Glucosuria and all-cause mortality among general screening participants
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Dipstick urine tests are used for general health screening in Japan, but how the test results (e.g., glucosuria) relate to mortality is unknown.
Subjects participated in a nationwide screening in 2008 in six districts in Japan. We identified those who might have died using the national database of death certificates from 2008 to 2012 (total registered ~ 6 million) and verified candidates with the regional National Health Insurance Agency and public health nurses. Diabetes mellitus (DM) was defined as HbA1c ≥ 6.5%, fasting blood glucose ≥ 126 mg/dl, or medicated for DM. Hazard ratio (HR) and 95% confidence interval (CI) were calculated by Cox proportional hazard analysis. Glucosuria was defined as dipstick ≥ 1 +.
Among 209,060 subjects, we identified 2714 fatalities (median follow-up 3.57 years). Crude mortality rates were 1.2% for those without glucosuria and 3.4% for those with glucosuria. After adjusting for sex, age, body mass index, comorbidity (DM, hypertension, and dyslipidemia), history (stroke, heart disease, and kidney disease), and lifestyle (smoking, drinking, walking, and exercise), the HR (95% CI) for dipstick glucosuria was 1.475 (1.166–1.849, P < 0.001). DM subjects with glucosuria (N = 4655) had a higher HR [1.302 (1.044–1.613, P = 0.020)] than DM subjects without glucosuria (N = 20,245), and non-DM subjects with glucosuria (N = 470) had a higher HR [2.511 (1.539–3.833, P < 0.001)] than non-DM subjects without glucosuria (N = 183,690).
Dipstick glucosuria significantly affected mortality in Japanese community-based screening participants.
KeywordsGlucosuria Proteinuria Chronic kidney disease (CKD) Mortality rate Obesity
This study was not possible without the generous support of the public health nurses, the Kokuho Agency in each district. This work was supported by a Health and Labor Sciences Research Grants for “Study on the design of the comprehensive health care system for chronic kidney disease (CKD) based on the individual risk assessment by Specific Health Checkup” from the Ministry of Health, Labor and Welfare of Japan, and a Grant-in-Aid for “Research on Advanced Chronic Kidney Disease (REACH-J), Practical Research Project for Renal Disease” from the Japan Agency for Medical Research and Development, AMED.
Compliance with ethical standards
Conflict of interest
All authors have declared that no conflict of interest exists.
All procedures performed in studies involving human participants were performed in accordance with the ethical standards of the institutional and/or national research committee at which the studies were conducted (Fukushima Medical University; IRB Approval Number #1485, #2771) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
This study was performed according to Ethical Guidelines for Medical and Health Research Involving Human Subjects enacted by MHLW of Japan [http://www.mhlw.go.jp/file/06-Seisakujouhou-10600000-Daijinkanboukouseikagakuka/0000069410.pdf and http://www.mhlw.go.jp/file/06-Seisakujouhou-10600000-Daijinkanboukouseikagakuka/0000080278.pdf]. In the context of the guideline, the investigators shall not necessarily be required to obtain informed consent, but we made public information concerning this study on the web [http://www.fmu.ac.jp/univ/sangaku/data/koukai_2/2771.pdf] and ensured the opportunities for the research subjects to refuse use of their personal information.
- 3.Iseki K, Asahi K, Yamagata K, et al. Mortality risk among screened subjects of the Specific Health Check and Guidance Program in Japan 2008–2012. Clin Exp Nephrol. 2017. https://doi.org/10.1007/s10157-017-1392-y. (Epub ahead of print).