuals as a representative sample of the Japanese population from 1990 to 2015 in accordance with the National Survey on Cardiovascular Diseases in Japan. Specifically, NIPPON DATA includes 3 long-term cohort studies, with baseline surveys conducted in 1980, 1990, and 2010, which are called as NIPPON DATA80, NIPPON DATA90, and NIPPON DATA 2010, respectively. The details of these cohorts were reported previously.13, 14, 15, 16

In

Results

The mean values and prevalence of the baseline characteristics of the patients are summarized by the combination of CKD and anemia information (Tables 1 and 2).

Table 3 shows the distribution of eGFR by gender in this population. Table 4 shows the distribution of anemia by gender in this population. The percentage below mild anemia was approximately 7% in menand 19% in women. Anemia was more prevalent among women.

Table 5 lists the adjusted HRs and 95% CIs for CVD mortality in men and women

Discussion

This study investigated the effects of CKD and anemia on CVD in a general population. In this study, the cut-off value for anemia was based on clinical mild anemia. Results showed that the combination of CKD and anemia is an independent risk factor for CVD in both genders. Although CKD alone is a risk factor for CVD in both men and women, even mild anemia per se is a risk factor for CVD in men. The risk of combined CKD and anemia was higher than that of CKD or anemia alone.

A large, globally

Disclosures

The authors have no conflicts of interest to declare.

Acknowledgment

The authors would like to express their deepest gratitude to Professor O.T. for his great guidance throughout this research as my supervisor. The authors would also like to thank NIPPON DATA research team for their appropriate advice as secondary reviewers in the preparation of this thesis.

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    Funding: This study was supported by a grant-in-aid from the Ministry of Health, Labour and Welfare (Tokyo, Japan) under the auspices of the Japanese Association for Cerebro-Cardiovascular Disease Control (Tokyo, Japan ), a Research Grant for Cardiovascular Diseases (7A-2) from the Ministry of Health, Labour and Welfare, and Health and Labour Sciences Research Grants, Japan (Comprehensive Research on Aging and Health H11-Chouju-046, H14-Chouju-003, H17-Chouju-012, H19-Chouju-Ippan-014 and Comprehensive Research on Life-Style Related Diseases including cardiovascular Diseases and Diabetes Mellitus H22-Junkankitou-Seishuu -Sitei-017, H25-Junkankitou-Seishuu-Sitei-022, H30-Junkankitou-Sitei-002, 21FA2002).

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