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Matsumoto Y, Orihara Y, Asakura M, Min KD, Okuhara Y, Azuma K, Nishimura K, Sunayama I, Kashiwase K, Naito Y, Goda A, Ishihara M. Urine albumin-to-creatinine ratio on admission predicts early rehospitalization in patients with acute decompensated heart failure. Heart Vessels 2022; 37:1184-1194. [PMID: 35034172 DOI: 10.1007/s00380-022-02025-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 01/07/2022] [Indexed: 12/13/2022]
Abstract
Detecting high-risk patients for early rehospitalization is crucial in heart failure patient care. An association of albuminuria with cardiovascular events is well known. However, its predictive impact on rehospitalization for acute decompensated heart failure (ADHF) remains unknown. In this study, 190 consecutive patients admitted due to ADHF between 2017 and April 2019 who underwent urinalysis were enrolled. Among them, 140 patients from whom urine albumin-to-creatinine ratio (UACR) was measured with spot urine samples on admission were further analyzed. The association between UACR and rehospitalization due to HF during 1 year after discharge was evaluated. The mean age of 140 participants was 77.6 years and 55% were men. Only 18% (n = 25) of patients presented with normoalbuminuria (UACR < 30 mg/g∙creatinine), whereas 59% (n = 83) and 23% (n = 32) showed microalbuminuria (UACR 30-300 mg/g·creatinine) and macroalbuminuria (UACR > 300 mg/g·creatinine), respectively. The level of UACR on admission was correlated with the risk of subsequent rehospitalization due to HF (p = 0.017). The receiver operating characteristic analysis indicated that the best cut-off values for the UACR and B-type natriuretic peptide (BNP) levels to predict ADHF rehospitalization were 50 mg/g·creatinine and 824 pg/ml, respectively. When the patients were divided into four groups using both cut-off values, the individual predictive impacts of UACR and BNP on rehospitalization were comparable. Patients with both elevated UACR and BNP levels had a higher rate of HF rehospitalization than those with elevated BNP levels alone (p < 0.05). The combination of both values enabled more accurate prediction of HF rehospitalization than BNP levels alone. In conclusion, UACR could be a new useful biomarker to predict HF rehospitalization in patients with ADHF, especially in combination with the levels of BNP, and should be further evaluated in a prospective study.
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Affiliation(s)
- Yuki Matsumoto
- Department of Cardiovascular and Renal Medicine, Hyogo College of Medicine, 1-1, Mukogawa-cho, Nishinomiya, Hyogo, 663-8501, Japan
| | - Yoshiyuki Orihara
- Department of Cardiovascular and Renal Medicine, Hyogo College of Medicine, 1-1, Mukogawa-cho, Nishinomiya, Hyogo, 663-8501, Japan
| | - Masanori Asakura
- Department of Cardiovascular and Renal Medicine, Hyogo College of Medicine, 1-1, Mukogawa-cho, Nishinomiya, Hyogo, 663-8501, Japan.
| | - Kyung-Duk Min
- Department of Cardiovascular and Renal Medicine, Hyogo College of Medicine, 1-1, Mukogawa-cho, Nishinomiya, Hyogo, 663-8501, Japan
| | - Yoshitaka Okuhara
- Department of Cardiovascular and Renal Medicine, Hyogo College of Medicine, 1-1, Mukogawa-cho, Nishinomiya, Hyogo, 663-8501, Japan
| | - Kohei Azuma
- Department of Cardiovascular and Renal Medicine, Hyogo College of Medicine, 1-1, Mukogawa-cho, Nishinomiya, Hyogo, 663-8501, Japan
| | - Koichi Nishimura
- Department of Cardiovascular and Renal Medicine, Hyogo College of Medicine, 1-1, Mukogawa-cho, Nishinomiya, Hyogo, 663-8501, Japan
| | - Isamu Sunayama
- Department of Cardiovascular and Renal Medicine, Hyogo College of Medicine, 1-1, Mukogawa-cho, Nishinomiya, Hyogo, 663-8501, Japan
| | - Kazunori Kashiwase
- Cardiovascular Division, National Hospital Organization, Osaka-Minami Medical Center, Osaka, Japan
| | - Yoshiro Naito
- Department of Cardiovascular and Renal Medicine, Hyogo College of Medicine, 1-1, Mukogawa-cho, Nishinomiya, Hyogo, 663-8501, Japan
| | - Akiko Goda
- Department of Cardiovascular and Renal Medicine, Hyogo College of Medicine, 1-1, Mukogawa-cho, Nishinomiya, Hyogo, 663-8501, Japan
| | - Masaharu Ishihara
- Department of Cardiovascular and Renal Medicine, Hyogo College of Medicine, 1-1, Mukogawa-cho, Nishinomiya, Hyogo, 663-8501, Japan
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Lye WK, Paterson E, Patterson CC, Maxwell AP, Binte Mohammed Abdul RB, Tai ES, Cheng CY, Kayama T, Yamashita H, Sarnak M, Shlipak M, Matsushita K, Mutlu U, Ikram MA, Klaver C, Kifley A, Mitchell P, Myers C, Klein BE, Klein R, Wong TY, Sabanayagam C, McKay GJ. A systematic review and participant-level meta-analysis found little association of retinal microvascular caliber with reduced kidney function. Kidney Int 2021; 99:696-706. [PMID: 32810524 PMCID: PMC7898278 DOI: 10.1016/j.kint.2020.06.033] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Revised: 06/07/2020] [Accepted: 06/11/2020] [Indexed: 01/09/2023]
Abstract
Previously, variation in retinal vascular caliber has been reported in association with chronic kidney disease (CKD) but findings remain inconsistent. To help clarify this we conducted individual participant data meta-analysis and aggregate data meta-analysis on summary estimates to evaluate cross-sectional associations between retinal vascular caliber and CKD. A systematic review was performed using Medline and EMBASE for articles published until October 2018. The aggregate analysis used a two-stage approach combining summary estimates from eleven studies (44,803 patients) while the individual participant analysis used a one-stage approach combining raw data from nine studies (33,222 patients). CKD stages 3-5 was defined as an estimated glomerular filtration rate under 60 mL/min/1.73m2. Retinal arteriolar and venular caliber (central retinal arteriolar and venular equivalent) were assessed from retinal photographs using computer-assisted methods. Logistic regression estimated relative risk of CKD stages 3-5 associated with a 20 μm decrease (approximately one standard deviation) in central retinal arteriolar and venular equivalent. Prevalence of CKD stages 3-5 was 11.2% of 33,222 and 11.3% of 44,803 patients in the individual participant and aggregate data analysis, respectively. No significant associations were detected in adjusted analyses between central retinal arteriolar and venular equivalent and CKD stages 3-5 in the aggregate analysis for central retinal arteriolar relative risk (0.98, 95% confidence interval 0.94-1.03); venular equivalent (0.99, 0.95-1.04) or individual participant central retinal arteriolar (0.99, 0.95-1.04) or venular equivalent (1.01, 0.97-1.05). Thus, meta-analysis provided little evidence to suggest that cross sectional direct measurements of retinal vascular caliber was associated with CKD stages 3-5 in the general population. Hence, meta-analyses of longitudinal studies evaluating the association between retinal parameters and CKD stages 3-5 may be warranted.
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Affiliation(s)
- Weng Kit Lye
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore
| | - Euan Paterson
- Centre for Public Health, Queen's University Belfast, Belfast, Northern Ireland, UK
| | | | - Alexander P Maxwell
- Centre for Public Health, Queen's University Belfast, Belfast, Northern Ireland, UK
| | | | - E Shyong Tai
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore
| | - Ching Yu Cheng
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore
| | - Takamasa Kayama
- Department of Advanced Cancer Science, Yamagata University, Yamagata, Japan
| | | | - Mark Sarnak
- William B. Schwartz Division of Nephrology, Department of Medicine, Tufts Medical Center, Boston, Massachusetts, USA
| | - Michael Shlipak
- Division of Nephrology, Department of Medicine, San Francisco VA Medical Center, San Francisco, California, USA
| | - Kunihiro Matsushita
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Unal Mutlu
- Department of Epidemiology, Erasmus University Medical Center, Rotterdam, the Netherlands; Department of Ophthalmology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Mohammad A Ikram
- Department of Epidemiology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Caroline Klaver
- Department of Epidemiology, Erasmus University Medical Center, Rotterdam, the Netherlands; Department of Ophthalmology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Annette Kifley
- Centre for Vision Research, Department of Ophthalmology, Westmead Institute for Medical Research, University of Sydney, Sydney, New South Wales, Australia
| | - Paul Mitchell
- Centre for Vision Research, Department of Ophthalmology, Westmead Institute for Medical Research, University of Sydney, Sydney, New South Wales, Australia
| | - Chelsea Myers
- Department of Ophthalmology and Visual Sciences, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Barbara E Klein
- Department of Ophthalmology and Visual Sciences, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Ronald Klein
- Department of Ophthalmology and Visual Sciences, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Tien Y Wong
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore
| | | | - Gareth J McKay
- Centre for Public Health, Queen's University Belfast, Belfast, Northern Ireland, UK.
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Uju Y, Kanzaki T, Yamasaki Y, Kondo T, Nanasawa H, Takeuchi Y, Yanagisawa Y, Kusanishi S, Nakano C, Enomoto T, Sako A, Yanai H, Mishima S, Mimori S, Igarashi K, Takizawa T, Hayakawa T. A cross-sectional study on metabolic similarities and differences between inpatients with schizophrenia and those with mood disorders. Ann Gen Psychiatry 2020; 19:53. [PMID: 32983246 PMCID: PMC7510094 DOI: 10.1186/s12991-020-00303-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Accepted: 09/15/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND One of the main causes of death in psychiatric patients is cardiovascular diseases which are closely related with lifestyle-related diseases. Psychiatric disorders include schizophrenia and mood disorders, whose symptoms and treatment medicines are different, suggesting that they might have different metabolic disorders. Thus, we studied the differences of lifestyle-related diseases between schizophrenia and mood disorders in Japan. METHODS This cross-sectional study was performed from 2015 to 2017. Study participants were 189 Japanese hospitalized patients (144 schizophrenia group, 45 mood disorders group) in the department of psychiatry at Kohnodai hospital. We examined physical disorders, metabolic status of glucose and lipid, estimated glomerular filtration rate (eGFR) and brain magnetic resonance imaging. We compared these data between schizophrenia and mood disorders groups using analysis of covariance or logistic regression analysis. In comparisons between inpatients with schizophrenia or mood disorders group and the standard, we quoted 'The National Health and Nutrition Survey in Japan 2015' by Ministry of Health, Labor and Welfare as the standard. RESULTS eGFR and prevalence of smoking were significantly lower in patients with mood disorder group than those with schizophrenia group by adjustment for age. In comparisons between patients with schizophrenia group or mood disorders group and each standard, the ratio of silent brain infarction (SBI) and cerebral infarction were significantly high in both groups. Schizophrenia group showed significantly higher prevalence of diabetes, low high-density lipoprotein (HDL) cholesterolemia, metabolic syndrome and smoking than the standard. Mood disorders group had significantly high prevalence of low HDL-cholesterolemia compared with the standard. Fasting blood glucose and HbA1c were significantly higher in schizophrenia group and female mood disorders group than the standard. Female mood disorders group had significantly decreased eGFR with increased ratio of eGFR < 60 ml/min than the standard. CONCLUSIONS Participants of both groups had increased ratio of SBI and cerebral infarction, accompanied with glucose and lipid disorders. Compared with schizophrenia group, mood disorders group showed significantly low eGFR and prevalence of smoking.
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Affiliation(s)
- Yoriyasu Uju
- Department of Psychiatry, Kohnodai Hospital, National Center for Global Health and Medicine, 1-7-1, Kohnodai, Ichikawa, Japan
| | - Tetsuto Kanzaki
- Department of Drug Informatics, Graduate School and Faculty of Pharmaceutical Sciences, Chiba University, 1-8-1, Inohana, Chuo-ku, Chiba, Japan
| | - Yuki Yamasaki
- Department of Drug Informatics, Graduate School and Faculty of Pharmaceutical Sciences, Chiba University, 1-8-1, Inohana, Chuo-ku, Chiba, Japan
| | - Tadayuki Kondo
- Department of Psychiatry, Kohnodai Hospital, National Center for Global Health and Medicine, 1-7-1, Kohnodai, Ichikawa, Japan
| | - Hideki Nanasawa
- Department of Psychiatry, Kohnodai Hospital, National Center for Global Health and Medicine, 1-7-1, Kohnodai, Ichikawa, Japan
| | - Yu Takeuchi
- Department of Psychiatry, Kohnodai Hospital, National Center for Global Health and Medicine, 1-7-1, Kohnodai, Ichikawa, Japan
| | - Yuta Yanagisawa
- Department of Psychiatry, Kohnodai Hospital, National Center for Global Health and Medicine, 1-7-1, Kohnodai, Ichikawa, Japan
| | - Shun Kusanishi
- Department of Psychiatry, Kohnodai Hospital, National Center for Global Health and Medicine, 1-7-1, Kohnodai, Ichikawa, Japan
| | - Chieko Nakano
- Department of Psychiatry, Kohnodai Hospital, National Center for Global Health and Medicine, 1-7-1, Kohnodai, Ichikawa, Japan
| | - Tetsuro Enomoto
- Department of Psychiatry, Kohnodai Hospital, National Center for Global Health and Medicine, 1-7-1, Kohnodai, Ichikawa, Japan
| | - Akahito Sako
- Department of Internal Medicine, Kohnodai Hospital, National Center for Global Health and Medicine, 1-7-1, Kohnodai, Ichikawa, Japan
| | - Hidekazu Yanai
- Department of Internal Medicine, Kohnodai Hospital, National Center for Global Health and Medicine, 1-7-1, Kohnodai, Ichikawa, Japan
| | - Shunichi Mishima
- Department of Diabetes, Endocrinology and Metabolism, Kohnodai Hospital, National Center for Global Health and Medicine, 1-7-1, Kohnodai, Ichikawa, Japan
| | - Seisuke Mimori
- Department of Clinical Medicine, Faculty of Pharmacy, Chiba Institute of Science, 15-8, Shiomi-cho, Choshi, Japan
| | - Kazuei Igarashi
- Amine Pharma Research Institute, Innovation Plaza at Chiba University, 1-8-1, Inohana, Chuo-ku, Chiba, Japan
| | - Tsuyoshi Takizawa
- Department of Biostatistics, Faculty of Pharmacy, Chiba Institute of Science, 15-8, Shiomi-cho, Choshi, Japan
| | - Tatsuro Hayakawa
- Department of Psychiatry, Kohnodai Hospital, National Center for Global Health and Medicine, 1-7-1, Kohnodai, Ichikawa, Japan
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Association between urinary salt excretion and albuminuria in Japanese patients with chronic kidney disease: the Fukuoka kidney disease registry study. Clin Exp Nephrol 2020; 25:9-18. [PMID: 32860538 DOI: 10.1007/s10157-020-01950-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 07/29/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Several large population-based studies have demonstrated that urinary salt excretion (USALT) is associated with albuminuria. However, this relationship has not been assessed in a large cohort study of patients with chronic kidney disease (CKD). Thus, the present study aimed to elucidate whether USALT was independently associated with albuminuria in a large cohort of patients with CKD. METHODS This cross-sectional study was conducted in 4075 patients with CKD not on dialysis. USALT (g/day) was estimated from spot urine. Patients were divided into quartiles (Q1-Q4) according to estimated USALT. Multivariable regression models were used to determine whether USALT was independently related to urinary albumin-to-creatinine ratio (UACR) or the presence of macroalbuminuria. RESULTS In multivariable linear regression analyses, 1-g/day increment in USALT was significantly associated with log UACR [coefficient 0.098, 95% confidence interval (CI) 0.075-0.121]. In addition, compared with the first USALT quartile, the third and fourth quartiles exhibited significant associations with log UACR (Q3: coefficient 0.305, 95% CI 0.154-0.456; Q4: coefficient 0.601, 95% CI 0.447-0.756). Furthermore, multivariable logistic regression analyses showed that USALT (1-g/day increment) was significantly associated with the presence of macroalbuminuria [odds ratio (OR) 1.11, 95% CI 1.07-1.14]; the third and fourth USALT quartiles exhibited significantly greater risks of macroalbuminuria, compared with the first quartile (Q3: OR 1.33, 95% CI 1.09-1.62; Q4: OR 1.89, 95% CI 1.54-2.32). CONCLUSIONS This significant association of USALT with UACR and macroalbuminuria suggests that higher USALT may cause increased albuminuria, thereby contributing to kidney disease progression.
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Addition of Metabolic Syndrome to Albuminuria Provides a New Risk Stratification Model for Diabetic Kidney Disease Progression in Elderly Patients. Sci Rep 2020; 10:6788. [PMID: 32321994 PMCID: PMC7176677 DOI: 10.1038/s41598-020-63967-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2019] [Accepted: 04/08/2020] [Indexed: 12/28/2022] Open
Abstract
Elderly patients with type 2 diabetes (T2DM) are more prone to developing diabetic kidney disease (DKD). Patients with DKD can develop albuminuria, and some studies have suggested an association between metabolic syndrome and albuminuria. The prevalence of both metabolic syndrome and albuminuria increases with age. We evaluated the association of these risk factors with worsening renal function and albuminuria progression in 460 T2DM patients with a mean age of 72 years. During the 5-year follow-up period, progression of albuminuria and worsening of renal function were observed in 97 (21.2%) and 23 (5.1%) patients, respectively. After adjusting for confounding factors, the group with metabolic syndrome had a higher multivariable-adjusted hazard ratio (HR) for worsening renal function (P = 0.038) and albuminuria progression (P = 0.039) than the group without metabolic syndrome. When patients were divided into four groups according to the presence of metabolic syndrome and/or albuminuria, the HR gradually increased. The group with both albuminuria and metabolic syndrome exhibited the highest cumulative incidence of worsening renal function (P = 0.003). When we redefined metabolic syndrome to exclude the blood pressure (BP) component, similar results were obtained. We concluded that the presence of metabolic syndrome independently predicts the progression of renal disease in elderly patients with T2DM. The use of both metabolic syndrome and albuminuria provides a better risk stratification model for DKD progression than albuminuria alone.
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Marketou ME, Maragkoudakis S, Anastasiou I, Nakou H, Plataki M, Vardas PE, Parthenakis FI. Salt-induced effects on microvascular function: A critical factor in hypertension mediated organ damage. J Clin Hypertens (Greenwich) 2019; 21:749-757. [PMID: 31002481 DOI: 10.1111/jch.13535] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Revised: 03/07/2019] [Accepted: 03/19/2019] [Indexed: 12/17/2022]
Abstract
Salt has been linked very closely to the occurrence and complications of arterial hypertension. A large percentage of patients with essential hypertension are salt-sensitive; that is, their blood pressure increases with increased salt intake and decreases with its reduction. For this reason, emphasis is placed on reducing salt intake to better regulate blood pressure. In day-to-day clinical practice this is viewed as mandatory for hypertensive patients who are judged to be salt-sensitive. Previous studies have highlighted the negative effect of high-salt diets on macrovascular function, which also affects blood pressure levels by increasing peripheral resistances. More recent studies provide a better overview of the pathophysiology of microvascular disorders and show that they are largely due to the overconsumption of salt. Microvascular lesions, which have a major impact on the functioning of vital organs, are often not well recognized in clinical practice and are not paid sufficient attention. In general, the damage caused by hypertension to the microvascular network is likely to be overlooked, while reversion of the damage is only rarely considered as a therapeutic target by the treating physician. The purpose of this review is to summarize the impact and the harmful consequences of increased salt consumption in the microvascular network, their significance and pathophysiology, and at the same time to place some emphasis on their treatment and reversion, mainly through diet.
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Affiliation(s)
- Maria E Marketou
- Department of Cardiology, Heraklion University Hospital, Heraklion, Greece
| | | | - Ioannis Anastasiou
- Department of Cardiology, Heraklion University Hospital, Heraklion, Greece
| | - Helen Nakou
- Barts Heart Centre, St Bartholomew's Hospital, London, UK
| | - Marina Plataki
- Department of Cardiology, Heraklion University Hospital, Heraklion, Greece
| | - Panos E Vardas
- Department of Cardiology, Heraklion University Hospital, Heraklion, Greece
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Jayasekara JMKB, Dissanayake DM, Shihana F, Sivakanesan R, Silva RN, Gunawickrama SHNP. Comparison of Serum Cystatin C and Creatinine Levels among Individuals with Persisting Proteinuria in Farming Communities of Rural Sri Lanka. Malays J Med Sci 2019; 25:67-75. [PMID: 30914880 PMCID: PMC6422570 DOI: 10.21315/mjms2018.25.6.7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Accepted: 10/17/2018] [Indexed: 11/17/2022] Open
Abstract
Background Chronic kidney disease of uncertain aetiology (CKDu) is one of the major health concerns among agricultural communities in Sri Lanka. Individuals involved in severe agricultural works for their livelihood are highly vulnerable for this disease and patients have been detected with persisting proteinuria at community-level screening. The current study was designed to evaluate the diagnosis of two functional markers of kidney damage using individuals with persisting proteinuria as the baseline. Methods One hundred and fifty hard-working agricultural farmers from high-prevalence area for CKDu (Madawachchiya) were screened three times for proteinuria; 66 proteinuric and 21 non-proteinuric were identified as the baseline classification. Selected individuals were analysed further for creatinine, protein and cystatin C in urine and creatinine, cystatin C in serum. Urine protein-to-creatinine ratio (UP/UC) was calculated. Results Based on creatinine and cystatin C cut-off levels in serum, individuals were classified as high or normal. Diagnosis of two functional markers (creatinine and cystatin C) were evaluated using receiver operating characteristic (ROC) curve and in terms of sensitivity and specificity using UP/UC as the baseline. Creatinine and cystatin C-based eGFR (estimated Glomerular filtration rate) levels were calculated, and Pearson’s correlation coefficient was determined between different eGFR measurements using UP/UC. Mean (SD) UP/UC ratio, serum creatinine, and serum cystatin C levels of the proteinuric subjects were 129.0 (18.4) mg/mmol, 1.35 (0.39) mg/dL, 1.69 (0.58) mg/L. For non-proteniuric individuals, the results were found to be 14.4 (2.28), 1.22 (0.40) mg/dL, 0.82 (0.25) mg/L. The ROC analysis showed excellent accuracy in using cystatin C for identifying proteinuric patients than creatinine area under the curve (AUC): 0.9675, P < 0.001). Cut-off points were identified as 1.015 mg/dL for serum creatinine and 0.930mg/L for cystatin C. Furthermore, cystatin C based Hoek formula showed the better correlation (0.635, P < 0.001) with UP/UC compared with creatinine based modification of diet in renal disease (MDRD) formula. Conclusion The study showed elevated serum cystatin C in patients with persisting proteinuria compared with non-responding serum creatinine. Moreover, cystatin C-based eGFR equations were more accurate to determine the kidney function than serum creatinine in proteinuric patients who are vulnerable for CKDu in high-prevalence areas.
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Affiliation(s)
| | | | - Fathima Shihana
- South Asian Clinical Toxicology Research Collaboration, Faculty of Medicine, University of Peradeniya, Sri Lanka
| | - Ramaiya Sivakanesan
- Department of Biochemistry, Faculty of Medicine, University of Peradeniya, Sri Lanka
| | - Rajith Niloshan Silva
- Department of Medical Laboratory Sciences, Faculty of Allied Health Sciences, Sir John Kotelawala Defence University, Sri Lanka
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Kataoka-Yahiro M, Davis J, Gandhi K, Rhee CM, Page V. Asian Americans & chronic kidney disease in a nationally representative cohort. BMC Nephrol 2019; 20:10. [PMID: 30626357 PMCID: PMC6327460 DOI: 10.1186/s12882-018-1145-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Accepted: 11/20/2018] [Indexed: 12/27/2022] Open
Abstract
Background There is a paucity of specific data on early stages of chronic kidney disease (CKD) among Asian Americans (AAs). The objective of this study was to examine the independent association of Asian race/ethnicity and socio-demographic and co-morbidity factors with markers of early kidney damage, ascertained by ACR levels, as well as kidney dysfunction, ascertained by eGFR levels in a large cross-sectional sample of AAs enrolled in the National Health and Nutrition Examination Survey (NHANES). Methods Secondary data analyses of the NHANES 2011–2014 data of a nationally representative sample of 5907 participants 18 years and older, US citizens, and of Asian and White race. NHANES data included race (Asian vs. White), as well as other socio-demographic information and comorbidities. Urine albumin-to-creatinine ratio (ACR) categories and estimated glomerular filtration rate (eGFR) were used as indicators for CKD. Descriptive analyses using frequencies, means (standard deviations), and chi-square tests was first conducted, then multivariable logistic regression serial adjustment models were used to examine the associations between race/ethnicity, other socio-demographic factors (age, sex, education), and co-morbidities (obesity, diabetes, hypertension) with elevated ACR levels (A2 & A3 – CKD Stages 3 and 4–5, respectively) as well as reduced eGFR (G3a-G5 and G3b –G5 - CKD Stage 3–5). Results AAs were more likely than White participants to have ACR levels > 300 mg/g (A3) (adjusted OR (aOR) (95% CI) 2.77 (1.55, 4.97), p = 0.001). In contrast, adjusted analyses demonstrated that AAs were less likely to have eGFR levels < 60 ml/min/1.73 m2 (G3a-G5) (aOR (95% CI) 0.50 (0.35, 0.72), p < .001). Conclusions This is one of the first large U.S. population-based studies of AAs that has shown a comparatively higher risk of elevated ACR > 300 mg/g levels (A3) but lower risk of having eGFR levels < 60 ml/min/1.732 m2 (G3a-G5). The findings support the need to address the gaps in knowledge regarding disparities in risk of early stage CKD among AAs. Electronic supplementary material The online version of this article (10.1186/s12882-018-1145-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Merle Kataoka-Yahiro
- Department of Nursing, School of Nursing and Dental Hygiene, University of Hawai'i at Manoa, 2528 McCarthy Mall, Webster Hall 409, Honolulu, HI, 96822, USA.
| | - James Davis
- Office of Biostatistics and Quantitative Health Sciences, John A. Burns School of Medicine, Honolulu, HI, 96813, USA
| | - Krupa Gandhi
- Office of Biostatistics and Quantitative Health Sciences, John A. Burns School of Medicine, Honolulu, HI, 96813, USA
| | - Connie M Rhee
- Division of Nephrology and Hypertension, University of California Irvine School of Medicine, 101 The City Drive South, City Tower, Suite 400, Orange, CA, 92868, USA
| | - Victoria Page
- National Kidney Foundation of Hawaii, Health Innovation Division, 1314 S. King Street #1555, Honolulu, HI, 96814, USA
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The association between urinary sodium excretion and blood pressure in a community-based population: the Yamagata (Takahata) study. Clin Exp Nephrol 2018; 23:380-386. [DOI: 10.1007/s10157-018-1654-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Accepted: 09/30/2018] [Indexed: 10/28/2022]
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10
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Rajah R, Eng MF, Tan SY. Impact of pharmacist‐led education sessions on the knowledge and practice of calcium carbonate administration among Malaysian chronic kidney disease patients. JOURNAL OF PHARMACY PRACTICE AND RESEARCH 2018. [DOI: 10.1002/jppr.1382] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Affiliation(s)
- Retha Rajah
- Seberang Jaya Hospital Seberang Jaya City Penang Malaysia
| | - May Fern Eng
- Seberang Jaya Hospital Seberang Jaya City Penang Malaysia
| | - Siao Yin Tan
- Seberang Jaya Hospital Seberang Jaya City Penang Malaysia
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Choi I, Moon H, Kang SY, Ko H, Shin J, Lee J. The Risk of Microalbuminuria by Obesity Phenotypes according to Metabolic Health and Obesity: The Korean National Health and Nutrition Examination Survey 2011-2014. Korean J Fam Med 2018; 39:168-173. [PMID: 29788705 PMCID: PMC5975987 DOI: 10.4082/kjfm.2018.39.3.168] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2016] [Revised: 05/19/2017] [Accepted: 05/23/2017] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND The present study aimed at identifying the difference in the risk of microalbuminuria among individuals with various obesity phenotypes in terms of metabolic health and obesity. METHODS This cross-sectional study included 15,268 individuals and used data from the National Health and Nutrition Survey conducted from 2011 to 2014. Obesity was defined as body mass index ≥25 kg/m². Metabolically unhealthy was defined as meeting two or more of the following criteria: systolic and diastolic blood pressure ≥130/85 mm Hg or current use of hypertensive drugs; triglyceride level ≥150 mg/dL; high-density lipoprotein level <40/50 mg/dL (in both men and women); and fasting blood glucose level ≥100 mg/dL or current use of oral antidiabetic medications. The participants were further classified into four subgroups: metabolically healthy non-obese (MHNO), metabolically healthy obese (MHO), metabolically unhealthy non-obese (MUNO), and metabolically unhealthy obese (MUO). RESULTS A significant difference was observed in the microalbuminuria ratio among the four groups. The MHNO group was considered as the reference group, and the MHO, MUNO, and MUO groups were at an increased risk for microalbuminuria by 1.42 fold (95% confidence interval [95% CI], 1.03-1.96), 2.02 fold (95% CI, 1.61-2.53), and 3.40 fold (95% CI, 2.70-4.26), respectively, after adjusting confounding factors. CONCLUSION The MUNO group had a higher risk of developing microalbuminuria than the MHNO group. Thus, based on this result, differences were observed in the risk of developing microalbuminuria among individuals with various obesity subtypes.
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Affiliation(s)
- Inyoung Choi
- Department of Family Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Heesun Moon
- Department of Family Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - So Young Kang
- Department of Family Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hyeonyoung Ko
- Department of Family Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jinyoung Shin
- Department of Family Medicine, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea
| | - Jungkwon Lee
- Department of Family Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Razi F, Nasli-Esfahani E, Bandarian F. Association of serum uric acid with nephropathy in Iranian type 2 diabetic patients. J Diabetes Metab Disord 2018; 17:71-75. [PMID: 30288387 PMCID: PMC6154522 DOI: 10.1007/s40200-018-0340-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Accepted: 12/16/2017] [Indexed: 12/14/2022]
Abstract
Background Diabetic nephropathy (DN) is the major cause of end-stage renal disease. Recent studies suggest that it is probable that uric acid is involved in the pathogenesis of diabetic nephropathy. This study aim was to investigate the association between serum uric acid and kidney function in Iranian patients with type 2 diabetes mellitus. Methods In this case-control study, a total of 201 diabetic patients with or without impaired kidney function (glomerular filtration rate/GFR < 60 and GFR ≥ 60) were selected. In both groups, serum fasting glucose (FBS), HbA1c, urea, creatinine, uric acid and lipid profile, urine albumin and GFR were measured and results were compared between the two groups. The results also categorized into three groups based on uric acid tertiles. Results Serum levels of uric acid, urea and creatinine as well as urine albumin/creatinine ratio (ACR) were significantly different between the two groups. GFR, creatinine and also urea were significantly different between uric acid tertiles (p < 0.05). Conclusions Serum uric acid is associated with decreased GFR as well as albuminuria and can be used as an indicator of DN.
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Affiliation(s)
- Farideh Razi
- Diabetes Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, 5th floor, Diabetes Clinic, cross Heyat Ave, Shahrivar Ave., North Kargar St, Tehran, 1411715851 Iran
| | - Ensieh Nasli-Esfahani
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Fatemeh Bandarian
- Diabetes Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, 5th floor, Diabetes Clinic, cross Heyat Ave, Shahrivar Ave., North Kargar St, Tehran, 1411715851 Iran
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Machida H, Shibata Y, Inoue S, Igarashi A, Tokairin Y, Yamauchi K, Kimura T, Sato K, Nakano H, Nishiwaki M, Kobayashi M, Yang S, Minegishi Y, Furuyama K, Yamamoto T, Watanabe T, Konta T, Ueno Y, Kato T, Kayama T, Kubota I. Prevalence of diabetes mellitus in individuals with airflow obstruction in a Japanese general population: The Yamagata-Takahata Study. Respir Investig 2017; 56:34-39. [PMID: 29325679 DOI: 10.1016/j.resinv.2017.11.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2017] [Revised: 10/24/2017] [Accepted: 11/07/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND Diabetes has been reported as a comorbidity of chronic obstructive pulmonary disease (COPD) in Western countries, but it has not been demonstrated in epidemiological reports in Japan. The purpose of this study was to clarify whether the relationship between airflow obstruction and diabetes can be confirmed in a Japanese general population. METHODS From 2004 to 2006, blood sampling and pulmonary function tests were performed on 3045 people over the age of 40 years in annual health check-ups held in Takahata, Yamagata Prefecture, Japan. Pulmonary function was re-evaluated in 2009 and 2011. RESULTS The prevalence of diabetes did not differ between subjects with and without airflow obstruction. Furthermore, although body mass index decreased, no increase in the prevalence of diabetes was observed with the progression of airflow obstruction. The annual changes in forced expiration volume in 1s (FEV1) did not differ depending on the presence or absence of diabetes in the study population. CONCLUSION There was no difference in the prevalence of diabetes between subjects with airflow obstruction and those without. As patients with COPD in Japan are thinner than in the West, diabetes may not be a common comorbidity in Japanese patients with COPD.
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Affiliation(s)
- Hiroyoshi Machida
- Department of Cardiology, Pulmonology, and Nephrology, Yamagata University School of Medicine, 2-2-2 Iida-Nishi, Yamagata 990-9585, Japan.
| | - Yoko Shibata
- Department of Cardiology, Pulmonology, and Nephrology, Yamagata University School of Medicine, 2-2-2 Iida-Nishi, Yamagata 990-9585, Japan.
| | - Sumito Inoue
- Department of Cardiology, Pulmonology, and Nephrology, Yamagata University School of Medicine, 2-2-2 Iida-Nishi, Yamagata 990-9585, Japan.
| | - Akira Igarashi
- Department of Cardiology, Pulmonology, and Nephrology, Yamagata University School of Medicine, 2-2-2 Iida-Nishi, Yamagata 990-9585, Japan.
| | - Yoshikane Tokairin
- Department of Cardiology, Pulmonology, and Nephrology, Yamagata University School of Medicine, 2-2-2 Iida-Nishi, Yamagata 990-9585, Japan.
| | - Keiko Yamauchi
- Department of Cardiology, Pulmonology, and Nephrology, Yamagata University School of Medicine, 2-2-2 Iida-Nishi, Yamagata 990-9585, Japan.
| | - Tomomi Kimura
- Department of Cardiology, Pulmonology, and Nephrology, Yamagata University School of Medicine, 2-2-2 Iida-Nishi, Yamagata 990-9585, Japan.
| | - Kento Sato
- Department of Cardiology, Pulmonology, and Nephrology, Yamagata University School of Medicine, 2-2-2 Iida-Nishi, Yamagata 990-9585, Japan.
| | - Hiroshi Nakano
- Department of Cardiology, Pulmonology, and Nephrology, Yamagata University School of Medicine, 2-2-2 Iida-Nishi, Yamagata 990-9585, Japan.
| | - Michiko Nishiwaki
- Department of Cardiology, Pulmonology, and Nephrology, Yamagata University School of Medicine, 2-2-2 Iida-Nishi, Yamagata 990-9585, Japan.
| | - Maki Kobayashi
- Department of Cardiology, Pulmonology, and Nephrology, Yamagata University School of Medicine, 2-2-2 Iida-Nishi, Yamagata 990-9585, Japan.
| | - Sujeong Yang
- Department of Cardiology, Pulmonology, and Nephrology, Yamagata University School of Medicine, 2-2-2 Iida-Nishi, Yamagata 990-9585, Japan.
| | - Yukihiro Minegishi
- Department of Cardiology, Pulmonology, and Nephrology, Yamagata University School of Medicine, 2-2-2 Iida-Nishi, Yamagata 990-9585, Japan.
| | - Kodai Furuyama
- Department of Cardiology, Pulmonology, and Nephrology, Yamagata University School of Medicine, 2-2-2 Iida-Nishi, Yamagata 990-9585, Japan.
| | - Tomoka Yamamoto
- Department of Cardiology, Pulmonology, and Nephrology, Yamagata University School of Medicine, 2-2-2 Iida-Nishi, Yamagata 990-9585, Japan.
| | - Tetsu Watanabe
- Department of Cardiology, Pulmonology, and Nephrology, Yamagata University School of Medicine, 2-2-2 Iida-Nishi, Yamagata 990-9585, Japan.
| | - Tsuneo Konta
- Department of Cardiology, Pulmonology, and Nephrology, Yamagata University School of Medicine, 2-2-2 Iida-Nishi, Yamagata 990-9585, Japan.
| | - Yoshiyuki Ueno
- Global Center of Excellence Program Study Group, Yamagata University School of Medicine, 2-2-2 Iida-Nishi, Yamagata 990-9585, Japan.
| | - Takeo Kato
- Global Center of Excellence Program Study Group, Yamagata University School of Medicine, 2-2-2 Iida-Nishi, Yamagata 990-9585, Japan.
| | - Takamasa Kayama
- Global Center of Excellence Program Study Group, Yamagata University School of Medicine, 2-2-2 Iida-Nishi, Yamagata 990-9585, Japan.
| | - Isao Kubota
- Department of Cardiology, Pulmonology, and Nephrology, Yamagata University School of Medicine, 2-2-2 Iida-Nishi, Yamagata 990-9585, Japan.
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A nationwide prospective cohort study of patients with advanced chronic kidney disease in Japan: The Reach-J CKD cohort study. Clin Exp Nephrol 2017; 22:309-317. [DOI: 10.1007/s10157-017-1453-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2017] [Accepted: 07/15/2017] [Indexed: 11/30/2022]
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15
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Effect of genomics-related literacy on non-communicable diseases. J Hum Genet 2017; 62:839-846. [PMID: 28490765 DOI: 10.1038/jhg.2017.50] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2017] [Revised: 03/30/2017] [Accepted: 04/08/2017] [Indexed: 01/29/2023]
Abstract
Recent progress in genomic research has raised expectations for the development of personalized preventive medicine, although genomics-related literacy of patients will be essential. Thus, enhancing genomics-related literacy is crucial, particularly for individuals with low genomics-related literacy because they might otherwise miss the opportunity to receive personalized preventive care. This should be especially emphasized when a lack of genomics-related literacy is associated with elevated disease risk, because patients could therefore be deprived of the added benefits of preventive interventions; however, whether such an association exists is unclear. Association between genomics-related literacy, calculated as the genomics literacy score (GLS), and the prevalence of non-communicable diseases was assessed using propensity score matching on 4646 participants (males: 1891; 40.7%). Notably, the low-GLS group (score below median) presented a higher risk of hypertension (relative risk (RR) 1.09, 95% confidence interval (CI) 1.03-1.16) and obesity (RR 1.11, 95% CI 1.01-1.22) than the high-GLS group. Our results suggest that a low level of genomics-related literacy could represent a risk factor for hypertension and obesity. Evaluating genomics-related literacy could be used to identify a more appropriate population for health and educational interventions.
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Nomura K, Asayama K, Jacobs L, Thijs L, Staessen JA. Renal function in relation to sodium intake: a quantitative review of the literature. Kidney Int 2017; 92:67-78. [PMID: 28412019 DOI: 10.1016/j.kint.2016.11.032] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Revised: 11/22/2016] [Accepted: 11/29/2016] [Indexed: 01/10/2023]
Abstract
We undertook a quantitative literature review to search for evidence underpinning current guidelines proposing a reduction of sodium intake to less than 2.4 g/d for the management of chronic kidney disease. We searched PubMed for peer-reviewed articles published from January 1980 through May 2016. Two investigators screened 5072 publications and extracted data from 36, including 11 cross-sectional and 5 longitudinal observational studies and 20 intervention trials. Within-study effect sizes were pooled and standardized to a sodium gradient of 100 mmol/d by using inverse-variance weighted random effects models. Among cross-sectional studies, the pooled odds ratio for albuminuria was 1.23 (95% confidence interval [CI], 0.92-1.64, P = 0.16), and the pooled mean difference in glomerular filtration rate amounted to 8.5 ml/min (CI, -2.3 to 19.2 ml/min; P = 0.12). In the cohort studies, the pooled relative risk of a renal endpoint was 1.08 (CI, 0.92-1.29; P = 0.35). In the intervention trials (median duration, 14 days [range, 4-186 days]), the mean differences in estimated glomerular filtration rate and albuminuria (high vs. low sodium intake) averaged 4.6 ml/min (CI, 3.4-5.8 ml/min; P < 0.0001) and 53% (CI, 21-84; P = 0.001), respectively. Cochran's Q statistic indicated significant heterogeneity among cross-sectional studies for both estimated glomerular filtration rate and albuminuria (P < 0.0001) and among intervention trials for albuminuria (P = 0.04). In conclusion, there is no robust evidence suggesting that long-term reduction of salt intake would prevent chronic kidney disease or delay its progression. However, our current findings, which were mainly obtained in people with slight renal impairment, cannot be extrapolated to patients with moderate or severe chronic kidney disease.
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Affiliation(s)
- Kyoko Nomura
- Department of Hygiene and Public Health, Teikyo University School of Medicine, Tokyo, Japan
| | - Kei Asayama
- Department of Hygiene and Public Health, Teikyo University School of Medicine, Tokyo, Japan; Department of Planning for Drug Development and Clinical Evaluation, Tohoku University Graduate School of Pharmaceutical Sciences, Sendai, Japan
| | - Lotte Jacobs
- Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
| | - Lutgarde Thijs
- Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
| | - Jan A Staessen
- Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium; R&D Group VitaK, Maastricht University, Maastricht, The Netherlands.
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Choi JW, Moon S, Jang EJ, Lee CH, Park JS. Association of prediabetes-associated single nucleotide polymorphisms with microalbuminuria. PLoS One 2017; 12:e0171367. [PMID: 28158221 PMCID: PMC5291388 DOI: 10.1371/journal.pone.0171367] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Accepted: 01/19/2017] [Indexed: 01/14/2023] Open
Abstract
Increased glycemic exposure, even below the diagnostic criteria for diabetes mellitus, is crucial in the pathogenesis of diabetic microvascular complications represented by microalbuminuria. Nonetheless, there is limited evidence regarding which single nucleotide polymorphisms (SNPs) are associated with prediabetes and whether genetic predisposition to prediabetes is related to microalbuminuria, especially in the general population. Our objective was to answer these questions. We conducted a genomewide association study (GWAS) separately on two population-based cohorts, Ansung and Ansan, in the Korean Genome and Epidemiology Study (KoGES). The initial GWAS was carried out on the Ansung cohort, followed by a replication study on the Ansan cohort. A total of 5682 native Korean participants without a significant medical illness were classified into either control group (n = 3153) or prediabetic group (n = 2529). In the GWAS, we identified two susceptibility loci associated with prediabetes, one at 17p15.3-p15.1 in the GCK gene and another at 7p15.1 in YKT6. When variations in GCK and YKT6 were used as a model of prediabetes, this genetically determined prediabetes increased microalbuminuria. Multiple logistic regression analyses revealed that fasting glucose concentration in plasma and SNP rs2908289 in GCK were associated with microalbuminuria, and adjustment for age, gender, smoking history, systolic blood pressure, waist circumference, and serum triglyceride levels did not attenuate this association. Our results suggest that prediabetes and the associated SNPs may predispose to microalbuminuria before the diagnosis of diabetes mellitus. Further studies are needed to explore the details of the physiological and molecular mechanisms underlying this genetic association.
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Affiliation(s)
- Jong Wook Choi
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul, South Korea
| | - Shinje Moon
- Division of Endocrinology and Metabolism, Hallym University College of Medicine, Seoul, South Korea
| | - Eun Jung Jang
- Korea Centers for Disease Control and Prevention, Cheongju-si, Chungcheongbuk-do, Korea
| | - Chang Hwa Lee
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul, South Korea
- * E-mail: (JSP); (CHL)
| | - Joon-Sung Park
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul, South Korea
- * E-mail: (JSP); (CHL)
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Assessment of Prevalence of Chronic Kidney Disease and Its Predisposing Factors in Kerman City. Nephrourol Mon 2017. [DOI: 10.5812/numonthly.41794] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Makino N, Shirahata N, Honda T, Ando Y, Matsuda A, Ikeda Y, Ito M, Nishise Y, Saito T, Ueno Y, Kawata S. Pancreatic hyperechogenicity associated with hypoadiponectinemia and insulin resistance: A Japanese population study. World J Hepatol 2016; 8:1452-1458. [PMID: 27957243 PMCID: PMC5124716 DOI: 10.4254/wjh.v8.i33.1452] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Revised: 09/08/2016] [Accepted: 10/18/2016] [Indexed: 02/06/2023] Open
Abstract
AIM To examine the relationship between pancreatic hyperechogenicity and risk factors for metabolic syndrome.
METHODS A general population-based survey of lifestyle-related diseases was conducted from 2005 to 2006 in Japan. The study involved 551 participants older than 40 year of age. Data for 472 non-diabetic adults were included in the analysis. The measures included the demographic factors, blood parameters, results of a 75 g oral glucose tolerance test, and abdominal ultrasonography. The echogenicity of the pancreas and liver was compared, and then the subjects were separated into two groups: cases with pancreatic hyperechogenicity (n = 208) and cases without (controls, n = 264). The differences between both groups were compared using an unpaired t-test or Fisher’s exact test. Multiple logistic regression analysis was used to determine the relationship between the pancreatic hyperechogenicity and clinical and biochemical parameters.
RESULTS Subjects with pancreatic hyperechogenicity had decreased serum adiponectin concentration compared to control subjects [8.9 (6.5, 12.8) vs 11.1 (7.8, 15.9), P < 0.001] and more frequently exhibited features of metabolic syndrome. Logistic regression analysis showed that the following variables were significantly and independently associated with pancreatic hyperechogenicity: Presence of hypoadiponectinemia, increased body mass index (BMI), higher homeostasis model assessment of insulin resistance (HOMA-IR) score, and presence of fatty liver. Similar associations were also observed in subjects with pancreatic hyperechogenicity without fatty liver. Multivariate association analysis of data from participants without fatty liver showed that hypoadiponectinemia was significantly associated with pancreatic hyperechogenicity (OR = 0.93, 95%CI: 0.90 - 0.97, P < 0.001). This association was independent of other confounding variables. Additionally, an increased BMI and higher HOMA-IR score were significantly associated with pancreatic hyperechogenicity.
CONCLUSION Pancreatic hyperechogenicity is independently associated with increased BMI, insulin resistance, and hypoadiponectinemia in the general population.
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Association of the Aspartate Aminotransferase to Alanine Aminotransferase Ratio with BNP Level and Cardiovascular Mortality in the General Population: The Yamagata Study 10-Year Follow-Up. DISEASE MARKERS 2016; 2016:4857917. [PMID: 27872510 PMCID: PMC5107869 DOI: 10.1155/2016/4857917] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/10/2016] [Revised: 09/24/2016] [Accepted: 10/09/2016] [Indexed: 01/08/2023]
Abstract
Background. Early identification of high risk subjects for cardiovascular disease in health check-up is still unmet medical need. Cardiovascular disease is characterized by the superior increase in aspartate aminotransferase (AST) to alanine aminotransferase (ALT). However, the association of AST/ALT ratio with brain natriuretic peptide (BNP) levels and cardiovascular mortality remains unclear in the general population. Methods and Results. This longitudinal cohort study included 3,494 Japanese subjects who participated in a community-based health check-up, with a 10-year follow-up. The AST/ALT ratio increased with increasing BNP levels. And multivariate logistic analysis showed that the AST/ALT ratio was significantly associated with a high BNP (≥100 pg/mL). There were 250 all-cause deaths including 79 cardiovascular deaths. Multivariate Cox proportional hazard regression analysis revealed that a high AST/ALT ratio (>90 percentile) was an independent predictor of all-cause and cardiovascular mortality after adjustment for confounding factors. Kaplan-Meier analysis demonstrated that cardiovascular mortality was higher in subjects with a high AST/ALT ratio than in those without. Conclusions. The AST/ALT ratio was associated with an increase in BNP and was predictive of cardiovascular mortality in a general population. Measuring the AST/ALT ratio during routine health check-ups may be a simple and cost-effective marker for cardiovascular mortality.
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Sato H, Konta T, Ichikawa K, Suzuki N, Kabasawa A, Suzuki K, Hirayama A, Shibata Y, Watanabe T, Kato T, Ueno Y, Kayama T, Kubota I. Comparison of the predictive ability of albuminuria and dipstick proteinuria for mortality in the Japanese population: the Yamagata (Takahata) study. Clin Exp Nephrol 2016; 20:611-617. [PMID: 26542055 PMCID: PMC4956708 DOI: 10.1007/s10157-015-1193-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2015] [Accepted: 10/26/2015] [Indexed: 11/28/2022]
Abstract
BACKGROUND Albuminuria and proteinuria are known risk factors for premature death. This study compared the ability of albuminuria and proteinuria to predict mortality in a community-based population. METHODS We evaluated the urinary albumin creatinine ratio (ACR) and proteinuria by dipstick at a baseline survey and examined the association between the 7-year mortality and three categories (albuminuria [ACR ≥ 30 mg/g], trace proteinuria, and ≥[1+] proteinuria) in 3446 Japanese subjects at a local health check. RESULTS Albuminuria, ≥trace proteinuria, and ≥(1+) proteinuria were identified in 514 (14.9 %), 290 (8.4 %), and 151 (4.4 %) subjects, respectively. There were 138 deaths during the follow-up period, including 41 cardiovascular deaths. A Kaplan-Meier analysis showed that all-cause mortality significantly increased along with the increase in ACR and proteinuria levels (log-rank P < 0.01). The mortality rate (deaths per 1000 person-year) was higher in subjects with albuminuria (12.8), ≥trace proteinuria (12.6), and ≥(1+) proteinuria (16.2) than in all subjects (6.9). A Cox proportional hazard model analysis showed that all three categories were significant predictors of all-cause mortality in the unadjusted model, although after adjustment for possible confounders, a significant association was observed only with albuminuria. Albuminuria, but not proteinuria, was a significant predictor of cardiovascular mortality in both the unadjusted and adjusted models. CONCLUSION Albuminuria had a high prevalence and was strongly associated with mortality, as compared with proteinuria by dipstick, suggesting that albuminuria might be a superior predictor of poor prognosis in the Japanese population.
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Affiliation(s)
- Hiroko Sato
- Department of Cardiology, Pulmonology, and Nephrology, Yamagata University School of Medicine, 2-2-2, Iida-Nishi, Yamagata, 990-9585, Japan
| | - Tsuneo Konta
- Department of Cardiology, Pulmonology, and Nephrology, Yamagata University School of Medicine, 2-2-2, Iida-Nishi, Yamagata, 990-9585, Japan.
| | - Kazunobu Ichikawa
- Department of Cardiology, Pulmonology, and Nephrology, Yamagata University School of Medicine, 2-2-2, Iida-Nishi, Yamagata, 990-9585, Japan
| | - Natsuko Suzuki
- Department of Cardiology, Pulmonology, and Nephrology, Yamagata University School of Medicine, 2-2-2, Iida-Nishi, Yamagata, 990-9585, Japan
| | - Asami Kabasawa
- Department of Cardiology, Pulmonology, and Nephrology, Yamagata University School of Medicine, 2-2-2, Iida-Nishi, Yamagata, 990-9585, Japan
| | - Kazuko Suzuki
- Department of Cardiology, Pulmonology, and Nephrology, Yamagata University School of Medicine, 2-2-2, Iida-Nishi, Yamagata, 990-9585, Japan
| | - Atsushi Hirayama
- Department of Cardiology, Pulmonology, and Nephrology, Yamagata University School of Medicine, 2-2-2, Iida-Nishi, Yamagata, 990-9585, Japan
| | - Yoko Shibata
- Department of Cardiology, Pulmonology, and Nephrology, Yamagata University School of Medicine, 2-2-2, Iida-Nishi, Yamagata, 990-9585, Japan
| | - Tetsu Watanabe
- Department of Cardiology, Pulmonology, and Nephrology, Yamagata University School of Medicine, 2-2-2, Iida-Nishi, Yamagata, 990-9585, Japan
| | - Takeo Kato
- Global COE, Yamagata University School of Medicine, Yamagata, Japan
| | - Yoshiyuki Ueno
- Global COE, Yamagata University School of Medicine, Yamagata, Japan
| | - Takamasa Kayama
- Global COE, Yamagata University School of Medicine, Yamagata, Japan
| | - Isao Kubota
- Department of Cardiology, Pulmonology, and Nephrology, Yamagata University School of Medicine, 2-2-2, Iida-Nishi, Yamagata, 990-9585, Japan
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Anyabolu EN, Chukwuonye II, Anyabolu AE, Enwere O. A look at risk factors of proteinuria in subjects without impaired renal filtration function in a general population in Owerri, Nigeria. Pan Afr Med J 2016; 23:257. [PMID: 27516822 PMCID: PMC4963176 DOI: 10.11604/pamj.2016.23.257.8189] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2015] [Accepted: 03/14/2016] [Indexed: 12/31/2022] Open
Abstract
Introduction Proteinuria is a common marker of kidney damage. This study aimed at determining predictors of proteinuria in subjects without impaired renal filtration function in Owerri, Nigeria. Methods This was a cross-sectional study involving 136 subjects, consecutively drawn from Federal Medical Centre (FMC), Owerri, Nigeria. Relevant investigations were performed, including 24-hour urine protein (24HUP). Correlation and multivariate linear regression analysis were used to determine the association and strength of variables to predict proteinuria. Proteinuria was defined as 24HUP ≥0.300g and impaired renal filtration function as creatinine clearance (ClCr) <90mls/min. P<0.05 was taken as statistically significant. Results Mean age of subjects was 38.58 ±11.79 years. Female/male ratio was 3:1. High 24-hour urine volume (24HUV) (p<0.001), high spot urine protein/creatinine ratio (SUPCR) (p<0.001), high 24-hour urine protein/creatinine ratio (24HUPCR) (p<0.001), high 24-hour urine protein/osmolality ratio (24HUPOR) (p<0.001), low 24-hour urine creatinine/osmolality ratio (24HUCOR) (p<0.001), and low spot urine protein/osmolality ratio (SUPOR) (p<0.001), predicted proteinuria in this study. Conclusion The risk factors of proteinuria in subjects without impaired renal filtration function in Owerri, Nigeria, included 24HUV, SUPCR, 24HUPCR, 24HUPOR, 24HUCOR and SUPOR. Further research should explore the relationship between urine creatinine and urine osmolality, and how this relationship may affect progression of kidney damage, with or without impaired renal filtration function.
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Affiliation(s)
- Ernest Ndukaife Anyabolu
- Division of Nephrology, Department of Medicine, lmo State University Teaching Hospital, Orlu, Nigeria
| | | | - Arthur Ebelenna Anyabolu
- Division of Respirology, Department of Medicine, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Nigeria
| | - Okezie Enwere
- Division of Nephrology, Department of Medicine, lmo State University Teaching Hospital, Orlu, Nigeria
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Khoundabi B, Kazemnejad A, Mansourian M, Faghihimani E. Factors Associated With Serum Albumin in Diabetes Mellitus Type 2 With Microalbuminuria Using Non-Normal Mixed Models: A Prospective Cohort Study. IRANIAN RED CRESCENT MEDICAL JOURNAL 2016; 18:e20671. [PMID: 26889385 PMCID: PMC4752729 DOI: 10.5812/ircmj.20671] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/26/2014] [Revised: 07/06/2014] [Accepted: 08/05/2014] [Indexed: 01/08/2023]
Abstract
Background: The globally increasing epidemic of diabetes will lead to serious problems including diabetic nephropathy and kidney diseases in near future. The first clinical diagnosable stage in a diabetic kidney disease is microalbuminuria (urinary albumin excretion of 30 - 300 g/24 hours). Objectives: This prospective cohort study investigated the risk factors of microalbuminuria in patients with type 2 diabetes who had been registered in endocrine and metabolism research center in Isfahan city, Iran. Patients and Methods: This prospective cohort study was performed on 90 diabetic type 2 patients with microalbuminuria, who were selected according to the consecutive sample selection method during 6 years. Data were collected through regular and systematic measurements of serum albumin as the response variable and body mass index, systolic and diastolic blood pressure, the duration of diabetes, glycosylated hemoglobin (HbA1c), total cholesterol, triglyceride (TG), fasting blood sugar (FBS), low-density lipoprotein (LDL), and high-density lipoprotein (HDL) as the related factors. Non-normal mixed models were used to investigate the impact of effective factors on the amount of excreted serum albumin. Results: According to the deviance information criterion (DIC = 56.2), the non-normal mixed effects model with the skewed t distribution had a best fit and indicated that HbA1c, HDL and total cholesterol had a significant effect on the amount of albumin in urine (P < 0.05). Conclusions: Using nonnormal mixed models may lead to the best results as compared to common normality assumption.
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Affiliation(s)
- Batoul Khoundabi
- Department of Biostatistics, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, IR Iran
| | - Anoshirvan Kazemnejad
- Department of Biostatistics, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, IR Iran
- Corresponding Author: Anoshirvan Kazemnejad, Department of Biostatistics, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, IR Iran. Tel: +98-2182883875, Fax: +98-2182884524, E-mail:
| | - Marjan Mansourian
- Department of Epidemiology and Biostatistics, School of Public Health, Isfahan University of Medical Sciences, Isfahan, IR Iran
| | - Elham Faghihimani
- Department of Internal Medicine, Isfahan Endocrine and Metabolism Research Center, Isfahan University of Medical Sciences, Isfahan, IR Iran
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Nakamura S, Narimatsu H, Sato H, Sho R, Otani K, Kawasaki R, Karasawa S, Daimon M, Yamashita H, Kubota I, Ueno Y, Kato T, Yoshioka T, Fukao A, Kayama T. Gene–environment interactions in obesity: implication for future applications in preventive medicine. J Hum Genet 2015; 61:317-22. [DOI: 10.1038/jhg.2015.148] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2015] [Revised: 10/24/2015] [Accepted: 11/05/2015] [Indexed: 01/10/2023]
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Nakamura S, Narimatsu H, (Ito) Sasahara Y, Sho R, Kawasaki R, Yamashita H, Kubota I, Ueno Y, Kato T, Yoshioka T, Fukao A, Kayama T. Health management in cancer survivors: Findings from a population-based prospective cohort study-the Yamagata Study (Takahata). Cancer Sci 2015; 106:1607-15. [PMID: 26471007 PMCID: PMC4714694 DOI: 10.1111/cas.12811] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2015] [Revised: 08/31/2015] [Accepted: 09/01/2015] [Indexed: 12/14/2022] Open
Abstract
The number of cancer survivors is increasing; however, optimal health management of cancer survivors remains unclear due to limited knowledge. To elucidate the risk of non-communicable diseases, and the effect of lifestyle habits on risk of non-communicable diseases, we compared cancer survivors and those who never had cancer (non-cancer controls) using a population-based prospective cohort study. The baseline survey of 2292 participants was carried out from 2004 to 2006, and the follow-up survey of 2124 participants was carried out in 2011. We compared the baseline characteristics and the risk of non-communicable diseases between cancer survivors and non-cancer controls. Analyzed participants included 124 cancer survivors (men/women, 57/67), and 2168 non-cancer controls (939/1229). Several lifestyle factors and nutritional intake significantly differed between survivors and non-cancer controls, although smoking status did not differ between the groups (P = 0.30). Univariate logistic regression analysis showed increased risk of death (odds ratio [OR], 3.64; 95% confidence interval [CI], 2.19-6.05) and heart disease (OR, 2.60; 95% CI, 1.06-6.39) in cancer survivors. Increased risk of heart disease was also significant (OR, 2.95; 95% CI, 1.05-8.26; P = 0.04) in the multivariate analysis of the smoking-related cancer subgroup. Current smoking significantly increased risk of death (OR, 2.42; 95% CI, 1.13-5.18). Specific management should be implemented for cancer survivors. More intense management against smoking is necessary, as continued smoking in cancer survivors may increase the risk of second primary cancer. Moreover, cancer survivors are at a high risk of heart disease; thus, additional care should be taken.
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Affiliation(s)
- Sho Nakamura
- Department of Clinical OncologyFaculty of MedicineYamagata UniversityYamagataJapan
| | - Hiroto Narimatsu
- Department of Public HealthYamagata University Graduate School of MedicineYamagataJapan
- Cancer Prevention and Control DivisionKanagawa Cancer Center Research InstituteYokohamaJapan
| | - Yuriko (Ito) Sasahara
- Department of Clinical OncologyFaculty of MedicineYamagata UniversityYamagataJapan
- Department of Medical OncologyYamagata Prefectural Central HospitalYamagataJapan
| | - Ri Sho
- Department of Public HealthYamagata University Graduate School of MedicineYamagataJapan
| | - Ryo Kawasaki
- Department of Public HealthYamagata University Graduate School of MedicineYamagataJapan
| | - Hidetoshi Yamashita
- Department of Ophthalmology and Visual SciencesFaculty of MedicineYamagata UniversityYamagataJapan
| | - Isao Kubota
- Department of First Department of Internal MedicineFaculty of MedicineYamagata UniversityYamagataJapan
| | - Yoshiyuki Ueno
- Department of Second Department of Internal MedicineFaculty of MedicineYamagata UniversityYamagataJapan
| | - Takeo Kato
- Department of Third Department of Internal MedicineFaculty of MedicineYamagata UniversityYamagataJapan
| | - Takashi Yoshioka
- Department of Clinical OncologyFaculty of MedicineYamagata UniversityYamagataJapan
| | - Akira Fukao
- Department of Public HealthYamagata University Graduate School of MedicineYamagataJapan
| | - Takamasa Kayama
- Department of Advanced Cancer ScienceFaculty of MedicineYamagata UniversityYamagataJapan
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Rim JH, Lee YH, Cha BS, Lee SG, Kim JH. Central obesity is an independent risk factor for microalbuminuria in both the general Korean women and nondiabetic nonhypertensive subpopulation: Association of microalbuminuria and metabolic syndrome from the Korea National Health and Nutrition Examination Survey 2011-2012. Clin Chim Acta 2015; 448:74-9. [PMID: 26100568 DOI: 10.1016/j.cca.2015.06.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2015] [Revised: 06/10/2015] [Accepted: 06/11/2015] [Indexed: 11/30/2022]
Abstract
BACKGROUND We investigated the major contributing component of metabolic syndrome (MetS) that results in microalbuminuria (MAU) in the general population as well as in nondiabetic nonhypertensive subjects. METHODS The study population consisted of a total of 9961 subjects (4429 men and 5532 women) who participated in the Korea National Health and Nutrition Examination Surveys conducted in 2011 and 2012. MAU was defined as a urine albumin-to-creatinine ratio of >3.39mg/mmol. After analyzing the contribution of each five MetS components for the presence of MAU with adjustment for other risk factors in the total population, we further examined the contribution of these components to MAU in the nondiabetic nonhypertensive subpopulation. RESULTS The most significantly associated factors for MAU in both genders were high blood pressure, followed by impaired fasting glucose, and high triglycerides. In addition, central obesity contributed significantly to MAU only in women. For the nondiabetic nonhypertensive subpopulation, high blood pressure in both genders and central obesity in women were important risk factors for MAU. We suggest two possible hypotheses for the gender different phenomenon. CONCLUSIONS Central obesity was an independent risk factor for MAU in the general Korean women as well as in the nondiabetic nonhypertensive women.
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Affiliation(s)
- John Hoon Rim
- Department of Laboratory Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea; Department of Medicine, Yonsei University Graduate School of Medicine, Seoul, Republic of Korea
| | - Yong-Ho Lee
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Bong-Soo Cha
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Sang-Guk Lee
- Department of Laboratory Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea.
| | - Jeong-Ho Kim
- Department of Laboratory Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
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Narimatsu H, Nakata Y, Nakamura S, Sato H, Sho R, Otani K, Kawasaki R, Kubota I, Ueno Y, Kato T, Yamashita H, Fukao A, Kayama T. Applying data envelopment analysis to preventive medicine: a novel method for constructing a personalized risk model of obesity. PLoS One 2015; 10:e0126443. [PMID: 25973987 PMCID: PMC4431757 DOI: 10.1371/journal.pone.0126443] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2014] [Accepted: 04/02/2015] [Indexed: 11/19/2022] Open
Abstract
Data envelopment analysis (DEA) is a method of operations research that has not yet been applied in the field of obesity research. However, DEA might be used to evaluate individuals’ susceptibility to obesity, which could help establish effective risk models for the onset of obesity. Therefore, we conducted this study to evaluate the feasibility of applying DEA to predict obesity, by calculating efficiency scores and evaluating the usefulness of risk models. In this study, we evaluated data from the Takahata study, which was a population-based cohort study (with a follow-up study) of Japanese people who are >40 years old. For our analysis, we used the input-oriented Charnes-Cooper-Rhodes model of DEA, and defined the decision-making units (DMUs) as individual subjects. The inputs were defined as (1) exercise (measured as calories expended) and (2) the inverse of food intake (measured as calories ingested). The output was defined as the inverse of body mass index (BMI). Using the β coefficients for the participants’ single nucleotide polymorphisms, we then calculated their genetic predisposition score (GPS). Both efficiency scores and GPS were available for 1,620 participants from the baseline survey, and for 708 participants from the follow-up survey. To compare the strengths of the associations, we used models of multiple linear regressions. To evaluate the effects of genetic factors and efficiency score on body mass index (BMI), we used multiple linear regression analysis, with BMI as the dependent variable, GPS and efficiency scores as the explanatory variables, and several demographic controls, including age and sex. Our results indicated that all factors were statistically significant (p < 0.05), with an adjusted R2 value of 0.66. Therefore, it is possible to use DEA to predict environmentally driven obesity, and thus to establish a well-fitted model for risk of obesity.
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Affiliation(s)
- Hiroto Narimatsu
- Department of Public Health, Yamagata University Graduate School of Medicine, Yamagata, Japan
- * E-mail:
| | - Yoshinori Nakata
- Department of Healthcare Management, Teikyo University Graduate School of Public Health, Tokyo, Japan
| | - Sho Nakamura
- Department of Clinical Oncology, Yamagata University Faculty of Medicine, Yamagata, Japan
| | - Hidenori Sato
- Genome Informatics Unit, Institute for Promotion of Medical Science Research, Yamagata University Faculty of Medicine, Yamagata, Japan
| | - Ri Sho
- Department of Public Health, Yamagata University Graduate School of Medicine, Yamagata, Japan
| | - Katsumi Otani
- Department of Public Health, Yamagata University Graduate School of Medicine, Yamagata, Japan
| | - Ryo Kawasaki
- Department of Public Health, Yamagata University Graduate School of Medicine, Yamagata, Japan
| | - Isao Kubota
- First Department of Internal Medicine, Yamagata University Faculty of Medicine, Yamagata, Japan
| | - Yoshiyuki Ueno
- Second Department of Internal Medicine, Yamagata University Faculty of Medicine, Yamagata, Japan
| | - Takeo Kato
- Third Department of Internal Medicine, Yamagata University Faculty of Medicine, Yamagata, Japan
| | - Hidetoshi Yamashita
- Department of Ophthalmology and Visual Sciences, Yamagata University Faculty of Medicine, Yamagata, Japan
| | - Akira Fukao
- Department of Public Health, Yamagata University Graduate School of Medicine, Yamagata, Japan
| | - Takamasa Kayama
- Department of Neurosurgery, Yamagata University Faculty of Medicine, Yamagata, Japan
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Park SY, Park YK, Cho KH, Choi HJ, Han JH, Han KD, Han BD, Yoon YJ, Kim YH. Normal range albuminuria and metabolic syndrome in South Korea: the 2011-2012 Korean National Health and Nutrition Examination Survey. PLoS One 2015; 10:e0125615. [PMID: 25978637 PMCID: PMC4433278 DOI: 10.1371/journal.pone.0125615] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2015] [Accepted: 03/24/2015] [Indexed: 01/21/2023] Open
Abstract
Background It is well-known that there is a close relationship between metabolic syndrome (MetS) and microalbuminuria. However, some recent studies have found that even normal range albuminuria was associated with MetS and cardiometabolic risk factors. The purpose of this study is to analyze the relationship between MetS and normal range albuminuria and to calculate the cutoff value for albuminuria that correlates with MetS in the representative fraction of Korean population. Methods Data were obtained from the 2011–2012 Korea National Health and Nutrition Examination Survey and included 9,650 subjects aged ≥19 years. We measured metabolic parameters: fasting blood glucose, waist circumference, blood pressure, and lipids, and albumin-to-creatinine ratio (ACR). The optimal ACR cutoff points for MetS were examined by the receiver operating characteristic curve. Multivariate logistic regression was used to obtain the prevalence of MetS and its components according to the ACR levels. Results The first cutoff value of ACR were 4.8 mg/g for subjects with ≥3 components of MetS. There was a graded association between ACR and prevalence of MetS and its components. If ACR was <4 mg/g, there was no significant increase in the prevalence of MetS or its components. From the ACR level of 4–5 mg/g, the prevalence of MetS significantly increased after adjusting for age, sex, body mass index, smoking, alcohol intake, exercise, and medications for diabetes mellitus and hypertension (odds ratio; 95% confidence intervals = 1.416; 1.041–1.926). Conclusions Albuminuria within the normal range (around 5 mg/g) was associated with prevalence of MetS in the Korean population.
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Affiliation(s)
- Si-Young Park
- Department of Family Medicine, Eulji University College of Medicine, Daejeon, South Korea
| | - Yong-Kyu Park
- Department of Medical Statistics, Catholic University College of Medicine, Seoul, South Korea
| | - Kyung-Hwan Cho
- Department of Family Medicine, Korea University College of Medicine, Seoul, South Korea
| | - Hee-Jeong Choi
- Department of Family Medicine, Eulji University College of Medicine, Daejeon, South Korea
| | - Jee-Hye Han
- Department of Family Medicine, Eulji University College of Medicine, Daejeon, South Korea
| | - Kyung-Do Han
- Department of Medical Statistics, Catholic University College of Medicine, Seoul, South Korea
| | - Byung-Duck Han
- Department of Family Medicine, Korea University College of Medicine, Seoul, South Korea
| | - Yeo-Joon Yoon
- Department of Family Medicine, Korea University College of Medicine, Seoul, South Korea
| | - Yang-Hyun Kim
- Department of Family Medicine, Korea University College of Medicine, Seoul, South Korea
- * E-mail:
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Kawabata N, Kawamura T, Utsunomiya K, Kusano E. High salt intake is associated with renal involvement in Japanese patients with type 2 diabetes mellitus. Intern Med 2015; 54:311-7. [PMID: 25748740 DOI: 10.2169/internalmedicine.54.2464] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVE The aim of our study was to investigate clinical and nutritional factors associated with renal involvement in patients with type 2 diabetes. PATIENTS We performed a cross-sectional study of 71 patients with type 2 diabetes who were being educated at our hospital from September 2006 to February 2008. The patients were divided into two groups; Group I consisted of 40 patients with both an estimated glomerular filtration rate (eGFR) of ≥ 60 mL/min/1.73 m(2) and normoalbuminuria, and Group II consisted of 31 patients with either microalbuminuria/overt proteinuria or an eGFR of <60 mL/min/1.73 m(2). We compared the age, body mass index (BMI), blood pressure, duration from onset of diabetes, use of hypoglycemic agents and insulin, biochemistry data, including HbA1c, pulse wave velocity corrected by blood pressure (PWVc) and the daily intake of several nutrients between the two groups. A multivariate logistic regression analysis was performed to identify factors independently associated with renal involvement. RESULTS Group II had significantly higher values for BMI, the duration of diabetes, triglycerides, uric acid and PWVc than Group I. Group II tended to have a high salt intake compared to Group I. The multivariate logistic analysis revealed that the daily salt intake, PWVc and uric acid were independent factors associated with renal involvement (odds ratio, 1.15, 1.84 and 2.00; 95% confidence interval, 1.02-1.31, 1.04-3.27 and 1.04-3.85, respectively). CONCLUSION Our data suggest that a high salt intake, in addition to arteriosclerosis, is associated with renal involvement in our cohort with type 2 diabetes.
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Affiliation(s)
- Nao Kawabata
- Department of Clinical Nutrition, Jichi Medical University Hospital, Japan
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Han SY, Hong JW, Noh JH, Kim DJ. Association of the estimated 24-h urinary sodium excretion with albuminuria in adult koreans: the 2011 Korea National Health and Nutrition Examination Survey. PLoS One 2014; 9:e109073. [PMID: 25313865 PMCID: PMC4196757 DOI: 10.1371/journal.pone.0109073] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2014] [Accepted: 09/08/2014] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Sodium intake and albuminuria have important roles in blood pressure and renal progression. Although their relationship has been reported, the results have not been consistent and all studies have examined small populations. OBJECTIVE This study investigated the role of the estimated 24-h urinary sodium excretion as a marker of sodium intake and albuminuria. DESIGN This investigation included 5,187 individuals age 19 years and older from a cross-sectional, nationally representative, stratified survey: The Korea National Health and Nutrition Examination Survey (KNHANES V-2), in 2011. Albuminuria was defined as a urinary albumin/creatinine ratio ≥30 mg/g. The 24-h urinary sodium excretion was estimated from a spot urine. RESULTS On classifying our participants into quartiles based on the estimated 24-h urinary sodium excretion, the prevalence of albuminuria increased with the 24-h urinary sodium excretion (5.3, 5.7, 7.5, and 11.8% in the first through fourth quartiles, respectively, p for trend <0.001). Even after adjusting for age, sex, diabetes, obesity, and hypertension, the significance persisted. In a multiple logistic regression analysis, the second and third quartiles of the estimated 24-h urinary sodium excretion were not associated with the presence of albuminuria with the first quartile as a control. However, the fourth quartile was significantly associated with the presence of albuminuria (odds ratio 1.61 [95% confidence interval 1.71-2.21], p = 0.003) after adjusting for age, sex, diabetes, obesity, and hypertension. CONCLUSIONS These findings suggest that salt intake is associated with the presence of albuminuria in the general Korean adult population.
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Affiliation(s)
- Sang Youb Han
- Department of Internal Medicine, Ilsan-Paik Hospital, College of Medicine, Inje University, Goyang, Republic of Korea
| | - Jae Won Hong
- Department of Internal Medicine, Ilsan-Paik Hospital, College of Medicine, Inje University, Goyang, Republic of Korea
| | - Jung Hyun Noh
- Department of Internal Medicine, Ilsan-Paik Hospital, College of Medicine, Inje University, Goyang, Republic of Korea
| | - Dong-Jun Kim
- Department of Internal Medicine, Ilsan-Paik Hospital, College of Medicine, Inje University, Goyang, Republic of Korea
- * E-mail:
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Nagasawa Y, Hasuike Y, Nanami M, Kuragano T, Nakanishi T. Albuminuria and hypertension: the chicken or the egg? Hypertens Res 2014; 38:8-10. [PMID: 25185833 DOI: 10.1038/hr.2014.135] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Yasuyuki Nagasawa
- Division of Kidney and Dialysis, Department of Internal Medicine, Hyogo College of Medicine, Mukogawa-Cho, Nishinomiya, Japan
| | - Yukiko Hasuike
- Division of Kidney and Dialysis, Department of Internal Medicine, Hyogo College of Medicine, Mukogawa-Cho, Nishinomiya, Japan
| | - Masayoshi Nanami
- Division of Kidney and Dialysis, Department of Internal Medicine, Hyogo College of Medicine, Mukogawa-Cho, Nishinomiya, Japan
| | - Takahiro Kuragano
- Division of Kidney and Dialysis, Department of Internal Medicine, Hyogo College of Medicine, Mukogawa-Cho, Nishinomiya, Japan
| | - Takeshi Nakanishi
- Division of Kidney and Dialysis, Department of Internal Medicine, Hyogo College of Medicine, Mukogawa-Cho, Nishinomiya, Japan
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Schernthaner G, Mogensen CE, Schernthaner GH. The effects of GLP-1 analogues, DPP-4 inhibitors and SGLT2 inhibitors on the renal system. Diab Vasc Dis Res 2014; 11:306-23. [PMID: 25116004 PMCID: PMC4230539 DOI: 10.1177/1479164114542802] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Diabetic nephropathy (DN) affects an estimated 20%-40% of patients with type 2 diabetes mellitus (T2DM). Key modifiable risk factors for DN are albuminuria, anaemia, dyslipidaemia, hyperglycaemia and hypertension, together with lifestyle factors, such as smoking and obesity. Early detection and treatment of these risk factors can prevent DN or slow its progression, and may even induce remission in some patients. DN is generally preceded by albuminuria, which frequently remains elevated despite treatment in patients with T2DM. Optimal treatment and prevention of DN may require an early, intensive, multifactorial approach, tailored to simultaneously target all modifiable risk factors. Regular monitoring of renal function, including urinary albumin excretion, creatinine clearance and glomerular filtration rate, is critical for following any disease progression and making treatment adjustments. Dipeptidyl peptidase (DPP)-4 inhibitors and sodium-glucose cotransporter 2 (SGLT2) inhibitors lower blood glucose levels without additional risk of hypoglycaemia, and may also reduce albuminuria. Further investigation of the potential renal benefits of DPP-4 and SGLT2 inhibitors is underway.
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Affiliation(s)
| | - Carl Erik Mogensen
- Medical Department M (Diabetes & Endocrinology), Aarhus University Hospital, Aarhus, Denmark
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Ocular and systemic factors associated with glaucoma in chronic kidney disease patients. Int Urol Nephrol 2014; 46:2191-8. [DOI: 10.1007/s11255-014-0804-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2014] [Accepted: 07/17/2014] [Indexed: 11/25/2022]
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Slight increase in urinary albumin excretion within the normal range predicts incident hypertension in a community-based Japanese population: the Takahata study. Hypertens Res 2014; 38:56-60. [PMID: 25007767 DOI: 10.1038/hr.2014.117] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2013] [Revised: 04/30/2014] [Accepted: 05/22/2014] [Indexed: 11/08/2022]
Abstract
Recent studies have suggested that urine albumin excretion in the high normal range predicts hypertension. However, the relationship between urinary albumin excretion in spot urine and incident hypertension remains unclear in the general Japanese population. To clarify this relationship, we conducted a cohort study in a community-based population of 412 normotensive individuals without diabetes and renal insufficiency and examined the incidence of hypertension using the urinary albumin-to-creatinine ratio (UACR) at baseline. Incident hypertension was defined as new-onset systolic blood pressure ⩾ 140 mm Hg and/or diastolic blood pressure ⩾ 90 mm Hg and/or the use of anti-hypertensive drugs. During the follow-up period (median, 6.7 years), 133 subjects (32.3%) newly developed hypertension. The incidence of hypertension increased with an increase in baseline UACR (20.4% for UACR <5 mg g(-1), 34.0% for 5-9.9 mg g(-1) UACR and 40.4% for 10-29.9 mg g(-1), P=0.002). Multivariate logistic regression analysis, after adjustment for possible confounders, showed that UACR 5-9.9 mg g(-1) and 10-29.9 mg g(-1) were independent risks for incident hypertension compared with UACR <5 mg g(-1) (odds ratio (OR) 2.15, 95% confidence interval (CI) 1.16-4.10 and OR 2.67, 95% CI 1.36-5.38, respectively). Subgroup analysis revealed that subjects with increased UACR (⩾ 5 mg g(-1)) had a higher risk of incident hypertension than did those with low UACR (<5 mg g(-1)), irrespective of their backgrounds (age, sex, smoking, alcohol consumption, obesity and urinary sodium excretion). In conclusion, this study showed that a slight increase in urinary albumin excretion might predict incident hypertension in a community-based Japanese population.
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Pleiotropic effect of common variants at ABO Glycosyltranferase locus in 9q32 on plasma levels of pancreatic lipase and angiotensin converting enzyme. PLoS One 2014; 9:e55903. [PMID: 24586218 PMCID: PMC3938410 DOI: 10.1371/journal.pone.0055903] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2012] [Accepted: 01/16/2014] [Indexed: 12/20/2022] Open
Abstract
For forty-three clinical test values presumably associated to common complex human diseases, we carried out a genome-wide association study using 600K SNPs in a general Japanese population of 1,639 individuals (1,252 after quality control procedures) drawn from a regional cohort, followed by a replication study for statistically significant SNPs (p = 1.95×10−9–8.34×10−39) using an independent population of 1,671 from another cohort. In this single two-stage study, we newly found strong and robust associations of common variants at the ABO histo-blood glycosyltransferase locus in 9q32 with the plasma levels of pancreatic lipase (P-LIP), in addition to successful confirmation of the known ABO association of angiotensin converting enzyme (ACE) independent of the ACE1 gene in 17q23.2 with the ACE level. Our results are compatible with the previously reported association between the ABO gene and pancreatic cancer, and show that the effect of these common variants at the ABO locus on the P-LIP and ACE levels is largely opposing and pleiotropic.
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Murai S, Tanaka S, Dohi Y, Kimura G, Ohte N. The prevalence, characteristics, and clinical significance of abnormal albuminuria in patients with hypertension. Sci Rep 2014; 4:3884. [PMID: 24457614 PMCID: PMC3900920 DOI: 10.1038/srep03884] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2013] [Accepted: 01/09/2014] [Indexed: 11/25/2022] Open
Abstract
Kidney function and cardiovascular disease are closely connected and albuminuria is a proven marker of cardiovascular risk. The present study investigated the prevalence and characteristics of albuminuria in patients with hypertension. Outpatients with essential hypertension under medical treatment were enrolled in this study (n = 350, 70.0 ± 11.4 years old). Urine samples were collected for the measurement of albumin concentration, which are expressed as the ratio of urine albumin to creatinine concentration (mg/g Cr). Cross-sectional analyses were also performed of the relationships between urinary albumin and other variables. Urinary albumin was detected in 88.3% of patients, while only 35.4% showed abnormal albuminuria (≥30 mg/g Cr). The presence of abnormal albuminuria was independently correlated with systolic blood pressure, B-type natriuretic peptide, and C-reactive protein by multivariate analysis (P < 0.05). Furthermore, multivariate regression analysis identified systolic blood pressure, serum creatinine, B-type natriuretic peptide, and C-reactive protein as the only factors showing independent correlation with urinary albumin (P < 0.05). Thus, approximately 35% of hypertensive patients had abnormal albuminuria. Urinary albumin was closely associated with blood pressure, C-reactive protein, and B-type natriuretic peptide, indicating that the severity of albuminuria parallels that of systemic inflammation, cardiac load, and blood pressure.
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Affiliation(s)
- Shunsuke Murai
- Department of Cardio-Renal Medicine and Hypertension, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Satoru Tanaka
- Department of Cardio-Renal Medicine and Hypertension, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Yasuaki Dohi
- Department of Cardio-Renal Medicine and Hypertension, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | | | - Nobuyuki Ohte
- Department of Cardio-Renal Medicine and Hypertension, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
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Prevalence of and factors associated with albuminuria in the Korean adult population: the 2011 Korea National Health and Nutrition Examination Survey. PLoS One 2013; 8:e83273. [PMID: 24386169 PMCID: PMC3873941 DOI: 10.1371/journal.pone.0083273] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2013] [Accepted: 11/12/2013] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Microalbuminuria is associated with increased risk of renal disease and cardiovascular diseases even in non-diabetic subjects. High incidence rates of microalbuminuria have been found in a number of population-based studies. However, the prevalence and risk factors associated with microalbuminuria in the general population in Korea are unclear. OBJECTIVES The present study was performed to estimate the prevalence of microalbuminuria and investigate the associated risk factors in the general adult population using the Fifth Korea National Health and Nutrition Examination Survey (KNHANES V-2) data from 2011. METHODS A total of 5,202 participants (mean age, 45.6 years; men, 2,337; women, 2,865) were included in the analysis. Microalbuminuria was evaluated in participants of KNHANES V-2 based on the urine albumin-creatinine ratio. Estimated glomerular filtration rate was calculated using the Modification of Diet in Renal Disease study equation. RESULTS The weighted prevalence of microalbuminuria was 5.2% (95% CI, 4.4-6.1) in the general population. The prevalence of albuminuria is increased with age. After adjustment for age and sex, the presence of albuminuria was associated with increased waist circumference, systolic and diastolic blood pressure, aspartate aminotransferase, triglyceride, fasting plasma glucose, and the presence of hypertension and diabetes. In logistic regression analyses, older age, female sex, diabetes, hypertension, and serum aspartate aminotransferase were independently associated with the presence of albuminuria. CONCLUSION The prevalence of microalbuminuria was found to be 5.2%, and conventional risk factors for cardiovascular diseases are closely related to the presence of microalbuminuria in Korea. Microalbuminuria may be a useful marker to identify individuals with increased risk of cardiovascular disease.
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Hao G, Wang Z, Zhang L, Chen Z, Wang X, Guo M, Tian Y, Shao L, Zhu M. Prevalence of microalbuminuria among middle-aged population of China: a multiple center cardiovascular epidemiological study. Angiology 2013; 66:49-56. [PMID: 24301423 DOI: 10.1177/0003319713513144] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
We assessed the prevalence of microalbuminuria (MAU) and the relationships with other cardiovascular (CV) risk factors among a middle-aged Chinese population. Data from 10 313 participants were included in our cross-sectional survey. Microalbuminuria was defined as the urine albumin to creatinine ratio of 30:300 mg/g from a single-spot morning urine sample. Microalbuminuria was found to be common in males and females (15.04% vs 10.09%) aged 35 to 64 years in this Chinese general population, especially in those with obesity, hypertension, and diabetes. Multivariate analysis found that body mass index, triglyceride, high-sensitivity C-reactive protein, alcohol consumption, hypertension, and diabetes were independently associated with MAU. Microalbuminuria may be a useful indicator for risk of CV disease in general populations.
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Affiliation(s)
- Guang Hao
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Disease, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing, China
| | - ZengWu Wang
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Disease, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing, China
| | - Linfeng Zhang
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Disease, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing, China
| | - Zuo Chen
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Disease, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing, China
| | - Xin Wang
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Disease, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing, China
| | - Min Guo
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Disease, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing, China
| | - Ye Tian
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Disease, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing, China
| | - Lan Shao
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Disease, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing, China
| | - Manlu Zhu
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Disease, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing, China
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Ando K, Kawarazaki H, Miura K, Matsuura H, Watanabe Y, Yoshita K, Kawamura M, Kusaka M, Kai H, Tsuchihashi T, Kawano Y. [Scientific Statement]. Hypertens Res 2013; 36:1009-19. [DOI: 10.1038/hr.2013.102] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2013] [Accepted: 07/24/2013] [Indexed: 02/05/2023]
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Celik F, Ahdi M, Meesters EW, van de Laar A, Brandjes DPM, Gerdes VEA. The longer-term effects of Roux-en-Y gastric bypass surgery on sodium excretion. Obes Surg 2013; 23:358-64. [PMID: 22983770 DOI: 10.1007/s11695-012-0764-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Obesity is an independent risk factor for hypertension and chronic kidney disease. During the first months after bariatric surgery, an improvement of sodium excretion has been described. The aim of this work was to study the influence of bariatric surgery on sodium excretion at more than a year after the intervention. METHODS Patients who have undergone Roux-en-Y gastric bypass (RYGB) and who had collected a 24-h urine sample before surgery more than 12 months ago were asked to participate. A second 24-h urine sample was collected. Blood pressure and weight were measured. The difference in sodium excretion before and after surgery was calculated, and the relationship with blood pressure and weight loss was investigated. RESULTS We included 33 patients; the median follow-up time was 21 months (range 14-41). Sodium excretion was high before surgery (median 195 mmol/day, IQR range 167-247) and decreased by 18 % after surgery (median 160 mmol/day, IQR range 118-205, p = 0.015), while there were significant improvements in body weight (% EWL 80.9 ± 21.8), systolic blood pressure (126 to 120 mmHg, p = 0.02), and diastolic blood pressure (84 to 77 mmHg, p = 0.002), even with a reduced number of antihypertensive drugs. CONCLUSIONS After RYGB and considerable weight loss, sodium excretion remains high in the longer term. The profound improvement in blood pressure cannot be explained by reductions in sodium excretion after RYGB.
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Affiliation(s)
- Funda Celik
- Department of Internal Medicine, Slotervaart Hospital, Louwesweg 6, 1066 EC, Amsterdam, The Netherlands.
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The prevalence and characteristics of microalbuminuria in the general population: a cross-sectional study. BMC Res Notes 2013; 6:256. [PMID: 23830507 PMCID: PMC3846492 DOI: 10.1186/1756-0500-6-256] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2013] [Accepted: 07/03/2013] [Indexed: 01/09/2023] Open
Abstract
Background Microalbuminuria is a marker of cardiovascular events. This study investigated the prevalence of microalbuminuria in the general population and the factors that can affect urinary excretion of albumin. Methods Apparently healthy subjects who participated in a health checkup at our hospital were enrolled in this study (n = 7963, male 64.0%, 56.2 ± 11.8 years old) Urine samples were collected for the measurement of albumin concentrations, which were expressed as the ratio of urinary albumin to creatinine concentrations (UACR [mg/g Cr]). Individual salt intake was assessed by estimating the 24-hour urinary salt excretion of subjects. Results The mean blood pressure was 124 ± 15/76 ± 10 mmHg and 31.6%, 7.4%, and 44.1% of subjects had hypertension, diabetes mellitus, and dyslipidemia, respectively. Urinary albumin was detected in 7265 subjects (91.2%: UACR ≥ 300 mg/g Cr, 0.5%; 300 > UACR ≥ 30 mg/g Cr, 4.6%; 30 > UACR ≥ 20 mg/g Cr, 2.4%; 20 > UACR ≥ 10 mg/g Cr, 8.7%; 10 > UACR ≥ 5 mg/g Cr, 21.8%; UACR < 5 mg/g Cr, 53.2%). In subjects with detectable albuminuria, UACR was independently correlated with age, systolic blood pressure, serum creatinine, fasting plasma glucose, and salt intake after adjustment for possible factors (P < 0.0001). Conclusion The prevalence of microalbuminuria was found to be 4.6% in the general population. The urinary excretion of albumin was closely associated with blood pressure and salt intake. These data indicated the importance of salt restriction for the prevention of cardiovascular disease and end-stage renal disease.
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Prevalence of microalbuminuria and associated risk factors among adult Korean hypertensive patients in a primary care setting. Hypertens Res 2013; 36:807-23. [DOI: 10.1038/hr.2013.44] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2012] [Revised: 02/13/2013] [Accepted: 02/14/2013] [Indexed: 11/09/2022]
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Koya D, Campese VM. Statin use in patients with diabetes and kidney disease: the Japanese experience. J Atheroscler Thromb 2013; 20:407-24. [PMID: 23518468 DOI: 10.5551/jat.16261] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Diabetes is a leading cause of chronic kidney disease (CKD) and end-stage renal disease (ESRD) in developed nations, including Japan and the United States. Japan has the unenviable distinction of having one of the world's highest rates of dialysis: in 2011, there were over 300,000 dialysis patients (2,383 per million people), with diabetic patients accounting for almost half of all incident cases. Concomitance of CKD and diabetes predicts a greater risk of cardiovascular disease (CVD) than either condition in isolation. Hence, appropriate management of modifiable cardiovascular (CV) risk factors, including dyslipidemia, is paramount in this high-risk group. The United States and Japan have distinct approaches to cholesterol management, with more stringent therapeutic targets for lipid control advocated in US guidelines. However, upward trends in cholesterol levels and coronary heart disease incidence in Japan may provide justification for more intensive CV risk factor management strategies by Japanese physicians to achieve maximum benefit. Attainment of recommended lipid goals in Japan is poor, particularly in patients with diabetes and/or CKD in whom CV risk factors are often undertreated. Statin therapy has been shown to be safe and effective in reducing CV risk in patients with diabetes and/or CKD stages 1-5. Moreover, statins may impart a renoprotective effect by preventing or delaying progressive loss of kidney function. This review summarizes evidence from studies in Western and Japanese populations to highlight the CV and renal benefits of lipid-lowering agents in CKD patients, including those with diabetes.
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Affiliation(s)
- Daisuke Koya
- Division of Diabetology and Endocrinology, Kanazawa Medical University, Japan.
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Albuminuria is an independent predictor of all-cause and cardiovascular mortality in the Japanese population: the Takahata study. Clin Exp Nephrol 2013; 17:805-10. [DOI: 10.1007/s10157-013-0770-3] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2012] [Accepted: 01/07/2013] [Indexed: 11/27/2022]
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Suzuki K, Konta T, Kudo K, Sato H, Ikeda A, Ichikawa K, Ueno Y, Kato T, Kayama T, Kubota I. The association between serum uric acid and renal damage in a community-based population: the Takahata study. Clin Exp Nephrol 2012. [DOI: 10.1007/s10157-012-0743-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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Constructing a contemporary gene-environmental cohort: study design of the Yamagata Molecular Epidemiological Cohort Study. J Hum Genet 2012; 58:54-6. [PMID: 23171998 DOI: 10.1038/jhg.2012.128] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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Impact of insulin resistance on silent and ongoing myocardial damage in normal subjects: the Takahata study. EXPERIMENTAL DIABETES RESEARCH 2012; 2012:815098. [PMID: 23093954 PMCID: PMC3474255 DOI: 10.1155/2012/815098] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/09/2012] [Revised: 08/04/2012] [Accepted: 08/30/2012] [Indexed: 11/20/2022]
Abstract
Background. Insulin resistance (IR) is part of the metabolic syndrome (Mets) that develops after lifestyle changes and obesity. Although the association between Mets and myocardial injury is well known, the effect of IR on myocardial damage remains unclear. Methods and Results. We studied 2200 normal subjects who participated in a community-based health check in the town of Takahata in northern Japan. The presence of IR was assessed by homeostasis model assessment ratio, and the serum level of heart-type fatty acid binding protein (H-FABP) was measured as a maker of silent and ongoing myocardial damage. H-FABP levels were significantly higher in subjects with IR and Mets than in those without metabolic disorder regardless of gender. Multivariate logistic analysis showed that the presence of IR was independently associated with latent myocardial damage (odds ratio: 1.574, 95% confidence interval 1.1–2.3) similar to the presence of Mets. Conclusions. In a screening of healthy subjects, IR and Mets were similarly related to higher H-FABP levels, suggesting that there may be an asymptomatic population in the early stages of metabolic disorder that is exposed to myocardial damage and might be susceptible to silent heart failure.
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Enomoto D, Okura T, Nagao T, Jotoku M, Irita J, Miyoshi KI, Higaki J. Relationship between renal hemodynamics and urinary type IV collagen in patients with essential hypertension. Clin Exp Hypertens 2012; 34:612-6. [PMID: 22564177 DOI: 10.3109/10641963.2012.683911] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Urinary type IV collagen excretion (uT4C) in diabetic patients is higher than in normal subjects. In this study, we investigated the relationship between uT4C and renal hemodynamics in 42 patients with essential hypertension. The renal resistive index (RI) is calculated from blood flow velocities measured using pulsed-wave in interlobar arteries. There was a significant correlation between uT4C to creatinine ratio (uT4C/uCr) and age, hemoglobin A1c (HbA1c), and RI. A stepwise regression analysis showed that RI was independently associated with uT4C/uCr. These results indicated that uT4C may be a marker of renovascular stiffness due to glomerulosclerosis in patients with essential hypertension.
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Affiliation(s)
- Daijiro Enomoto
- Department of Integrated Medicine and Informatics, Ehime University Graduate School of Medicine, Toon City, Japan
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Yamamoto K, Komatsu Y, Yamamoto H, Izumo H, Sanoyama K, Monden M, Takeda K, Nakahara F, Yoshida K. Establishment of a method to detect microalbuminuria by measuring the total urinary protein-to-creatinine ratio in diabetic patients. TOHOKU J EXP MED 2012; 225:195-202. [PMID: 22008591 DOI: 10.1620/tjem.225.195] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Diabetes and chronic kidney disease (CKD) which are risk facters of cardiovascular disease, are increasing global public health problems. Microalbuminuria is an early sign of progressive cardiovascular and renal disease in individuals with or without diabetes. Screening for microalbuminuria and early treatment are recommended for patients with increased cardiovascular and renal risk factors. However, the procedure used to measure urinary albumin is expensive. Alternatively, the measurement of total urinary protein is simple and inexpensive. Thus, we aimed to establish a method that could predict the presence of microalbuminuria by measuring the total protein-to-creatinine ratio. Spot urine samples were obtained from 150 patients with diabetes mellitus, and the total protein-to-creatinine ratio and the albumin-to-creatinine ratio (ACR) were measured. There was a significant positive correlation between the protein-to-creatinine ratio and the ACR (r = 0.95). The presence of albuminuria (both micro- and macroalbuminuria) could be predicted from the value of the protein-to-creatinine ratio in more than 90% of patients. A receiver-operating characteristic curve analysis revealed that the protein-to-creatinine ratio had a sensitivity and a specificity of 90.8% and 91.9%, respectively, for the detection of albuminuria and a cutoff value of 0.091 g/g creatinine. These results suggest that screening for microalbuminuria can be replaced by the detection of the protein-to-creatinine ratio, which may be cost-effective for patients with cardiovascular risks as well as for the general population.
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Affiliation(s)
- Kyoko Yamamoto
- Department of Laboratory Medicine and Clinical Science, Tohoku University Graduate School of Medicine, Sendai, Japan
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Relationship between dietary intake and microalbuminuria: findings from the Takahata study. Clin Exp Nephrol 2011; 16:147-55. [PMID: 21964760 DOI: 10.1007/s10157-011-0539-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2011] [Accepted: 09/01/2011] [Indexed: 12/31/2022]
Abstract
BACKGROUND Although several studies have investigated the relationship between dietary nutrient intake and microalbuminuria, no study of an Asian population has been reported. The present study investigates the relationship between dietary intake and microalbuminuria in a general Japanese population. METHODS We analyzed 675 men and 924 women who did not have diabetes. Participants who had a urinary albumin-to-creatinine ratio (UACR) ≥300 mg/g, who did not complete a questionnaire regarding food frequency and who did not provide complete urine measurements were excluded. Nutrient intake was assessed by validated food frequency questionnaire. Microalbuminuria was defined as UACR ≥30 mg/g. The relationship between dietary nutrient intake and microalbuminuria was examined using a multiple logistic regression model adjusted for age, total energy intake, body mass index, smoking status, systolic blood pressure and use of antihypertensive medication. RESULTS No significant association was observed among the men. The multiple adjusted odds ratios (95% confidence interval) of having microalbuminuria per 1 standard deviation increase in total protein (%kcal), animal protein (%kcal), animal protein (g/day), animal fat, niacin, carbohydrate and β-cryptoxanthin among the women were 1.33 (1.07-1.66), 1.35 (1.09-1.66), 1.42 (1.08-1.88), 1.29 (1.05-1.59), 1.28 (1.04-1.57), 0.73 (0.58-0.92) and 0.76 (0.59-0.996), respectively. The multiple adjusted odds ratio (95% confidence interval) of having microalbuminuria in the highest quintile of n-3 polyunsaturated fatty acids compared with the lowest was 2.16 (1.03-4.54). CONCLUSION Less animal protein and more β-cryptoxanthin in the diet might help to prevent microalbuminuria. Prospective studies including controlled trials are required to confirm this conclusion.
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