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Role of dipstick proteinuria for predicting cardiovascular events: a Japanese cardiovascular hospital database analysis

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Abstract

Initial screening for proteinuria by urine dipstick test (UDT) may be useful for predicting clinical outcomes. The Shinken Database includes all the new patients visiting the Cardiovascular Institute Hospital in Tokyo, Japan. Patients for whom UDT was performed at their initial visit between 2004 and 2010 (n = 7131) were divided into three groups according to the test results: negative, trace, and positive (1+ to 4+) proteinuria. During the mean follow-up period of 3.4 years, 233 (3.1%) deaths, 255 (3.6%) heart failure (HF) events, and 106 (1.5%) ischemic stroke (IS) events occurred. Prevalence of atherothrombotic risks increased with an increase in the amounts of proteinuria. The incidence of all-cause death, HF and IS events increased significantly from negative to trace to positive proteinuria groups (log rank test, P for trend < 0.001). Multivariate analysis revealed independent association between proteinuria and all-cause death [hazard ratio (HR): 1.50, 95% confidence interval (CI) 1.07–2.10], HF (HR: 1.55, 95% CI 1.14–2.12), and IS (HR: 2.08, 95% CI 1.26–3.45). Even trace proteinuria was independently associated with HF (HR: 1.64, 95% CI 1.07–2.53) and IS (HR: 2.17, 95% CI 1.14–4.11) and with all-cause death (HR: 1.56, 95% CI 0.99–2.47). In conclusions, dipstick proteinuria was independently associated with cardiovascular events and death, suggesting that the UDT is a useful tool for evaluating patients’ risk for such adverse events.

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Acknowledgements

We thank Shiro Ueda and Nobuko Ueda at Medical Edge Company, Ltd., for assembling the database using the Clinical Study Supporting System, and Yurika Hashiguchi, Takashi Osada, Hiroaki Arai, and Hiroshi Nakai for data management and system administration. We also thank Dr. Yasuo Okumura and Ms. Wendy Alexander-Adams for her help in reporting our findings in English.

Funding

This study was supported in part by the Practical Research Project for Lifestyle-Related Diseases including Cardiovascular Diseases and Diabetes Mellitus from the Japan Agency for Medical Research and Development, AMED (JP17ek0210082).

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Authors and Affiliations

  1. Department of Cardiovascular Medicine, The Cardiovascular Institute, Nishiazabu 3-2-19, Minato-ku, Tokyo, 1060031, Japan

    Riku Arai, Shinya Suzuki, Hiroto Kano, Hiroaki Semba, Takuto Arita, Naoharu Yagi, Takayuki Otsuka, Shunsuke Matsuno, Yuko Kato, Tokuhisa Uejima, Yuji Oikawa, Junji Yajima & Takeshi Yamashita

  2. Department of Cardiovascular Surgery, The Cardiovascular Institute, Tokyo, Japan

    Minoru Matsuhama

  3. Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan

    Riku Arai & Yasuo Okumura

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  1. Riku Arai
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Correspondence to Riku Arai.

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Conflict of interest

Dr. Suzuki received research funding from Tanabe-Mitsubishi, and Daiichi-Sankyo. Dr. Takayuki Otsuka received research funding and remuneration from Nippon Boehringer Ingelheim. Dr. Yamashita received research funding from Nippon Boehringer Ingelheim, Daiichi Sankyo, Bayer Healthcare, and Bristol-Myers Squibb, and remuneration from Nippon Boehringer Ingelheim, Daiichi Sankyo, Bayer Healthcare, Bristol-Myers Squibb, Pfizer, Toa Eiyo, and Ono Pharmaceutical.

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Arai, R., Suzuki, S., Kano, H. et al. Role of dipstick proteinuria for predicting cardiovascular events: a Japanese cardiovascular hospital database analysis. Heart Vessels 35, 1256–1269 (2020). https://doi.org/10.1007/s00380-020-01596-y

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