Higher cardiovascular mortality in men with persistent dipstick hematuria
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ORIGINAL ARTICLE
Higher cardiovascular mortality in men with persistent dipstick hematuria Kunitoshi Iseki1 · Tsuneo Konta1 · Koichi Asahi1 · Kunihiro Yamagata1 · Shouichi Fujimoto1 · Kazuhiko Tsuruya1 · Ichiei Narita1 · Masato Kasahara1 · Yugo Shibagaki1 · Toshiki Moriyama1 · Masahide Kondo1 · Tsuyoshi Watanabe1 Received: 24 June 2020 / Accepted: 7 September 2020 © Japanese Society of Nephrology 2020
Abstract Background We previously reported that dipstick hematuria (UH) was associated with higher all-cause mortality in men, but not in women. We extended the observation and examined the causes of death using repeated urinalysis in men. Methods Subjects were those who participated the Tokutei–Kenshin between 2008 to 2015 in seven districts. Using National database of death certificate, we identified those who might have died and confirmed further with the collaborations of the regional National Health Insurance agency and public health nurses. Dipstick results of 1 + and higher were defined as hematuria. Hazard ratio (HR) and 95% confidence interval (CI) were calculated using the Cox proportional hazard analysis. We adjusted for age, body mass index, eGFR, proteinuria, comorbid condition (diabetes mellitus, hypertension, and dyslipidemia), past history (stroke, heart disease, and kidney disease), and lifestyle (smoking, drinking, walking, and exercise). Results A total of 170,119 men were studied and 70,350 (41.4% of the total) were re-examined next year. The prevalence of UH (−/−), UH (−/+), UH (±), and UH (+ /+) was 77.2% (N = 54,298), 14.0% (N = 9,838), 1.4% (N = 1014) and 7.4% (N = 5,200), respectively. We identified 1,162 deaths (1.7% of the total of the re-examined). The adjusted HR (95% CI) was 1.49 (1.22–1.81) for all-cause mortality and 1.83 (1.23–2.71) for cardiovascular death compared to those with UH (−/−), respectively. However, that for cancer mortality risk was not significant: 1.23 (0.92–1.64). Conclusions In men, persistent dipstick hematuria is a significantly risk factor of all-cause mortality, in particular cardiovascular death among general screening participants. Keywords Hematuria · Cardiovascular disease · Screening · Survival
Introduction Dipstick proteinuria is playing a central role in the diagnosis of chronic kidney disease (CKD) which is quite different from dipstick hematuria [1]. Hematuria has been known as a cardinal sign of CKD and predicting the progression to end-stage renal disease (ESRD) [2–4]. Recently, several reports [5, 6] have shown that hematuria is also a risk factor Electronic supplementary material The online version of this article (https://doi.org/10.1007/s10157-020-01971-z) contains supplementary material, which is available to authorized users. * Kunitoshi Iseki [email protected] 1
Steering Committee for “Design of the comprehensive health care system for chronic kidney disease (CKD) based on the individual risk assessment by Specific Health Checkups”, Fukushima, Japan
of mortality. We also reported that asymptomatic hematuria was a signif
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