Iseki Kunitoshi, Konta Tsuneo, Asahi Koichi, Yamagata Kunihiro, Fujimoto Shouichi, Tsuruya Kazuhiko, Narita Ichiei, Kasahara Masato, Shibagaki Yugo, Moriyama Toshiki, Kondo Masahide, Watanabe Tsuyoshi
Steering Committee for "Design of the comprehensive health care system for chronic kidney disease (CKD) based on the individual risk assessment by Specific Health Checkups", Fukushima, Japan.
Clin Exp Nephrol. 2021 Feb;25(2):150-156. doi: 10.1007/s10157-020-01971-z. Epub 2020 Sep 22.
We previously reported that dipstick hematuria (UH) was associated with higher all-cause mortality in men, but not in women. We extended the observation and examined the causes of death using repeated urinalysis in men.
Subjects were those who participated the Tokutei-Kenshin between 2008 to 2015 in seven districts. Using National database of death certificate, we identified those who might have died and confirmed further with the collaborations of the regional National Health Insurance agency and public health nurses. Dipstick results of 1 + and higher were defined as hematuria. Hazard ratio (HR) and 95% confidence interval (CI) were calculated using the Cox proportional hazard analysis. We adjusted for age, body mass index, eGFR, proteinuria, comorbid condition (diabetes mellitus, hypertension, and dyslipidemia), past history (stroke, heart disease, and kidney disease), and lifestyle (smoking, drinking, walking, and exercise).
A total of 170,119 men were studied and 70,350 (41.4% of the total) were re-examined next year. The prevalence of UH (-/-), UH (-/+), UH (±), and UH (+ /+) was 77.2% (N = 54,298), 14.0% (N = 9,838), 1.4% (N = 1014) and 7.4% (N = 5,200), respectively. We identified 1,162 deaths (1.7% of the total of the re-examined). The adjusted HR (95% CI) was 1.49 (1.22-1.81) for all-cause mortality and 1.83 (1.23-2.71) for cardiovascular death compared to those with UH (-/-), respectively. However, that for cancer mortality risk was not significant: 1.23 (0.92-1.64).
In men, persistent dipstick hematuria is a significantly risk factor of all-cause mortality, in particular cardiovascular death among general screening participants.
我们之前报道过，试纸法检测血尿（UH）与男性全因死亡率升高相关，但与女性无关。我们扩大了观察范围，并通过对男性进行重复尿液分析来研究死亡原因。
研究对象为2008年至2015年期间在七个地区参加特定健康检查的人群。利用国家死亡证明数据库，我们确定了可能已经死亡的人员，并通过与地区国民健康保险机构和公共卫生护士合作进行进一步确认。试纸检测结果为1+及以上被定义为血尿。使用Cox比例风险分析计算风险比（HR）和95%置信区间（CI）。我们对年龄、体重指数、估算肾小球滤过率、蛋白尿、合并症（糖尿病、高血压和血脂异常）、既往病史（中风、心脏病和肾病）以及生活方式（吸烟、饮酒、步行和运动）进行了调整。
共研究了170,119名男性，其中70,350人（占总数的41.4%）在次年接受了复查。血尿（-/-）、血尿（-/+）、血尿（±）和血尿（+/+）的患病率分别为77.2%（N = 54,298）、14.0%（N = 9,838）、1.4%（N = 1014）和7.4%（N = 5,200）。我们确定了1,162例死亡（占复查总数的1.7%）。与血尿（-/-）的男性相比，全因死亡率的调整后HR（95%CI）为1.49（1.22 - 1.81），心血管死亡的调整后HR为1.83（1.23 - 2.71）。然而，癌症死亡风险的HR不显著：1.23（0.92 - 1.64）。
在男性中，持续性试纸法检测血尿是全因死亡率的显著危险因素，尤其是在一般筛查参与者中的心血管死亡。
