Definition and validity of chronic kidney disease as a cardiovascular risk factor in the community-based population

尚未确定可有效区分心血管事件（CVE）高风险受试者与日本普通人群的慢性肾脏疾病（CKD）定义。本研究的目的是检查CKD的定义可能有助于预测我们人群中的CVE。基线数据包括血清肌酐和蛋白尿测定社区居住的成年人（n=14131，年龄=63）。采用改良MDRD公式计算肾小球滤过率（eGFR），以eGFR<60、eGFR<60或蛋白尿阳性、eGFR <60或微量蛋白尿3种方法定义CKD。对CVE（卒中、心力衰竭、心肌梗死/猝死）进行了前瞻性调查（平均随访= 2.7年）。结果表明，在CVE风险预测方面，用于区分非CKD的最有力的CKD定义是（3）的定义（HR=1.36，95%CI=1.07-1.74 ; p<0.05）。总之，在日本一般人群中，最有用的CKD定义是eGFR<60和/或尿蛋白微量。

The definition of chronic kidney disease (CKD) which effectively discriminates high-risk subjects for cardiovascular events (CVE) from the Japanese general population has yet to be established. The aim of this study was to examine which definition of CKD might be useful for the prediction of CVE in our population. Baseline data including serum creatinine and proteinuria were determined in community- dwelling adults (n=14131, age=63). Estimated glomerular filtration rate (eGFR) was calculated using a modified MDRD equation, and CKD was defined by the three methods : (1) eGFR<60, (2) eGFR<60 or proteinuria positive, (3) eGFR<60 or proteinuria trace. CVE (stroke, heart failure, myocardial infarction/sudden death) were surveyed prospectively (mean follow-up = 2.7 years). As results, the most powerful definition of CKD for discriminating non-CKD in terms of CVE risk prediction was the definition of (3) (HR=1.36, 95%CI=1.07-1.74 ; p<0.05). In conclusion, the most useful definition of CKD for CVE risk-prediction in the Japanese general population appears to be eGFR<60 and/or urine protein trace.