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Glucosuria and all-cause mortality among general screening participants

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Abstract

Background

Dipstick urine tests are used for general health screening in Japan, but how the test results (e.g., glucosuria) relate to mortality is unknown.

Methods

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 +.

Results

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).

Conclusion

Dipstick glucosuria significantly affected mortality in Japanese community-based screening participants.

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Acknowledgements

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.

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Authors and Affiliations

  1. Clinical Research Support Center, Tomishiro Central Hospital, Ueda 25, Tomigusuku, Okinawa, 901-0243, Japan

    Kunitoshi Iseki

  2. Steering Committee of Research on Design of the Comprehensive Health Care System for Chronic Kidney Disease (CKD) Based on the Individual Risk Assessment by Specific Health Check, Fukushima, Japan

    Kunitoshi Iseki, Tsuneo Konta, Koichi Asahi, Kunihiro Yamagata, Shouichi Fujimoto, Kazuhiko Tsuruya, Ichiei Narita, Masato Kasahara, Yugo Shibagaki, Toshiki Moriyama, Masahide Kondo & Tsuyoshi Watanabe

  3. Okinawa Heart and Renal Association (OHRA), Okinawa, Japan

    Kunitoshi Iseki & Chiho Iseki

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  1. Kunitoshi Iseki
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For the “Design of the Comprehensive Health Care System for Chronic Kidney Disease (CKD) Based on the Individual Risk Assessment by Specific Health Check”

Corresponding author

Correspondence to Kunitoshi Iseki.

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Conflict of interest

All authors have declared that no conflict of interest exists.

Ethics approval

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.

Informed consent

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.

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Iseki, K., Konta, T., Asahi, K. et al. Glucosuria and all-cause mortality among general screening participants. Clin Exp Nephrol 22, 850–859 (2018). https://doi.org/10.1007/s10157-017-1528-0

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