Outcome of subjects with elevated serum creatinine in a community-based mass screening
- 16 Downloads
The outcome and prognosis of screened subjects with elevated levels of serum creatinine (>-176.8 μmol/L [≥2.0 mg/dL]) in a community-based mass health screening were examined in Okinawa, Japan.
From 1983 to 1992, a total of more than 1.24 million people had received at least 1 screening by the Okinawa General Health Maintenance Association. The status of 250,091 individuals for whom data on serum creatine levels was available, as of January 1, 1996, was examined by using information from the Okinawa Dialysis Study registry, which included data on the end-stage renal disease (ESRD) program, and by reviewing the medical charts.
A total of 289 screened subjects (187 men and 102 women) were investigated in this study. The total duration of observation was 1081.8 person-years. Clinical demographics and the incidence of ESRD, and the death of patients with ESRD before starting dialysis therapy (ESRD+death) were compared in 2 consecutive periods: A (1983 to 1987) and B (1988 to 1992). The incidence of ESRD and ESRD+death was 122.4 (161.5) per 1000 person-years in period A, whereas that of period B was 143.8 (170.2) per 1000 person-years. In the period 1988 to 1992, the hazards ratio for ESRD and ESRD+death was 1.50 and 1.38, respectively. The 95% confidence interval was 1.05 to 2.15 and 0.99 to 1.91, respectively, when compared to the period of 1983 to 1987.
This study shows that the risk of ESRD and ESRD+death is not decreasing, therefore the current strategy for the prevention of ESRD is not satistactory. Further study is needed to determine the underlying causes and mechanisms of the progression of renal disease.
Key wordsserum creatinine dialysis mass screening end-stage renal disease
Unable to display preview. Download preview PDF.
- 1.Hull AR, Parker TF III. Proceedings from the morbidity, mortality and prescription of dialysis symposium, Dallas, TX, September 15 to 19, 1989. Am J Kidney Dis 1990;15:375–385.Google Scholar
- 3.Kinjo K, Kimura Y, Shinzato Y, Tomori M, Komine Y, Kawazoe N, Takishita S, Fukiyama K, and the COSMO Group. An epidemiological analysis of cardiovascular diseases in Okinawa, Japan. Hypertens Res 1992; 15:111–119.Google Scholar
- 6.MacMahon S. Blood pressure and the risks of cardiovascular disease. In: Swales JD (ed) Textbook of hypertension. Cambridge. Blackwell Science, 1994:46–57.Google Scholar
- 16.Bergstrom J, Alverstrand A, Bucht H, Gutierrez A. Progression of chronic renal failure is retarded with more frequent clinical follow-ups and better blood pressure control. Clin Nephrol 1996;25:1–6.Google Scholar
- 18.Ronco PM, Flahault A. Editorials. Drug-induced end-stage renal disease. N Engl J Med 1994;331:1711–1712.Google Scholar
- 20.Health and Welfare Statistics Association: Health Services in Japan (Kokumin Eisei No Doko). Indices of Health and Welfare (Kosei No Shihyo) (in Japanese). Tokyo: Ministry of Health and Welfare, 1990;37:S79-S86.Google Scholar
- 21.Klahr S, Levey AS, Beck GJ, Caggiula AW, Hunsicker L, Kusek JW, Striker G, for the Modification of Diet in Renal Disease Study Group. The effects of dietary protein restriction and blood pressure control on the progression of chronic renal disease. N Engl J Med 1994; 330:877–884.PubMedCrossRefGoogle Scholar
- 26.Yoshida H, Mitarai T, Kawamura T, Kitajima T, Miyazaki Y, Nagasawa R, Kawaguchi Y, Kubo H, Ichikawa I, Sakai O. Role of the deletion polymorphism of the angiotensin converting enzyme gene in the progression and therapeutic responsiveness of IgA nephropathy. J Clin Invest 1995;96:2162–2169.PubMedCrossRefGoogle Scholar
- 27.Maschio G, Alberti D, Janin G, Locatelli F, Mann, JFE, Motolese M, Ponticelli C, Ritz E, Zucchelli P, and the Angiotensin-Converting-Enzyme Inhibition in Progressive Renal Insufficiency Study Group. Effect of the angiotensin-converting enzyme inhibitor benazepril on the progression of chronic renal insufficiency. N Engl J Med 1996;334:939–945.PubMedCrossRefGoogle Scholar