Impact of self-reported walking habit on slower decline in renal function among the general population in a longitudinal study: the Japan Specific Health Checkups (J-SHC) Study

Predictive risk factors for early-stage renal dysfunction: An analysis of specific health checkup data for the general Japanese population

BACKGROUND AND AIMS

Early prevention of chronic kidney disease is critical. We aimed to identify predictive risk factors for early-stage renal dysfunction.

METHODS AND RESULTS

This retrospective study analyzed specific health checkup data from the general Japanese population. We included 1385 adults who underwent a specific health checkup in 2013 and 2019 and had an estimated glomerular filtration rate (eGFR) ≥60 mL/min/1.73 m2 in 2013. The composite endpoint was the progression of renal dysfunction for 6 years, including doubling of serum creatinine levels, ≥30 % decline in eGFR, and ≥30 % increase in the urine albumin-to-creatinine ratio (UACR) for individuals with UACR ≥30 mg/gCre at baseline or progression to ≥30 mg/gCre for those with UACR <30 mg/gCre at baseline. Participants were categorized into groups with and without progression of renal dysfunction. Univariate analysis of health checkup data and questionnaire data collected in 2013 was conducted, followed by multiple logistic regression analyses. Significant between-group differences were observed in age, body weight, body mass index (BMI), waist circumference, medication for hypertension and hyperlipidemia, systolic and diastolic blood pressure, high-density lipoprotein cholesterol, diabetes, glycated hemoglobin (HbA1c), urine glucose qualitative, UACR, urine protein-to-creatinine ratio, current smoking, weight gain, and walking habits. Logistic regression analysis showed that BMI (odds ratio [95 % confidence interval]: 1.14 [1.07-1.24], P < 0.001), HbA1c (1.57 [1.24-1.98], P < 0.001), and walking habits (0.51 [0.33-0.80], P = 0.003) were significantly associated with renal dysfunction progression.

CONCLUSIONS

Higher BMI and HbA1c and lower walking habits were associated with early-stage renal dysfunction, even in the general population.

Relationship Between Swallowing Function and Low Serum Albumin Levels in Older Japanese People Aged ≥ 75 Years

BACKGROUND/OBJECTIVES

This cross-sectional study aimed to investigate the relationship between swallowing function and low serum albumin levels in older Japanese people (aged ≥ 75 years).

METHODS

A total of 3258 participants (1325 males, 1933 females; mean age, 80.8 years) who had a dental checkup in Gifu City, Japan, between April 2020 and March 2021 were recruited. Swallowing function was assessed using the repetitive saliva swallow test, with poor swallowing function defined as swallowing fewer than three times in 30 s. A serum albumin level < 3.6 G/dL was considered low.

RESULTS

In total, 78 participants (2%) had a low serum albumin level. Furthermore, after adjusting for age, gender, circulatory disease, support/care-need certification, number of present teeth, and tongue and lip function, a low serum albumin level was positively associated with older (odds ratio [OR]: 1.115; 95% confidence interval [CI]: 1.064-1.169), male (OR: 2.208; 95% CI: 1.360-3.584), circulatory disease (OR: 1.829; 95% CI: 1.079-3.099), support/care-need certification (OR: 2.087; 95% CI: 1.208-3.606), and poor swallowing function (OR: 2.379; CI: 1.377-4.112).

CONCLUSIONS

These results indicate that poor swallowing function was associated with a low serum albumin level in older Japanese people aged ≥ 75 years.

Reduction in all-cause medical and caregiving costs through innovative health awareness projects in a rural area in Japan: a retrospective cohort study

BACKGROUND

This study evaluates cost reduction in participants of a health awareness program (the Center of Healthy Aging Program, CHAP) in a Japanese rural area, characterized by an annual check-up and personalized interview on health issues and related risks immediately after the check-up.

METHODS

This is a cross-sectional study using medical and caregiving costs and Japan-specific health check-up results in Hirosaki residents stored by the local government, which were individually-based linked to the CHAP information collected by Hirosaki University. This is the first study that used anonymized data with individually-based linkages to both a research institute and a local government in Japan under a strict limitation regarding linking to third-party data. We included residents who had been continuously enrolled for > 6 months as of 1 July 2015. We compared 5-year all-cause costs between three groups (with CHAP, with Japan-specific health check-up, and no check-up) using a multivariate negative binomial regression model considering risk factors including lifestyle habits and an inverse probability weight to adjust for baseline characteristics: age, sex, Charlson comorbidity index, baseline care level, and risk score of coronary heart diseases.

RESULTS

A total of 384, 9805, and 32,630 residents aged 40-74 years were included for the CHAP, Japan-specific health check-up, and no check-up groups, respectively. The Japan-specific health check-up group showed older and higher Charlson comorbidity index than the others. After inverse probability weight adjusting, the amount of all-cause medical costs was significantly lower only in the CHAP group. Faster walking speed and exercise habits were independently associated with lower all-cause medical and caregiving costs.

CONCLUSIONS

We demonstrated a 5-year all-cause cost reduction in residents who participated in the CHAP and also suggested the effect of exercise habits in Hirosaki, which indicated the significance of individually-based data linkages to external third-party data for all local governments to improve the health condition of residents.

Kidney function at 3 months after acute kidney injury is an unreliable indicator of subsequent kidney dysfunction: the NARA-AKI Cohort Study

BACKGROUND

The relationship between kidney function at 3 months after acute kidney injury (AKI) and kidney function prognosis has not been characterized.

METHODS

This retrospective cohort study included adults who underwent noncardiac surgery under general anesthesia. Exclusion criteria included obstetric or urological surgery, missing data and preoperative dialysis. Linear mixed-effects models were used to compare estimated glomerular filtration rate (eGFR) slopes in patients with and without AKI. Multivariable Cox proportional hazard models were used to examine the associations of AKI with incident chronic kidney disease (CKD) and decline in eGFR ≥30%.

RESULTS

Among 5272 patients, 316 (6.0%) developed AKI. Among 1194 patients with follow-up creatinine values, eGFR was stable or increased in patients with and without AKI at 3 months postoperatively and declined thereafter. eGFR decline after 3 months postoperatively was faster among patients with AKI than among patients without AKI (P = .09). Among 938 patients without CKD-both at baseline and at 3 months postoperatively-226 and 161 developed incident CKD and a decline in eGFR ≥30%, respectively. Despite adjustment for eGFR at 3 months, AKI was associated with incident CKD {hazard ratio [HR] 1.73 [95% confidence interval (CI) 1.06-2.84]} and a decline in eGFR ≥30% [HR 2.41 (95% CI 1.51-3.84)].

CONCLUSIONS

AKI was associated with worse kidney outcomes, regardless of eGFR at 3 months after surgery. Creatinine-based eGFR values at 3 months after AKI might be affected by acute illness-induced loss of muscle mass. Kidney function might be more accurately evaluated much later after surgery or using cystatin C values.

Healthy Lifestyle and Incident Hypertension and Diabetes in Participants with and without Chronic Kidney Disease: The Japan Specific Health Checkups (J-SHC) Study

Objective Whether or not combined lifestyle factors are associated with similar decreases in risks of incident hypertension and diabetes among individuals with and without chronic kidney disease (CKD) remains unclear. Methods This population-based prospective cohort study included participants 40-74 years old who were free from heart disease, stroke, renal failure, hypertension, diabetes, and hypercholesterolemia at baseline (n =60,234). Healthy lifestyle scores (HLSs) were calculated by adding the total number of 5 healthy lifestyle factors (non-smoking, body mass index <25 kg/m², regular exercise, healthy eating habits, and moderate or less alcohol consumption). Cox proportional hazards models were used to examine associations between the HLS and incident hypertension or type 2 diabetes and whether or not CKD modified these associations. Results During a median of 4 years, there were 2,773 incident hypertension cases (30.1 cases per 1,000 person-years) and 263 incident diabetes cases (2.4 cases per 1,000 person-years). The risk of developing hypertension and diabetes decreased linearly as participants adhered to more HLS components. Compared with adhering to 0, 1, or 2 components, adherence to all 5 HLS components was associated with a nearly one-half reduction in the risk of hypertension [hazard ratio (HR) =0.52; 95% confidence interval (CI), 0.45-0.60] and diabetes (HR=0.51; 95% CI, 0.32-0.81) in fully adjusted models. CKD did not have a modifying effect on associations between the HLS and incident hypertension (P_interaction=0.6) or diabetes (P_interaction=0.3). Conclusion Adherence to HLS components was associated with reduced risks of incident hypertension and diabetes, regardless of CKD status.