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Association between microscopic hematuria and albuminuria in patients with chronic kidney disease caused by diabetes and hypertension: the Fukuoka Kidney disease Registry Study

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Abstract

Background

The association between microscopic hematuria (MH) and albuminuria in patients with chronic kidney disease (CKD) caused by diabetes and hypertension remains unclear.

Methods

The Fukuoka Kidney disease Registry Study is a Japanese multicenter prospective cohort study of 4476 patients with non-dialysis-dependent CKD. In this cohort, we conducted a cross-sectional study in 994 patients with diabetic nephropathy and hypertensive nephrosclerosis. Patients were divided into three groups according to erythrocyte count in urine sediment [T1: < 5/high power field (HPF); T2: 5–9/HPF; T3: ≥ 10/HPF]. Macroalbuminuria was defined as urinary albumin-creatinine ratio > 300 mg/g. Associations between the degree of MH (T1–T3) and the prevalence of macroalbuminuria were analyzed using logistic regression.

Results

The prevalence of macroalbuminuria was 50.8%, 50.4%, and 67.4% in T1 (n = 725), T2 (n = 226), and T3 (n = 43), respectively. The multivariable-adjusted odds ratios for the presence of macroalbuminuria were 0.95 [95% confidence interval (CI) 0.65–1.39; P = 0.86] and 2.50 (95% CI 1.15–5.47; P = 0.022) for patients in T2 and T3, respectively, compared with patients in T1.

Conclusions

MH with erythrocytes ≥ 10/HPF was significantly associated with increased prevalence of macroalbuminuria in patients with non-dialysis-dependent CKD caused by diabetes and hypertension.

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Data availabity statement

The dataset used in this study is under the control of the Data Management Committee of Fukuoka Kidney disease Registry and cannot be shared publicly due to the data set containing patient data. However, when the researcher needs to use the data for the individual patient level meta-analysis or the validation study between another independent cohort, the data set will be available. The amended protocol will need to be approved by the Kyushu University ethical committee. Send a request to Toshiaki Nakano, MD, PhD, Kyushu University.

Abbreviations

BMI:

Body mass index

CI:

Confidence interval

CKD:

Chronic kidney disease

CVD:

Cardiovascular disease

DN:

Diabetic nephropathy

eGFR:

Estimated glomerular filtration rate

GBM:

Glomerular basement membrane

HPF:

High power field

HTN:

Hypertensive nephrosclerosis

IDI:

Integrated discrimination improvement

LDL:

Low-density lipoprotein

MAP:

Mean arterial pressure

MH:

Microscopic hematuria

NRI:

Net reclassification index

OR:

Odds ratio

RAS-i:

Renin–angiotensin system inhibitors

RBC:

Red blood cell

UACR:

Urinary albumin–creatinine ratio

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Acknowledgements

The authors thank all physicians and medical staff who participated in the FKR study. Steering Committee and Principal Collaborators of the FKR Study Group: Satoru Fujimi (Fukuoka Renal Clinic), Hideki Hirakata (Fukuoka Renal Clinic), Tadashi Hirano (Hakujyuji Hospital), Tetsuhiko Yoshida (Hamanomachi Hospital), Takashi Deguchi (Hamanomachi Hospital), Hideki Yotsueda (Harasanshin Hospital), Kiichiro Fujisaki (Iizuka Hospital), Keita Takae (Japanese Red Cross Fukuoka Hospital), Koji Mitsuiki (Japanese Red Cross Fukuoka Hospital), Akinori Nagashima (Japanese Red Cross Karatsu Hospital), Ritsuko Katafuchi (Kano Hospital), Hidetoshi Kanai (Kokura Memorial Hospital), Kenji Harada (Kokura Memorial Hospital), Tohru Mizumasa (Kyushu Central Hospital), Takanari Kitazono (Kyushu University), Toshiaki Nakano (Kyushu University), Toshiharu Ninomiya (Kyushu University), Kumiko Torisu (Kyushu University), Akihiro Tsuchimoto (Kyushu University), Shunsuke Yamada (Kyushu University), Hiroto Hiyamuta (Kyushu University), Shigeru Tanaka (Kyushu University), Dai Matsuo (Munakata Medical Association Hospital), Yusuke Kuroki (National Fukuoka-Higashi Medical Center), Hiroshi Nagae (National Fukuoka-Higashi Medical Center), Masaru Nakayama (National Kyushu Medical Center), Kazuhiko Tsuruya (Nara Medical University), Masaharu Nagata (Shin-eikai Hospital), Taihei Yanagida (Steel Memorial Yawata Hospital), and Shotaro Ohnaka (Tagawa City Hospital). We thank Richard Robins, PhD, from Edanz (https://jp.edanz.com/ac) for editing a draft of this manuscript.

Funding

The authors of this manuscript have no funding to disclose as described by Clinical and Experimental Nephrology.

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Authors and Affiliations

  1. Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi, Fukuoka, 812-8582, Japan

    Kaneyasu Nakagawa, Shigeru Tanaka, Takanari Kitazono & Toshiaki Nakano

  2. Division of Nephrology and Dialysis Center, Japanese Red Cross Fukuoka Hospital, Fukuoka, Japan

    Kaneyasu Nakagawa

  3. Department of Nephrology, Nara Medical University, Kashihara, Nara, Japan

    Kazuhiko Tsuruya

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  1. Kaneyasu Nakagawa
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  2. Shigeru Tanaka
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  3. Kazuhiko Tsuruya
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  4. Takanari Kitazono
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  5. Toshiaki Nakano
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Contributions

KN contributed to study design and data interpretation and wrote the manuscript. ST contributed to data acquisition, data management, and data interpretation and reviewed and revised the manuscript. KT, TN, and TK contributed to data management and data interpretation and reviewed and revised the manuscript. All authors provided both intellectual content of critical importance toward the work described and final approval of the version to be published.

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Correspondence to Toshiaki Nakano.

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Nakagawa, K., Tanaka, S., Tsuruya, K. et al. Association between microscopic hematuria and albuminuria in patients with chronic kidney disease caused by diabetes and hypertension: the Fukuoka Kidney disease Registry Study. Clin Exp Nephrol 27, 227–235 (2023). https://doi.org/10.1007/s10157-022-02298-7

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