Baseline characteristics and prevalence of cardiovascular disease in newly visiting or referred chronic kidney disease patients to nephrology centers in Japan: a prospective cohort study.

BACKGROUND: About 39,000 patients were newly prescribed renal replacement therapy in Japan in 2011, resulting in a total of more than 300,000 patients being treated with dialysis. This high prevalence of treated end stage kidney disease (ESKD) patients is an emergent problem that requires immediate attention. We launched a prospective cohort study to evaluate population specific characteristics of the progression of chronic kidney disease (CKD). In this report, we describe the baseline characteristics and risk factors for cardiovascular disease (CVD) prevalence among this cohort. METHODS: New patients from 16 nephrology centers who were older than 20 years of age and who visited or were referred for the treatment of CKD stage 2-5, but were not on dialysis therapy, were recruited in this study. At enrollment, medical history, lifestyle behaviors, functional status and current medications were recorded, and blood and urine samples were collected. Estimated glomerular filtration rate (eGFR) was calculated by a modified three-variable equation. RESULTS: We enrolled 1138 patients, 69.6% of whom were male, with a mean age of 68 years. Compared with Western cohorts, patients in this study had a lower body mass index (BMI) and higher proteinuria. The prevalence of CVD was 26.8%, which was lower than that in Western cohorts but higher than that in the general Japanese population. Multivariate analysis demonstrated the following association with CVD prevalence: hypertension (adjusted odds ratio (aOR) 3.57; 95% confidence interval (CI) 1.82-7.02); diabetes (aOR 2.45; 95% CI 1.86-3.23); hemoglobin level less than 11 g/dl (aOR 1.61; 95% CI 1.21-2.15); receiving anti-hypertensive agents (aOR 3.54; 95% CI 2.27-5.53); and statin therapy (aOR 2.73; 95% CI 2.04-3.66). The combination of decreased eGFR and increased proteinuria was also associated with a higher prevalence of CVD. CONCLUSIONS: The participants in this cohort had a lower BMI, higher proteinuria and lower prevalence of CVD compared with Western cohorts. Lower eGFR and high proteinuria were associated with CVD prevalence. Prospective follow up of these study patients will contribute to establishment of individual population-based treatment of CKD.

Serum levels and urinary excretion of salusin-alpha in renal insufficiency.

Salusin-alpha was recently shown to exert anti-atherosclerotic effects and its potential role as a clinical marker for atherosclerosis has been proposed. We determined serum salusin-alpha concentrations in 99 patients across a diverse range of renal functions and urinary salusin-alpha excretions in 12 patients with non-dialyzed renal failure using a highly sensitive and specific radioimmunoassay. Serum salusin-alpha concentrations in patients with moderate to advanced renal insufficiency (eGFR < 30 ml/min/1.73 m(2)) were significantly lower than those with preserved renal function (eGFR > 60 ml/min/1.73 m(2)) (6.1 + or - 2.4 pmol/l vs. 11.8 + or - 1.1 pmol/l, p < 0.05). Since renal failure is frequently associated with atherosclerosis, we analyzed the relationship between serum salusin-alpha and eGFR after excluding patients with advanced atherosclerotic diseases. The serum salusin-alpha level was correlated with eGFR values (n = 94, p < 0.005). Patients with renal insufficiency showed reduced urinary salusin-alpha excretion, but the magnitude of the reduction was less than that for the decrease in serum salusin-alpha. Consequently, their salusin-alpha clearance often exceeded endogenous creatinine clearance levels. In conclusion, the decreased serum concentrations of salusin-alpha, an anti-atherosclerotic peptide, may be associated with impaired renal function, suggesting a potential role of decreased salusin-alpha in the acceleration of atherosclerosis in chronic kidney diseases. Urinary salusin-alpha may originate from the renal tubules, and may not necessarily represent the peptides filtered at the glomerulus.